Related Experiment Video
Updated: Jan 21, 2026
Development of a Larval Zebrafish Infection Model for Clostridioides difficile
Published on: February 14, 2020
Risk factors for Clostridioides (Clostridium) difficile infection following solid organ transplantation in children
Elisa Ochfeld1,2, Lauren C Balmert3, Sameer J Patel4,5
1Pediatric Allergy-Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Insights
Clostridioides difficile infection (CDI) is a common complication in pediatric solid organ transplant (SOT) recipients, often occurring later post-transplant. CDI risk is associated with calcineurin inhibitor use and recent antibiotic exposure.
Area of Science:
- Pediatric Solid Organ Transplantation
- Infectious Diseases
- Immunosuppression
Background:
- Clostridioides difficile infection (CDI) is an increasing concern in pediatric solid organ transplant (SOT) recipients.
- Risk factors for CDI in this vulnerable population remain poorly understood.
Purpose of the Study:
- To characterize the risk factors associated with CDI in pediatric SOT recipients.
Main Methods:
- Retrospective case-control study at a children's hospital.
- Included SOT recipients aged 1-22 years tested for C. difficile via PCR between 2009-2017.
- Generalized linear mixed models used to compare CDI risk factors in PCR-positive vs. PCR-negative cases.
Main Results:
- 33% of 205 SOT recipients developed CDI, with a median time to diagnosis of 8.9 months post-SOT.
- CDI was independently associated with calcineurin inhibitor use (OR 2.38) and systemic antibiotic exposure within 30 days (OR 1.74).
- Kidney, liver, and heart transplants were the most common SOT procedures.
Conclusions:
- CDI is a significant, relatively late complication following pediatric SOT.
- Calcineurin inhibitor use and recent systemic antibiotic exposure are independent risk factors for CDI.
- Further research is needed to evaluate the impact of specific immunosuppressive and antibiotic choices on CDI risk reduction.
Background:
Clostridioides (Clostridium) difficile infection (CDI) in pediatric solid organ transplant (SOT) recipients is a growing problem, though CDI risk factors in this population are poorly understood. Our objective was to characterize CDI risk factors in pediatric SOT recipients.
Methods:
This retrospective case-control study, performed at a single freestanding academic children's hospital, included all SOT recipients age 1-22 years who were tested for C. difficile by toxin B gene PCR between August 2009 and August 2017. CDI risk factors were assessed by comparing PCR-positive and PCR-negative cases by generalized linear mixed models.
Results:
Between August 2009 and August 2017, 409 SOTs were performed of which 138 (33.7%), 134 (32.8%), 131 (32.0%), and 6 (1.5%) were kidney, liver, heart, and small intestine transplants, respectively. Of 205 SOT recipients were tested for CDI, with 723 C. difficile PCR tests performed among these patients. 68/205 (33%) patients developed CDI at least once during the study period. Median (interquartile range) time to diagnosis of first CDI following SOT was 8.9 (1.2, 19.6) months. CDI was independently associated with calcineurin inhibitor use at time of C. difficile testing (odds ratio [OR] 2.38, 95% confidence interval [CI] 1.08, 5.24, P = 0.03) and systemic antibiotic exposure within 30 days of C. difficile testing (OR 1.74, 95% CI 1.08, 2.79, P = 0.02).
Conclusions:
CDI is a common, relatively late post-transplant complication and independently associated with calcineurin inhibitor and systemic antibiotic exposure. The potential impact of specific immunosuppressive drug and antibiotic selection on CDI risk reduction requires further investigation.
More Related Videos
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:15Factors Affecting Drug Distribution: Organ Perfusion Rate
Perfusion rate-limited distribution relies on the...
02:37Metallic Solids
All metallic solids exhibit high thermal and electrical conductivity, metallic luster, and malleability....
02:22Structures of Solids
02:18Network Covalent Solids
To break or to melt a covalent network solid, covalent bonds must be broken. Because covalent bonds are relatively strong, covalent network solids are typically...
02:54Molecular and Ionic Solids
Molecular Solids
Molecular crystalline solids, such as ice, sucrose (table sugar), and iodine, are solids that are composed of neutral molecules as their constituent units. These molecules are held together by weak intermolecular forces such as London dispersion forces, dipole-dipole interactions, or hydrogen bonds, which...