title: Risk factors and epidemiology of Clostridium difficile infection in hematopoietic stem cell transplant recipients during the peritransplant period.
abstract: BACKGROUND
  Hematopoietic stem cell transplant (HSCT) recipients represent a high-risk group for developing Clostridium difficile (CD) infection (CDI). We aimed to identify specific risk factors for CDI in an HSCT patient population during the peritransplant period.
  
  
  METHODS
  We performed a case-control study within a cohort of HSCT patients who received a transplant from November 2010 to March 2013. Cases had a clinical presentation compatible with CDI and a positive stool sample Xpert®C. difficile test. Controls were CDI negative and matched on age, gender, and transplant type. Peritransplant period was defined as -30 days or time of stem cell mobilization maneuver to 30 days post transplant in autologous SCT or 90 days post transplant in allogeneic SCT.
  
  
  RESULTS
  Of 781 HSCTs performed during the study period, 650 (83.2%) had a stool sample submitted for CD testing. Eight-six (13.2%) cases with CDI were identified. Most of the cases were diagnosed within a week after transplantation (median of 5 days). In adjusted analysis, prior hospitalization (odds ratio [OR]: 2.01, 95% confidence interval [CI] 1.2-3.36), prior cephalosporin administration (OR 2.72, 95% CI: 1.54-4.83), and prior chemotherapy (OR: 3.26, 95% CI: 1.92-5.5) were significantly associated with CDI.
  
  
  CONCLUSIONS
  Hospitalization, and prior antibiotic and chemotherapy use are risk factors that are not easily modifiable, which emphasizes the need to start investigating preventive or prophylactic strategies in this high-risk population.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA.
authors.forename: Sol Del Mar
authors.initials: SD
authors.lastname: Aldrete
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA.|Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA.
authors.forename: Colleen S
authors.initials: CS
authors.lastname: Kraft
authors.affiliation: Division of Epidemiology and Biostatics, Georgia State University, Atlanta, GA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Magee
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Duke University, Durham, NC, USA.
authors.forename: Austin
authors.initials: A
authors.lastname: Chan
authors.affiliation: Department of Pharmacy, Emory University Hospital, Winship Cancer Institute, Atlanta, GA, USA.
authors.forename: Don
authors.initials: D
authors.lastname: Hutcherson
authors.affiliation: Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA.
authors.forename: Amelia A
authors.initials: AA
authors.lastname: Langston
authors.affiliation: Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA.
authors.forename: Brian I
authors.initials: BI
authors.lastname: Greenwell
authors.affiliation: Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Burd
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Friedman-Moraco
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016022:Case-Control Studies; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins
keywords: 
  Clostridium difficile
  ; hematopoietic stem cell transplant; peritransplant