Introduction: Infection with Clostridium Difficile (C.Diff) can com- plicate the postoperative course of lung transplant (LTX) patients (pts) exposing them to additional morbidity. In this study we evaluated the impact of routine C.Diff prophylaxis after LTX on the occurrence of disease and patient outcome. Methods: We reviewed the episodes of C.Diff infection in 2 Groups of LTX recipients. Group A comprised of 160 consecutive LTX recipients from 7/01 to 8/04. All patients in Group A received C.Diff prophylaxis with metronidazole 250 mg po tid and Lactinex 1g. po qid for 14 days after LTX, and during and after 1 week of antbiotic therapy. Group B consisted of 160 pts from 9/97–7/1 who did not receive C.Diff prophylaxis. Results: 320 LTX were performed between 9/97–8/04. 11 were heart-double lung, 128 double lung and 181 were single LTX. Median age was 53.6 yrs. Overall, 209 pts (65%) had samples sent for C.Diff; 57 pts had positive samples. In Group A C.Diff infection occurred in 19 pts. 13 pts had 1 single specimen positive, while 6 had more than 1 specimen. Median time of occurrence was 119 days after LTX (range 4–361). In Group B infection occurred in 38 pts. 14 pts had one single positive specimen, while 9 had more than 1 sample positive for C.Diff. Median time of occurrence after LTX was 42 days (range 1–1115).31% of patients in group A and 26% in Group B were on antibiotics at the time of C.Diff infection. CMV mismatch, type of transplant, sex, age, the type of antifungal prophylaxis did not differ between the groups. 1 year survival was 87% in Group A vs. 70% in Group B. One patient in Group A had colectomy as compared to 2 in Group B. No deaths were directly related to C.Diff infection. Conclusions: The number of pts with C.Diff colitis was significantly higher in the group not receiving prophylaxis [12%(19/160) vs. 24%(38/160);p 0.006]. Median duration to onset of C.Diff colitis seems longer (Median 119 vs 42 days p NS).
Clostridium Difficile colitis after lung transplantation: The role of routine prophylaxis
Bertani A;
2005-01-01
Abstract
Introduction: Infection with Clostridium Difficile (C.Diff) can com- plicate the postoperative course of lung transplant (LTX) patients (pts) exposing them to additional morbidity. In this study we evaluated the impact of routine C.Diff prophylaxis after LTX on the occurrence of disease and patient outcome. Methods: We reviewed the episodes of C.Diff infection in 2 Groups of LTX recipients. Group A comprised of 160 consecutive LTX recipients from 7/01 to 8/04. All patients in Group A received C.Diff prophylaxis with metronidazole 250 mg po tid and Lactinex 1g. po qid for 14 days after LTX, and during and after 1 week of antbiotic therapy. Group B consisted of 160 pts from 9/97–7/1 who did not receive C.Diff prophylaxis. Results: 320 LTX were performed between 9/97–8/04. 11 were heart-double lung, 128 double lung and 181 were single LTX. Median age was 53.6 yrs. Overall, 209 pts (65%) had samples sent for C.Diff; 57 pts had positive samples. In Group A C.Diff infection occurred in 19 pts. 13 pts had 1 single specimen positive, while 6 had more than 1 specimen. Median time of occurrence was 119 days after LTX (range 4–361). In Group B infection occurred in 38 pts. 14 pts had one single positive specimen, while 9 had more than 1 sample positive for C.Diff. Median time of occurrence after LTX was 42 days (range 1–1115).31% of patients in group A and 26% in Group B were on antibiotics at the time of C.Diff infection. CMV mismatch, type of transplant, sex, age, the type of antifungal prophylaxis did not differ between the groups. 1 year survival was 87% in Group A vs. 70% in Group B. One patient in Group A had colectomy as compared to 2 in Group B. No deaths were directly related to C.Diff infection. Conclusions: The number of pts with C.Diff colitis was significantly higher in the group not receiving prophylaxis [12%(19/160) vs. 24%(38/160);p 0.006]. Median duration to onset of C.Diff colitis seems longer (Median 119 vs 42 days p NS).I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
