Incidence, Risk Factors, and Outcomes of Clostridium difficile Infections in Kidney Transplant Recipients

Background Kidney transplant recipients (KTR) may be at increased risk for Clostridium difficile infections (CDI) but risk factors and outcomes in this population have not been well studied. Methods An observational cohort study was conducted to determine the incidence, risk factors, and outcomes of CDI in KTR. A total of 1,816 KTR transplanted between 2000 and 2013 at Toronto General Hospital were included. Sixty-eight patients developed CDI. Controls were selected at a 4:1 ratio using risk-set sampling and risk factors were explored using conditional logistic regression models. The impact of CDI on graft outcomes was evaluated using Cox proportional hazards models. Results The incidence rate of CDI was 0.64 cases/100 person-years. Independent predictors of CDI included antibiotic use (OR 2.88 [95%CI: 1.35, 6.15]), increased duration of hospitalization posttransplant (OR 1.04 [95%CI: 1.02, 1.06]), receiving a deceased donor kidney (OR 2.98 [95%CI: 1.47, 6.05]), and a history of biopsy-proven acute rejection (OR 5.82 [95%CI: 2.22, 15.26]). In the Cox proportional hazards model, CDI was found to be an independent risk factor for the subsequent development of biopsy-proven acute rejection (HR 2.18 [95% CI: 1.34, 3.55]). Conclusions Our results confirm that transplant-specific factors place KTR at a higher risk for CDI. CDI may increase the risk of adverse outcomes such as biopsy-proven acute rejection. These findings emphasize the importance of preventive strategies to reduce the morbidity associated with CDI in KTR. Address correspondence to: S. Joseph Kim, MD, PhD, MHS, FRCPC, Toronto General Hospital, University Health Network, 585 University Avenue, 11-PMB-129, Toronto, Ontario, Canada M5G 2N2. Email: joseph.kim@uhn.ca. Office: 416-340-3228. Fax: 416-340-4701 AUTHORSHIP Research design: G. Li, Trac, Husain, Famure, Y. Li, Kim Writing the paper: G. Li, Trac, Husain, Famure, Kim Performance of the research: G. Li, Trac, Husain, Famure, Kim Contributed analytic tools: G. Li, Trac, Y. Li, Kim Participated in data analysis: G. Li, Trac, Husain, Famure, Y. Li, Kim DISCLOSURE The authors have no conflicts of interest to disclose as it relates to this work. FUNDING No external funding was acquired to support this research. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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