Risk factors associated with <i>Clostridium difficile</i> infection in kidney transplant recipients

Spinner, Michael L.; Stephany, Brian; Cerrato, Pooja; Lam, Simon W.; Neuner, Elizabeth; Patel, Kajal S.

doi:10.1111/tid.12918

Cited by 12 publications

(19 citation statements)

References 20 publications

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“…6,7 Unfortunately, these are relatively common within the transplant population and do not provide much of a basis for targeted prophylaxis modalities, which are needed given the potential impact of CDI on allograft outcomes. 5 In a recent study by Spinner et al, 5 the use of antibiotics for the treatment of UTI and tacrolimus levels were associated with increased risk of CDI. However, these are not modifiable because treatment of UTI in the first year after transplant is evidence based, guideline driven, and tied to mitigation of negative outcomes, as are early posttransplant tacrolimus goals.…”

Section: Discussionmentioning

confidence: 98%

“…3,4 Risk factors associated with CDI in renal transplant (RTX) have been described. 5,6 However the epidemiology and perioperative risk of CDI at the time of transplant surgery has not been fully elucidated. Additionally, there is a need for identification of modifiable risk factors and means to determine which patients are at highest risk and may benefit from targeted preventive strategies.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology, Risk Factors, and Outcomes After Early Posttransplant Clostridiodes difficile Infection in Renal Transplant Recipients

et al. 2019

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Background: Modifiable risk-factors associated with Clostridioides difficile infection (CDI) in renal-transplant (RTX) have not been clearly established and peri-transplant risk has not been described. Objective: Evaluate epidemiology, risk-factors and outcomes after CDI occurring in the first 90 days after RTX (CDI-90).Methods: Observational cohort study/survival analysis of adult RTX recipients from 1/1/2012-12/31/2015. Primary outcome was CDI-90 incidence/risk-factors. Secondary outcome was evaluation of post-90 day transplant outcomes. Results: 982 patients met inclusion criteria; 46 with CDI-90 and 936 without (comparator). CDI incidence in the total population was 4.7% at 90 days, 6.3% at 1 year, and 6.4% at 3 years. Incidence of CDI-90 was 5%; time to diagnosis was 19.4±25 days (median 7). Risk-factors for CDI-90 were alemtuzumab induction (Hazard ratio [HR] 1.5, 95% CI(1.1-2.0), p = 0.005) and age at transplant (HR 1.007/year, 95% CI (1.002-1.012), p= 0.007). However, risk-factors for CDI at any time were different; donation-after-circulatory-death (DCD) donor (HR 2.5 95% CI (1.3-4.9), p = 0.008) and female gender (HR 1.6 95% CI (1.0-2.7), p = 0.049). On Kaplan-Meier, CDI-90 appeared to have an impact on patient/graft survival, however when analyzed in a multivariable stepwise Cox proportional hazards model, only age was significantly associated with survival ( p = 0.002). Conclusion and Relevance: Incidence of CDI-90 is low, mostly occurring in the first post-operative month. Risk-factors vary temporally based on time from transplant. In the early post-op period induction agent and age at transplant are significant, but not after. Associations between CDI and negative graft outcomes appear to be largely driven by age. Future studies validating these risk-factors as well as targeted prophylaxis strategies and their effect on long term graft outcomes and the host microbiome are needed.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Epidemiology, Risk Factors, and Outcomes After Early Posttransplant Clostridiodes difficile Infection in Renal Transplant Recipients

et al. 2019

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“…[11][12][13][14] A recent study at this institution also identified increased C difficile infection risk with antibiotic treatment for UTIs, AOR 4.17 (95% CI 1.12-15.54). 15 Collectively, this illustrates that the seemingly benign choice to treat ASB can lead to future infectious consequences. Due to the lack of proven benefit and increased risk for complications, antimicrobial stewardship programs are increasingly recognizing ASB treatment as an antimicrobial "never event."…”

Section: Re Sultsmentioning

confidence: 99%

Impact of asymptomatic bacteriuria incidence and management post–kidney transplantation

