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

Erick F. Mayer, Gabriela Maron, Ronald H. Dallas, Jose Ferrolino, Li Tang, Yilun Sun, Lara Danziger-Isakov, Grant C. Paulsen, Brian T. Fisher, Surabhi B. Vora, Janet Englund, William J. Steinbach, Marian Michaels, Michael Green, Nava Yeganeh, Joy E. Gibson, Samuel R. Dominguez, Maribeth R. Nicholson, Daniel E. Dulek, Monica I. ArduraSujatha Rajan, Blanca E. Gonzalez, Christy Beneri, Betsy C. Herold

Research output: Contribution to journalArticle

Abstract

Hematopoietic cell transplant (HCT) and solid organ transplant (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 (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.5-4.7), proton pump inhibitors (PPIs; 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.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - Jan 1 2020

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Keywords

  • clinical research/practice
  • epidemiology
  • infection and infectious agents—bacterial: Clostridiodes difficile
  • infectious disease
  • pediatrics

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Mayer, E. F., Maron, G., Dallas, R. H., Ferrolino, J., Tang, L., Sun, Y., Danziger-Isakov, L., Paulsen, G. C., Fisher, B. T., Vora, S. B., Englund, J., Steinbach, W. J., Michaels, M., Green, M., Yeganeh, N., Gibson, J. E., Dominguez, S. R., Nicholson, M. R., Dulek, D. E., ... Herold, B. C. (Accepted/In press). A multicenter study to define the epidemiology and outcomes of Clostridioides difficile infection in pediatric hematopoietic cell and solid organ transplant recipients. American Journal of Transplantation. https://doi.org/10.1111/ajt.15826