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Background There is limited knowledge about risk factors for Clostridioides difficile infection (CDI) and recurrent CDI in solid organ transplant (SOT) recipients. Methods A case-control study of CDI in SOT recipients compared with controls (SOT recipients who did not present CDI). Results Sixty-seven patients from 1089 SOT recipients (6.2%) suffered at least one episode of CDI. The mean age was 55 ± 12 years and 20 cases (69%) were men. The accumulated incidence was 8% in liver transplantation, 6.2% in lung transplantation, 5.4% in heart transplantation, and 4.7% in kidney transplantation. Twenty-nine cases (43.3%) were diagnosed during the first 3 months after SOT. Forty-one cases (61.2%) were hospital acquired. Thirty-one patients with CDI presented with mild-moderate infection (46.3%), 30 patients with severe infection (44.8%), and 6 patients with severe-complicated disease (9%). Independent variables found to be related with CDI were hospitalization in the previous 3 months (odds ratio: 2.99; [95% confidence interval 1.21-7.37]) and the use of quinolones in the previous month (odds ratio: 3.71 [95% confidence interval 1.16-11.8]). Eleven patients (16.4%) had at least one recurrence of CDI. Previous treatment with amoxicillin-clavulanate, severe-complicated index episode, and high serum creatinine were associated with recurrent CDI in the univariant analysis Conclusions Liver transplant recipients presented the highest incidence of CDI among SOT recipients. Risk factors for CDI were hospitalization in the previous 3 months and the use of quinolones in the previous month.

Resumen Introduccion y objetivos El uso de dispositivos cardiacos implantables (DCI) se ha expandido en los ultimos anos. La infeccion relacionada con estos dispositivos es una de las principales complicaciones y se asocia con grandes morbilidad, mortalidad y costes. El objetivo del estudio es construir una puntuacion predictiva del riesgo de infeccion del DCI. Metodos Se diseno un estudio retrospectivo de casos y controles anidado. Tanto los casos como los controles pertenecian a una cohorte que incluia a todos los pacientes sometidos a un procedimiento relacionado con un DCI entre enero de 2009 y diciembre de 2015. Los casos se definieron como pacientes con infeccion, y se selecciono aleatoriamente a 3 controles de la cohorte por cada caso incluido. Resultados Durante el periodo de estudio, se realizaron 2.323 procedimientos. Se identificaron en total 33 infecciones relacionadas con el DCI. Se selecciono como controles a 99 pacientes. Se identificaron como factores de riesgo independientes el indice de Charlson (OR = 1,33; IC95%, 1,07-1,67), la anticoagulacion oral (OR = 3,51; IC95%, 1,44-8,54), la revision o el reemplazo de un dispositivo anterior (OR = 2,75; IC95%, 1,12-6,71) y la presencia de mas de 2 cables (OR = 3,42; IC95%, 1,25-9,37). Se genero una escala de riesgo predictivo y se denomino CIED-AI (indice de Charlson, mas de 2 cables/electrodos, revision/reemplazo del dispositivo, anticoagulacion oral, infeccion previa). Esta puntuacion presento un area bajo la curva receiver operating characteristic de 0,79 (IC95%, 0,71-0,88). Conclusiones La puntuacion CIED-AI puede ayudar a identificar a los pacientes con mayor riesgo de infeccion que serian candidatos a medidas de prevencion intensivas.

Introduction and objectives The use of cardiac implantable electronic devices (CIEDs) has expanded in recent years. Infection related to these devices constitutes one of the main complications and is associated with high morbidity, mortality, and financial cost. The aim of this study was to construct a predictive risk score of acquiring CIED infection. Methods We designed a retrospective, nested case-control study. Both cases and controls belonged to a cohort that included all patients who underwent a CIED-related procedure between January 2009 and December 2015. Cases were defined as patients with infection, and 3 infection-free controls were randomly selected from the cohort for each case included. Results During the study period, 2323 procedures were performed. A total of 33 CIED-related infections were identified. Ninety-nine patients were selected as controls. Independent risk factors were the Charlson index (OR, 1.33; 95%CI, 1.07-1.67), oral anticoagulation (OR, 3.51; 95%CI, 1.44-8.54), revision or replacement of a previous device (OR, 2.75; 95%CI, 1.12-6.71) and the presence of more than 2 leads (OR, 3.42; 95%CI, 1.25-9.37). A predictive risk score was generated and denominated CIED-AI (Charlson Index, more than 2 leads/Electrodes, Device revision/replacement, oral Anticoagulation, previous Infection). This score had an area under the receiver operating characteristic curve of 0.79 (95%CI, 0.71-0.88). Conclusions The CIED-AI score may help to identify patients at higher risk of infection, who could be candidates for intensive preventive measures.

Resumen Introduccion La afectacion del intestino delgado por Clostridium difficile constituye una entidad clinica infrecuente. Metodo Se presenta el primer caso de enteritis por C. difficile diagnosticado en Espana y se realiza una revision de la literatura medica. Resultados Varon de 30 anos de edad intervenido por recidiva de un tumor germinal retroperitoneal. Siete dias despues presento vomitos, diarrea y, finalmente, obstruccion intestinal por seudomembranas originadas por enteritis por C. difficile. En la literatura medica han sido descritos otros 57 casos de enteritis por C. difficile. La edad media era de 52 ± 17 anos con un rango desde 18 a 86 anos. Veintinueve pacientes (50%) presentaban enfermedad inflamatoria intestinal. Cuarenta y siete (81%) tenian antecedentes de cirugia de colon o intestino delgado. La mortalidad fue mas acusada en pacientes de mayor edad y en los que no presentaban enfermedad inflamatoria intestinal. Conclusion La enteritis por C. difficile se caracteriza por su elevada gravedad y mortalidad.

Background: Clinical features of Clostridium difficile infection (CDI) cases diagnosed by detection of polymerase chain reaction (PCR), with negative toxin enzyme immunoassay results (EIA) have not been fully elucidated. The purpose of this study was to determine the magnitude of CDI patients who had negative EIA toxin determinations but positive PCR tests, and their differences in clinical presentation. Methods: We performed a retrospective study comparing the clinical features of CDI cases detected by EIA (toxins A + B) with cases detected by PCR (toxin negative, PCR positive) over a 16-month period. Only patients with an initial Clostridium difficile infection episode that fulfilled a standardized definition were included. Results: During the study period, 107 episodes of CDI were detected. Seventy-four patients (69%) had positive glutamate dehydrogenase (GDH) antigen and EIA determinations (EIA positive patients). Thirty-three patients (31%) had GDH positive, negative toxin EIA and positive PCR determination (PCR positive patients). PCR positive patients were younger, 57 (27) years (mean [SD]), than EIA positive patients, 71 (16) years, (p < 0.001). Fewer PCR positive patients were receiving proton pump inhibitors (21 patients, 64%) than EIA positive patients (61 patients, 82%, p = 0.034). The clinical presentation was similar in both groups. In the multivariate analysis, lower age was identified as the only independent variable associated with PCR positive patients. Conclusions: One third of Clostridium difficile infection patients present negative toxin EIA and PCR positive tests. Performing PCR determination after the negative EIA test is more relevant in younger patients.