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Toxigenic Clostridioides difficile colonization as a risk factor for development of C. difficile infection in solid-organ transplant patients

Published online by Cambridge University Press:  16 September 2020

Jack Keegan Open the ORCID record for Jack Keegan [Opens in a new window] ,
Blake W. Buchan ,
Nathan A. Ledeboer ,
Zhipeng Zhou ,
Johnny C. Hong ,
Mary Beth Graham  and
L. Silvia Munoz-Price
Jack Keegan*
Affiliation:
Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Blake W. Buchan
Affiliation:
Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
Nathan A. Ledeboer
Affiliation:
Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
Zhipeng Zhou
Affiliation:
Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
Johnny C. Hong
Affiliation:
Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
Mary Beth Graham
Affiliation:
Division of Infectious Disease, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
L. Silvia Munoz-Price
Affiliation:
Division of Infectious Disease, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
*
Author for correspondence: Jack Keegan, E-mail: jkeegan@mcw.edu
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Abstract

Background:

The association between Clostridioides difficile colonization and C. difficile infection (CDI) is unknown in solid-organ transplant (SOT) patients. We examined C. difficile colonization and healthcare-associated exposures as risk factors for development of CDI in SOT patients.

Methods:

The retrospective study cohort included all consecutive SOT patients with at least 1 screening test between May 2017 and April 2018. CDI was defined as the presence of diarrhea (without laxatives), a positive C. difficile clinical test, and the use of C. difficile-directed antimicrobial therapy as ordered by managing clinicians. In addition to demographic variables, exposures to antimicrobials, immunosuppressants, and gastric acid suppressants were evaluated from the time of first screening test to the time of CDI, death, or final discharge.

Results:

Of the 348 SOT patients included in our study, 33 (9.5%) were colonized with toxigenic C. difficile. In total, 11 patients (3.2%) developed CDI. Only C. difficile colonization (odds ratio [OR], 13.52; 95% CI, 3.46–52.83; P = .0002), age (OR, 1.09; CI, 1.02–1.17; P = .0135), and hospital days (OR, 1.05; 95% CI, 1.02–1.08; P = .0017) were independently associated with CDI.

Conclusions:

Although CDI was more frequent in C. difficile colonized SOT patients, the overall incidence of CDI was low in this cohort.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 3 , March 2021 , pp. 287 - 291
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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