Hospital-onset Clostridium difficile infection among solid organ transplant recipients.
Clostridium difficile infection (CDI) is a considerable health issue in the United States and represents the most common healthcare-associated infection. Solid organ transplant recipients are at increased risk of CDI, which can affect both graft and patient survival. However, little is known about the impact of CDI on health services utilization posttransplantation. We examined hospital-onset CDI from 2012 to 2014 among transplant recipients in the University HealthSystem Consortium, which includes academic medical center-affiliated hospitals in the United States. Infection was five times more common among transplant recipients than among general medicine inpatients (209 vs 40 per 10 000 discharges), and factors associated with CDI among transplant recipients included transplant type, risk of mortality, comorbidities, and inpatient complications. Institutional risk-standardized CDI varied more than 3-fold across high-volume hospitals (infection ratio 0.54-1.82, median 1.04, interquartile range 0.78-1.28). CDI was associated with increased 30-day readmission, transplant organ complications, cytomegalovirus infection, inpatient costs, and lengths of stay. Total observed inpatient days and direct costs for those with CDI were substantially higher than risk-standardized expected values (40 094 vs 22 843 days, costs $198 728 368 vs $154 020 528). Further efforts to detect, prevent, and manage CDI among solid organ transplant recipients are warranted.
Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL.|Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL.|School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
J P
JP
Donnelly
Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL.
H E
HE
Wang
Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL.
J E
JE
Locke
Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL.|Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL.|Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL.
R B
RB
Mannon
Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL.
M M
MM
Safford
Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL.|Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL.
J W
JW
Baddley
D000328:Adult; D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D017721:Hospital Costs; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000191:economics; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D066027:Transplant Recipients / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States
bacterial: clostridium difficile; complication: infectious; health services and outcomes research; infection and infectious agents; infectious disease