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The Impact of Clostridium difficile Infection on Future Outcomes of Solid Organ Transplant Recipients

Published online by Cambridge University Press:  19 March 2018

Ruihong Luo ,
Janice M. Weinberg  and
Tamar F. Barlam
Ruihong Luo*
Affiliation:
Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at University of California–Los Angeles, California Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
Janice M. Weinberg
Affiliation:
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
Tamar F. Barlam
Affiliation:
Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
*
Address correspondence to Ruihong Luo, 10833 Le Conte Ave, CHS 37-121, Los Angeles, California 90095 ([email protected]).
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Abstract

OBJECTIVE

Clostridium difficile infection (CDI) is common in solid organ transplant (SOT) recipients, but few studies have examined long-term outcomes. We studied the impact of CDI after SOT on mortality and transplant organ complication-related hospitalizations (TOH).

METHODS

SOT recipients ≥18 years of age with at least 1 year of posttransplant data were analyzed using the MarketScan database for 2007–2014. Patients who died within one year of transplant were followed until death. Patients were grouped as early CDI (ie, first occurrence ≤90 days posttransplant), late CDI (ie, first occurrence >90 days posttransplant) and controls (ie, no CDI occurrence during follow-up). The risk of mortality or TOH after CDI was evaluated using Cox and logistic regressions, respectively.

RESULTS

Overall, 96 patients had early CDI, 97 patients had late CDI, and 5,913 patients were used as controls. The risk for death was significantly higher in the early CDI group than the control group (hazard ratio [HR],1.92; 95% confidence interval [CI], 1.12–3.29; P=.018); there was no significant difference between the late CDI group and the control group (HR, 0.86; 95% CI, 0.38–1.94; P=.717). Both the early CDI group (odds ratio [OR], 2.19; 95% CI, 1.45–3.31; P<.001) and the late CDI group (OR, 4.36; 95% CI, 2.84–6.71; P<.001) had higher risk for TOH than the control group. For those patients who survived >90 days posttransplant, both the early CDI group (n=89) and the late CDI group (n=97) had increased risk for death or TOH during follow-up than the control group (n=5,734).

CONCLUSION

Though our study could not prove causality, both early and late CDI occurrence in SOT recipients were associated with worse future outcomes than for SOT recipients without CDI.

Infect Control Hosp Epidemiol 2018;39:563–570

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 5 , May 2018 , pp. 563 - 570
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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