Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Infect Control Hosp Epidemiol. 2021 Mar;42(3):287-291. doi: 10.1017/ice.2020.431. Epub 2020 Sep 16.
The association between Clostridioides difficile colonization and C. difficile infection (CDI) is unknown in solid-organ transplant (SOT) patients. We examined C. difficile colonization and healthcare-associated exposures as risk factors for development of CDI in SOT patients.
The retrospective study cohort included all consecutive SOT patients with at least 1 screening test between May 2017 and April 2018. CDI was defined as the presence of diarrhea (without laxatives), a positive C. difficile clinical test, and the use of C. difficile-directed antimicrobial therapy as ordered by managing clinicians. In addition to demographic variables, exposures to antimicrobials, immunosuppressants, and gastric acid suppressants were evaluated from the time of first screening test to the time of CDI, death, or final discharge.
Of the 348 SOT patients included in our study, 33 (9.5%) were colonized with toxigenic C. difficile. In total, 11 patients (3.2%) developed CDI. Only C. difficile colonization (odds ratio [OR], 13.52; 95% CI, 3.46-52.83; P = .0002), age (OR, 1.09; CI, 1.02-1.17; P = .0135), and hospital days (OR, 1.05; 95% CI, 1.02-1.08; P = .0017) were independently associated with CDI.
Although CDI was more frequent in C. difficile colonized SOT patients, the overall incidence of CDI was low in this cohort.
艰难梭菌定植与艰难梭菌感染（CDI）之间的关联在实体器官移植（SOT）患者中尚不清楚。我们研究了艰难梭菌定植和与医疗保健相关的暴露作为 SOT 患者发生 CDI 的危险因素。
回顾性研究队列包括所有在 2017 年 5 月至 2018 年 4 月期间至少接受过 1 次筛查试验的连续 SOT 患者。CDI 的定义为存在腹泻（无泻药）、艰难梭菌临床检测阳性以及管理临床医生开的艰难梭菌定向抗菌治疗。除了人口统计学变量外，还评估了从首次筛查试验到 CDI、死亡或最终出院时使用的抗生素、免疫抑制剂和胃酸抑制剂。
在我们的研究中，共有 348 名 SOT 患者，其中 33 名（9.5%）艰难梭菌定植。总共有 11 名患者（3.2%）发生 CDI。只有艰难梭菌定植（比值比[OR]，13.52；95%CI，3.46-52.83；P=.0002）、年龄（OR，1.09；CI，1.02-1.17；P=.0135）和住院天数（OR，1.05；95%CI，1.02-1.08；P=.0017）与 CDI 独立相关。
尽管 CDI 在艰难梭菌定植的 SOT 患者中更为常见，但在本队列中 CDI 的总体发生率较低。
