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Chirurgie 12. September 2014

Solid organ recipients are at increased risk for recurrent Clostridium difficile colitis

Background: Solid organ transplant (SOT) recipients carry a high risk of developing Clostridium difficile-associated colitis (CDAC) and an increased risk for recurrence.

Patients and methods: Between December 1996 and September 2007, a total of 227 patients with CDAC were identified when querying our institutional surgical infection database. This included 169 nontransplant patients and 58 SOT recipients, including 1 cardiac, 19 renal, 2 pancreas, 5 renal/pancreas, and 31 liver recipients.

Results: Overall, we recorded 556 infectious episodes at any site in the 227 patients analyzed who eventually developed CDAC (2.4 episodes/patient); the total number of CDAC episodes was 255: 204 patients had a single episode and 23 patients had multiple episodes of CDAC. There were 19 patients with two episodes, 3 with three episodes, and 1 with four episodes. Of the 23 patients with recurrent CDAC, 11 (48 %) were SOT recipients. A total of 19 % of SOT recipients had recurrent CDAC as compared with only 7 % for nontransplant patients (p = 0.0197). Time to first CDAC recurrence was a median of 58 (range, 17–1372) days for SOT recipients and a median of 30 (range, 6–108) days for nontransplant patients (p = 0.047).

Conclusions: SOT recipients at our institution were found to be a high-risk group for CDAC and had an almost threefold risk for recurrent disease. Double-drug coverage, extended application of metronidazole, and profound reduction in the level of immunosuppression may help to cope with this emerging problem.

Univ. Doz. H. J. R. Bonatti, R. Metzger, B. R. Swenson, S. Pawlowski, R. W. Krell, T. L. Pruett, K. L. Brayman, C. D. Sifri, R. G. Sawyer, European Surgery 4/2014

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