Bacteraemia from an unrecognized source (occult bacteraemia) occurring during Clostridium difficile infection

Thomas, J.; Newman, Kathryn C.; Doshi, Simit; Logan, Nancy; Musher, Daniel M.

doi:10.3109/00365548.2010.546366

Cited by 7 publications

(4 citation statements)

References 10 publications

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“…We believe this makes our findings more applicable to a general inpatient population. Our results are overall consistent with more recent findings, based off a much larger sample population, that there is no difference in frequency of BSI relative to CDI [11]. …”

Section: Discussionsupporting

confidence: 93%

“…CDI was determined to be a risk factor for VRE bacteremia in a small cohort (N=59) of VRE-colonized acute leukemia patients [10]. A more recent retrospective analysis of CDI+ patients found no difference in the incidence of non-Staphylococcal BSI relative to CDI, but BSI occurring after CDI was more likely to be without an obvious source, suggesting colonic translocation [11]. In addition to the above studies regarding gut bacterial translocation, C. difficile bacteremia itself is a rare clinical entity [12].…”

Section: Introductionmentioning

confidence: 99%

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Is Clostridium difficile infection a risk factor for subsequent bloodstream infection?

et al. 2017

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Background Clostridium difficile infection (CDI) is a common nosocomial diarrheal illness increasingly associated with mortality in United States. The underlying factors and mechanisms behind the recent increases in morbidity from CDI have not been fully elucidated. Murine models suggest a mucosal barrier breakdown leads to bacterial translocation and subsequent bloodstream infection (BSI). This study tests the hypothesis that CDI is associated with subsequent BSI in humans. Methods We conducted a retrospective cohort study on 1132 inpatients hospitalized >72 hours with available stool test results for toxigenic C. difficile. The primary outcome was BSI following CDI. Secondary outcomes included 30-day mortality, colectomy, readmission, and ICU admission. Unadjusted and adjusted logistic regression models were developed. Results CDI occurred in 570 of 1132 patients (50.4%). BSI occurred in 86 (7.6%) patients. Enterococcus (14%) and Klebsiella (14%) species were the most common organisms. Patients with BSI had higher comorbidity scores and were more likely to be male, on immunosuppression, critically ill, and have a central venous catheter in place. Of the patients with BSI, 36 (42%) had CDI. CDI was not associated with subsequent BSI (OR 0.69; 95% CI 0.44–1.08; P =.103) in unadjusted analysis. In multivariable modeling, CDI appeared protective against subsequent BSI (OR 0.57; 95% CI 0.34–0.96; P = .036). Interaction modeling suggests a complicated relationship among CDI, BSI, antibiotic exposure, and central venous catheter use. Conclusions In this cohort of inpatients that underwent testing for CDI, CDI was not a risk factor for developing subsequent BSI.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Is Clostridium difficile infection a risk factor for subsequent bloodstream infection?

et al. 2017

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“…Similarly, in a study investigating non-staphylococcal BSIs in relation to the time from the first Cdiff-positive fecal sample, bacteremia from unrecognized sources (occult BSI) occurred more frequently from 3 days before to 10 days after Cdiff toxin positivity compared to the pre-Cdiff period. Of note, during the Cdiff period, positive blood cultures were characterized by a greater percentage of enterococci (50%), and the majority of occult BSI resolved without treatment [ 25 ]. In line with these findings, CDI has been identified as a risk factor for vancomycin-resistant enterococci (VRE) bacteremia in a small cohort ( n = 59) of patients with acute leukemia [ 27 ].…”

Section: Bacterial Blood-stream Infections and Clostridioid...mentioning

confidence: 99%

Concurrent and Subsequent Co-Infections of Clostridioides difficile Colitis in the Era of Gut Microbiota and Expanding Treatment Options

