Early Clostridioides difficile infection characterizations, risks, and outcomes in allogeneic hematopoietic stem cell and solid organ transplant recipients
| Autor: | Celalettin Ustun, Smarika Sapkota, Jo Anne H. Young, Qing Cao, Daniel J. Weisdorf, Steven Richmond, Karam M. Obeid, Timothy L. Pruett, Allison P Watson, Fatma Keklik Karadag |
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| Rok vydání: | 2021 |
| Předmět: |
Diarrhea
medicine.medical_specialty genetic structures Epidemiology Hypogammaglobulinemia rates outcomes Gastroenterology allogeneic hematopoietic stem cell transplant hemic and lymphatic diseases Internal medicine risk factors Toxins Medicine Humans Disease Cumulative incidence In patient Risk factor Antibody Retrospective Studies Transplantation Lung business.industry Clostridioides difficile solid organ transplant Hematopoietic Stem Cell Transplantation Hematopoietic stem cell Organ Transplantation Colitis Hematopoietic Stem Cells mortality Transplant Recipients surgical procedures operative Infectious Diseases medicine.anatomical_structure Clostridioides difficile infection Clostridium Infections business Solid organ transplantation Clostridioides |
| Zdroj: | Transplant infectious disease : an official journal of the Transplantation SocietyREFERENCES. 24(1) |
| ISSN: | 1399-3062 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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