Risk factors associated with Clostridium difficile infection after kidney and pancreas transplantation.
| Autor: | Shah SA; Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA., Tsapepas DS, Kubin CJ, Martin ST, Mohan S, Ratner LE, Pereira M, Kapur S, Dadhania D, Walker-McDermott JK |
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| Jazyk: | angličtina |
| Zdroj: | Transplant infectious disease : an official journal of the Transplantation Society [Transpl Infect Dis] 2013 Oct; Vol. 15 (5), pp. 502-9. Date of Electronic Publication: 2013 Jul 25. |
| DOI: | 10.1111/tid.12113 |
| Abstrakt: | Background: Clostridium difficile infection (CDI) is a common cause of nosocomial antibiotic-associated diarrhea with an increased incidence reported in solid organ transplant recipients. We sought to determine if kidney and/or pancreas transplant recipients possess unique risk factors for CDI. Methods: Between January 2009 and February 2011, 942 kidney and 56 pancreas transplants were performed at the 2 centers. Of these, 28 recipients (kidney, n = 24; pancreas, n = 4) developed CDI. Cases were matched to controls (n = 56) in a 1:2 ratio. Results: Those with CDI were mostly male patients (82% vs. 48%, P = 0.003), deceased-donor organ recipients (86% vs. 64%, P = 0.045), more likely to have leukopenia (18% vs. 4%, P = 0.038), and had undergone a gastrointestinal procedure within 3 months preceding CDI diagnosis (18% vs. 4%, P = 0.038). Cases had higher cumulative and restricted antimicrobial exposure in days (37 ± 79 vs. 8 ± 12, P = 0.009 and 27 ± 69 vs. 7 ± 10, P = 0.032). Cephalosporin use was more common among cases (43% vs. 16%, P = 0.008). Conclusion: Careful antimicrobial selection and assurance of optimal treatment duration in the kidney and pancreas transplant population is prudent. Clinicians should have a heightened awareness of CDI risk particularly during periods of leukopenia and in the setting of gastrointestinal procedures. (© 2013 John Wiley & Sons A/S.) |
| Databáze: | MEDLINE |
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