Risk factors for Clostridium difficile infection in intestinal transplant recipients during the first year post-transplant

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Abstract

Background: Clostridium difficile is the most common cause of healthcare-associated infectious diarrhea. Risk factors for C. difficile infections (CDI) in intestinal transplant recipients (ITR) are not well-defined. The aim of our study was to assess specific risk factors for CDI in ITR. Methods: This is a 1:3 case–control study that included 29 ITR who developed CDI (cases) and 87 ITR without CDI (controls) observed during the first year post-transplantation. Wilcoxon rank sum and Fisher's exact tests were used to compare variables. Univariate and multivariable conditional logistic regressions analysis were performed to identify risk factors for CDI. Results: The multivariable conditional logistic regression analysis showed that proton pump inhibitors (PPI) administration (odds ratio [OR] = 0.06; 95% confidence interval [CI]: 0.007-0.52; P =.01) was the only factor associated with lower rates of CDI. Outcomes for cases vs controls: rejection episodes 24.14% vs 20.69% (P =.7), graft loss 0% vs 2.3% (P =.99), and survival rate 1 year post-transplantation 79.3% (59.6-90.1%) vs 87.2% (78.1-92.7%) (P =.38). Conclusions: Proton pump inhibitor administration might be protective for CDI in ITR. Risks factors for CDI might be different in ITR compared to other populations; anatomical differences and medications administered in the post-transplantation period may affect intestinal microbiota.

Original languageEnglish (US)
Article numbere12858
JournalTransplant Infectious Disease
Volume20
Issue number2
DOIs
StatePublished - Apr 2018

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Clostridium Infections
Clostridium difficile
Transplants
Infection
Proton Pump Inhibitors
Transplantation
Logistic Models
Regression Analysis
Infection Control
Transplant Recipients
Diarrhea
Survival Rate
Odds Ratio
Confidence Intervals
Delivery of Health Care

Keywords

  • Clostridium difficile
  • diarrhea
  • enteritis
  • intestinal transplant
  • risk factors

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases

Cite this

@article{e816d841b9d94673b6516a7d8c26d052,
title = "Risk factors for Clostridium difficile infection in intestinal transplant recipients during the first year post-transplant",
abstract = "Background: Clostridium difficile is the most common cause of healthcare-associated infectious diarrhea. Risk factors for C. difficile infections (CDI) in intestinal transplant recipients (ITR) are not well-defined. The aim of our study was to assess specific risk factors for CDI in ITR. Methods: This is a 1:3 case–control study that included 29 ITR who developed CDI (cases) and 87 ITR without CDI (controls) observed during the first year post-transplantation. Wilcoxon rank sum and Fisher's exact tests were used to compare variables. Univariate and multivariable conditional logistic regressions analysis were performed to identify risk factors for CDI. Results: The multivariable conditional logistic regression analysis showed that proton pump inhibitors (PPI) administration (odds ratio [OR] = 0.06; 95{\%} confidence interval [CI]: 0.007-0.52; P =.01) was the only factor associated with lower rates of CDI. Outcomes for cases vs controls: rejection episodes 24.14{\%} vs 20.69{\%} (P =.7), graft loss 0{\%} vs 2.3{\%} (P =.99), and survival rate 1 year post-transplantation 79.3{\%} (59.6-90.1{\%}) vs 87.2{\%} (78.1-92.7{\%}) (P =.38). Conclusions: Proton pump inhibitor administration might be protective for CDI in ITR. Risks factors for CDI might be different in ITR compared to other populations; anatomical differences and medications administered in the post-transplantation period may affect intestinal microbiota.",
keywords = "Clostridium difficile, diarrhea, enteritis, intestinal transplant, risk factors",
author = "L. Guzman and F. Qiu and Kalil, {Andre C} and Mercer, {David F} and Langnas, {Alan Norman} and Florescu, {Diana F}",
year = "2018",
month = "4",
doi = "10.1111/tid.12858",
language = "English (US)",
volume = "20",
journal = "Transplant Infectious Disease",
issn = "1398-2273",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Risk factors for Clostridium difficile infection in intestinal transplant recipients during the first year post-transplant

AU - Guzman, L.

AU - Qiu, F.

AU - Kalil, Andre C

AU - Mercer, David F

AU - Langnas, Alan Norman

AU - Florescu, Diana F

PY - 2018/4

Y1 - 2018/4

N2 - Background: Clostridium difficile is the most common cause of healthcare-associated infectious diarrhea. Risk factors for C. difficile infections (CDI) in intestinal transplant recipients (ITR) are not well-defined. The aim of our study was to assess specific risk factors for CDI in ITR. Methods: This is a 1:3 case–control study that included 29 ITR who developed CDI (cases) and 87 ITR without CDI (controls) observed during the first year post-transplantation. Wilcoxon rank sum and Fisher's exact tests were used to compare variables. Univariate and multivariable conditional logistic regressions analysis were performed to identify risk factors for CDI. Results: The multivariable conditional logistic regression analysis showed that proton pump inhibitors (PPI) administration (odds ratio [OR] = 0.06; 95% confidence interval [CI]: 0.007-0.52; P =.01) was the only factor associated with lower rates of CDI. Outcomes for cases vs controls: rejection episodes 24.14% vs 20.69% (P =.7), graft loss 0% vs 2.3% (P =.99), and survival rate 1 year post-transplantation 79.3% (59.6-90.1%) vs 87.2% (78.1-92.7%) (P =.38). Conclusions: Proton pump inhibitor administration might be protective for CDI in ITR. Risks factors for CDI might be different in ITR compared to other populations; anatomical differences and medications administered in the post-transplantation period may affect intestinal microbiota.

AB - Background: Clostridium difficile is the most common cause of healthcare-associated infectious diarrhea. Risk factors for C. difficile infections (CDI) in intestinal transplant recipients (ITR) are not well-defined. The aim of our study was to assess specific risk factors for CDI in ITR. Methods: This is a 1:3 case–control study that included 29 ITR who developed CDI (cases) and 87 ITR without CDI (controls) observed during the first year post-transplantation. Wilcoxon rank sum and Fisher's exact tests were used to compare variables. Univariate and multivariable conditional logistic regressions analysis were performed to identify risk factors for CDI. Results: The multivariable conditional logistic regression analysis showed that proton pump inhibitors (PPI) administration (odds ratio [OR] = 0.06; 95% confidence interval [CI]: 0.007-0.52; P =.01) was the only factor associated with lower rates of CDI. Outcomes for cases vs controls: rejection episodes 24.14% vs 20.69% (P =.7), graft loss 0% vs 2.3% (P =.99), and survival rate 1 year post-transplantation 79.3% (59.6-90.1%) vs 87.2% (78.1-92.7%) (P =.38). Conclusions: Proton pump inhibitor administration might be protective for CDI in ITR. Risks factors for CDI might be different in ITR compared to other populations; anatomical differences and medications administered in the post-transplantation period may affect intestinal microbiota.

KW - Clostridium difficile

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KW - enteritis

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