Prevalence of Clostridium difficile Infection among Solid Organ Transplant Recipients: A Meta-Analysis of Published Studies

Abstract

Several factors including antibiotic use, immunosuppression and frequent hospitalizations make solid organ transplant (SOT) recipients vulnerable to Clostridium difficile infection (CDI). We conducted a meta-analysis of published studies from 1991-2014 to estimate the prevalence of CDI in this patient population. We searched PubMed, EMBASE and Google Scholar databases. Among the 75,940 retrieved citations, we found 30 studies coded from 35 articles that were relevant to our study. Based on these studies, we estimated the prevalence of CDI among 21,683 patients who underwent transplantation of kidney, liver, lungs, heart, pancreas, intestine or more than one organ and stratified each study based on the type of transplanted organ, place of the study conduction, and size of patient population. The overall estimated prevalence in SOT recipients was 7.4% [95%CI, (5.6-9.5%)] and it varied based on the type of organ transplant. The prevalence was 12.7% [95%CI, (6.4%-20.9%)] among patients who underwent transplantation for more than one organ. The prevalence among other SOT recipients was: lung 10.8% [95% CI, (5.5%-17.7%)], liver 9.1 % [95%CI, (5.8%-13.2%)], intestine 8% [95% CI, (2.6%-15.9%)], heart 5.2% [95%CI, (1.8%-10.2%)], kidney 4.7% [95% CI, (2.6%-7.3%)], and pancreas 3.2% [95% CI, (0.5%-7.9%)]. Among the studies that reported relevant data, the estimated prevalence of severe CDI was 5.3% [95% CI (2.3%-9.3%)] and the overall recurrence rate was 19.7% [95% CI, (13.7%-26.6%)]. In summary, CDI is a significant complication after SOT and preventive strategies are important in order to reduce the CDI related morbidity and mortality.

Hospital-Onset Clostridium difficile Infection Among Solid Organ Transplant Recipients

“…(8, 15, 22) In a recent meta-analysis, Paudel, et al examined thirty studies assessing CDI among SOTs from 1991-2014, spanning three continents. (22) The authors reported a pooled CDI rate of 7.4%, with the highest burden in co-transplants and transplants of the lung, liver, and intestine. (22) In a single center descriptive study, Tsapepas, et al found an overall incidence of 4% among SOTs, with the highest occurring in lung transplant recipients.…”

“…(22) The authors reported a pooled CDI rate of 7.4%, with the highest burden in co-transplants and transplants of the lung, liver, and intestine. (22) In a single center descriptive study, Tsapepas, et al found an overall incidence of 4% among SOTs, with the highest occurring in lung transplant recipients. (15) Our study differed from prior efforts in several important ways, potentially leading to differing results.…”

Fecal microbiota transplantation for recurrent Clostridium difficile infection in patients with solid organ transplants: an institutional experience and review of the literature

“…Among patients receiving solid organ transplantation (SOT) and hematopoietic stem cell transplantation, CDI rates also increased . Factors contributing to increased pathogenicity of C. difficile in this population include iatrogenic immunosuppression, antibiotic use, and prolonged or frequent hospitalizations . CDI among transplant receipts is associated with significant morbidity and mortality …”

Changes in Composition of the Gut Bacterial Microbiome after Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection in a Pediatric Heart Transplant Patient

“…We (unpublished data) and others have noted significant changes in the murine gut microbiome in response to mycophenolate mofetil (MMF) and other immunosuppressive drugs (3, 4). Increased susceptibility to infection is a known complication following SOT and the rate of Clostridium difficile infection (CDI) in SOT patients may be up to five times higher in comparison to other hospitalized patients (5). Antibiotics are a commonly reported risk factor for CDI due to depletion of protective bacteria, and reconstitution with fecal microbiota transplantation (FMT) is a promising therapeutic option that has been successfully applied to SOT patients and children (6, 7).…”