Bohn

Athans

Kovacs

et al. 2019

Clinical Transplantation

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Objective Urinary tract infections (UTIs) are the most commonly occurring infectious complication following kidney transplantation. Questions remain regarding whether asymptomatic bacteriuria (ASB) should be treated. The aim was to evaluate the incidence and management of ASB in kidney transplant recipients at a large academic medical center. Methods All subjects receiving an isolated kidney transplant between September 2012 and October 2016, and with at least one ASB episode were included. Demographics, symptomatology, and urine culture data were collected on subjects with bacteriuria in the first year post‐transplant. Cultures were classified by symptoms, ASB treatment trends were analyzed, and ASB‐to‐UTI progression was compared between ASB treatment and non‐treatment. Results A total of 527 subjects were transplanted with 64 developing at least one ASB episode. The incidence of ASB was 12.1% and treated 74.6% of the time. Neither lack of ASB treatment (P = 0.463) nor ASB within the first month post‐transplant (P = 0.303) were associated with ASB‐to‐UTI progression. Conclusion Despite high ASB treatment rate, this was not found to be protective against ASB‐to‐UTI progression. ASB within the first month post‐transplant also did not correlate with increased progression risk. These results suggest minimization of ASB treatment in kidney transplant recipients remains an important antimicrobial stewardship target.

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“… 29 , 30 Any intervention may have to be administered for extended time periods to ensure complete clearance of the organism; this warrants additional considerations of safety and tolerability. Finally, many at-risk patients may be immunocompromised; 31 , 32 therefore, the most appropriate interventions are those that can be tolerated by these individuals as well.…”

Section: Specific Challenges For Anti- C Difficmentioning

confidence: 99%

Anti-virulence strategies for Clostridioides difficile infection: advances and roadblocks

2020

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Clostridioides difficile infection (CDI) is a common healthcare- and antibiotic-associated diarrheal disease. If mis-diagnosed, or incompletely treated, CDI can have serious, indeed fatal, consequences. The clinical and economic burden imposed by CDI is great, and the US Centers for Disease Control and Prevention has named the causative agent, C. difficile (CD), as an Urgent Threat To US healthcare. CDI is also a significant problem in the agriculture industry. Currently, there are no FDA-approved preventives for this disease, and the only approved treatments for both human and veterinary CDI involve antibiotic use, which, ironically, is associated with disease relapse and the threat of burgeoning antibiotic resistance. Research efforts in multiple laboratories have demonstrated that non-toxin factors also play key roles in CDI, and that these are critical for disease. Specifically, key CD adhesins, as well as other surface-displayed factors have been shown to be major contributors to host cell attachment, and as such, represent attractive targets for anti-CD interventions. However, research on anti-virulence approaches has been more limited, primarily due to the lack of genetic tools, and an as-yet nascent (but increasingly growing) appreciation of immunological impacts on CDI. The focus of this review is the conceptualization and development of specific anti-virulence strategies to combat CDI. Multiple laboratories are focused on this effort, and the field is now at an exciting stage with numerous products in development. Herein, however, we focus only on select technologies (Figure 1) that have advanced near, or beyond, pre-clinical testing (not those that are currently in clinical trial), and discuss roadblocks associated with their development and implementation.

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Risk factors associated with Clostridium difficile infection in kidney transplant recipients

Abstract: Maintaining a clinically appropriate tacrolimus trough and judicious antibiotic use and selection for UTI treatment could potentially reduce CDI in the kidney transplant population.

Cited by 12 publications

References 20 publications

Epidemiology, Risk Factors, and Outcomes After Early Posttransplant Clostridiodes difficile Infection in Renal Transplant Recipients

Epidemiology, Risk Factors, and Outcomes After Early Posttransplant Clostridiodes difficile Infection in Renal Transplant Recipients

Impact of asymptomatic bacteriuria incidence and management post–kidney transplantation

Anti-virulence strategies for Clostridioides difficile infection: advances and roadblocks

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