Clostridium difficile Infection in Liver Transplant Recipients: A Retrospective Study of Rates, Risk Factors and Outcomes

• Published in: American journal of transplantation Vol. 14; no. 8; pp. 1901 - 1907
• Main Authors: Mittal, C., Hassan, S., Arshad, S., Jeepalyam, S., Bruni, S., Miceli, M., Jacobsen, G., Abouljoud, M., Bajjoka, I., Ramesh, M., Alangaden, G.
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Wiley 01-08-2014; Elsevier Limited
• Subjects: Adult; Bacterial: Clostridium difficile; Biological and medical sciences; clinical research; Clostridioides difficile; Clostridium difficile; Clostridium Infections - epidemiology; Comorbidity; Diarrhea - microbiology; End Stage Liver Disease - epidemiology; End Stage Liver Disease - microbiology; Epidemiology; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Health risk assessment; hepatology; Humans; infection and infectious agents; Infections; infectious disease; intestinal disease: infectious; Intestinal Diseases - microbiology; Length of Stay; Liver; Liver Failure - microbiology; Liver Failure - surgery; Liver Transplantation; Male; Medical sciences; Michigan; Middle Aged; Mortality; Other diseases. Semiology; practice; Prevalence; Proportional Hazards Models; Public health. Hygiene; Public health. Hygiene-occupational medicine; Recurrence; Retrospective Studies; Risk Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Michigan; USA, Michigan, Detroit; Prognosis; Digestive system; Liver; Rate; Clostridium difficile; Clostridiales; Diarrhea; Transplantation; Retrospective study; Homotransplantation; Epidemiology; Infection; Treatment; Surgery; Clostridiaceae; Risk factor; Bacteria; Graft; Digestive diseases; Intestinal disease; Evolution; practice; intestinal disease: infectious; clinical research; infectious disease; Bacterial: Clostridium difficile; hepatology; infection and infectious agents; liver transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.12798

Clostridium difficile infection (CDI) occurs in 3–7% of liver transplant recipients (LTR). However, few data exist on the recent epidemiology, predictors and outcomes of CDI in LTR. A cohort study was performed including LTR from 2000 to 2010 at a tertiary care hospital in Detroit. CDI was defined as diarrhea with a stool C. difficile positive test. Data analyzed included demographics, comorbidities, length of stay (LOS), severity of CDI, rates of recurrence (<12 weeks), relapse (<4 weeks) and overall mortality. Predictors of CDI were calculated using Cox proportional hazard model; 970 LTR were followed for years. Overall prevalence of CDI was 18.9%. Incidence of CDI within 1 year of transplant was 12.4%. Severe CDI occurred in 29.1%. CDI recurrence and relapse rates were 16.9% and 9.7%, respectively. Independent predictors of CDI were year of transplant (hazard ratio [HR] 1.137, 95% confidence interval [CI] 1.06–1.22; p < 0.001), white race (105/162 whites, HR 1.47, 95% CI 1.03–2.1; p = 0.035), Model for End‐Stage Liver Disease score (HR 1.03, 95% CI 1.01–1.045, p = 0.003) and LOS (HR 1.01, 95% CI 1.005–1.02, p < 0.001). Significant mortality was observed among LTR with CDI compared to those without CDI (p = 0.003). We concluded that CDI is common among LTR and is associated with higher mortality.
A retrospective cohort study of Clostridium difficile infection in 970 liver transplant recipients finds high prevalence (18.9%), recurrence (16.9%), and relapse (9.7%) rates, and significantly higher all‐cause mortality.