Claire Kennedy1, Carmel Waldron1, Mairead Skally2, Leah Gaughan3, Colm Magee1, Karen Burns2,4, Fidelma Fitzpatrick2,5. 1. Department of Nephrology, Beaumont Hospital, Dublin, Ireland. 2. Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland. 3. Department of Pharmacy, Beaumont Hospital, Dublin, Ireland. 4. Health Protection Surveillance Centre, Dublin, Ireland. 5. Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland.
Abstract
BACKGROUND: We aimed to describe the epidemiology and outcomes of CDI in a national kidney transplant center from 2008 to 2015. METHODS: Adult kidney and kidney-pancreas transplant recipients were included for analysis if they met the surveillance CDI case definition. Rates of new healthcare-associated CDI (HA-CDI) were expressed per 10 000 KTR/KTPR bed days used (BDU) to facilitate comparisons. RESULTS: Fifty-two cases of CDI were identified in 42 KTRs and KPTRs. This corresponded to an average annual rate of 9.6 per 10 000 BDU, higher than that seen among general hospital inpatients locally, nationally, and internationally. Of the 45 cases (87%) that were considered HA-CDI, nine (20%) had symptom onset in the community. Recent proton-pump inhibitor (PPI) and broad-spectrum antimicrobial exposure preceded the majority of cases. KTRs and KPTRs with CDI had a longer mean length of hospital stay (35 days) than those KTR and KPTRs admitted during the same period that did not have CDI (8 days). CONCLUSIONS: Education regarding CDI must be extended to transplant recipients and their general practitioners. Other targets for future CDI rate reduction must include stringent antimicrobial stewardship (both in hospital and in the community) and judicious PPI prescribing.
BACKGROUND: We aimed to describe the epidemiology and outcomes of CDI in a national kidney transplant center from 2008 to 2015. METHODS: Adult kidney and kidney-pancreas transplant recipients were included for analysis if they met the surveillance CDI case definition. Rates of new healthcare-associated CDI (HA-CDI) were expressed per 10 000 KTR/KTPR bed days used (BDU) to facilitate comparisons. RESULTS: Fifty-two cases of CDI were identified in 42 KTRs and KPTRs. This corresponded to an average annual rate of 9.6 per 10 000 BDU, higher than that seen among general hospital inpatients locally, nationally, and internationally. Of the 45 cases (87%) that were considered HA-CDI, nine (20%) had symptom onset in the community. Recent proton-pump inhibitor (PPI) and broad-spectrum antimicrobial exposure preceded the majority of cases. KTRs and KPTRs with CDI had a longer mean length of hospital stay (35 days) than those KTR and KPTRs admitted during the same period that did not have CDI (8 days). CONCLUSIONS: Education regarding CDI must be extended to transplant recipients and their general practitioners. Other targets for future CDI rate reduction must include stringent antimicrobial stewardship (both in hospital and in the community) and judicious PPI prescribing.
Authors: M J T Crobach; D W Notermans; C Harmanus; I M J G Sanders; S C De Greeff; E J Kuijper Journal: Open Forum Infect Dis Date: 2019-11-26 Impact factor: 3.835