title: Identification of Risk Factors Associated With Clostridium difficile Infection in Liver Transplantation Recipients: A Single-Center Analysis.
abstract: Clostridium difficile remains the leading cause of health care-associated infectious diarrhea, and its incidence and severity are increasing in liver transplant recipients. Several known risk factors for C difficile infection (CDI) are inherently associated with liver transplantation, such as severe underlying illness, immunosuppression, abdominal surgery, and broad-spectrum antibiotic use. We conducted a single-center retrospective case control study to characterize risk factors for CDI among patients who received a liver transplant from January 2008 to December 2012. We also examined the associations of post-transplantation CDI with transplant outcomes. Cases were defined as having diarrhea with a positive test for C difficile by either toxin A/B enzyme immunoassay (EIA) or glutamate dehydrogenase EIA and polymerase chain reaction within 1 year after transplantation. Sixty-five consecutive patients were evaluated, of which 15 (23%) developed CDI. The median time from transplantation to CDI diagnosis was 65 days (interquartile range [IQR] 13-208) and more than one-half (53%) had severe infection. Risk factors that were associated with CDI among liver transplant recipients included: (1) previous history of CDI (20% vs 0%; P = .001); (2) exposure to proton-pump inhibitor therapy (93% vs 60%; P = .015); (3) antimicrobial therapy before transplantation (47% vs 18%; P = .039); (4) a prolonged length of stay before transplantation (1 day [IQR, 1-19] vs 1 day [IQR, 0-1]; P = .028); and (5) chronic kidney disease (53% vs 20%; P = .011). There was no significant differences in patient survivals at 6 months (93% vs 96%; P = .67) and 12 months (87% vs 94%; P = .35) among CDI case and control subjects, respectively.
authors: Department of Pharmacy, University of Vermont Medical Center, Burlington, Vermont.
authors: B G
authors: BG
authors: Rogala
authors: Department of Pharmacy, Hahnemann University Hospital, Philadelphia, Pennsylvania; Division of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors: G E
authors: GE
authors: Malat
authors: Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors: D H
authors: DH
authors: Lee
authors: Division of Nephrology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors: M N
authors: MN
authors: Harhay
authors: Division of Nephrology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors: A M
authors: AM
authors: Doyle
authors: Department of Pharmacy, Hahnemann University Hospital, Philadelphia, Pennsylvania; Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. Electronic address: tiffany.bias@tenethealth.com.
authors: T E
authors: TE
authors: Bias
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000209:etiology*; D003428:Cross Infection / Q000209:etiology*; D003967:Diarrhea / Q000139:chemically induced; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction
chemical_list: D000900:Anti-Bacterial Agents