Recurrent Clostridioides difficile infections in solid organ transplant recipients: The international CALIPSO study

IF 14.3 1区医学 Q1 INFECTIOUS DISEASES

Journal of Infection Pub Date : 2024-10-05 DOI:10.1016/j.jinf.2024.106306

Giusy Tiseo , Dafna Yahav , Alaa Atamna , Tomer Avni , Manuel Causse , Elena Pérez-Nadales , Alessandra Mularoni , Elena Reigadas , María Olmedo-Samperio , Mario Fernández-Ruiz , Zaira R. Palacios-Baena , Jesus Rodríguez-Baño , Paolo De Simone , Giandomenico Biancofiore , Eman Fares Sabik , Mical Paul , José María Aguado , Ugo Boggi , Patricia Muñoz , Julián Torres-Cisneros , Marco Falcone

{"title":"Recurrent Clostridioides difficile infections in solid organ transplant recipients: The international CALIPSO study","authors":"Giusy Tiseo , Dafna Yahav , Alaa Atamna , Tomer Avni , Manuel Causse , Elena Pérez-Nadales , Alessandra Mularoni , Elena Reigadas , María Olmedo-Samperio , Mario Fernández-Ruiz , Zaira R. Palacios-Baena , Jesus Rodríguez-Baño , Paolo De Simone , Giandomenico Biancofiore , Eman Fares Sabik , Mical Paul , José María Aguado , Ugo Boggi , Patricia Muñoz , Julián Torres-Cisneros , Marco Falcone","doi":"10.1016/j.jinf.2024.106306","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the risk of recurrent <em>Clostridioides difficile</em> infection (CDI) in solid-organ transplant (SOT) recipients.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"89 6","pages":"Article 106306"},"PeriodicalIF":14.3000,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Infection","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0163445324002408","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

Abstract

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.

查看原文本刊更多论文

实体器官移植受者复发性艰难梭菌感染：国际 CALIPSO 研究。

目的：评估实体器官移植受者复发艰难梭菌感染（CDI）的风险：评估实体器官移植（SOT）受者复发艰难梭菌感染（CDI）的风险：回顾性多中心研究，包括移植后一年内（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，定义为自首次发病后56天内再次发生CDI。采用亚分布危险模型多变量分析法进行竞争风险分析：共纳入 191 名 SOT 受者：101例（52.9%）为肾脏受者，66例（34.6%）为肝脏受者，11例（5.8%）为肺脏受者，8例（4.2%）为胰腺-肾脏同时受者，4例（2.1%）为心脏受者，1例（0.5%）为单纯胰腺受者。首次CDI的治疗方法为：万古霉素（114例，59.7%）、万古霉素+甲硝唑（39例，20.4%）、甲硝唑（26例，13.6%）、非达霉素（9例，4.7%），3名患者未接受任何治疗。首次感染 CDI 后，17/191（8.9%）名患者在 56 天内死亡，且未复发，23/191（12%）名患者复发。在复发 CDI 的患者中，56 天死亡率为 30.4%（7/23 名患者）。在多变量分析中，重症 CDI（sHR4.01，95% CI 1.77-9.08，pConclusions：甲硝唑单药治疗会增加SOT受者复发CDI的风险。在这种情况下应实施旨在降低复发风险的治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Infection 医学-传染病学

CiteScore

45.90

自引率

3.20%

发文量

475

审稿时长

16 days

期刊介绍： The Journal of Infection publishes original papers on all aspects of infection - clinical, microbiological and epidemiological. The Journal seeks to bring together knowledge from all specialties involved in infection research and clinical practice, and present the best work in the ever-changing field of infection. Each issue brings you Editorials that describe current or controversial topics of interest, high quality Reviews to keep you in touch with the latest developments in specific fields of interest, an Epidemiology section reporting studies in the hospital and the general community, and a lively correspondence section.