1513. Epidemiology and Risk Factors for Clostridium difficile Infection in Lung Transplant Recipients
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA 2013 Poster (Verheyden) final.pdf (235.8 kB)
  • Background: C. difficile infection (CDI) is an important infectious complication in solid organ transplant (txp).  We sought to describe epidemiology and risk factors for CDI in lung txp.

    Methods: Retrospective chart review (1/1/2008 to 12/31/2012) of index hospitalization for lung txp at a single institution.  Baseline demographics and risk factors including antibiotic (abx) exposure were evaluated.  Impact of metronidazole for CDI prophylaxis was also examined. CDI was defined as positive EIA or PCR.

    Results: A total of 529 lung txps (212 single, 312 bilateral, and 5 heart/lung) occurred over the 5 year period.  Demographics included mean age 57±13 years, 66% male, and median hospital LOS 20 days (IQR 12-38).  Overall incidence of CDI was 5% (25 cases) at 30 days and 7% (38 cases) at 90 days post-transplant.  Incidence varied by year; 7% in 2008, 3% in 2009, 7% in 2010, 16% in 2011, and 5% in 2012 (p<0.001).  Median time to CDI was 11 (IQR 6-37) days.  Complications from CDI occurred in 6/38 cases; megacolon (n=3), perforation (n=1), ICU transfer (n=1) and hospital death (n=2).  43 patients (8%) received metronidazole 250 mg q8 hrs as CDI prophylaxis; 3/43 (7%) developed CDI at 30 days and 5/43 (12%) developed CDI at 90 days.  Metronidazole prophylaxis was not associated with a lower CDI incidence at either time point.  Cases of CDI at 30 days were compared to controls to evaluate risk factors (Table 1).  The only independent risk factors for CDI were IV abx use > 14 days (OR 2.96, 95% CI 1.17-7.48, p=0.022) and 3rd & 4th gen cephalosporin use (OR 2.84, 95% CI 1.19-6.8, p=0.019).  Hospital mortality was 16% (4/25) in CDI cases vs 6% (29/504) in controls, p=0.062. 

    Table 1

    CDI Cases

    N=25

    Controls

    N=504

    P value

    Hospital LOS, days, median (range)

    28 (160)

    20 (236)

    0.024

    IV abx > 14 days

    18 (72%)

    204 (41%)

    0.002

    Carbapenem

    13 (52%)

    149 (30%)

    0.025

    3rd & 4th Gen Cephalosporin

    10 (40%)

    73 (15%)

    0.002

    Fluoroquinolone

    13 (52%)

    201 (40%)

    0.296

    Clindamycin

    1 (4%)

    5 (1%)

    0.253

     Conclusion: In the first 90 days post-txp, CDI occurred in 7% of patients; with about half of cases occurring within 10 days of txp.  Abx exposure, especially 3rd & 4th gen cephalosporins and longer durations were independent risk factors for CDI.  Judicious selection and duration of abx is paramount to preventing CDI in lung txp.

    Collin Verheyden, PharmD1, Seth Bauer, PharmD1, Marcus Haug III, PharmD, MSc1, Marie Budev, DO, MPH2, Thomas G. Fraser, MD, FSHEA3 and Elizabeth A. Neuner, PharmD1, (1)Pharmacy, Cleveland Clinic, Cleveland, OH, (2)Lung Transplantation Center, Cleveland Clinic, Cleveland, OH, (3)Infectious Disease, Cleveland Clinic Foundation, Cleveland, OH

    Disclosures:

    C. Verheyden, None

    S. Bauer, None

    M. Haug III, None

    M. Budev, None

    T. G. Fraser, None

    E. A. Neuner, None

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