Ilett Emma E, Helleberg Marie, Reekie Joanne, Murray Daniel D, Wulff Signe M, Khurana Mark P, Mocroft Amanda, Daugaard Gedske, Perch Michael, Rasmussen Allan, Sørensen Søren S, Gustafsson Finn, Frimodt-Møller Niels, Sengeløv Henrik, Lundgren Jens
PERSIMUNE Centre of Excellence, Rigshospitalet, Copenhagen, Denmark.
Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK.
Open Forum Infect Dis. 2019 Feb 19;6(4):ofz086. doi: 10.1093/ofid/ofz086. eCollection 2019 Apr.
Transplant recipients are an immunologically vulnerable patient group and are at elevated risk of infection (CDI) compared with other hospitalized populations. However, risk factors for CDI post-transplant are not fully understood.
Adults undergoing solid organ (SOT) and hematopoietic stem cell transplant (HSCT) from January 2010 to February 2017 at Rigshospitalet, University of Copenhagen, Denmark, were retrospectively included. Using nationwide data capture of all CDI cases, the incidence and risk factors of CDI were assessed.
A total of 1687 patients underwent SOT or HSCT (1114 and 573, respectively), with a median follow-up time (interquartile range) of 1.95 (0.52-4.11) years. CDI was diagnosed in 15% (164) and 20% (114) of the SOT and HSCT recipients, respectively. CDI rates were highest in the 30 days post-transplant for both SOT and HSCT (adjusted incidence rate ratio [aIRR], 6.64; 95% confidence interval [CI], 4.37-10.10; and aIRR, 2.85; 95% CI, 1.83-4.43, respectively, compared with 31-180 days). For SOT recipients, pretransplant CDI and liver and lung transplant were associated with a higher risk of CDI in the first 30 days post-transplant, whereas age and liver transplant were risk factors in the later period. Among HSCT recipients, myeloablative conditioning and a higher Charlson Comorbidity Index were associated with a higher risk of CDI in the early period but not in the late period.
Using nationwide data, we show a high incidence of CDI among transplant recipients. Importantly, we also find that risk factors can vary relative to time post-transplant.
移植受者是免疫功能脆弱的患者群体，与其他住院人群相比，发生艰难梭菌感染（CDI）的风险更高。然而，移植后CDI的危险因素尚未完全明确。
回顾性纳入2010年1月至2017年2月在丹麦哥本哈根大学 Rigshospitalet 接受实体器官移植（SOT）和造血干细胞移植（HSCT）的成人患者。利用全国范围内所有CDI病例的数据采集，评估CDI的发病率和危险因素。
共有1687例患者接受了SOT或HSCT（分别为1114例和573例），中位随访时间（四分位间距）为1.95（0.52 - 4.11）年。SOT和HSCT受者中分别有15%（164例）和20%（114例）被诊断为CDI。SOT和HSCT移植后30天内的CDI发生率均最高（调整发病率比[aIRR]分别为6.64；95%置信区间[CI]为4.37 - 10.10；以及aIRR为2.85；95%CI为1.83 - 4.43，与移植后31 - 180天相比）。对于SOT受者，移植前CDI以及肝移植和肺移植与移植后前30天内较高的CDI风险相关，而年龄和肝移植是后期的危险因素。在HSCT受者中，清髓性预处理和较高的Charlson合并症指数与早期较高的CDI风险相关，但与后期无关。
利用全国范围的数据，我们发现移植受者中CDI的发病率很高。重要的是，我们还发现危险因素可能因移植后时间的不同而有所变化。
