title: Clostridium difficile infection increases mortality risk in lung transplant recipients.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) and associated mortality in solid organ transplant recipients is rising, but data are scarce in lung transplant recipients. We aimed to characterize CDI and its effect on mortality in a large cohort of lung transplant recipients.
  
  
  METHODS
  Lung transplant recipients were identified from our transplant database from 2000 to 2011. Cox proportional hazard models were used to calculate hazard ratios for CDI and death after adjusting for potential confounders identified from bivariate analysis.
  
  
  RESULTS
  We identified 388 patients (196 female, 192 male), with a median age of 56 years (range, 8-75 years), during the study period. CDI developed after transplant in 89 (22.9%), with 27 (7.0%) developing CDI during the initial hospitalization at a mean diagnosis of 12.7 ± 11.4 days. Incidence varied widely each year (median, 24%; range, 5%-32%), with the highest rates in 2007 to 2008. Post-operative length of stay was identified as a significant predictor of CDI (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.01-1.03). Early CDI was an independent significant predictor of death (HR, 1.96; 95% CI, 1.14-3.36) as well as CDI anytime after transplant (HR, 1.61; 95% CI, 1.02-2.52).
  
  
  CONCLUSIONS
  CDI rates varied widely from 2000 through 2011, with the highest rates in 2007 to 2008. Lung transplant recipients who developed CDI had a higher risk of death, especially when CDI occurred in the first 6 months after transplant.
authors.affiliation: Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, Minnesota. Electronic address: Leex1203@umn.edu.
authors.forename: Janet T
authors.initials: JT
authors.lastname: Lee
authors.forename: Rosemary F
authors.initials: RF
authors.lastname: Kelly
authors.forename: Marshall I
authors.initials: MI
authors.lastname: Hertz
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Dunitz
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Shumway
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D016360:Clostridioides difficile; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000601:surgery*; D004761:Enterocolitis, Pseudomembranous / Q000150:complications* / Q000382:microbiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014180:Transplantation / Q000401:mortality*; D055815:Young Adult
keywords: Clostridium difficile infection; colitis; lung transplantation; mortality; transplant infection