Hematopoietic cell transplant (HCT) and solid organ transplant (SOT) recipients are at increased risk for Clostridioides difficile infection (CDI). We conducted a multicenter retrospective study to describe the incidence of CDI in children transplanted between January 2010 and June 2013. Nested case‐control substudies, matched 1:1 by transplant type, institution, patient age, and time of year (quartile) of transplant, identified CDI risk factors. Cohorts included 1496 HCT and 1090 SOT recipients. Among HCT recipients, 355 CDI episodes were diagnosed in 265 recipients (18.2%). Nested case‐control study identified prior history of CDI (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.5‐4.7), proton pump inhibitors (PPIs; OR 2.1, 95% CI 1.3‐3.4), and exposure to third‐ (OR 2.4, 95% CI 1.4‐4.2) or fourth‐generation (OR 2.1, 95% CI 1.2‐3.7) cephalosporins as risk factors. Notably, fluoroquinolone exposure appeared protective (OR 0.6, 95% CI 0.3‐0.9). Ninety‐two episodes of CDI were diagnosed among 79 SOT recipients (7.3%), and exposure to PPIs (OR 2.4, 95% CI 1.1‐5.4) and third‐generation cephalosporin therapy (OR 3.9, 95% CI 1.4‐10.5) were identified as risk factors. Strategies to decrease PPI use and changes in the class of prophylactic antibiotics may impact CDI incidence and warrant further study.

中文翻译：

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一项多中心研究，旨在确定儿科造血细胞和实体器官移植受者艰难梭菌感染的流行病学和结果。

造血细胞移植 (HCT) 和实体器官移植 (SOT) 受者感染艰难梭菌的风险增加感染（CDI）。我们进行了一项多中心回顾性研究，以描述 2010 年 1 月至 2013 年 6 月期间接受移植的儿童的 CDI 发病率。嵌套病例对照子研究，按移植类型、机构、患者年龄和一年中的移植时间（四分位数）进行 1:1 匹配, 确定了 CDI 风险因素。队列包括 1496 名 HCT 和 1090 名 SOT 接受者。在 HCT 接受者中，265 名接受者 (18.2%) 诊断出 355 次 CDI 发作。巢式病例对照研究确定了 CDI 的既往病史（比值比 [OR] 2.6，95% 置信区间 [CI] 1.5-4.7）、质子泵抑制剂（PPIs；OR 2.1，95% CI 1.3-3.4）和暴露于第三代（OR 2.4，95% CI 1.4-4.2）或第四代（OR 2.1，95% CI 1.2-3.7）头孢菌素作为危险因素。值得注意的是，氟喹诺酮暴露似乎具有保护作用（OR 0.6，95% CI 0.3-0.9）。79 名 SOT 接受者 (7.3%) 诊断出 92 次 CDI，接触 PPIs (OR 2.4, 95% CI 1.1-5.4) 和第三代头孢菌素治疗 (OR 3.9, 95% CI 1.4-10.5)确定为危险因素。减少 PPI 使用的策略和预防性抗生素类别的变化可能会影响 CDI 的发生率，需要进一步研究。