The epidemiology of Clostridium difficile infections in kidney transplant recipients: an analysis of incidence, risk factors, management, prevention, prognostic determinants and outcomes

JULS Volume 10, Issue 1

George (Jia Qi) Li1

1 Faculty of Arts and Science, University of Toronto, Toronto, Canada

Corresponding Author: George Li (lig@uhnresearch.ca)

Abstract

Kidney transplantation is the ideal treatment for end-stage renal disease. However, post-operative maintenance required to preserve the transplanted organ includes a lifetime of immunosuppression as well as frequent antibiotics, leaving kidney transplant recipients (KTRs) particularly vulnerable to infections. Clostridium difficile, a gram-positive bacterium, is one opportunistic infective agent that affects KTRs. C. difficile infections (CDIs) occur in the gut, where disruptions in the natural microbiome often caused by wide-spectrum antibiotics allow the species to expand and produce toxins, leading to significant diarrhea and colitis, and in some cases even toxic megacolon or death. Literature in the area of CDIs in the KTR population is sparse and plagued by inconsistencies and inadequacies in the diagnostic methods used. Due to this, the reported incidence rates vary between lower than 1% to as high as 8%. Common risk factors found included bacterial colonization, blood and human leukocyte antigen (HLA) incompatible transplants, antibiotic usage, and certain immunosuppressive medications such as anti-thymocyte globulins and mycophenolate mofetil. Management usually begins with withdrawal of any potentially causative antibiotics, and subsequent replacement with targeted antibiotics such as metronidazole and vancomycin – this approach was found to be effective in the KTR population, however prophylaxis was suggested as an area that needed more research. Relationships between CDIs and graft outcome have been poorly studied, with no reports CDIs leading to higher numbers of graft failure or rejection – this may suggest, at least in the short term, that CDI has little impact on graft outcome, however longer term studies are needed.