The rise of Clostridium difficile infection in lung transplant recipients in the modern era
Identifieur interne : 002259 ( Istex/Corpus ); précédent : 002258; suivant : 002260The rise of Clostridium difficile infection in lung transplant recipients in the modern era
Auteurs : Janet T. Lee ; Marshall I. Hertz ; Jordan M. Dunitz ; Rosemary F. Kelly ; Jonathan D'Cunha ; Bryan A. Whitson ; Sara J. ShumwaySource :
- Clinical Transplantation [ 0902-0063 ] ; 2013-03.
English descriptors
- KwdEn :
- Abdominal pain, Additional patients, Antibiotic, Average number, Baseline characteristics, Bilateral surgery, Blood transfusion, Brosis, Brosis copd idiopathic, Brosis patients, Cardiopulmonary, Cardiothoracic surgery, Cephalosporin, Clin microbiol, Clostridium, Clostridium colitis, Clostridium infection, Cohort, Colitis, Control hosp epidemiol, Economic burden, Entire hospital, Fulminant colitis, Hazard ratio, Hazard ratios, Heart transplant recipients, Higher mortality rate, Higher rates, Hospitalization, Hypervirulent strain, Immunosuppression, Immunosuppression diagnosis, Incidence, Incidence analysis, Incidence rate, Incidence rates, Initial hospitalization, Initial hospitalization cardiopulmonary, Inpatient, Lung transplant population, Lung transplant recipients, Lung transplantation, Multivariate analysis, Nationwide inpatient sample, Nationwide inpatient sample database, Overall incidence, Patient population, Potential risk factors, Prevalent cases, Proportional hazard models, Recent years, Recipient, Recipient populations, Recurrence rate, Recurrent episodes, Retrospective chart review, Risk factors, Same hospital, Sequential lung transplant, Solid organ transplant recipients, Study period, Surgery, Survival curves, Total length, Transfusion, Transpl, Transplant, Transplantation, Unadjusted analysis, Women length, Worse outcomes.
- Teeft :
- Abdominal pain, Additional patients, Antibiotic, Average number, Baseline characteristics, Bilateral surgery, Blood transfusion, Brosis, Brosis copd idiopathic, Brosis patients, Cardiopulmonary, Cardiothoracic surgery, Cephalosporin, Clin microbiol, Clostridium, Clostridium colitis, Clostridium infection, Cohort, Colitis, Control hosp epidemiol, Economic burden, Entire hospital, Fulminant colitis, Hazard ratio, Hazard ratios, Heart transplant recipients, Higher mortality rate, Higher rates, Hospitalization, Hypervirulent strain, Immunosuppression, Immunosuppression diagnosis, Incidence, Incidence analysis, Incidence rate, Incidence rates, Initial hospitalization, Initial hospitalization cardiopulmonary, Inpatient, Lung transplant population, Lung transplant recipients, Lung transplantation, Multivariate analysis, Nationwide inpatient sample, Nationwide inpatient sample database, Overall incidence, Patient population, Potential risk factors, Prevalent cases, Proportional hazard models, Recent years, Recipient, Recipient populations, Recurrence rate, Recurrent episodes, Retrospective chart review, Risk factors, Same hospital, Sequential lung transplant, Solid organ transplant recipients, Study period, Surgery, Survival curves, Total length, Transfusion, Transpl, Transplant, Transplantation, Unadjusted analysis, Women length, Worse outcomes.
Abstract
Clostridium difficile infection (CDI) rates have been rising in recent years. We aimed to characterize CDI in lung transplant recipients in the modern era and hypothesized that CDI would increase the mortality risk.
