title: Outcome of Clostridium difficile-associated disease in solid organ transplant recipients: a prospective and multicentre cohort study.
abstract: Clostridium difficile-associated disease (CDAD) is the most common cause of nosocomial diarrhea. Information about CDAD in solid organ transplant (SOT) recipients is scarce. To determine its epidemiology and risk factors, we conducted a cohort study in which 4472 SOT patients were prospectively included in the RESITRA/REIPI (Spanish Research Network for the Study of Infection in Transplantation) database between July 2003 and July 2006. Forty-two episodes of CDAD were diagnosed in 36 patients. The overall incidence was 0.94%. Median onset of infection was 31.5 days (range 6-741); in half the cases, onset occurred during the first month after transplantation. In 26% of cases, there was no previous antibiotic use. Independent risk factors for CDAD using Cox regression analysis were previous use of first- and second-generation cephalosporins (HR 3.68; 95%CI 1.8-7.52; P < 0.001), ganciclovir prophylactic use (HR 3.09; 95%CI 1.44-6.62; P = 0.004) and corticosteroid use before transplantation (HR 2.95; 95%CI 1.1-7.9; P = 0.031). There were no deaths related to CDAD. In summary, the incidence of CDAD in SOT was low, most cases were diagnosed soon after transplantation and the prognosis was good.
authors.affiliation: Infectious Diseases Department, Hospital Vall d'Hebron, Barcelona, Spain. oscar.len@vhir.org
authors.forename: Oscar
authors.initials: O
authors.lastname: Len
authors.forename: Dolores
authors.initials: D
authors.lastname: Rodríguez-Pardo
authors.forename: Joan
authors.initials: J
authors.lastname: Gavaldà
authors.forename: José María
authors.initials: JM
authors.lastname: Aguado
authors.forename: Marino
authors.initials: M
authors.lastname: Blanes
authors.forename: Nuria
authors.initials: N
authors.lastname: Borrell
authors.forename: Germán
authors.initials: G
authors.lastname: Bou
authors.forename: Jordi
authors.initials: J
authors.lastname: Carratalà
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Cisneros
authors.forename: Jesús
authors.initials: J
authors.lastname: Fortún
authors.forename: Mercé
authors.initials: M
authors.lastname: Gurguí
authors.forename: Miguel
authors.initials: M
authors.lastname: Montejo
authors.forename: Carlos
authors.initials: C
authors.lastname: Cervera
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Angel
authors.initials: A
authors.lastname: Asensio
authors.forename: Julián
authors.initials: J
authors.lastname: Torre-Cisneros
authors.forename: Albert
authors.initials: A
authors.lastname: Pahissa
mesh_terms: D000328:Adult; D000368:Aged; D002511:Cephalosporins / Q000009:adverse effects; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology*; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D015774:Ganciclovir / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019737:Transplants / Q000009:adverse effects*
chemical_list: D002511:Cephalosporins; D015774:Ganciclovir