Risk Factors for Early vs. Late Onset Clostridium difficile Infection(CDI) in Solid Organ Transplant Recipients (SOTR).
Multi-Organ Transplant, University Health Network, Toronto, ON, Canada.
Meeting: 2016 American Transplant Congress
Abstract number: D112
Keywords: Bacterial infection, Outcome, Risk factors
Session Information
Date: Tuesday, June 14, 2016
Session Name: Poster Session D: Fungi, PJP, Mycobacteria, Infection Risk Factors, Vaccination and Donor Derived Infections
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Introduction: CDI is one of the most common infections among SOTR, and is associated with significant morbidity and mortality. However, the data regarding early vs. late onset of CDI are limited. In this retrospective cohort study, we assessed the risk factors and outcomes associated with early vs. late onset CDI in SOTR.
Methods: SOTR transplanted at our center with C.difficile positive PCR (Cepheid Xpert) from January 2011 to December 2014 were identified through the Clinical Microbiology Laboratory database. Early onset was defined as a positive C.difficile PCR at ≤ 100 days post-transplant.
Results: 263 episodes of CDI were diagnosed in 200 SOTR. The mean age of the cohort was 56 (range 20-81)years. Transplant types included kidney (n = 65), liver (n = 71), lung (n = 39), heart (n = 14), kidney/pancreas (n = 8), liver/kidney (n = 2) and heart/lung (n = 1). CDI occurred at a median of 235.5 (range 3, 12392) days. Early onset CDI was noted in 42%(84/200) patients. The risk factors associated with early CDI are shown below
Early(n=84) | Late(n=116) | Univariate p value | OR(95% CI) | Multivariate p value | OR(95% CI) | ||
ATG usage within 3months | 36(42.9%) | 3(2.6%) | <0.001 | 0.035(0.01-0.12) | <0.001 | 0.022(0.005-0.09) | |
Fluoroquinolones | 34(40.5%) | 36(31.3%) | 0.18 | 0.108 | |||
1st generation Cephalosporin | 49(58.3%) | 14(12.1%) | <0.001 | 0.10(0.05-0.20) | <0.001 | 0.095(0.03-0.26) | |
3rd and 4th generation Cephalosporins | 26(31.0%) | 19(16.4%) | 0.02 | 0.44(0.22-0.86) | 0.407 | ||
| PPI usage | 70(83.3%) | 86(74.1%) | 0.12 | 0.962 | |||
Hospital stay within 4 weeks | 68(81%) | 61(52.6%) | <0.001 | 0.26(0.14-0.50) | 0.086 | ||
Severe CDI | 42(50%) | 56(48.3%) | 0.81 | 0.782 | |||
albumin | 2.99(SD 0.57) | 3.20(SD 0.807) |
| 0.735 |
. Recurrence of CDI occurred in 16% (32/200) patients. The all cause 30 days mortality in late onset CDI cohort was significantly higher [10.3 %( 12/116) vs. 2.4%(2/84); p=0.036] However no difference in the rate of recurrence or readmission were noted.
Conclusions: Our study shows that the early onset CDI patients were more likely to have received 1st generation cephalosporins and ATG. Severity of the disease was similar between the early compared to the late onset group. All cause 30 days mortality was significantly higher in late onset group.
CITATION INFORMATION: Natori Y, Shiotsuka M, Oen L, Renner E, Singer L, Ross H, Kumar D, Rotstein C, Humar A, Husain S. Risk Factors for Early vs. Late Onset Clostridium difficile Infection(CDI) in Solid Organ Transplant Recipients (SOTR). Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Natori Y, Shiotsuka M, Oen L, Renner E, Singer L, Ross H, Kumar D, Rotstein C, Humar A, Husain S. Risk Factors for Early vs. Late Onset Clostridium difficile Infection(CDI) in Solid Organ Transplant Recipients (SOTR). [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-factors-for-early-vs-late-onset-clostridium-difficile-infectioncdi-in-solid-organ-transplant-recipients-sotr/. Accessed November 15, 2019.« Back to 2016 American Transplant Congress