Waseem Amjad, MBBS

A clostridium difficile infection (CDI) is linked to longer hospital stays and higher mortality rates for patients with intestinal transplantations.

A team, led by Waseem Amjad, MBBS, Clinical Investigation, Harvard Medical School, compared outcomes for intestinal transplant recipients between a group with CDI and a group without CDI.

Transplantations and CDI

While organ transplantation is a known risk factor for CDI, there is not much data on how CDI impacts the intestinal transplant population.

In the study, the investigators used data from the National Readmission Database (2010-2017) on outcomes of patients having a history of intestinal transplantation and computed association of CD with readmission and hospital resource utilization in multivariable models adjusted for demographics and comorbidities.

Hospital Stays, Cost, and Mortality

Overall, there were 8442 hospitalizations with the history of intestinal transplantation in indexed hospital admissions during the study period, 3.8% (n = 320) of which had CDI. Patients who underwent an intestine transplant and had CD had a higher median cost of $54,430 compared to patients who did not have CDI ($48,888) (β, 71,814; 95% CI, 676–142 953; P = .048).

The median length of stay was also longer in the CDI group compared to the non-CDI group (7 days vs. 5 days) (: 5.51 95% CI: 0.73–10.29, P = .02).

After analyzing mortality rate data, the team found intestinal transplant complications, the presence of malnutrition, acute kidney injuries, intensive care unit admissions, and sepsis were similar in both study groups.

In addition, CDI was the top cause of 30-day readmission in this patient population during the index admission.

The results also show the problem is growing.

The number of 30-day readmissions increased between 2010-2017.

“CDI hospitalization in post–intestine transplant patients occurs commonly and is associated with a longer length of stay and higher costs during hospitalization,” the authors wrote. “The CDI was the most common cause of readmission after the index admission of CDI in these patients.”

Solid Organ Transplants

Data from 2022 show patients who receive a solid organ transplant (SOT) are at an increased risk of CDI.

It is widely known that solid organ transplant recipients are at an increased risk for CDI infections and other complications. For example, the rate of colectomy in this patient population is more than 3 times higher than the rate of post-CDI colectomy in the general population.

Overall, the 1-year CDI incidence increased throughout the duration of the study (from 23.1; 95% CI, 12.8-41.8 per 1000 person-years in 2004 to 46.7; 95% CI, 35.0-62.3 per 1000 person-years in 2017; P = .001).

C difficile infections was linked to a 16.8% (n = 122) 90-day mortality rate.

Specifically for the kidney transplant cohort, CDI was generally late-onset (median interval, 2.2; IQR, 0.4-6.0 years) compared with recipients of other organs.

In addition, AKI that required dialysis was significantly linked to short-term (aOR, 1.86; 95% CI, 1.07-3.26) and long-term (aHR, 1.89; 95% CI, 1.29-2.78) mortality.

Late-onset CDI was also significantly associated with a greater risk of both short-term (aOR, 4.26; 95% CI, 2.51-7.22) and long-term (aHR, 2.49; 95% CI, 1.78-3.49) mortality.

The study, “An analysis of the outcomes of Clostridioides difficile occurring in intestinal transplant recipients requiring hospitalization,” was published online in Transplant Infectious Disease.