Candidemia Subsequent to Severe Infection Due to Clostridium difficile: Is There a Link?

Guastalegname, Maurizio; Russo, Alessandro; Falcone, Marco; Giuliano, Simone; Venditti, Mario

doi:10.1093/cid/cit362

Cited by 31 publications

(16 citation statements)

References 6 publications

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“…Recently, we reported our experience of studying candidemia subsequent to severe CDI (8)(9)(10), and we observed an association between Candida species BSI and CDI, especially if caused by ribotype 027 strains. We reported a case of severe community-onset health care-associated CDI complicated by carbapenemase-producing Klebsiella pneumoniae BSI (11).…”

mentioning

confidence: 87%

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

Falcone

Russo

Iraci

et al. 2016

Antimicrob Agents Chemother

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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. C lostridium difficile infection (CDI) is an emerging infection, usually occurring after exposure to broad-spectrum antibiotics (1-3). This infection can be mild and self-limiting but might progress to severe disease with ileus, toxic megacolon, and eventually, death. The incidence, severity, and acquisition of infection of people formerly classified as being at low risk seem to be increasing, and a hypervirulent, fluoroquinolone-resistant C. difficile strain, named NAP1/BI/027, is associated with severe symptoms, high recurrence rates, and poor outcomes (4-6).The alterations occurring in the intestinal flora, which is recognized as a microbiome, may promote the translocation of pathogens in the blood and the development of nosocomial bloodstream infections (BSIs) (7). Recently, we reported our experience of studying candidemia subsequent to severe CDI (8-10), and we observed an association between Candida species BSI and CDI, especially if caused by ribotype 027 strains. We reported a case of severe community-onset health care-associated CDI complicated by carbapenemase-producing Klebsiella pneumoniae BSI (11). Thus, it was hypothesized that antibiotic therapy and/or other clinical characteristics related to CDI (i.e., severity, recurrence, disease caused by a highly virulent strain, etc.) contribute to alterations of the colon indigenous microbiota and eventually predispose patients to .The aim of our study was to analyze the clinical findings for patients with CDI and primary nosocomial BSI to determine the risk factors and outcomes associated with these infections.(This work was presented as an oral communication during the 55th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Diego, CA, 17 to 21 September 2015 [15].) MATERIALS AND METHODSStudy design and study patients. This was a retrospective study of patients who were admitted from January 2014 to December 2014 to two large hospitals in Rome: Policlinico Umberto I-Sapienza University Hospital (1,200 beds and 49,000 admissions/year in 2014) and the San Giovanni-Addolorata Hospital (700 beds and 30,000 admissions/year in 2014). All adults (aged Ͼ18 years) with a documented CDI initially were included in the study. Patients for whom we could not obtain medical records were excluded from the final analysis. The ethics committee of the Policlinico Umberto I approved the study.Data were extracted from the medical records of patients and from hospital computerized databases or clinical charts according to a prepared questionnaire. The following data were reviewed: demographics, clinical and laboratory findings, comorbidity conditions (like diabetes mellitus, cardiovascular disease, pulmonary disease, renal disease, hepatic disease, central nervous...

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mentioning

confidence: 87%

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

Falcone

Russo

Iraci

et al. 2016

Antimicrob Agents Chemother

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“…Patients treated for CDI were found to be able to acquire Candida , while Candida levels in precolonized patients showed a reduction of C. albicans during treatment (34). CDI patients were less likely to have C. albicans overgrowth (33), but C. albicans bloodstream infections were reported after a CDI episode (31). Finally, CDI-positive patients were reported to have higher C. albicans colonization rates (30).…”

Section: Discussionmentioning

confidence: 99%

“…Several recent studies have tried to define a possible correlation between C. albicans overgrowth and the presence of C. difficile . However, both positive (30–32) and negative correlations (33, 34) have been reported, and it remains uncertain how these two organisms interact.…”

Section: Introductionmentioning

confidence: 99%

Interspecies Interactions between Clostridium difficile and Candida albicans

Leeuwen

Peet

Bikker

et al. 2016

mSphere

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Candida albicans and Clostridium difficile are two opportunistic pathogens that reside in the human gut. A few studies have focused on the prevalence of C. albicans in C. difficile-infected patients, but none have shown the interaction(s) that these two organisms may or may not have with each other. In this study, we used a wide range of different techniques to better understand this interaction at a macroscopic and microscopic level. We found that in the presence of C. albicans, C. difficile can survive under ambient aerobic conditions, which would otherwise be toxic. We also found that C. difficile affects the hypha formation of C. albicans, most likely through the excretion of p-cresol. This ultimately leads to an inability of C. albicans to form a biofilm. Our study provides new insights into interactions between C. albicans and C. difficile and bears relevance to both fungal and bacterial disease.

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“…Fidaxomicin, a newly licensed macrocyclic antibiotic recently approved to treat CDI, is characterized by a narrow spectrum of activity almost limited to CD and consequent preservation of intestinal flora compared to vancomycin [13]. Preservation of intestinal flora could represent a useful therapeutic option not only in reducing CDI recurrence rate [9], but also in preventing BSIs secondary to severe CDI.…”

Section: Discussionmentioning

confidence: 99%

Severe community onset healthcare-associated Clostridium difficile infection complicated by carbapenemase producing Klebsiella pneumoniae bloodstream infection

et al. 2014

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BackgroundClostridium difficile infection (CDI) and Klebsiella pneumoniae carbapenemase producing-Klebsiella pneumoniae (KPC-Kp) bloodstream infection (BSI) are emerging health-care associated (HCA) diseases of public health concern, in terms of morbidity, mortality, and insufficient response to antibiotic therapy. