A multicenter study to define the epidemiology and outcomes of Clostridioides difficile infection in pediatric hematopoietic cell and solid organ transplant recipients.

TitleA multicenter study to define the epidemiology and outcomes of Clostridioides difficile infection in pediatric hematopoietic cell and solid organ transplant recipients.
Publication TypeJournal Article
Year of Publication2020
AuthorsMayer EF, Maron G, Dallas RH, Ferrolino J, Tang L, Sun Y, Danziger-Isakov L, Paulsen GC, Fisher BT, Vora SB, Englund J, Steinbach WJ, Michaels M, Green M, Yeganeh N, Gibson JE, Dominguez SR, Nicholson MR, Dulek DE, Ardura MI, Rajan S, Gonzalez BE, Beneri C, Herold BC
JournalAm J Transplant
Date Published2020 Feb 16
ISSN1600-6143
Abstract

Hematopoietic cell transplantation (HCT) and solid organ transplantation (SOT) recipients are at increased risk for Clostridioides difficile infection (CDI). We conducted a multicenter retrospective study to describe the incidence of CDI in children transplanted between January 2010 and June 2013. Nested case-control substudies, matched 1:1 by transplant type, institution, patient age, and time of year (quartile) of transplant, identified CDI risk factors. Cohorts included 1496 HCT and 1090 SOT recipients. Among HCT recipients, 355 CDI episodes were diagnosed in 265 recipients (18.2%). Nested case-control study identified prior history of CDI (OR 2.6, 95% CI 1.5 - 4.7), proton-pump inhibitors (OR 2.1, 95% CI 1.3 - 3.4), and exposure to third (OR 2.4, 95% CI 1.4 - 4.2) or fourth generation (OR 2.1, 95% CI 1.2 - 3.7) cephalosporins as risk factors. Notably, fluoroquinolone exposure appeared protective (OR 0.6, 95% CI 0.3 - 0.9). Ninety-two episodes of CDI were diagnosed among 79 SOT recipients (7.3%) and exposure to PPIs (OR 2.4, 95% CI 1.1 - 5.4) and third generation cephalosporin therapy (OR 3.9, 95% CI 1.4 - 10.5) were identified as risk factors. Strategies to decrease PPI use and changes in the class of prophylactic antibiotics may impact CDI incidence and warrant further study.

DOI10.1111/ajt.15826
Alternate JournalAm. J. Transplant.
PubMed ID32064754