Prevalence and outcomes of Clostridioides difficile infection in liver transplant recipients

Abstract

Background and aim: Data are limited on whether Clostridioides difficile infection (CDI) in the first year after liver transplantation (LT) is associated with increased mortality.In an Australian setting without hypervirulent strain of C. difficile we investigated the prevalence, risk factors, and patient survival associated with CDI in LT. Methods:Consecutive patients who underwent deceased-donor LT from 2007 to 2017 were studied retrospectively. Prevalence and long-term outcomes of LT recipients with and without CDI were examined in the entire LT cohort. A case-control study was performed to investigate risk factors associated with CDI.Results: Six hundred and forty-nine patients underwent LT, of which 32 (4.9%) were diagnosed with CDI within the first 12 months post-LT. There was no difference in patient survival in the overall LT cohort on Kaplan-Meier analysis when stratified by CDI status (log-rank test, p = .08). Furthermore, age was the only predictor of mortality on Cox regression (hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.00-1.13, p = .03). On multivariable logistic regression, rifaximin pre-LT reduced risk (odds ratio (OR) 0.22, 95% CI 0.65-0.74, p = .01) whereas antibiotics pre-LT (OR 7.02, 95% CI 1.26-39.01, p = .03) and length of hospital stay after LT (OR 1.03, 95% CI 1.01-1.06, p = .02) were associated with increased risk of CDI.Conclusions: Within the local setting of our study, CDI within 12 months post-LT is of low severity, associated with pre-LT antibiotic exposure and longer hospital stay but no survival impact after LT. Rifaximin use pre-LT reduced the risk of CDI post-LT.

Low rate of surgical site infections after liver transplantation: A 5‐year retrospective cohort study

“…22 Prolonged antibiotic use increases the risk of Clostridium difficile infection, which must be taken into consideration when determining the duration of prophylaxis. 23,24 Ideally, adequately powered randomized controlled trials are needed for a comparison of antibiotic regimens to better elucidate the optimal duration of prophylaxis post-LT.…”

Incidence and risk factors of Clostridioides difficile infection in liver transplant recipients: A comprehensive literature review

“…This study used a 2-step C. difficile testing methodology, increasing their rate of detection and incidence. Kortt et al [10] evaluated LTRs who received deceased donor transplants in 11 years and the incidence of CDI over the first year following the transplant. They described no difference in overall survival among LTRs with and without CDI; decreased risk of infection was seen with the use of rifaximin (p = 0.0); increased risk was seen with antibiotic use, especially penicillins (p = 0.03) along with length of stay after LT (p = 0.02).…”

“…No date of publication, location, or demographic limitations were placed. Mittal et al [2] Retrospective Ali et al [8] Retrospective Kortt et al [10] Case Gomez-Simmonds et al [11] Longitudinal Sullivan et al [12] Retrospective crosssectional study/2016/ New York, USA association was noted between CDI in LTRs along with higher mortality associated with it.…”

Shorter is better: The case for short antibiotic courses for common infections in solid organ transplant recipients

“…Among SOTRs, multidrug resistant (MDR) infection is common and increasingly prevalent [80][81][82] and is associated with worse graft and/or patient survival. 59,[83][84][85] CDI is common among nonkidney SOTRs [86][87][88] and is associated with significant morbidity: increased risk of graft rejection, 89 longer LOS, 86,90 higher risk of hospital readmission, 90 and higher risk of mortality. 90 SOTRs experience frequent antibiotic exposure and high rates of CDI and MDR infectionsshortening antibiotic durations may result in more relative benefit than in the general population.…”