title: Frequency and risks associated with Clostridium difficile-associated diarrhea after pediatric solid organ transplantation: a single-center retrospective review.
abstract: BACKGROUND
  Morbidity and mortality related to Clostridium difficile infection (CDI) has increased, but epidemiology and risk factors within pediatric solid organ transplant (SOT) recipients are uncertain.
  
  
  METHODS
  A retrospective cohort study of SOT recipients age ≤18 years at transplantation from 2010 to 2013 was performed. Patients with CDI were compared with matched CDI-negative controls with diarrhea.
  
  
  RESULTS
  Of 202 patients, the majority were male (58%) and Caucasian (77%). Kidney (42%) was the most common organ transplanted, followed by liver (38%), heart (17%), and multivisceral/intestine (3%). Age ranged from 3 weeks to 18 years (median 4.7 years, mean 6.6; interquartile range [IQR] 1.5-11.2). In 104 SOT recipients, at least 1 unformed stool was tested; 25 patients were positive for CDI. Most testing occurred by 60 days post transplant (mean 164, median 57, IQR 14-227). First negative tests occurred concurrently (mean 153, median 54, IQR 13-214) to the 25 patients with CDI (mean 199, median 65, IQR 32-238). In univariable analyses, age, gender, ethnicity, obesity, and calcineurin inhibitor choice were not associated with CDI. Liver recipients were more likely to have CDI (18.4% liver, 4.7% kidney, 8.8% heart, P < 0.01). Twenty CDI patients were matched to 35 controls. In multivariable analyses, neither recent hospitalization nor antibiotic duration or intensity was associated with CDI. Acid-blockade appeared protective (risk ratio 0.13, 95% confidence interval 0.02-0.78).
  
  
  CONCLUSIONS
  CDI occurs in 12% of pediatric SOT recipients, but 24% of those tested with diarrhea were positive. In patients with diarrhea, prior hospitalization and antibiotic duration or intensity were not associated with CDI.
authors: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: J
authors: J
authors: Ciricillo
authors: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: D
authors: D
authors: Haslam
authors: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: S
authors: S
authors: Blum
authors: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: M-O
authors: MO
authors: Kim
authors: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: C
authors: C
authors: Liu
authors: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: G
authors: G
authors: Paulsen
authors: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: J
authors: J
authors: Courter
authors: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. lara.danziger-isakov@cchmc.org.
authors: L
authors: L
authors: Danziger-Isakov
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D016377:Organ Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: 
  Clostridium difficile
  ; diarrhea; pediatric transplantation; risk factors