Recurrent Clostridioides difficile infections in solid organ transplant recipients: The international CALIPSO study - 06/12/24
ESCMID Study Group for Infections in the Elderly (ESGIE)
Summary |
Objective |
To evaluate the risk of recurrent Clostridioides difficile infection (CDI) in solid-organ transplant (SOT) recipients.
Methods |
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.
Results |
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.
Conclusions |
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.
Le texte complet de cet article est disponible en PDF.Graphical Abstract |
Highlights |
• | The risk of recurrent CDI in SOT recipients after the first CDI episode is about 12%. |
• | Metronidazole monotherapy is associated with increased risk of recurrent CDI. |
• | Approaches to reduce the risk of recurrence should be applied in this population. |
Keywords : Clostridioides difficile, Solid organ transplant, Recurrence, Metronidazole, Bezlotoxumab
Plan
Vol 89 - N° 6
Article 106306- décembre 2024 Retour au numéro
Article précédent
- Effect of a campaign with oral polio vaccine on general health: A cluster-randomised trial in rural Guinea-Bissau
- Line M. Nanque, Anshu Varma, Sanne M. Thysen, Christine S. Benn, Justiniano SD Martins, Aksel KG Jensen, Claudino Correia, Sören Möller, Anita Van den Biggelaar, Peter Aaby, Ane B. Fisker
- Regulation of plasma soluble receptors of TNF and IL-1 in patients with COVID-19 differs from that observed in sepsis
- Muhammed D. Aksu, Tijmen van der Ent, Zhenhua Zhang, Anca L. Riza, Aline H. de Nooijer, Isis Ricaño-Ponce, Nico Janssen, Job J. Engel, Ioana Streata, Helga Dijkstra, Heidi Lemmers, Inge Grondman, Valerie A.C.M. Koeken, Eleni Antoniadou, Nikolaos Antonakos, Frank L. van de Veerdonk, Yang Li, Evangelos J. Giamarellos-Bourboulis, Mihai G. Netea, Athanasios Ziogas
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?