Url:
DOI: 10.1111/ctr.12064
Links to Exploration step
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<front><div type="abstract">Clostridium difficile infection (CDI) rates have been rising in recent years. We aimed to characterize CDI in lung transplant recipients in the modern era and hypothesized that CDI would increase the mortality risk.</div>
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<sourceDesc><biblStruct type="article"><analytic><title level="a" type="main">The rise of <hi rend="italic"><hi rend="fc">C</hi>
lostridium difficile</hi>
infection in lung transplant recipients in the modern era</title>
<author xml:id="author-0000" role="corresp"><persName><forename type="first">Janet T.</forename>
<surname>Lee</surname>
</persName>
<affiliation><orgName>Department of Surgery</orgName>
<orgName>University of Minnesota</orgName>
<address><settlement type="city">Minneapolis</settlement>
<region>MN</region>
<country key="US">USA</country>
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<affiliation>Corresponding author: Janet T. Lee, Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN 55455, USA. Tel.: +1 612 625 4377; fax: +1 612 625 4406; e‐mail: leex1203@umn.edu</affiliation>
</author>
<author xml:id="author-0001"><persName><forename type="first">Marshall I.</forename>
<surname>Hertz</surname>
</persName>
<affiliation><orgName>Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine</orgName>
<orgName>Department of Medicine</orgName>
<orgName>University of Minnesota</orgName>
<address><settlement type="city">Minneapolis</settlement>
<region>MN</region>
<country key="US">USA</country>
</address>
</affiliation>
</author>
<author xml:id="author-0002"><persName><forename type="first">Jordan M.</forename>
<surname>Dunitz</surname>
</persName>
<affiliation><orgName>Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine</orgName>
<orgName>Department of Medicine</orgName>
<orgName>University of Minnesota</orgName>
<address><settlement type="city">Minneapolis</settlement>
<region>MN</region>
<country key="US">USA</country>
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<author xml:id="author-0003"><persName><forename type="first">Rosemary F.</forename>
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<affiliation><orgName>Division of Cardiothoracic Surgery</orgName>
<orgName>Department of Surgery</orgName>
<orgName>University of Minnesota</orgName>
<address><settlement type="city">Minneapolis</settlement>
<region>MN</region>
<country key="US">USA</country>
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<author xml:id="author-0004"><persName><forename type="first">Jonathan</forename>
<surname>D'Cunha</surname>
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<affiliation><orgName>Division of Cardiothoracic Surgery</orgName>
<orgName>Department of Surgery</orgName>
<orgName>University of Minnesota</orgName>
<address><settlement type="city">Minneapolis</settlement>
<region>MN</region>
<country key="US">USA</country>
</address>
</affiliation>
<affiliation><orgName>Division of Cardiothoracic Surgery</orgName>
<orgName>Department of Surgery</orgName>
<orgName>University of Pittsburgh</orgName>
<address><settlement type="city">Pittsburgh</settlement>
<region>PA</region>
<country key="US">USA</country>
</address>
</affiliation>
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<author xml:id="author-0005"><persName><forename type="first">Bryan A.</forename>
<surname>Whitson</surname>
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<affiliation><orgName>Division of Cardiothoracic Surgery</orgName>
<orgName>Department of Surgery</orgName>
<orgName>University of Minnesota</orgName>
<address><settlement type="city">Minneapolis</settlement>
<region>MN</region>
<country key="US">USA</country>
</address>
</affiliation>
<affiliation><orgName>Division of Cardiothoracic Surgery</orgName>
<orgName>Department of Surgery</orgName>
<orgName>The Ohio State University</orgName>
<address><settlement type="city">Columbus</settlement>
<region>OH</region>
<country key="US">USA</country>
</address>
</affiliation>
</author>
<author xml:id="author-0006"><persName><forename type="first">Sara J.</forename>
<surname>Shumway</surname>
</persName>
<affiliation><orgName>Division of Cardiothoracic Surgery</orgName>
<orgName>Department of Surgery</orgName>
<orgName>University of Minnesota</orgName>
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<monogr><title level="j" type="main">Clinical Transplantation</title>
<title level="j" type="alt">CLINICAL TRANSPLANTATION</title>
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<profileDesc><abstract style="main" xml:id="ctr12064-abs-0001"><head>Abstract</head>
Purpose
<p><hi rend="italic">Clostridium difficile</hi>
infection (<hi rend="fc">CDI</hi>
) rates have been rising in recent years. We aimed to characterize <hi rend="fc">CDI</hi>
