445Epidemiology and Outcomes of Clostridium difficile Infections in Heart and Heart-lung Transplant Recipients

Background. Clostridium difficileinfection (CDI) is an important cause of diarrhea in transplant recipients, and often complicated by the use of intense immunosuppression and need for antibiotic prophylaxis. We aimed to investigate the epidemiology of CDI in heart and heart-lung transplant (HT) recipients and assessed its impact on outcomes. Methods. This is a retrospective study of HT recipients from 2000 to 2013. CDI was defined by presence of diarrhea and a positive toxigenic Clostridium difficilein stool measured by toxin enzyme immunoassay (EIA) (2000-2006) or polymerase chain reaction (2007-2013). Survival was assessed using Kaplan-Meier method. The hazard ratio (HR) for all-cause mortality was calculated using Cox proportional hazard model. Results. A total of 322 HT recipients were at risk during the 14-year study period. The median age was 53 years (IQR, 44-60); 66 % were male. During the median followup of 49 months (IQR, 1995), 27 (8.4%) patients developed CDI after transplant. Of those, six (28.5%) developed CDI within 30 days of transplant, while 21 (71.5%) patients developed CDI beyond 30 days from transplant. Two (7.4%) had hypervirulent NAP1/BI/027 strain. Six (22%) had at least 1 episode of recurrent CDI. No patient required colectomy or died from CDI. However, patients with CDI had worse overall survival compared to non-CDI patients (log rank test; p < 0.01) (Figure 1).In univariate analysis, the predictors of mortality in HT recipients were: CDI anytime after transplant [HR 2.33; 95% CI, 1.14-4.32 (p = 0.02)], female donor [HR 1.83; 95% CI, 1.09-3.03 (p = 0.02)], older donor age per 1 year increase [HR 1.05; 95% CI, 0.99-1.03 (p = 0.09)] and combined heart-lung transplant [HR 2.13; 95% CI, 0.82-4.60 (p = 0.11)].In a multivariate analysis, CDI anytime after transplant remained significantly associated with all-cause mortality [HR 2.23; 95% CI, 1.07-4.27 (p = 0.03)]. Conclusion. CDI is a common cause of diarrhea in HT patients. CDI is significantly associated with, and an independent predictor for, increased mortality after heart transplantation. Efforts to prevent CDI may improve survival of HT recipients. Disclosures. All authors: No reported disclosures.