title: Risk Factors for Clostridium Difficile Diarrhea in Patients With Solid Organ Transplantation.
abstract: BACKGROUND
  There is limited knowledge about specific risk factors for Clostridium difficile infection (CDI).
  
  
  METHODS
  A retrospective study comparing cases of CDI in solid organ transplant (SOT) recipients with controls (SOT recipients who did not present CDI).
  
  
  RESULTS
  Thirty patients with SOT from 1340 transplantation recipients had at least 1 episode of CDI (2.23%). The accumulated incidence was 3.06% in liver transplantation, 2.78% in lung transplantation, 2.36% in kidney transplantation, and 0.33% in heart transplantation. Seven (23%) cases occurred during the first 2 months. Fifteen (50%) cases were community acquired. Colonoscopy was performed in 6 (20%) cases, but pseudomembranes were observed in only 1 (16%) case. Independent variables found to be related to CDI were previous treatment with proton pump inhibitors (PPIs; odds ratio [OR] 5.5; 95% confidence interval [CI] 1.2-32.0), immunosuppressive regimen including mycophenolate (OR 5.2; 95%CI 1.1-18), hospitalization during the previous 3 months (OR 5.1; 95%CI 1.1-17), and antibiotic treatment during the previous month (OR 6.7; 95%CI 1.4-23). Five (16.7%) patients did not respond to the initial treatment. Recurrences were noted in 6 (20%) patients.
  
  
  CONCLUSIONS
  Liver transplant recipients presented the highest incidence. Risk factors for CDI were previous treatment with PPIs, immunosuppressive regimen containing mycophenolate, prior hospitalization, and prior antibiotic treatment.
authors.affiliation: Unidad de Enfermedades Infecciosas, Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Majadahonda, Madrid, Spain Spanish Network for Research in Infectious Diseases (REIPI), Sevilla, Spain aramosm@salud.madrid.org.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ramos
authors.affiliation: Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Ortiz
authors.affiliation: Departamento de Medicina Preventiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Asensio
authors.affiliation: Departamento de Microbiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Rocío
authors.initials: R
authors.lastname: Martínez-Ruiz
authors.affiliation: Unidad de Enfermedades Infecciosas, Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Múñez
authors.affiliation: Departamento de Medicina Preventiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Cantero
authors.affiliation: Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cozar
authors.affiliation: Departamento de Neumología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Piedad
authors.initials: P
authors.lastname: Ussetti
authors.affiliation: Departamento de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Portolés
authors.affiliation: Unidad de Transplante Hepático, Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Majadahonda, Madrid, Spain.
authors.forename: Valentín
authors.initials: V
authors.lastname: Cuervas-Mons
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology*; D003967:Diarrhea; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D019737:Transplants
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clostridium difficile; antibiotic-associated diarrhea; metronidazole; mycophenolate mofetil; proton pump inhibitors