title: Clostridium difficile infection, a descriptive analysis of solid organ transplant recipients at a single center.
abstract: Clostridium difficile is a bacterial enteric pathogen, which causes clinical disease among solid organ transplant (SOT) recipients. This large, single-center, retrospective study describes incidence, demographics, and impact of C. difficile infection (CDI) among adult SOT recipients, cardiac (n=5), lung (n=14), liver (n=9), renal (n=26), and multiorgan (n=9) patients transplanted and diagnosed with CDI (geneB PCR) between 9/2009 and 12/2012. The overall incidence of CDI in our population during the 40-month period of study was 4%. CDI incidence among cardiac, lung, liver, and renal transplant recipients was 1.9%, 7%, 2.7%, and 3.2%, respectively (P=0.03 between organ-types). Median time from transplant to CDI for all was 51 (14-249) days, with liver recipients having the shortest time to infection, median 36 (15-101) days, and lung recipients having a longer time to infection, median 136 (29-611) days. Antibiotic exposure within 3 months of CDI was evident in 45 of the 63 (71%) patients in this study, 80%, 79%, 100%, 58%, and 67% of cardiac, lung, liver, renal, and multiorgan transplant recipients, respectively. Most patients (83%) were hospitalized within the 3 months preceding CDI. Recipients were followed for a median time of 23 (16-31) months; at the time of last follow-up, 83% of allografts were functioning, and 86% of patients were alive. One death and 1 graft failure were causally related to CDI. CDI had an overall incidence of 4%; clinicians should have heightened awareness for CDI, especially among patients receiving antibiotics, with increased monitoring and aggressive management of CDI.
authors.affiliation: Department of Pharmacy, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA. Electronic address: det9021@nyp.org.
authors.forename: Demetra S
authors.initials: DS
authors.lastname: Tsapepas
authors.affiliation: Department of Pharmacy, Hartford Hospital, Hartford CT, USA.
authors.forename: Spencer T
authors.initials: ST
authors.lastname: Martin
authors.affiliation: Department of Pharmacy, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Miao
authors.affiliation: Department of Pharmacy, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
authors.forename: Shreya A
authors.initials: SA
authors.lastname: Shah
authors.affiliation: Department of Pharmacy, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
authors.forename: Jenna
authors.initials: J
authors.lastname: Scheffert
authors.affiliation: Department of Pharmacy, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Fester
authors.affiliation: Department of Pharmacy, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
authors.forename: Karlene
authors.initials: K
authors.lastname: Ma
authors.affiliation: Theravance Biopharma, Inc. South San Francisco, CA, USA.
authors.forename: Asma
authors.initials: A
authors.lastname: Lat
authors.affiliation: Department of Transplantation, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Egan
authors.affiliation: Department of Pharmacy, Hackensack University Medical Center, Hackensack, NJ, USA.
authors.forename: Jaclyn T
authors.initials: JT
authors.lastname: McKeen
mesh_terms: D000328:Adult; D000368:Aged; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D016019:Survival Analysis; D066027:Transplant Recipients; D019737:Transplants
keywords: Clostridium difficile; Epidemiology; Infection; Solid organ transplantation