1089. Clostridium difficile infection (CDI) is an important cause of morbidity in the first 100 days following lung transplantation and is associated with allograft loss
Session: Poster Abstract Session: Infections After Solid Organ Transplants
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Nosocomial infections are important causes of mortality after lung transplantation (LTx), but there are few data about CDI within the first 100 days and its impact on long-term outcomes.

Methods: We retrospectively reviewed patients who underwent LTx from 1/1/2009 to 12/31/2010 at the University of Pittsburgh. Early postoperative CDI (E-CDI) was identified by positive C.difficile stool toxin assay and clinical symptoms within 100 days of LTx.

Results: The rate of E-CDI over this period was 11%: 10 patients had severe CDI (3 of whom had colitis, diagnosed clinically or radiographically), and 17 had mild E-CDI. The median time from LTx to E-CDI onset was 20 days (12-48 days). Patients with E-CDI were more likely to be hospitalized for >3 days prior to LTx than controls (33% vs 14%; p=0.03). There were no significant differences in baseline characteristics including age, sex, underlying pulmonary or medical conditions, CMV mismatch, open chest after LTx, types of induction treatment for LTx, immunosuppression augmentation for treatment of acute rejection, antibiotic use other than standard surgical prophylaxis between patients with E-CDI and controls. 11% (3/27) of patients with E-CDI had recurrence within 6 months after transplant. 1 patient with colitis required colectomy. There was no differences in the duration of ICU (median 8 days vs 5 days, p=0.15) or hospital stays (median 48 days vs 32 days, p=0.13) between patients with E-CDI and controls, nor were there differences in in-hospital mortality (7% vs 6%, p=1.0). The crude mortality for patients with E-CDI was significantly higher than for controls (22% vs 8%; p=0.047). On long-term follow-up, patients with E-CDI were more likely to have lung allograft failure than controls (18% vs 6%; p=0.06).

Conclusion: E-CDI is an important nosocomial infection after LTx, affecting 11% of patients. Pre-transplant hospitalization was a significant factor associated with E-CDI. E-CDI was associated with high morbidity including severe CDI or colitis during the short-term and lung allograft failure in the long-term.

Subject Category: O. Transplant infectious diseases

Jong Hun Kim, MD1, Jae Hong, MD1, Ryan K. Shields, PharmD2, Yoshiya Toyoda, MD, PhD1, Cornelius Clancy, MD3 and M. Hong Nguyen, MD1, (1)UPMC, Pittsburgh, PA, (2)University of Pittsburgh, Pittsburgh, PA, (3)University of Pittsburgh and VA Pittsburgh, Pittsburgh, PA


J. H. Kim, None

J. Hong, None

R. K. Shields, None

Y. Toyoda, None

C. Clancy, Pfizer: Grant Investigator, Research grant
Merck: Grant Investigator, Research support

M. H. Nguyen, None

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