Risk factors for Clostridium difficile Infection (CDI) in Intestinal Transplant Recipients (ITR) during the first year post-transplant.

Background: C. difficile is the most common cause of healthcare-associated infectious diarrhea. Risk factors for CDI in ITR are not well defined. The aim of our study was to assess specific risk factors for CDI in ITR.

Methods: We matched 1:3 case-control and included 29 ITR who developed CDI (cases) and 87 ITR who did not develop CDI (controls) during the first year post-transplant. Wilcoxon rank-sum and Fisher’s exact tests were used to compare variables. Univariate and multivariable conditional logistic regressions analysis were performed to identify risk factors.

Results: Table 1 describes characteristics of the two groups.

Table 1.

The median time-to-CDI after transplantation was 163 days (16 – 353 days). Results of univariate analysis are shown in Table 2.

Table 2.

The multivariable conditional logistic regression analysis showed that proton pump inhibitors (PPI) administration (OR=0.06; 95% CI: 0.007-0.52; p= 0.01) was associated with lower rates of CDI. Outcomes for cases vs. controls: episodes of rejection 24.14% vs. 20.69% (p= 0.7), graft loss 0% vs. 2.3% (p= 0.99) and survival rate 1 year post-transplant 79.3% (59.6-90.1%) vs. 87.2% (78.1- 92.7%) (p= 0.38).

Conclusion: We found PPI administration to be protective for CDI in ITR. Risks factors for CDI in ITR might be different from other populations, based on anatomical differences and medication administered both of which may impact intestinal microbiota.