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Clostridium difficile colitis in lung transplantation.

C C Gunderson1, M R Gupta, F Lopez

  • 1Department of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA.

Transplant Infectious Disease : an Official Journal of the Transplantation Society
|March 4, 2008
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Summary
This summary is machine-generated.

Clostridium difficile colitis (CDC) occurred in 7.4% of lung transplant patients. Early CDC in lung recipients was strongly associated with developing bronchiolitis obliterans syndrome (BOS), indicating a link between infection and chronic rejection.

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Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Transplantation Immunology

Background:

  • Clostridium difficile colitis (CDC) is a common hospital-acquired infection, particularly in patients with recent antibiotic use or hospitalization.
  • Lung transplant recipients often receive intensive antimicrobial therapy, increasing their risk for infections like CDC.
  • Bronchiolitis obliterans syndrome (BOS) is a significant complication and marker of chronic lung allograft rejection.

Purpose of the Study:

  • To investigate the epidemiology of CDC in lung transplant recipients.
  • To explore the potential association between CDC and the development of BOS in this patient population.

Main Methods:

  • A single-center retrospective study analyzing 208 lung transplant procedures between 1990 and 2005.
  • Patients were categorized as CDC+ (confirmed infection) or CDC- (no infection) based on C. difficile toxin assay.
  • Early and late postoperative CDC cases were analyzed separately regarding BOS development.

Main Results:

  • 15 lung recipients (7.4%) developed 23 episodes of CDC, with risk factors including recent antibiotic use, hospitalization, or increased steroid dosage.
  • All patients with early CDC developed BOS (100%).
  • 52% of patients with late CDC developed BOS, which could occur before or after the infection.

Conclusions:

  • CDC is a notable complication in lung transplant recipients, with a cumulative incidence of 14.7%.
  • A strong statistical association exists between early CDC and subsequent BOS development.
  • These findings suggest a potential link between early post-transplant infections and chronic lung allograft rejection.