Article ; Online: Early Clostridioides difficile infection characterizations, risks, and outcomes in allogeneic hematopoietic stem cell and solid organ transplant recipients.
Transplant infectious disease : an official journal of the Transplantation Society
2021 Volume 24, Issue 1, Page(s) e13720
Abstract: Background: Clostridioides difficile infection (CDI) frequently complicates allogeneic hematopoietic stem cell (allo-HCT) and solid organ transplantation (SOT).: Methods: We retrospectively analyzed risk factors and outcomes of CDI occurring within ... ...
Abstract | Background: Clostridioides difficile infection (CDI) frequently complicates allogeneic hematopoietic stem cell (allo-HCT) and solid organ transplantation (SOT). Methods: We retrospectively analyzed risk factors and outcomes of CDI occurring within 30 days of transplant. Results: Between March 2010 and June 2015, 466 allo-HCT and 1454 SOT were performed. The CDI cumulative incidence (95% CI) was 10% (8-13) and 4% (3-5), following allo-HCT and SOT, respectively (p < .01), occurring at a median (range) 7.5 days (1-30) and 11 (1-30), respectively (p = .18). In multivariate analysis, fluoroquinolones use within 14 days pre-transplantation was a risk factor for CDI following allo-HCT (HR 4.06 [95% CI 1.31-12.63], p = .02), and thoracic organ(s) transplantation was a risk factor for CDI following SOT (HR 3.03 [95% CI 1.31-6.98]) for lung and 3.90 (1.58-9.63) for heart and heart/kidney transplant, p = .02. Compared with no-CDI patients, the length of stay (LOS) was prolonged in both allo-HCT (35 days [19-141] vs. 29 [13-164], p < .01) and SOT with CDI (16.5 [4-101] vs. 7 [0-159], p < .01), though not directly attributed to CDI. In allo-HCT, severe acute graft-versus-host disease (aGVHD) occurred more frequently in patients with CDI (33.3% vs. 15.8% without CDI, p = .01) and most aGVHD (87.5%) followed CDI. Non-relapse mortality or overall survival, not attributed to CDI, were also similar in both allo-HCT and SOT. Conclusions: Early post-transplant CDI is frequent, associated with fluoroquinolones use in allo-HCT and the transplanted organ in SOT, and is associated with longer LOS in both the groups without difference in survival but with increased aGVHD in allo-HCT. |
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MeSH term(s) | Clostridioides difficile ; Clostridium Infections/epidemiology ; Hematopoietic Stem Cell Transplantation/adverse effects ; Hematopoietic Stem Cells ; Humans ; Organ Transplantation/adverse effects ; Retrospective Studies ; Transplant Recipients |
Language | English |
Publishing date | 2021-09-25 |
Publishing country | Denmark |
Document type | Journal Article |
ZDB-ID | 1476094-0 |
ISSN | 1399-3062 ; 1398-2273 |
ISSN (online) | 1399-3062 |
ISSN | 1398-2273 |
DOI | 10.1111/tid.13720 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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