title: Storage duration of red blood cell transfusion and Clostridium difficile infection: a within person comparison.
abstract: OBJECTIVE
  Randomized controlled trials demonstrated that red blood cell (RBC) transfusion elevates the risk of infection, and trials are underway to evaluate whether RBC storage affects outcomes. We previously reported that transfusion predicts Clostridium difficile infection (CDI) and, therefore, planned an investigation to examine this further using a more robust design.
  
  
  METHODS
  Within-person case-crossover study. Hospitalizations in which CDI developed (n = 406) were compared to hospitalizations for the same individuals in which CDI did not occur (n = 949). Transfusion volume and storage duration were assessed prior to the onset of CDI.
  
  
  METHODS
  University of Michigan Health System.
  
  
  METHODS
  Participants were individuals with a diagnosis of CDI from July 2009 through June 2012.
  
  
  RESULTS
  During the hospitalizations when CDI occurred, 34.7% of the patients received allogeneic RBC transfusions (mean volume, 688 ml) compared to 19.0% of patients in hospitalizations without CDI (mean volume, 180 ml). The odds of healthcare-associated CDI increased by 76% (95% CI 1.39-2.23) for every liter of RBCs transfused and was elevated in both nonsurgical (OR = 1.90) and surgical (OR = 1.86) hospitalizations. In patients who received RBC transfusions, the odds of developing CDI increased by 6% for every additional day of RBC stored and by 53% for every week of additional storage (P = 0.002).
  
  
  CONCLUSIONS
  Hospitalizations in which a patient received a greater volume of RBC transfusions were more likely to be associated with the development of CDI. RBC units stored for a longer duration were associated with the development of healthcare-associated CDI after adjustment for RBC volume.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Mary A M
authors.initials: MA
authors.lastname: Rogers
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Dejan
authors.initials: D
authors.lastname: Micic
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York, United States of America.
authors.forename: Neil
authors.initials: N
authors.lastname: Blumberg
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America ; Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Vincent B
authors.initials: VB
authors.lastname: Young
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America ; Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, United States of America ; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.
authors.forename: David M
authors.initials: DM
authors.lastname: Aronoff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001793:Blood Preservation; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile; D018592:Cross-Over Studies; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology*; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D055815:Young Adult