title: Risk factors associated with Clostridium difficile infection after kidney and pancreas transplantation.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) is a common cause of nosocomial antibiotic-associated diarrhea with an increased incidence reported in solid organ transplant recipients. We sought to determine if kidney and/or pancreas transplant recipients possess unique risk factors for CDI.
  
  
  METHODS
  Between January 2009 and February 2011, 942 kidney and 56 pancreas transplants were performed at the 2 centers. Of these, 28 recipients (kidney, n = 24; pancreas, n = 4) developed CDI. Cases were matched to controls (n = 56) in a 1:2 ratio.
  
  
  RESULTS
  Those with CDI were mostly male patients (82% vs. 48%, P = 0.003), deceased-donor organ recipients (86% vs. 64%, P = 0.045), more likely to have leukopenia (18% vs. 4%, P = 0.038), and had undergone a gastrointestinal procedure within 3 months preceding CDI diagnosis (18% vs. 4%, P = 0.038). Cases had higher cumulative and restricted antimicrobial exposure in days (37 ± 79 vs. 8 ± 12, P = 0.009 and 27 ± 69 vs. 7 ± 10, P = 0.032). Cephalosporin use was more common among cases (43% vs. 16%, P = 0.008).
  
  
  CONCLUSIONS
  Careful antimicrobial selection and assurance of optimal treatment duration in the kidney and pancreas transplant population is prudent. Clinicians should have a heightened awareness of CDI risk particularly during periods of leukopenia and in the setting of gastrointestinal procedures.
authors.affiliation: Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Shah
authors.forename: D S
authors.initials: DS
authors.lastname: Tsapepas
authors.forename: C J
authors.initials: CJ
authors.lastname: Kubin
authors.forename: S T
authors.initials: ST
authors.lastname: Martin
authors.forename: S
authors.initials: S
authors.lastname: Mohan
authors.forename: L E
authors.initials: LE
authors.lastname: Ratner
authors.forename: M
authors.initials: M
authors.lastname: Pereira
authors.forename: S
authors.initials: S
authors.lastname: Kapur
authors.forename: D
authors.initials: D
authors.lastname: Dadhania
authors.forename: J K
authors.initials: JK
authors.lastname: Walker-McDermott
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D003428:Cross Infection / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D003967:Diarrhea / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clostridium difficile infection; kidney transplantation; pancreas transplantation; solid organ transplantation