Epidemiology, risk factors, and outcome of Clostridium difficile infection in heart and heart-lung transplant recipients

Jackrapong Bruminhent, Kelly A. Cawcutt, Charat Thongprayoon, Tanya M. Petterson, Walter K. Kremers, Raymund R. Razonable

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Clostridium difficile is a major cause of diarrhea in thoracic organ transplant recipients. We investigated the epidemiology, risk factors, and outcome of Clostridium difficile infection (CDI) in heart and heart-lung transplant (HT) recipients. Methods: This is a retrospective study from 2004 to 2013. CDI was defined by diarrhea and a positive toxigenic C. difficile in stool measured by toxin enzyme immunoassay (2004-2006) or polymerase chain reaction (2007-2013). Cox proportional hazards regression was used to model the association of risk factors with time to CDI and survival with CDI following transplantation. Results: There were 254 HT recipients, with a median age of 53 years (IQR, 45-60); 34% were female. During the median follow-up of 3.1 years (IQR, 1.3-6.1), 22 (8.7%) patients developed CDI. In multivariable analysis, risk factors for CDI were combined heart-lung transplant (HR 4.70; 95% CI, 1.30-17.01 [P=.02]) and retransplantation (HR 7.19; 95% CI, 1.61-32.12 [P=.01]). Acute cellular rejection was associated with a lower risk of CDI (HR 0.34; 95% CI, 0.11-0.94 [P=.04]). CDI was found to be an independent risk factor for mortality (HR 7.66; 95% CI, 3.41-17.21 [P<.0001]). Conclusions: Clostridium difficile infection after HT is more common among patients with combined heart-lung and those undergoing retransplantation. CDI was associated with a higher risk of mortality in HT recipients.

Original languageEnglish (US)
Article numbere12968
JournalClinical Transplantation
Volume31
Issue number6
DOIs
StatePublished - Jun 2017

Fingerprint

Clostridium Infections
Clostridium difficile
Epidemiology
Lung
Transplants
Diarrhea
Transplant Recipients
Mortality
Immunoenzyme Techniques
Thorax
Retrospective Studies
Transplantation

Keywords

  • Clostridium difficile
  • epidemiology
  • heart transplant
  • mortality
  • outcome
  • risk factor

ASJC Scopus subject areas

  • Transplantation

Cite this

Epidemiology, risk factors, and outcome of Clostridium difficile infection in heart and heart-lung transplant recipients. / Bruminhent, Jackrapong; Cawcutt, Kelly A.; Thongprayoon, Charat; Petterson, Tanya M.; Kremers, Walter K.; Razonable, Raymund R.

In: Clinical Transplantation, Vol. 31, No. 6, e12968, 06.2017.

Research output: Contribution to journalArticle

Bruminhent, Jackrapong ; Cawcutt, Kelly A. ; Thongprayoon, Charat ; Petterson, Tanya M. ; Kremers, Walter K. ; Razonable, Raymund R. / Epidemiology, risk factors, and outcome of Clostridium difficile infection in heart and heart-lung transplant recipients. In: Clinical Transplantation. 2017 ; Vol. 31, No. 6.
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abstract = "Background: Clostridium difficile is a major cause of diarrhea in thoracic organ transplant recipients. We investigated the epidemiology, risk factors, and outcome of Clostridium difficile infection (CDI) in heart and heart-lung transplant (HT) recipients. Methods: This is a retrospective study from 2004 to 2013. CDI was defined by diarrhea and a positive toxigenic C. difficile in stool measured by toxin enzyme immunoassay (2004-2006) or polymerase chain reaction (2007-2013). Cox proportional hazards regression was used to model the association of risk factors with time to CDI and survival with CDI following transplantation. Results: There were 254 HT recipients, with a median age of 53 years (IQR, 45-60); 34{\%} were female. During the median follow-up of 3.1 years (IQR, 1.3-6.1), 22 (8.7{\%}) patients developed CDI. In multivariable analysis, risk factors for CDI were combined heart-lung transplant (HR 4.70; 95{\%} CI, 1.30-17.01 [P=.02]) and retransplantation (HR 7.19; 95{\%} CI, 1.61-32.12 [P=.01]). Acute cellular rejection was associated with a lower risk of CDI (HR 0.34; 95{\%} CI, 0.11-0.94 [P=.04]). CDI was found to be an independent risk factor for mortality (HR 7.66; 95{\%} CI, 3.41-17.21 [P<.0001]). Conclusions: Clostridium difficile infection after HT is more common among patients with combined heart-lung and those undergoing retransplantation. CDI was associated with a higher risk of mortality in HT recipients.",
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T1 - Epidemiology, risk factors, and outcome of Clostridium difficile infection in heart and heart-lung transplant recipients

AU - Bruminhent, Jackrapong

AU - Cawcutt, Kelly A.

AU - Thongprayoon, Charat

AU - Petterson, Tanya M.

AU - Kremers, Walter K.

AU - Razonable, Raymund R.

PY - 2017/6

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N2 - Background: Clostridium difficile is a major cause of diarrhea in thoracic organ transplant recipients. We investigated the epidemiology, risk factors, and outcome of Clostridium difficile infection (CDI) in heart and heart-lung transplant (HT) recipients. Methods: This is a retrospective study from 2004 to 2013. CDI was defined by diarrhea and a positive toxigenic C. difficile in stool measured by toxin enzyme immunoassay (2004-2006) or polymerase chain reaction (2007-2013). Cox proportional hazards regression was used to model the association of risk factors with time to CDI and survival with CDI following transplantation. Results: There were 254 HT recipients, with a median age of 53 years (IQR, 45-60); 34% were female. During the median follow-up of 3.1 years (IQR, 1.3-6.1), 22 (8.7%) patients developed CDI. In multivariable analysis, risk factors for CDI were combined heart-lung transplant (HR 4.70; 95% CI, 1.30-17.01 [P=.02]) and retransplantation (HR 7.19; 95% CI, 1.61-32.12 [P=.01]). Acute cellular rejection was associated with a lower risk of CDI (HR 0.34; 95% CI, 0.11-0.94 [P=.04]). CDI was found to be an independent risk factor for mortality (HR 7.66; 95% CI, 3.41-17.21 [P<.0001]). Conclusions: Clostridium difficile infection after HT is more common among patients with combined heart-lung and those undergoing retransplantation. CDI was associated with a higher risk of mortality in HT recipients.

AB - Background: Clostridium difficile is a major cause of diarrhea in thoracic organ transplant recipients. We investigated the epidemiology, risk factors, and outcome of Clostridium difficile infection (CDI) in heart and heart-lung transplant (HT) recipients. Methods: This is a retrospective study from 2004 to 2013. CDI was defined by diarrhea and a positive toxigenic C. difficile in stool measured by toxin enzyme immunoassay (2004-2006) or polymerase chain reaction (2007-2013). Cox proportional hazards regression was used to model the association of risk factors with time to CDI and survival with CDI following transplantation. Results: There were 254 HT recipients, with a median age of 53 years (IQR, 45-60); 34% were female. During the median follow-up of 3.1 years (IQR, 1.3-6.1), 22 (8.7%) patients developed CDI. In multivariable analysis, risk factors for CDI were combined heart-lung transplant (HR 4.70; 95% CI, 1.30-17.01 [P=.02]) and retransplantation (HR 7.19; 95% CI, 1.61-32.12 [P=.01]). Acute cellular rejection was associated with a lower risk of CDI (HR 0.34; 95% CI, 0.11-0.94 [P=.04]). CDI was found to be an independent risk factor for mortality (HR 7.66; 95% CI, 3.41-17.21 [P<.0001]). Conclusions: Clostridium difficile infection after HT is more common among patients with combined heart-lung and those undergoing retransplantation. CDI was associated with a higher risk of mortality in HT recipients.

KW - Clostridium difficile

KW - epidemiology

KW - heart transplant

KW - mortality

KW - outcome

KW - risk factor

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