title: Clostridium difficile infection among kidney transplant recipients: frequency, clinical presentation, and outcome.
abstract: The objective of this study was to evaluate the frequency of Clostridium Difficile Infection (CDI) among kidney transplant recipients and describe the clinical picture in correlation with the presence of certain risk factors. We included kidney transplant recipients with a functioning graft, who were admitted during the period 1/2012-12/2013, and patients with ESRD who were admitted to undergo Kidney Transplantation (KTx) from a deceased or a living donor in the same period. Patients were screened following clinical indication of gastrointestinal infection. CDI diagnosis was based on a positive stool sample for CD toxins and stool culture. Within the period 2012-2013, we recorded 24 cases of CDI in 19 patients, accounting for a frequency of 5.4% of CDI in our population. In addition to diarrhea, 63.15% of the patients presented with fever, 31.25% with anorexia, while abdominal pain was a rare symptom (0.53%). None of the patients had ileus, bowel obstruction or megacolon. Fourteen patients (73.7%) had a history of recent exposure (15 days) to antimicrobial agents prior to the evolution of CDI symptoms. A relapse of the CDI infection was identified in five cases. CDI infection is a significant factor of morbidity in patients with KTx and should be considered in the clinical setting of diarrhea, even in cases with no exposure to antibiotic agents.
authors.affiliation: Transplantation Unit, Laikon General Hospital, Athens, Greece.
authors.forename: Sophia
authors.initials: S
authors.lastname: Lionaki
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Panagiotellis
authors.forename: Demetrios
authors.initials: D
authors.lastname: Moris
authors.forename: George
authors.initials: G
authors.lastname: Daikos
authors.forename: Mina
authors.initials: M
authors.lastname: Psyhogiou
authors.forename: Spiridon
authors.initials: S
authors.lastname: Vernadakis
authors.forename: Georgios
authors.initials: G
authors.lastname: Zavos
authors.forename: John N
authors.initials: JN
authors.lastname: Boletis
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019818:Clavulanic Acid / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D003967:Diarrhea / Q000188:drug therapy / Q000382:microbiology; D006760:Hospitalization; D006801:Humans; D007668:Kidney / Q000382:microbiology / Q000473:pathology; D007674:Kidney Diseases / Q000382:microbiology / Q000601:surgery*; D016030:Kidney Transplantation; D008875:Middle Aged; D009017:Morbidity; D012189:Retrospective Studies; D012307:Risk Factors; D013982:Ticarcillin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D019818:Clavulanic Acid; D013982:Ticarcillin
keywords: Renal transplantation; clostridium difficile infection; diarrhea