in lung transplant recipients in the modern era and hypothesized that <hi rend="fc">CDI</hi>
would increase the mortality risk.</p>
Methods
<p>We performed a retrospective chart review of patients undergoing transplantation at our center from 1/2006 to 7/2011. Attributes of <hi rend="fc">CDI</hi>
+ and <hi rend="fc">CDI</hi>
− groups were compared using Student's <hi rend="italic">t</hi>
‐ and chi‐square tests (α = 0.05). Multivariate <hi rend="fc">C</hi>
ox proportional hazard models were used to control for confounding factors.</p>
Results
<p>Overall <hi rend="fc">CDI</hi>
incidence was 22.5%. Seven of 151 patients (4.6%) developed <hi rend="fc">CDI</hi>
during the initial hospitalization after transplantation (mean time 10.6 ± 6 d) while 27 patients (19.7%) developed <hi rend="fc">CDI</hi>
after discharge (mean time 467 ± 471 d). Incidence rate was 224.6 cases/100 000 patient‐days compared to 110 cases/100 000 patient‐days (rate for entire hospital). <hi rend="fc">CDI</hi>
was not predictive of mortality (<hi rend="fc">HR</hi>
2.06, 95% <hi rend="fc">CI</hi>
0.94–4.52).</p>
Conclusion
<p><hi rend="fc">CDI</hi>
rates in lung transplant recipients are high in the modern era. No risk factors for <hi rend="fc">CDI</hi>
were identified. Although not statistically significant, <hi rend="fc">CDI</hi>
+ patients had a higher risk of death. The economic burden of <hi rend="fc">CDI</hi>
and trend toward worse outcomes for <hi rend="fc">CDI</hi>
patients have important implications for post‐operative surveillance of <hi rend="fc">CDI</hi>
‐related complications and need for <hi rend="fc">CDI</hi>
prophylaxis.</p>
</abstract>
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lostridium difficile</hi>
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<term xml:id="ctr12064-kwd-0003">lung transplantation</term>
<term xml:id="ctr12064-kwd-0004">thoracic surgery</term>
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<correspondenceTo><lineatedText><line>Corresponding author: Janet T. Lee, Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN 55455, USA.</line>
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, <author><familyName>Shumway</familyName>
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lostridium difficile</i>
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<creator affiliationRef="#ctr12064-aff-0002" creatorRole="author" xml:id="ctr12064-cr-0003"><personName><givenNames>Jordan M.</givenNames>
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<creator affiliationRef="#ctr12064-aff-0003" creatorRole="author" xml:id="ctr12064-cr-0004"><personName><givenNames>Rosemary F.</givenNames>
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<creator affiliationRef="#ctr12064-aff-0003 #ctr12064-aff-0004" creatorRole="author" xml:id="ctr12064-cr-0005"><personName><givenNames>Jonathan</givenNames>
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<creator affiliationRef="#ctr12064-aff-0003 #ctr12064-aff-0005" creatorRole="author" xml:id="ctr12064-cr-0006"><personName><givenNames>Bryan A.</givenNames>
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<creator affiliationRef="#ctr12064-aff-0003" creatorRole="author" xml:id="ctr12064-cr-0007"><personName><givenNames>Sara J.</givenNames>
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<affiliation countryCode="US" type="organization" xml:id="ctr12064-aff-0004"><orgDiv>Division of Cardiothoracic Surgery</orgDiv>
<orgDiv>Department of Surgery</orgDiv>
<orgName>University of Pittsburgh</orgName>
<address><city>Pittsburgh</city>
<countryPart>PA</countryPart>
<country>USA</country>
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<affiliation countryCode="US" type="organization" xml:id="ctr12064-aff-0005"><orgDiv>Division of Cardiothoracic Surgery</orgDiv>
<orgDiv>Department of Surgery</orgDiv>
<orgName>The Ohio State University</orgName>
<address><city>Columbus</city>
<countryPart>OH</countryPart>
<country>USA</country>
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<keywordGroup type="author"><keyword xml:id="ctr12064-kwd-0001"><i><fc>C</fc>
lostridium difficile</i>
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<abstractGroup><abstract type="main" xml:id="ctr12064-abs-0001"><title type="main">Abstract</title>
<section xml:id="ctr12064-sec-0001"><title type="main">Purpose</title>
<p><i>Clostridium difficile</i>
infection (<fc>CDI</fc>
) rates have been rising in recent years. We aimed to characterize <fc>CDI</fc>
in lung transplant recipients in the modern era and hypothesized that <fc>CDI</fc>
would increase the mortality risk.</p>
</section>
<section xml:id="ctr12064-sec-0002"><title type="main">Methods</title>
<p>We performed a retrospective chart review of patients undergoing transplantation at our center from 1/2006 to 7/2011. Attributes of <fc>CDI</fc>
+ and <fc>CDI</fc>
− groups were compared using Student's <i>t</i>
‐ and chi‐square tests (α = 0.05). Multivariate <fc>C</fc>
ox proportional hazard models were used to control for confounding factors.</p>
</section>
<section xml:id="ctr12064-sec-0003"><title type="main">Results</title>
<p>Overall <fc>CDI</fc>
incidence was 22.5%. Seven of 151 patients (4.6%) developed <fc>CDI</fc>
during the initial hospitalization after transplantation (mean time 10.6 ± 6 d) while 27 patients (19.7%) developed <fc>CDI</fc>
after discharge (mean time 467 ± 471 d). Incidence rate was 224.6 cases/100 000 patient‐days compared to 110 cases/100 000 patient‐days (rate for entire hospital). <fc>CDI</fc>
was not predictive of mortality (<fc>HR</fc>
2.06, 95% <fc>CI</fc>
0.94–4.52).</p>
</section>
<section xml:id="ctr12064-sec-0004"><title type="main">Conclusion</title>
<p><fc>CDI</fc>
rates in lung transplant recipients are high in the modern era. No risk factors for <fc>CDI</fc>
were identified. Although not statistically significant, <fc>CDI</fc>
+ patients had a higher risk of death. The economic burden of <fc>CDI</fc>
and trend toward worse outcomes for <fc>CDI</fc>
patients have important implications for post‐operative surveillance of <fc>CDI</fc>
‐related complications and need for <fc>CDI</fc>
prophylaxis.</p>
</section>
</abstract>
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<noteGroup xml:id="ctr12064-ntgp-0001"><note numbered="no" xml:id="ctr12064-note-0001">Conflict of interest: This study was not funded. The authors have no conflicts of interest to disclose.</note>
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<dateIssued encoding="w3cdtf">2013-03</dateIssued>
<dateCreated encoding="w3cdtf">2012-12-03</dateCreated>
<dateValid encoding="w3cdtf">2012-11-07</dateValid>
<edition>Lee JT, Hertz MI, Dunitz JM, Kelly RF, D'Cunha J, Whitson BA, Shumway SJ. The rise of Clostridium difficile infection in lung transplant recipients in the modern era.</edition>
<copyrightDate encoding="w3cdtf">2013</copyrightDate>
</originInfo>
<language><languageTerm type="code" authority="rfc3066">en</languageTerm>
<languageTerm type="code" authority="iso639-2b">eng</languageTerm>
</language>
<abstract>Clostridium difficile infection (CDI) rates have been rising in recent years. We aimed to characterize CDI in lung transplant recipients in the modern era and hypothesized that CDI would increase the mortality risk.</abstract>
<abstract>We performed a retrospective chart review of patients undergoing transplantation at our center from 1/2006 to 7/2011. Attributes of CDI+ and CDI− groups were compared using Student's t‐ and chi‐square tests (α = 0.05). Multivariate Cox proportional hazard models were used to control for confounding factors.</abstract>
<abstract>Overall CDI incidence was 22.5%. Seven of 151 patients (4.6%) developed CDI during the initial hospitalization after transplantation (mean time 10.6 ± 6 d) while 27 patients (19.7%) developed CDI after discharge (mean time 467 ± 471 d). Incidence rate was 224.6 cases/100 000 patient‐days compared to 110 cases/100 000 patient‐days (rate for entire hospital). CDI was not predictive of mortality (HR 2.06, 95% CI 0.94–4.52).</abstract>
<abstract>CDI rates in lung transplant recipients are high in the modern era. No risk factors for CDI were identified. Although not statistically significant, CDI+ patients had a higher risk of death. The economic burden of CDI and trend toward worse outcomes for CDI patients have important implications for post‐operative surveillance of CDI‐related complications and need for CDI prophylaxis.</abstract>
<subject><genre>keywords</genre>
<topic>Clostridium difficile</topic>
<topic>infection</topic>
<topic>lung transplantation</topic>
<topic>thoracic surgery</topic>
</subject>
<relatedItem type="host"><titleInfo><title>Clinical Transplantation</title>
</titleInfo>
<titleInfo type="abbreviated"><title>Clin Transplant</title>
</titleInfo>
<genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre>
<subject><genre>article-category</genre>
<topic>Original Article</topic>
</subject>
<identifier type="ISSN">0902-0063</identifier>
<identifier type="eISSN">1399-0012</identifier>
<identifier type="DOI">10.1111/(ISSN)1399-0012</identifier>
<identifier type="PublisherID">CTR</identifier>
<part><date>2013</date>
<detail type="volume"><caption>vol.</caption>
<number>27</number>
</detail>
<detail type="issue"><caption>no.</caption>
<number>2</number>
</detail>
<extent unit="pages"><start>303</start>
<end>310</end>
<total>8</total>
</extent>
</part>
</relatedItem>
<identifier type="istex">93C4B396FEE7033A9BA248BAECE199C1654E061F</identifier>
<identifier type="ark">ark:/67375/WNG-LWX0R9LR-M</identifier>
<identifier type="DOI">10.1111/ctr.12064</identifier>
<identifier type="ArticleID">CTR12064</identifier>
<accessCondition type="use and reproduction" contentType="copyright">© 2013 John Wiley & Sons A/S.© 2013 John Wiley & Sons A/S.</accessCondition>
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