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Transplant Direct. 2017 Mar 17;3(4):e145. doi: 10.1097/TXD.0000000000000662. eCollection 2017 Apr.

Risk for Clostridium difficile Infection After Allogeneic Hematopoietic Cell Transplant Remains Elevated in the Postengraftment Period.

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Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO.
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA.
Centers for Disease Control and Prevention, Atlanta, GA.
Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO.



Clostridium difficile infection (CDI) is a frequent cause of diarrhea among allogeneic hematopoietic cell transplant (HCT) recipients. It is unknown whether risk factors for CDI vary by time posttransplant.


We performed a 3-year prospective cohort study of CDI in allogeneic HCT recipients. Participants were enrolled during their transplant hospitalizations. Clinical assessments were performed weekly during hospitalizations and for 12 weeks posttransplant, and monthly for 30 months thereafter. Data were collected through patient interviews and chart review, and included CDI diagnosis, demographics, transplant characteristics, medications, infections, and outcomes. CDI cases were included if they occurred within 1 year of HCT and were stratified by time from transplant. Multivariable logistic regression was used to determine risk factors for CDI.


One hundred eighty-seven allogeneic HCT recipients were enrolled, including 63 (34%) patients who developed CDI. 38 (60%) CDI cases occurred during the preengraftment period (days 0-30 post-HCT) and 25 (40%) postengraftment (day >30). Lack of any preexisting comorbid disease was significantly associated with lower risk of CDI preengraftment (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.1-0.9). Relapsed underlying disease (OR, 6.7; 95% CI, 1.3-33.1), receipt of any high-risk antimicrobials (OR, 11.8; 95% CI, 2.9-47.8), and graft-versus-host disease (OR, 7.8; 95% CI, 2.0-30.2) were significant independent risk factors for CDI postengraftment.


A large portion of CDI cases occurred during the postengraftment period in allogeneic HCT recipients, suggesting that surveillance for CDI should continue beyond the transplant hospitalization and preengraftment period. Patients with continued high underlying severity of illness were at increased risk of CDI postengraftment.

Conflict of interest statement

Disclosures: E.R.D. has received grant funding from Sanofi Pasteur, Merck, and Rebiotix, and has been a consultant for Sanofi Pasteur, Merck, Rebiotix, Summit, and Valneva, all unrelated to this study. M.A.O. has received grant funding from Pfizer and Sanofi-Pasteur, and has been a consultant for Pfizer, Merck, and Sanofi-Pasteur, all unrelated to this study. V.J.F. has received funding from the CDC, unrelated to this study. K.A.R., K.M.B., S.S., F.P.S., T.M.C., and J.D. declare no conflicts of interest.

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