et al. 2022

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We narratively reviewed the physiopathology, epidemiology, and management of co-infections in Clostridioides difficile colitis (CDI) by searching the following keywords in Embase, MedLine, and PubMed: “Clostridium/Clostridioides difficile”, “co-infection”, “blood-stream infection” (BSI), “fungemia”, “Candida”, “Cytomegalovirus”, “probiotics”, “microbial translocation” (MT). Bacterial BSIs (mainly by Enterobacteriaceae and Enterococcus) and fungemia (mainly by Candida albicans) may occur in up to 20% and 9% of CDI, increasing mortality and length of hospitalization. Up to 68% of the isolates are multi-drug-resistant bacteria. A pivotal role is played by gut dysbiosis, intestinal barrier leakage, and MT. Specific risk factors are represented by CDI-inducing broad-spectrum antibiotics, oral vancomycin use, and CDI severity. Probiotics administration (mainly Saccharomyces and Lactobacillus) during moderate/severe CDI may favor probiotics superinfection. Other co-infections (such as Cytomegalovirus or protozoa) can complicate limited and specific cases. There is mounting evidence that fidaxomicin, bezlotoxumab, and fecal microbiota transplantation can significantly reduce the rate of co-infections compared to historical therapies by interrupting the vicious circle between CDI, treatments, and MT. Bacterial BSIs and candidemia represent the most common co-infections in CDI. Physicians should be aware of this complication to promptly diagnose and treat it and enforce preventive strategies that include a more comprehensive consideration of newer treatment options.

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“…Progression from gut colonization to clinical infection can occur through organism translocation into the bloodstream or through environmental contamination and subsequent re-introduction into the body [ 10 , 11 ]. This association between gut microbiome colonization is best established in patients with hematologic malignancies but has also been demonstrated in hospitalized adults, critically ill and postsurgical patients, pediatrics, and patients with Clostridioides difficile infection (CDI) [ 7 , 12 – 20 ]. It has been demonstrated across many MDRO including vancomycin-resistant enterococci (VRE), gram negatives such as carbapenem-resistant Enterobacterales (CRE) and MDR Pseudomonas aeruginosa , Candida spp., and methicillin-resistant Staphylococcus aureus (MRSA) [ 14 , 15 , 18 , 20 – 22 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Risk Stratification Approaches to Identify Patients with Clostridioides difficile Infection at Risk for Multidrug-Resistant Organism Gut Microbiota Colonization

Zasowski,

Ali,

Anugo

et al. 2023

Infect Dis Ther

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Introduction Multidrug-resistant organisms (MDRO) commonly colonize the gut microbiota of patients with Clostridioides difficile infection (CDI). This increases the likelihood of systemic infections with these MDROs. To help guide MDRO screening and/or empiric antibiotic therapy, we derived and compared predictive indices for MDRO gut colonization in patients with CDI. Methods This was a multicenter, retrospective cohort study of adult patients with CDI from July 2017 to April 2018. Stool samples were screened for MDRO via growth and speciation on selective antibiotic media and confirmed using resistance gene polymerase chain reaction. A regression-based risk score for MDRO colonization was constructed. Predictive performance via area under the receiver operating characteristic curve (aROC) of this index was compared with two other simplified risk stratification approaches: (1) prior healthcare exposure and/or high-CDI risk antibiotics; (2) number of prior high-CDI risk antibiotics. Results 50 (20.8%) of 240 included patients had MDRO colonization; 35 (14.6%) VRE, 18 (7.5%) MRSA, 2 (0.8%) CRE. Prior fluoroquinolone (aOR 2.404, 95% CI 1.095–5.279) and prior vancomycin (1.996, 95% CI 1.014–3.932) were independently associated with MDRO colonization while prior clindamycin (aOR 3.257, 95% CI 0.842–12.597) and healthcare exposure (aOR 2.138, 95% CI 0.964–4.740) were retained as explanatory variables. The regression-based risk score significantly predicted MDRO colonization (aROC 0.679, 95% CI 0.595–0.763), but was not significantly more predictive than prior healthcare exposure + prior antibiotics (aROC 0.646, 95% CI 0.565–0.727) or number of prior antibiotic exposures (aROC 0.642, 95% CI 0.554–0.730); P > 0.05 for both comparisons. Conclusion A simplified approach using prior healthcare exposure and receipt of prior antibiotics known to increase CDI risk identified patients at risk for MDRO gut microbiome colonization as effectively as individual patient/antibiotic risk modeling.

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Bacteraemia from an unrecognized source (occult bacteraemia) occurring during Clostridium difficile infection

Cited by 7 publications

References 10 publications

Is Clostridium difficile infection a risk factor for subsequent bloodstream infection?

Is Clostridium difficile infection a risk factor for subsequent bloodstream infection?

Concurrent and Subsequent Co-Infections of Clostridioides difficile Colitis in the Era of Gut Microbiota and Expanding Treatment Options

Comparison of Risk Stratification Approaches to Identify Patients with Clostridioides difficile Infection at Risk for Multidrug-Resistant Organism Gut Microbiota Colonization

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