CDI after liver transplant has no impact on mortality, Australian study finds

Clostridioides difficile Infection (ICD) after a liver transplant tends to be mild in severity and does not appear to affect survival rates, according to a new Australian report.

The report also suggests that pre-transplant rifaximin (Xifaxan) may have a protective effect against post-transplant CDI, although this finding is preliminary and should be confirmed in larger studies.

The discoveries were published in the journal Transplantation of infectious diseases.

Corresponding author Avik Majumdar MBBS (Hons) MPHTM PhD FRACP, University of Sydney and Royal Prince Albert Hospital, and colleagues, explained that CDI is a common infection associated with hospitals in Australia and elsewhere. other parts of the world. Patients receiving organ transplants are at particularly high risk, the authors noted.

While previous studies examined the risk of CDI and CDI-related mortality in patients receiving liver transplants, Majumdar and colleagues noted that these studies tended to be based in locations where hypervirulent strains of Clostridioides difficile are widespread. Australia has largely avoided hypervirulent strains, so the researchers wanted to know if and how the risk and outcome of CDI might be different in their context.

The authors retrospectively reviewed the cases of 649 patients who underwent liver transplantation from a donor who died between 2007 and 2017 at a single medical center. They then focused on the 32 patients (4.9%) who were diagnosed with CDI within one year of their transplant. The primary outcome of the study was overall survival, although Majumdar and his colleagues also probed for potential risk factors for CDI.

The data showed no statistical difference in patient survival between liver transplant patients who were diagnosed with CDI and those who were not. After using Cox regression analysis, the authors found only one predictor of mortality: age.

“We expected that C diff the infection would be more prevalent in this group than what we found, ”said Majumdar Contagion, “And in the same way, we were surprised by the low number of recurrences and / or serious C diff infection.”

Majumdar said their CDI rate (around 1 in 20) was higher than CDI rate in the general population, although he said it was lower than most studies looking specifically at transplant recipients. .

Majumdar and his colleagues then used multivariate logistic regression to see what factors might increase or decrease the risk of CDI. They found that patients who received rifaximin before their transplant had a significantly lower risk of CDI (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.65 – 0.74 p = 0.01) while the use of antibiotics in general significantly increased the risk (OR 7.02, 95% CI 1.26 – 39.01, p = 0 , 03). Length of hospital stay was also associated with an increased risk of CDI.

Majumdar said the discovery of rifaximin was a surprise, although he cautioned that more research would be needed to confirm its apparent protective benefit.

Majumdar said there are a number of ways the study setting, in an area without hypervirulent strains, likely affected the results.

“We are fortunate in Australia to have only had isolated cases of hypervirulent C diff, “he said.” In fact, we had no cases at our center during the study period (including in non-liver transplant recipients). “

He said previous research had shown CDI in liver transplant recipients in the United States to reach 16.7%, possibly due to the presence of hypervirulent strains in North America. He added that prescribing practices are also likely different in America, a factor that could also impact the risk and severity of CDI in this group of patients.

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