title: Epidemiology, risk factors, and outcomes of Clostridium difficile infection in kidney transplant recipients.
abstract: BACKGROUND
  We sought to describe the epidemiology and risk factors for Clostridium difficile infection (CDI) among kidney transplant recipients (KTR) between 1 January 2008 and 31 December 2010.
  
  
  METHODS
  A single-institution retrospective study was conducted among all adult KTR with CDI, defined as a positive test for C. difficile by a cell cytotoxic assay for C. difficile toxin A or B or polymerase chain reaction test for toxigenic C. difficile.
  
  
  RESULTS
  Among 603 kidney transplants performed between 1 January 2008 and 31 December 2010, 37 (6.1%) patients developed CDI: 12 (of 128; 9.4%) high-risk (blood group incompatible and/or anti-human leukocyte antigen donor-specific antibodies) vs. 25 (of 475; 5.3%, P = 0.08) standard-risk patients. The overall rate of CDI increased from 3.7% in 2008 to 9.4% in 2010 (P = 0.05). The median time to CDI diagnosis was 9 days, with 27 (73.0%) patients developing CDI within the first 30 days after their transplant, and 14 (51.8%) developing CDI within 7 days. A case-control analysis of 37 CDI cases and 74 matched controls demonstrated the following predictors for CDI among KTR: vancomycin-resistant Enterococcus colonization before transplant (odds ratio [OR]: 3.6, P = 0.03), receipt of an organ from Centers for Disease Control high-risk donor (OR: 5.9, P = 0.006), and administration of high-risk antibiotics within 30 days post transplant (OR: 6.6, P = 0.001).
  
  
  CONCLUSIONS
  CDI remains a common early complication in KTR, with rates steadily increasing during the study period. Host and transplant-related factors and exposure to antibiotics appeared to significantly impact the risk for CDI among KTR.
authors.affiliation: Department of Medicine, School of Medicine, The Johns Hopkins University, Baltimore, Maryland 21205, USA. dneofyt1@jhmi.edu
authors.forename: D
authors.initials: D
authors.lastname: Neofytos
authors.forename: K
authors.initials: K
authors.lastname: Kobayashi
authors.forename: C D
authors.initials: CD
authors.lastname: Alonso
authors.forename: J
authors.initials: J
authors.lastname: Cady-Reh
authors.forename: D
authors.initials: D
authors.lastname: Lepley
authors.forename: M
authors.initials: M
authors.lastname: Harris
authors.forename: N
authors.initials: N
authors.lastname: Desai
authors.forename: E
authors.initials: E
authors.lastname: Kraus
authors.forename: A
authors.initials: A
authors.lastname: Subramanian
authors.forename: S
authors.initials: S
authors.lastname: Treadway
authors.forename: D
authors.initials: D
authors.lastname: Ostrander
authors.forename: C
authors.initials: C
authors.lastname: Thompson
authors.forename: K
authors.initials: K
authors.lastname: Marr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents