Epidemiology, risk factors, and outcomes of Clostridium difficile infection in kidney transplant recipients

Abstract

We sought to describe the epidemiology and risk factors for Clostridium difficile infection (CDI) among kidney transplant recipients (KTR) between 1 January 2008 and 31 December 2010. A single-institution retrospective study was conducted among all adult KTR with CDI, defined as a positive test for C.difficile by a cell cytotoxic assay for C.difficile toxin A or B or polymerase chain reaction test for toxigenic C.difficile. Among 603 kidney transplants performed between 1 January 2008 and 31 December 2010, 37 (6.1%) patients developed CDI: 12 (of 128; 9.4%) high-risk (blood group incompatible and/or anti-human leukocyte antigen donor-specific antibodies) vs. 25 (of 475; 5.3%, P=0.08) standard-risk patients. The overall rate of CDI increased from 3.7% in 2008 to 9.4% in 2010 (P=0.05). The median time to CDI diagnosis was 9days, with 27 (73.0%) patients developing CDI within the first 30days after their transplant, and 14 (51.8%) developing CDI within 7days. A case-control analysis of 37 CDI cases and 74 matched controls demonstrated the following predictors for CDI among KTR: vancomycin-resistant Enterococcus colonization before transplant (odds ratio [OR]: 3.6, P=0.03), receipt of an organ from Centers for Disease Control high-risk donor (OR: 5.9, P=0.006), and administration of high-risk antibiotics within 30days post transplant (OR: 6.6, P=0.001). CDI remains a common early complication in KTR, with rates steadily increasing during the study period. Host and transplant-related factors and exposure to antibiotics appeared to significantly impact the risk for CDI among KTR.