Clostridium difficile Infection Among Allogeneic Hematopoietic Stem Cell and Solid Organ Transplant Recipients: Differences in Rates and Outcomes Open Access

Background. Clostridium difficile infection (CDI) is a major complication following allogeneic hematopoietic stem cell (allo-HCT) and solid organ transplantation (SOT). Differences of CDI rates, outcomes, and risk factors among these 2 groups were never directly compared.

Methods. Using prospectively collected data from 466 allo-HCT and 1728 SOT recipients between 3/1/2010 and 6/30/2015, we identified adult recipients with CDI within the first 3 months following transplantation. Demographics, high risk antibiotics (ABx) use, conditioning, induction, immunosuppressive regimens, Karnofsky performance score (KPS), and outcomes [length of stay (LOS) in days, recurrent CDI, complicated CDI (defined as CDI resulting in ICU stay, vasopressors use, IVF use, colectomy, or death), and mortality rate at 100 days post-transplant] of HCT and SOT were compared using χ² and Rank-sum tests for categorical and continuous variables.

Results. CDI occurred more frequently after allo-HCT (10%) vs SOT (4%), P < .01. Allo-HCT patients had a higher KPS (90, 95% CI: 70–100 vs 60, 95% CI: 20–100 in SOT, P < .01) received more high risk ABx within 14 days prior to transplantation (87% vs 54% in SOT, P < .01), but received less Antithymoglobulin (ATG) (18% vs 41% in SOT, P <.01). History of CDI was more common in allo-HCT (20% vs 8% in SOT, p = 0.03). Age, gender, and donor-recipient sex match were similar among groups. Fever during CDI was more frequent in allo-HCT than in SOT (30% vs 13%, P < .01). Recurrent, complicated, and CDI treatment modalities were similar among groups. The median LOS of allo-HCT with CDI tended to be shorter than that of SOT with CDI (0 day, 95%CI 0-22 days vs 4 day, 0-25 days). The cumulative incidence of mortality was higher in allo-HCT (24% vs 11% in SOT, p = 0.04); however, CDI-attributed mortality was similar among both groups (3% vs 0%, respectively, P = .12).

Conclusion. Though SOT recipients were more likely to receive ATG and to have a lower KPS, the incidence of CDI was higher in allo-HCT recipients. High risk ABx use, and history of CDI before transplantation likely contributed to higher incidence of CDI in allo-HCT recipients. The cumulative incidence of mortality, but not CDI-related mortality, was also higher among allo-HCT recipients.

Disclosures. All authors: No reported disclosures.

Author notes