title: Risk forClostridium difficileInfection After Allogeneic Hematopoietic Cell Transplant Remains Elevated in the Postengraftment Period.
abstract: BACKGROUND
  Clostridium difficileinfection (CDI) is a frequent cause of diarrhea among allogeneic hematopoietic cell transplant (HCT) recipients. It is unknown whether risk factors for CDI vary by time posttransplant.
  
  
  METHODS
  We performed a 3-year prospective cohort study of CDI in allogeneic HCT recipients. Participants were enrolled during their transplant hospitalizations. Clinical assessments were performed weekly during hospitalizations and for 12 weeks posttransplant, and monthly for 30 months thereafter. Data were collected through patient interviews and chart review, and included CDI diagnosis, demographics, transplant characteristics, medications, infections, and outcomes. CDI cases were included if they occurred within 1 year of HCT and were stratified by time from transplant. Multivariable logistic regression was used to determine risk factors for CDI.
  
  
  RESULTS
  One hundred eighty-seven allogeneic HCT recipients were enrolled, including 63 (34%) patients who developed CDI. 38 (60%) CDI cases occurred during the preengraftment period (days 0-30 post-HCT) and 25 (40%) postengraftment (day >30). Lack of any preexisting comorbid disease was significantly associated with lower risk of CDI preengraftment (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.1-0.9). Relapsed underlying disease (OR, 6.7; 95% CI, 1.3-33.1), receipt of any high-risk antimicrobials (OR, 11.8; 95% CI, 2.9-47.8), and graft-versus-host disease (OR, 7.8; 95% CI, 2.0-30.2) were significant independent risk factors for CDI postengraftment.
  
  
  CONCLUSIONS
  A large portion of CDI cases occurred during the postengraftment period in allogeneic HCT recipients, suggesting that surveillance for CDI should continue beyond the transplant hospitalization and preengraftment period. Patients with continued high underlying severity of illness were at increased risk of CDI postengraftment.
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO.
authors.forename: Erik R
authors.initials: ER
authors.lastname: Dubberke
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Reske
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Olsen
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO.
authors.forename: Kerry M
authors.initials: KM
authors.lastname: Bommarito
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO.
authors.forename: Sondra
authors.initials: S
authors.lastname: Seiler
authors.affiliation: Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Fernanda P
authors.initials: FP
authors.lastname: Silveira
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Tom M
authors.initials: TM
authors.lastname: Chiller
authors.affiliation: Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO.
authors.forename: John
authors.initials: J
authors.lastname: DiPersio
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO.
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser