title: Clostridium difficile infection in liver transplant recipients: a retrospective study of rates, risk factors and outcomes.
abstract: Clostridium difficile infection (CDI) occurs in 3-7% of liver transplant recipients (LTR). However, few data exist on the recent epidemiology, predictors and outcomes of CDI in LTR. A cohort study was performed including LTR from 2000 to 2010 at a tertiary care hospital in Detroit. CDI was defined as diarrhea with a stool C. difficile positive test. Data analyzed included demographics, comorbidities, length of stay (LOS), severity of CDI, rates of recurrence (<12 weeks), relapse (<4 weeks) and overall mortality. Predictors of CDI were calculated using Cox proportional hazard model; 970 LTR were followed for years. Overall prevalence of CDI was 18.9%. Incidence of CDI within 1 year of transplant was 12.4%. Severe CDI occurred in 29.1%. CDI recurrence and relapse rates were 16.9% and 9.7%, respectively. Independent predictors of CDI were year of transplant (hazard ratio [HR] 1.137, 95% confidence interval [CI] 1.06-1.22; p < 0.001), white race (105/162 whites, HR 1.47, 95% CI 1.03-2.1; p = 0.035), Model for End-Stage Liver Disease score (HR 1.03, 95% CI 1.01-1.045, p = 0.003) and LOS (HR 1.01, 95% CI 1.005-1.02, p < 0.001). Significant mortality was observed among LTR with CDI compared to those without CDI (p = 0.003). We concluded that CDI is common among LTR and is associated with higher mortality.
authors.affiliation: Division of Infectious Diseases, Henry Ford Health System, Detroit, MI.
authors.forename: C
authors.initials: C
authors.lastname: Mittal
authors.forename: S
authors.initials: S
authors.lastname: Hassan
authors.forename: S
authors.initials: S
authors.lastname: Arshad
authors.forename: S
authors.initials: S
authors.lastname: Jeepalyam
authors.forename: S
authors.initials: S
authors.lastname: Bruni
authors.forename: M
authors.initials: M
authors.lastname: Miceli
authors.forename: G
authors.initials: G
authors.lastname: Jacobsen
authors.forename: M
authors.initials: M
authors.lastname: Abouljoud
authors.forename: I
authors.initials: I
authors.lastname: Bajjoka
authors.forename: M
authors.initials: M
authors.lastname: Ramesh
authors.forename: G
authors.initials: G
authors.lastname: Alangaden
mesh_terms: D000328:Adult; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology*; D015897:Comorbidity; D003967:Diarrhea / Q000382:microbiology; D058625:End Stage Liver Disease / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000382:microbiology; D007902:Length of Stay; D017093:Liver Failure / Q000382:microbiology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008824:Michigan; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Bacterial: Clostridium difficile; clinical research; hepatology; infection and infectious agents; infectious disease; intestinal disease: infectious; liver transplantation; practice