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Risk Factors for Early vs. Late Onset Clostridium difficile Infection(CDI) in Solid Organ Transplant Recipients (SOTR).

Y. Natori, M. Shiotsuka, L. Oen, E. Renner, L. Singer, H. Ross, D. Kumar, C. Rotstein, A. Humar, S. Husain.

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

Related Abstracts
  • Clinical Risk Factors for the Recurrence of Clostridium difficile Infection (CDI) in Solid Organ Transplant Recipients (SOTR).
  • Incidence and Risks Associated With Clostridium Difficile Infection in the Pediatric Solid Organ Transplantation Population: A Single-Center Retrospective Review

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).

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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 January 23, 2021.

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