Clostridium difficile colitis in lung transplantation

C. C. Gunderson, M. R. Gupta, F. Lopez, G. A. Lombard, S. G. LaPlace, D. E. Taylor, G. S. Dhillon, V. G. Valentine

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Purpose. Clostridium difficile colitis (CDC) is the most common nosocomial infection of the gastrointestinal tract in patients with recent antibiotic use or hospitalization. Lung transplant recipients receive aggressive antimicrobial therapy postoperatively for treatment and prophylaxis of respiratory infections. This report describes the epidemiology of CDC in lung recipients from a single center and explores possible associations with bronchiolitis obliterans syndrome (BOS), a surrogate marker of chronic rejection. Methods. Patients were divided into those with confirmed disease (CDC+) and those without disease (CDC-) based on positive C. difficile toxin assay. Because of a bimodal distribution in the time to develop CDC, the early postoperative CDC+ group was analyzed separately from the late postoperative CDC+ cohort with respect to BOS development. Results. Between 1990 and 2005, 202 consecutive patients underwent 208 lung transplantation procedures. Of these, 15 lung recipients developed 23 episodes of CDC with a median follow-up period of 2.7 years (range, 0-13.6). All patients with confirmed disease had at least 1 of the following 3 risk factors: recent antibiotic use, recent hospitalization, or augmentation of steroid dosage. Of the early CDC+ patients, 100% developed BOS, but only 52% of the late CDC+ patients developed BOS, either preceding or following infection. Conclusion. CDC developed in 7.4% of lung transplant patients with identified risk factors, yielding a cumulative incidence of 14.7%. The statistical association of BOS development in early CDC+ patients suggests a relationship between early infections and future chronic lung rejection.

Original languageEnglish (US)
Pages (from-to)245-251
Number of pages7
JournalTransplant Infectious Disease
Volume10
Issue number4
DOIs
StatePublished - Aug 2008

Fingerprint

Clostridium difficile
Lung Transplantation
Colitis
Bronchiolitis Obliterans
Lung
Hospitalization
Anti-Bacterial Agents
Cross Infection
Infection
Respiratory Tract Infections
Gastrointestinal Tract
Epidemiology
Biomarkers

Keywords

  • Bronchiolitis obliterans syndrome
  • Clostridium difficile colitis
  • Infection
  • Lung transplantation
  • Rejection

ASJC Scopus subject areas

  • Transplantation
  • Microbiology (medical)
  • Immunology

Cite this

Gunderson, C. C., Gupta, M. R., Lopez, F., Lombard, G. A., LaPlace, S. G., Taylor, D. E., ... Valentine, V. G. (2008). Clostridium difficile colitis in lung transplantation. Transplant Infectious Disease, 10(4), 245-251. https://doi.org/10.1111/j.1399-3062.2008.00305.x

Clostridium difficile colitis in lung transplantation. / Gunderson, C. C.; Gupta, M. R.; Lopez, F.; Lombard, G. A.; LaPlace, S. G.; Taylor, D. E.; Dhillon, G. S.; Valentine, V. G.

In: Transplant Infectious Disease, Vol. 10, No. 4, 08.2008, p. 245-251.

Research output: Contribution to journalArticle

Gunderson, CC, Gupta, MR, Lopez, F, Lombard, GA, LaPlace, SG, Taylor, DE, Dhillon, GS & Valentine, VG 2008, 'Clostridium difficile colitis in lung transplantation', Transplant Infectious Disease, vol. 10, no. 4, pp. 245-251. https://doi.org/10.1111/j.1399-3062.2008.00305.x
Gunderson CC, Gupta MR, Lopez F, Lombard GA, LaPlace SG, Taylor DE et al. Clostridium difficile colitis in lung transplantation. Transplant Infectious Disease. 2008 Aug;10(4):245-251. https://doi.org/10.1111/j.1399-3062.2008.00305.x
Gunderson, C. C. ; Gupta, M. R. ; Lopez, F. ; Lombard, G. A. ; LaPlace, S. G. ; Taylor, D. E. ; Dhillon, G. S. ; Valentine, V. G. / Clostridium difficile colitis in lung transplantation. In: Transplant Infectious Disease. 2008 ; Vol. 10, No. 4. pp. 245-251.
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AU - Gunderson, C. C.

AU - Gupta, M. R.

AU - Lopez, F.

AU - Lombard, G. A.

AU - LaPlace, S. G.

AU - Taylor, D. E.

AU - Dhillon, G. S.

AU - Valentine, V. G.

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N2 - Purpose. Clostridium difficile colitis (CDC) is the most common nosocomial infection of the gastrointestinal tract in patients with recent antibiotic use or hospitalization. Lung transplant recipients receive aggressive antimicrobial therapy postoperatively for treatment and prophylaxis of respiratory infections. This report describes the epidemiology of CDC in lung recipients from a single center and explores possible associations with bronchiolitis obliterans syndrome (BOS), a surrogate marker of chronic rejection. Methods. Patients were divided into those with confirmed disease (CDC+) and those without disease (CDC-) based on positive C. difficile toxin assay. Because of a bimodal distribution in the time to develop CDC, the early postoperative CDC+ group was analyzed separately from the late postoperative CDC+ cohort with respect to BOS development. Results. Between 1990 and 2005, 202 consecutive patients underwent 208 lung transplantation procedures. Of these, 15 lung recipients developed 23 episodes of CDC with a median follow-up period of 2.7 years (range, 0-13.6). All patients with confirmed disease had at least 1 of the following 3 risk factors: recent antibiotic use, recent hospitalization, or augmentation of steroid dosage. Of the early CDC+ patients, 100% developed BOS, but only 52% of the late CDC+ patients developed BOS, either preceding or following infection. Conclusion. CDC developed in 7.4% of lung transplant patients with identified risk factors, yielding a cumulative incidence of 14.7%. The statistical association of BOS development in early CDC+ patients suggests a relationship between early infections and future chronic lung rejection.

AB - Purpose. Clostridium difficile colitis (CDC) is the most common nosocomial infection of the gastrointestinal tract in patients with recent antibiotic use or hospitalization. Lung transplant recipients receive aggressive antimicrobial therapy postoperatively for treatment and prophylaxis of respiratory infections. This report describes the epidemiology of CDC in lung recipients from a single center and explores possible associations with bronchiolitis obliterans syndrome (BOS), a surrogate marker of chronic rejection. Methods. Patients were divided into those with confirmed disease (CDC+) and those without disease (CDC-) based on positive C. difficile toxin assay. Because of a bimodal distribution in the time to develop CDC, the early postoperative CDC+ group was analyzed separately from the late postoperative CDC+ cohort with respect to BOS development. Results. Between 1990 and 2005, 202 consecutive patients underwent 208 lung transplantation procedures. Of these, 15 lung recipients developed 23 episodes of CDC with a median follow-up period of 2.7 years (range, 0-13.6). All patients with confirmed disease had at least 1 of the following 3 risk factors: recent antibiotic use, recent hospitalization, or augmentation of steroid dosage. Of the early CDC+ patients, 100% developed BOS, but only 52% of the late CDC+ patients developed BOS, either preceding or following infection. Conclusion. CDC developed in 7.4% of lung transplant patients with identified risk factors, yielding a cumulative incidence of 14.7%. The statistical association of BOS development in early CDC+ patients suggests a relationship between early infections and future chronic lung rejection.

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