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Updated: Feb 7, 2026

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Primary Prophylaxis for Clostridioides difficile Infection in Lung Transplant Recipients: A Retrospective Study.

Mark Irwin1, Nicole Leedy1, Sravanthi Nandavaram2

  • 1Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, USA.

Transplant Infectious Disease : an Official Journal of the Transplantation Society
|February 6, 2026
PubMed
Summary

Primary prophylaxis with oral vancomycin or metronidazole did not prevent Clostridioides difficile infection (CDI) in lung transplant recipients (LTRs). Higher mortality was observed in the prophylaxis group, warranting further investigation in high-risk populations.

Keywords:
Clostridioides difficilelung transplantprophylaxis

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Area of Science:

  • Infectious Diseases
  • Transplant Surgery
  • Pharmacology

Background:

  • Clostridioides difficile infection (CDI) poses a significant risk to solid organ transplant recipients, particularly lung transplant recipients (LTRs), often occurring with broad-spectrum antibiotic use.
  • The efficacy of oral vancomycin or metronidazole for primary CDI prophylaxis in LTRs remains unclear, despite their established roles in treatment or potential prophylaxis.

Purpose of the Study:

  • To evaluate the effectiveness of oral vancomycin or metronidazole as primary prophylaxis against Clostridioides difficile infection (CDI) during the index admission for lung transplant recipients (LTRs).

Main Methods:

  • A retrospective chart review was conducted on lung transplant recipients (LTRs) at the University of Kentucky between January 2020 and May 2023.
  • Patients were stratified based on the administration of primary CDI prophylaxis (oral vancomycin or metronidazole) during systemic antibiotic therapy.
  • Primary endpoint was CDI incidence during the index admission; secondary endpoints included 1-year CDI incidence and all-cause mortality.

Main Results:

  • Of 92 LTRs, 51 received prophylaxis and 41 did not. CDI incidence during the index admission was similar between groups (2.0% vs. 2.4%).
  • One-year CDI incidence was 5.9% in the prophylaxis group versus 2.4% in the non-prophylaxis group (p=0.626).
  • All-cause mortality was significantly higher in the prophylaxis group (41.2% vs. 19.5%; p=0.041), potentially due to greater baseline illness severity.

Conclusions:

  • Primary prophylaxis with oral vancomycin or metronidazole did not decrease CDI incidence in lung transplant recipients (LTRs).
  • Prophylaxis was more common in patients with longer hospital stays and antibiotic courses.
  • Further research with larger cohorts is necessary to determine the role of primary CDI prophylaxis in this vulnerable patient population.