Tiseo Giusy, Yahav Dafna, Atamna Alaa, Avni Tomer, Causse Manuel, Pérez-Nadales Elena, Mularoni Alessandra, Reigadas Elena, Olmedo-Samperio María, Fernández-Ruiz Mario, Palacios-Baena Zaira R, Rodríguez-Baño Jesus, De Simone Paolo, Biancofiore Giandomenico, Sabik Eman Fares, Paul Mical, Aguado José María, Boggi Ugo, Muñoz Patricia, Torres-Cisneros Julián, Farcomeni Alessio, Falcone Marco
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Infectious Diseases Unit, Sheba Medical Center, Ramat Gan, Israel.
J Infect. 2024 Dec;89(6):106306. doi: 10.1016/j.jinf.2024.106306. Epub 2024 Oct 5.
To evaluate the risk of recurrent Clostridioides difficile infection (CDI) in solid-organ transplant (SOT) recipients.
Retrospective multicenter study including SOT recipients with a first CDI episode in the year after transplantation (Jan 2017-June 2020). The primary outcome measure was recurrence, defined as a new CDI ≤56 days from the first episode. A competing risk analysis was performed using the sub-distribution hazard model multivariable analysis.
191 SOT recipients were included: 101 (52.9%) were kidney, 66 (34.6%) liver, 11 (5.8%) lung, 8 (4.2%) simultaneous pancreas-kidney, 4 (2.1%) heart and 1 (0.5%) pancreas alone recipients. Treatment for the first CDI were: vancomycin (n = 114,59.7%), vancomycin+metronidazole (n = 39,20.4%), metronidazole (n = 26,13.6%), fidaxomicin (n = 9,4.7%), 3 patients did not receive any therapy. After the first CDI, 17/191 (8.9%) patients died within 56-day mortality without having a recurrence, while 23/191 (12%) patients had a recurrence. Among patients with recurrent CDI, 56-day mortality rate was 30.4% (7/23 patients). On multivariable analysis, severe CDI (sHR4.01, 95% CI 1.77-9.08, p < .001) and metronidazole monotherapy (sHR 3.65, 95% CI 1.64-8.14, p = .001) were factors independently associated with recurrence.
Metronidazole monotherapy is associated with increased risk of recurrent CDI in SOT recipients. Therapeutic strategies aimed to reduce the risk of recurrence should be implemented in this setting.
评估实体器官移植（SOT）受者复发性艰难梭菌感染（CDI）的风险。
回顾性多中心研究，纳入移植后一年（2017年1月至2020年6月）首次发生CDI的SOT受者。主要结局指标为复发，定义为自首次发作起≤56天内出现新的CDI。使用亚分布风险模型多变量分析进行竞争风险分析。
共纳入191例SOT受者：101例（52.9%）为肾移植受者，66例（34.6%）为肝移植受者，11例（5.8%）为肺移植受者，8例（4.2%）为胰肾联合移植受者，4例（2.1%）为心脏移植受者，1例（0.5%）为单纯胰腺移植受者。首次CDI的治疗方法为：万古霉素（n = 114，59.7%）、万古霉素+甲硝唑（n = 39，20.4%）、甲硝唑（n = 26，13.6%）、非达霉素（n = 9，4.7%），3例患者未接受任何治疗。首次CDI后，17/191例（8.9%）患者在56天内死亡且无复发，而23/191例（12%）患者复发。在复发性CDI患者中，56天死亡率为30.4%（7/23例患者）。多变量分析显示，严重CDI（sHR 4.01，95%CI 1.77 - 9.08，p <.001）和甲硝唑单药治疗（sHR 3.65，95%CI 1.64 - 8.14，p = .001）是与复发独立相关的因素。
甲硝唑单药治疗与SOT受者复发性CDI风险增加相关。在此情况下应实施旨在降低复发风险的治疗策略。
