Dubberke E R, Reske K A, Olsen M A, Bommarito K, Cleveland A A, Silveira F P, Schuster M G, Kauffman C A, Avery R K, Pappas P G, Chiller T M
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.
Centers for Disease Control and Prevention, Atlanta, GA, USA.
Transpl Infect Dis. 2018 Apr;20(2):e12855. doi: 10.1111/tid.12855. Epub 2018 Mar 6.
Clostridium difficile infection (CDI) is a common complication of lung and allogeneic hematopoietic cell (HCT) transplant, but the epidemiology and outcomes of CDI after transplant are poorly described.
We performed a prospective, multicenter study of CDI within 365 days post-allogeneic HCT or lung transplantation. Data were collected via patient interviews and medical chart review. Participants were followed weekly in the 12 weeks post-transplant and while hospitalized and contacted monthly up to 18 months post-transplantation.
Six sites participated in the study with 614 total participants; 4 enrolled allogeneic HCT (385 participants) and 5 enrolled lung transplant recipients (229 participants). One hundred and fifty CDI cases occurred within 1 year of transplantation; the incidence among lung transplant recipients was 13.1% and among allogeneic HCTs was 31.2%. Median time to CDI was significantly shorter among allogeneic HCT than lung transplant recipients (27 days vs 90 days; P = .037). CDI was associated with significantly higher mortality from 31 to 180 days post-index date among the allogeneic HCT recipients (Hazard ratio [HR] = 1.80; P = .007). There was a trend towards increased mortality among lung transplant recipients from 120 to 180 days post-index date (HR = 4.7, P = .09).
The epidemiology and outcomes of CDI vary by transplant population; surveillance for CDI should continue beyond the immediate post-transplant period.
艰难梭菌感染（CDI）是肺部和异基因造血细胞移植（HCT）的常见并发症，但移植后CDI的流行病学和结局鲜有描述。
我们对异基因HCT或肺移植后365天内的CDI进行了一项前瞻性多中心研究。通过患者访谈和病历审查收集数据。移植后12周内每周对参与者进行随访，住院期间也进行随访，移植后长达18个月每月进行联系。
六个研究点参与了该研究，共有614名参与者；4个研究点纳入异基因HCT患者（385名参与者），5个研究点纳入肺移植受者（229名参与者）。移植后1年内发生了150例CDI病例；肺移植受者中的发病率为13.1%，异基因HCT受者中的发病率为31.2%。异基因HCT受者发生CDI的中位时间明显短于肺移植受者（27天对90天；P = 0.037）。在异基因HCT受者中，从索引日期起31至180天内，CDI与显著更高的死亡率相关（风险比[HR]=1.80；P = 0.007）。索引日期后120至180天内，肺移植受者的死亡率有增加趋势（HR = 4.7，P = 0.09）。
CDI的流行病学和结局因移植人群而异；对CDI的监测应在移植后短期内之后继续进行。
