Risk Factors for Clostridioides Difficile Diarrhea In Solid Organ Transplantation Recipients

BACKGROUND

There is limited knowledge about risk factors for Clostridioides difficile infection (CDI) and recurrent CDI in solid organ transplant (SOT) recipients.

METHODS

A case-control study of CDI in SOT recipients compared with controls (SOT recipients who did not present CDI).

RESULTS

Sixty-seven patients from 1089 SOT recipients (6.2%) suffered at least one episode of CDI. The mean age was 55 ± 12 years and 20 cases (69%) were men. The accumulated incidence was 8% in liver transplantation, 6.2% in lung transplantation, 5.4% in heart transplantation, and 4.7% in kidney transplantation. Twenty-nine cases (43.3%) were diagnosed during the first 3 months after SOT. Forty-one cases (61.2%) were hospital acquired. Thirty-one patients with CDI presented with mild-moderate infection (46.3%), 30 patients with severe infection (44.8%), and 6 patients with severe-complicated disease (9%). Independent variables found to be related with CDI were hospitalization in the previous 3 months (odds ratio: 2.99; [95% confidence interval 1.21-7.37]) and the use of quinolones in the previous month (odds ratio: 3.71 [95% confidence interval 1.16-11.8]). Eleven patients (16.4%) had at least one recurrence of CDI. Previous treatment with amoxicillin-clavulanate, severe-complicated index episode, and high serum creatinine were associated with recurrent CDI in the univariant analysis CONCLUSIONS: Liver transplant recipients presented the highest incidence of CDI among SOT recipients. Risk factors for CDI were hospitalization in the previous 3 months and the use of quinolones in the previous month.

Proposal for a Novel Score to Determine the Risk of Cardiac Implantable Electronic Device Infection

INTRODUCTION AND OBJECTIVES

The use of cardiac implantable electronic devices (CIEDs) has expanded in recent years. Infection related to these devices constitutes one of the main complications and is associated with high morbidity, mortality, and financial cost. The aim of this study was to construct a predictive risk score of acquiring CIED infection.

METHODS

We designed a retrospective, nested case-control study. Both cases and controls belonged to a cohort that included all patients who underwent a CIED-related procedure between January 2009 and December 2015. Cases were defined as patients with infection, and 3 infection-free controls were randomly selected from the cohort for each case included.

RESULTS

During the study period, 2323 procedures were performed. A total of 33 CIED-related infections were identified. Ninety-nine patients were selected as controls. Independent risk factors were the Charlson index (OR, 1.33; 95%CI, 1.07-1.67), oral anticoagulation (OR, 3.51; 95%CI, 1.44-8.54), revision or replacement of a previous device (OR, 2.75; 95%CI, 1.12-6.71) and the presence of more than 2 leads (OR, 3.42; 95%CI, 1.25-9.37). A predictive risk score was generated and denominated CIED-AI (Charlson Index, more than 2 leads/Electrodes, Device revision/replacement, oral Anticoagulation, previous Infection). This score had an area under the receiver operating characteristic curve of 0.79 (95%CI, 0.71-0.88).

CONCLUSIONS

The CIED-AI score may help to identify patients at higher risk of infection, who could be candidates for intensive preventive measures.

Risk factors for Clostridium difficile diarrhea in patients with inflammatory bowel disease

BACKGROUND

Despite the growing incidence of Clostridium difficile diarrhea (CCD) in patients with inflammatory bowel disease (IBD), little is known about the associated risk factors.

METHOD

A retrospective study comparing cases of CCD in patients with IBD to IBD carriers who did not develop CCD. A comparison was also made with patients who developed CCD but did not suffer IBD.

RESULTS

Three cases (20%) with IBD and CCD had received antibiotics during the previous three months versus none of the controls (IBD without CCD, p = 0.22). Ten cases (67%) received treatment with proton pump inhibitors (PPIs) versus 2 (13%) in the control group (IBD without CCD, p = 0.001). Seven cases underwent colonoscopy and pseudomembranes were seen in one (14%). Fourteen (93%) patients demonstrated a favourable response to metronidazole. Patients with IBD and CCD presented with younger age (36 ± 10 years), a higher degree of community-acquired infection (13 patients, 87%), immunosuppressive treatment (7 patients, 47%) and less patients had received previous antibiotic treatment (3 patients, 20%) than those with CCD without IBD. The proportion of patients who received treatment with PPIs was similar (66% and 80%, respectively p = 0.266).

CONCLUSIONS

CCD in IBD carriers affects younger patients, the majority are community acquired (less nosocomial) and it is more related to previous treatment with PPIs than with the antibiotic treatment. Clinical evolution is also favourable.