title: The epidemiology of Clostridium difficile infection in a national kidney transplant center.
abstract: We aimed to describe the epidemiology and outcomes of CDI in a national kidney transplant center from 2008 to 2015.
  
  
  
  Adult kidney and kidney-pancreas transplant recipients were included for analysis if they met the surveillance CDI case definition. Rates of new healthcare-associated CDI (HA-CDI) were expressed per 10 000 KTR/KTPR bed days used (BDU) to facilitate comparisons.
  
  
  
  Fifty-two cases of CDI were identified in 42 KTRs and KPTRs. This corresponded to an average annual rate of 9.6 per 10 000 BDU, higher than that seen among general hospital inpatients locally, nationally, and internationally. Of the 45 cases (87%) that were considered HA-CDI, nine (20%) had symptom onset in the community. Recent proton-pump inhibitor (PPI) and broad-spectrum antimicrobial exposure preceded the majority of cases. KTRs and KPTRs with CDI had a longer mean length of hospital stay (35 days) than those KTR and KPTRs admitted during the same period that did not have CDI (8 days).
  
  
  
  Education regarding CDI must be extended to transplant recipients and their general practitioners. Other targets for future CDI rate reduction must include stringent antimicrobial stewardship (both in hospital and in the community) and judicious PPI prescribing.
authors.affiliation: Department of Nephrology, Beaumont Hospital, Dublin, Ireland.
authors.forename: Claire
authors.identifier: 0000-0001-7277-2171
authors.initials: C
authors.lastname: Kennedy
authors.affiliation: Department of Nephrology, Beaumont Hospital, Dublin, Ireland.
authors.forename: Carmel
authors.initials: C
authors.lastname: Waldron
authors.affiliation: Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.
authors.forename: Mairead
authors.initials: M
authors.lastname: Skally
authors.affiliation: Department of Pharmacy, Beaumont Hospital, Dublin, Ireland.
authors.forename: Leah
authors.initials: L
authors.lastname: Gaughan
authors.affiliation: Department of Nephrology, Beaumont Hospital, Dublin, Ireland.
authors.forename: Colm
authors.initials: C
authors.lastname: Magee
authors.affiliation: Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.|Health Protection Surveillance Centre, Dublin, Ireland.
authors.forename: Karen
authors.initials: K
authors.lastname: Burns
authors.affiliation: Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.|Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Fidelma
authors.initials: F
authors.lastname: Fitzpatrick
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006085:Graft Survival; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: 
  Clostridium difficile
  ; antimicrobial; diarrhea; infection; kidney transplant; kidney-pancreas transplant