title: Clostridium difficile colitis in lung transplantation.
abstract: OBJECTIVE
  Clostridium difficile colitis (CDC) is the most common nosocomial infection of the gastrointestinal tract in patients with recent antibiotic use or hospitalization. Lung transplant recipients receive aggressive antimicrobial therapy postoperatively for treatment and prophylaxis of respiratory infections. This report describes the epidemiology of CDC in lung recipients from a single center and explores possible associations with bronchiolitis obliterans syndrome (BOS), a surrogate marker of chronic rejection.
  
  
  METHODS
  Patients were divided into those with confirmed disease (CDC+) and those without disease (CDC-) based on positive C. difficile toxin assay. Because of a bimodal distribution in the time to develop CDC, the early postoperative CDC+ group was analyzed separately from the late postoperative CDC+ cohort with respect to BOS development.
  
  
  RESULTS
  Between 1990 and 2005, 202 consecutive patients underwent 208 lung transplantation procedures. Of these, 15 lung recipients developed 23 episodes of CDC with a median follow-up period of 2.7 years (range, 0-13.6). All patients with confirmed disease had at least 1 of the following 3 risk factors: recent antibiotic use, recent hospitalization, or augmentation of steroid dosage. Of the early CDC+ patients, 100% developed BOS, but only 52% of the late CDC+ patients developed BOS, either preceding or following infection.
  
  
  CONCLUSIONS
  CDC developed in 7.4% of lung transplant patients with identified risk factors, yielding a cumulative incidence of 14.7%. The statistical association of BOS development in early CDC+ patients suggests a relationship between early infections and future chronic lung rejection.
authors.affiliation: Department of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Gunderson
authors.forename: M R
authors.initials: MR
authors.lastname: Gupta
authors.forename: F
authors.initials: F
authors.lastname: Lopez
authors.forename: G A
authors.initials: GA
authors.lastname: Lombard
authors.forename: S G
authors.initials: SG
authors.lastname: LaPlace
authors.forename: D E
authors.initials: DE
authors.lastname: Taylor
authors.forename: G S
authors.initials: GS
authors.lastname: Dhillon
authors.forename: V G
authors.initials: VG
authors.lastname: Valentine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001989:Bronchiolitis Obliterans / Q000453:epidemiology / Q000209:etiology; D002648:Child; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006084:Graft Rejection; D006801:Humans; D015994:Incidence; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors