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Risk Factors and Outcomes for Bloodstream Infections Secondary to Clostridium difficile Infection

Antimicrobial agents and chemotherapy, 2016-01, Vol.60 (1), p.252-257 [Peer Reviewed Journal]

Copyright © 2015, American Society for Microbiology. All Rights Reserved. ;Copyright © 2015, American Society for Microbiology. All Rights Reserved. 2015 American Society for Microbiology ;ISSN: 0066-4804 ;EISSN: 1098-6596 ;DOI: 10.1128/AAC.01927-15 ;PMID: 26482315

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Title:
Risk Factors and Outcomes for Bloodstream Infections Secondary to Clostridium difficile Infection
Author: Falcone, Marco ; Russo, Alessandro ; Iraci, Federica ; Carfagna, Paolo ; Goldoni, Paola ; Vullo, Vincenzo ; Venditti, Mario
Subjects: Aged ; Anti-Infective Agents ; Anti-Infective Agents - therapeutic use ; Bacteremia - drug therapy ; Bacteremia - microbiology ; Bacteremia - mortality ; Bacteremia - pathology ; Candida ; Candida - drug effects ; Candida - growth & development ; Candida - pathogenicity ; Candidiasis ; Candidiasis - drug therapy ; Candidiasis - microbiology ; Candidiasis - mortality ; Candidiasis - pathology ; Case-Control Studies ; Clostridioides difficile - drug effects ; Clostridioides difficile - growth & development ; Clostridioides difficile - pathogenicity ; Clostridium difficile ; Clostridium Infections ; Clostridium Infections - drug therapy ; Clostridium Infections - microbiology ; Clostridium Infections - mortality ; Clostridium Infections - pathology ; Coinfection ; Cross Infection ; Cross Infection - drug therapy ; Cross Infection - microbiology ; Cross Infection - mortality ; Cross Infection - pathology ; Enterobacteriaceae ; Enterobacteriaceae - drug effects ; Enterobacteriaceae - growth & development ; Enterobacteriaceae - pathogenicity ; Enterobacteriaceae Infections ; Enterobacteriaceae Infections - drug therapy ; Enterobacteriaceae Infections - microbiology ; Enterobacteriaceae Infections - mortality ; Enterobacteriaceae Infections - pathology ; Enterococcus - drug effects ; Enterococcus - growth & development ; Enterococcus - pathogenicity ; Epidemiology and Surveillance ; Female ; Gram-Positive Bacterial Infections ; Gram-Positive Bacterial Infections - drug therapy ; Gram-Positive Bacterial Infections - microbiology ; Gram-Positive Bacterial Infections - mortality ; Gram-Positive Bacterial Infections - pathology ; Humans ; Male ; Metronidazole - therapeutic use ; Multivariate Analysis ; Odds Ratio ; Risk Factors ; Survival Analysis ; Treatment Outcome ; Vancomycin - therapeutic use
Is Part Of: Antimicrobial agents and chemotherapy, 2016-01, Vol.60 (1), p.252-257
Description: We determined the incidence, risk factors, and outcomes of bloodstream infections (BSI) subsequent to Clostridium difficile infection (CDI). We performed a retrospective study of all patients with definite diagnosis of CDI admitted from January 2014 to December 2014 in two large hospitals in Rome. Two groups of patients were analyzed: those with CDI and subsequent BSI (CDI/BSI(+)) and those with CDI and no evidence of primary BSI (CDI/BSI(-)). Data about clinical features, microbiology, treatments, and mortality were obtained. Overall, 393 cases of CDI were included in the final analysis: 72 developed a primary nosocomial BSI, while 321 had CDI without microbiological and clinical evidence of BSI. Etiologic agents of BSI were Candida species (47.3%), Enterobacteriaceae (19.4%), enterococci (13.9%), and mixed infections (19.4%). In multivariate analysis, ribotype 027 status (odds ratio [OR], 6.5), CDI recurrence (OR, 5.5), severe CDI infection (OR, 8.3), and oral vancomycin at >500 mg/day (OR, 3.1) were recognized as factors independently associated with the development of nosocomial BSI. Thirty-day mortality from CDI diagnosis was higher for patients of the CDI/BSI(+) group than for the controls (38.9 versus 13.1%; P < 0.001). Among patients of the CDI/BSI(+) group, mortality attributable to primary BSI was as high as 57%. Our findings suggest that severe CDI is complicated by the development of nosocomial BSI. Candida species and enteric bacteria appear to be the leading causative pathogens and are associated with poor outcomes.
Publisher: United States: American Society for Microbiology
Language: English
Identifier: ISSN: 0066-4804
EISSN: 1098-6596
DOI: 10.1128/AAC.01927-15
PMID: 26482315
Source: PubMed Central (Open access)
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Risk Factors and Outcomes for Bloodstream Infections Secondary to Clostridium difficile Infection

Copyright © 2015, American Society for Microbiology. All Rights Reserved. ;Copyright © 2015, American Society for Microbiology. All Rights Reserved. 2015 American Society for Microbiology ;ISSN: 0066-4804 ;EISSN: 1098-6596 ;DOI: 10.1128/AAC.01927-15 ;PMID: 26482315

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