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Infections

Risk factors for recurrent Clostridium difficile infection in allogeneic hematopoietic cell transplant recipients

Bone Marrow Transplantation volume 51, pages 713–717 (2016)Cite this article

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Abstract

Clostridium difficile infection (CDI) is one of the leading causes of hospital-acquired infections in recent times. Hematopoietic stem cell transplantation (HSCT) confers increased risk for CDI because of prolonged hospital stay, immunosuppression, the need to use broad-spectrum antibiotics and a complex interplay of preparative regimen and GvHD-induced gut mucosal damage. Our study evaluated risk factors (RF) for recurrent CDI in HSCT recipients given the ubiquity of traditional RF for CDI in this population. Of the 499 allogeneic HSCT recipients transplanted between 2005 and 2012, 61 (12%) developed CDI within 6 months before transplant or 2 years after transplant and were included in the analysis. Recurrent CDI occurred in 20 (33%) patients. One year incidence of CDI recurrence was 31%. Multivariable analyses identified the number of antecedent antibiotics other than those used to treat CDI as the only significant RF for recurrence (hazard ratio 1.96, 95% confidence interval 1.09–3.52, P=0.025). Most recurrences occurred within 6 months of the first CDI, and the recurrence of CDI was associated with a trend for increased risk of mortality. This prompts the need for further investigation into secondary prophylaxis to prevent recurrent CDI.

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Authors and Affiliations

  1. Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA

    S Mani

  2. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

    L Rybicki

  3. Department of Hematologic and Oncologic Blood disorders, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    D Jagadeesh

  4. Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA

    S B Mossad

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  1. S Mani
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  2. L Rybicki
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Correspondence to S B Mossad.

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Competing interests

SBM is the principal investigator of a multicenter study sponsored by Merck Pharmaceuticals, manufacturer of Fidaxomicin. The remaining authors declare no conflict of interest.

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Mani, S., Rybicki, L., Jagadeesh, D. et al. Risk factors for recurrent Clostridium difficile infection in allogeneic hematopoietic cell transplant recipients. Bone Marrow Transplant 51, 713–717 (2016). https://doi.org/10.1038/bmt.2015.311

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