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Clostridioides Difficile: Where Should the Management Strategies in Transplant Vary?

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Emerging Transplant Infections

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Abstract

Infectious and noninfectious diarrheas are important complications in immunocompromised host (ICH) populations including hematologic stem cell (HSCT) and solid organ transplant (SOT) recipients. Adverse consequences of diarrhea, including fluid and electrolyte imbalances with resultant malabsorption of nutrition and medications, can lead to prolonged hospital stays or rehospitalizations. Clostridioides (formerly Clostridium) difficile is the most common infectious etiology of infectious diarrhea in hospitalized individuals, and the incidence of C. difficile infections (CDI) has steadily increased since 2000 (Lessa et al, Clin Infect Dis. 55 Suppl 2:S65–70, 2012; Balsells et al, J Glob Health. 9(1):010407, 2019). ICH populations are at increased risk of CDI and of experiencing severe or complicated clinical courses in both initial infection and subsequent recurrences. In addition to CDI risk factors identified in non-ICH populations, there are unique complicating risk factors in ICH patients. These include the use of therapies toxic to the gut mucosa (chemotherapy, mycophenolate, steroids), concurrent infection with cytomegalovirus which may directly damage gut mucosa and additionally alter immune responses to other pathogens, and the frequent need for concomitant antibiotic therapy. Consequences in ICH populations may include graft loss in SOT recipients, graft-versus-host disease (GVHD) in HSCT recipients, malnutrition, bacteremia from translocation of intestinal flora, and death. This chapter focuses on the epidemiology, clinical manifestations, diagnosis, and management of CDI in HSCT and SOT recipients.

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Authors and Affiliations

  1. Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA

    Jennifer C. Pisano & Kathleen M. Mullane

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  1. Jennifer C. Pisano
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  2. Kathleen M. Mullane
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Correspondence to Kathleen M. Mullane .

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Editors and Affiliations

  1. Immunocompromised Host Service Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA

    Michele I. Morris

  2. Transplant and Immunocompromised Host Infectious Diseases, Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Camille Nelson Kotton

  3. Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA

    Cameron R. Wolfe

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  1. Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA

    Michele I. Morris

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Pisano, J.C., Mullane, K.M. (2021). Clostridioides Difficile: Where Should the Management Strategies in Transplant Vary?. In: Morris, M.I., Kotton, C.N., Wolfe, C.R. (eds) Emerging Transplant Infections. Springer, Cham. https://doi.org/10.1007/978-3-030-25869-6_23

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  • DOI: https://doi.org/10.1007/978-3-030-25869-6_23

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