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Prevalence of Clostridium difficile infection among solid organ transplant recipients: a meta-analysis of published studies.

Paudel S, Zacharioudakis IM, Zervou FN, Ziakas PD, Mylonakis E - PLoS ONE (2015)

Bottom Line: Among the 75,940 retrieved citations, we found 30 studies coded from 35 articles that were relevant to our study.Among the studies that reported relevant data, the estimated prevalence of severe CDI was 5.3% [95% CI (2.3%-9.3%)] and the overall recurrence rate was 19.7% [95% CI, (13.7%-26.6%)].In summary, CDI is a significant complication after SOT and preventive strategies are important in order to reduce the CDI related morbidity and mortality.

View Article: PubMed Central - PubMed

Affiliation: Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America.

ABSTRACT
Several factors including antibiotic use, immunosuppression and frequent hospitalizations make solid organ transplant (SOT) recipients vulnerable to Clostridium difficile infection (CDI). We conducted a meta-analysis of published studies from 1991-2014 to estimate the prevalence of CDI in this patient population. We searched PubMed, EMBASE and Google Scholar databases. Among the 75,940 retrieved citations, we found 30 studies coded from 35 articles that were relevant to our study. Based on these studies, we estimated the prevalence of CDI among 21,683 patients who underwent transplantation of kidney, liver, lungs, heart, pancreas, intestine or more than one organ and stratified each study based on the type of transplanted organ, place of the study conduction, and size of patient population. The overall estimated prevalence in SOT recipients was 7.4% [95%CI, (5.6-9.5%)] and it varied based on the type of organ transplant. The prevalence was 12.7% [95%CI, (6.4%-20.9%)] among patients who underwent transplantation for more than one organ. The prevalence among other SOT recipients was: lung 10.8% [95% CI, (5.5%-17.7%)], liver 9.1 % [95%CI, (5.8%-13.2%)], intestine 8% [95% CI, (2.6%-15.9%)], heart 5.2% [95%CI, (1.8%-10.2%)], kidney 4.7% [95% CI, (2.6%-7.3%)], and pancreas 3.2% [95% CI, (0.5%-7.9%)]. Among the studies that reported relevant data, the estimated prevalence of severe CDI was 5.3% [95% CI (2.3%-9.3%)] and the overall recurrence rate was 19.7% [95% CI, (13.7%-26.6%)]. In summary, CDI is a significant complication after SOT and preventive strategies are important in order to reduce the CDI related morbidity and mortality.

No MeSH data available.


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Prevalence of CDI among solid organ transplant recipients.
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pone.0124483.g002: Prevalence of CDI among solid organ transplant recipients.

Mentions: The pooled prevalence of CDI among 21,683 SOT recipients was 7.4% [95%CI, (5.6–9.5%), τ2 = 0.039] (Fig 2). According to the Egger’s test, we found no evidence of small study effects for the overall estimated prevalence (bias: 1.93, p-value: 0.06). We also stratified our data based on the type of organ transplanted. The prevalence of CDI inpatients who underwent transplantation for more than one organ was 12.7% [95%CI, (6.4%-20.9%), τ2 = 0.069] (S1 Fig). The prevalence among other single SOT recipients was: lung transplant recipients 10.8% [95%CI, (5.5%-17.7%), τ2 = 0.064] (S2 Fig), liver 9.1% [95%CI, (5.8%-13.2%), τ2 = 0.048] (S3 Fig), intestine 8% [95% CI, (2.6%-15.9%), τ2 = 0.00] (S4 Fig), heart 5.2% [95%CI, (1.8%-10.2%), τ2 = 0.042] (S5 Fig), kidney 4.7% [95% CI, (2.6%-7.3%), τ2 = 0.028] (S6 Fig) and pancreas 3.2% [95% CI, (0.5%-7.9%), τ2 = 0.030] (S7 Fig). The differences in prevalence between kidney and liver (p-value: 0.07) and kidney and lung (p-value: 0.07) were marginally significant. The prevalence of CDI among kidney transplant recipients was also lower than intestine, heart and multiple organ recipients, but these differences did not reach statistical significance [kidney-heart (p-value: 0.83), kidney-intestine (p-value: 0.48) and kidney-multiple organs (p-value: 0.13)].


Prevalence of Clostridium difficile infection among solid organ transplant recipients: a meta-analysis of published studies.

Paudel S, Zacharioudakis IM, Zervou FN, Ziakas PD, Mylonakis E - PLoS ONE (2015)

Prevalence of CDI among solid organ transplant recipients.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4401454&req=5

pone.0124483.g002: Prevalence of CDI among solid organ transplant recipients.
Mentions: The pooled prevalence of CDI among 21,683 SOT recipients was 7.4% [95%CI, (5.6–9.5%), τ2 = 0.039] (Fig 2). According to the Egger’s test, we found no evidence of small study effects for the overall estimated prevalence (bias: 1.93, p-value: 0.06). We also stratified our data based on the type of organ transplanted. The prevalence of CDI inpatients who underwent transplantation for more than one organ was 12.7% [95%CI, (6.4%-20.9%), τ2 = 0.069] (S1 Fig). The prevalence among other single SOT recipients was: lung transplant recipients 10.8% [95%CI, (5.5%-17.7%), τ2 = 0.064] (S2 Fig), liver 9.1% [95%CI, (5.8%-13.2%), τ2 = 0.048] (S3 Fig), intestine 8% [95% CI, (2.6%-15.9%), τ2 = 0.00] (S4 Fig), heart 5.2% [95%CI, (1.8%-10.2%), τ2 = 0.042] (S5 Fig), kidney 4.7% [95% CI, (2.6%-7.3%), τ2 = 0.028] (S6 Fig) and pancreas 3.2% [95% CI, (0.5%-7.9%), τ2 = 0.030] (S7 Fig). The differences in prevalence between kidney and liver (p-value: 0.07) and kidney and lung (p-value: 0.07) were marginally significant. The prevalence of CDI among kidney transplant recipients was also lower than intestine, heart and multiple organ recipients, but these differences did not reach statistical significance [kidney-heart (p-value: 0.83), kidney-intestine (p-value: 0.48) and kidney-multiple organs (p-value: 0.13)].

Bottom Line: Among the 75,940 retrieved citations, we found 30 studies coded from 35 articles that were relevant to our study.Among the studies that reported relevant data, the estimated prevalence of severe CDI was 5.3% [95% CI (2.3%-9.3%)] and the overall recurrence rate was 19.7% [95% CI, (13.7%-26.6%)].In summary, CDI is a significant complication after SOT and preventive strategies are important in order to reduce the CDI related morbidity and mortality.

View Article: PubMed Central - PubMed

Affiliation: Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America.

ABSTRACT
Several factors including antibiotic use, immunosuppression and frequent hospitalizations make solid organ transplant (SOT) recipients vulnerable to Clostridium difficile infection (CDI). We conducted a meta-analysis of published studies from 1991-2014 to estimate the prevalence of CDI in this patient population. We searched PubMed, EMBASE and Google Scholar databases. Among the 75,940 retrieved citations, we found 30 studies coded from 35 articles that were relevant to our study. Based on these studies, we estimated the prevalence of CDI among 21,683 patients who underwent transplantation of kidney, liver, lungs, heart, pancreas, intestine or more than one organ and stratified each study based on the type of transplanted organ, place of the study conduction, and size of patient population. The overall estimated prevalence in SOT recipients was 7.4% [95%CI, (5.6-9.5%)] and it varied based on the type of organ transplant. The prevalence was 12.7% [95%CI, (6.4%-20.9%)] among patients who underwent transplantation for more than one organ. The prevalence among other SOT recipients was: lung 10.8% [95% CI, (5.5%-17.7%)], liver 9.1 % [95%CI, (5.8%-13.2%)], intestine 8% [95% CI, (2.6%-15.9%)], heart 5.2% [95%CI, (1.8%-10.2%)], kidney 4.7% [95% CI, (2.6%-7.3%)], and pancreas 3.2% [95% CI, (0.5%-7.9%)]. Among the studies that reported relevant data, the estimated prevalence of severe CDI was 5.3% [95% CI (2.3%-9.3%)] and the overall recurrence rate was 19.7% [95% CI, (13.7%-26.6%)]. In summary, CDI is a significant complication after SOT and preventive strategies are important in order to reduce the CDI related morbidity and mortality.

No MeSH data available.


Related in: MedlinePlus