Epidemiology, risk factors, and outcome of Clostridium difficile infection in heart and heart-lung transplant recipients.
Clostridium difficile is a major cause of diarrhea in thoracic organ transplant recipients. We investigated the epidemiology, risk factors, and outcome of Clostridium difficile infection (CDI) in heart and heart-lung transplant (HT) recipients.



This is a retrospective study from 2004 to 2013. CDI was defined by diarrhea and a positive toxigenic C. difficile in stool measured by toxin enzyme immunoassay (2004-2006) or polymerase chain reaction (2007-2013). Cox proportional hazards regression was used to model the association of risk factors with time to CDI and survival with CDI following transplantation.



There were 254 HT recipients, with a median age of 53 years (IQR, 45-60); 34% were female. During the median follow-up of 3.1 years (IQR, 1.3-6.1), 22 (8.7%) patients developed CDI. In multivariable analysis, risk factors for CDI were combined heart-lung transplant (HR 4.70; 95% CI, 1.30-17.01 [P=.02]) and retransplantation (HR 7.19; 95% CI, 1.61-32.12 [P=.01]). Acute cellular rejection was associated with a lower risk of CDI (HR 0.34; 95% CI, 0.11-0.94 [P=.04]). CDI was found to be an independent risk factor for mortality (HR 7.66; 95% CI, 3.41-17.21 [P<.0001]).



Clostridium difficile infection after HT is more common among patients with combined heart-lung and those undergoing retransplantation. CDI was associated with a higher risk of mortality in HT recipients.
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.|Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Jackrapong
0000-0003-0930-8936
J
Bruminhent
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Kelly A
KA
Cawcutt
Division of Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Charat
C
Thongprayoon
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.
Tanya M
TM
Petterson
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.|William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.
Walter K
WK
Kremers
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.|William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.
Raymund R
RR
Razonable
D016360:Clostridioides difficile / Q000472:pathogenicity*; D003015:Clostridium Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D066027:Transplant Recipients

Clostridium difficile
; epidemiology; heart transplant; mortality; outcome; risk factor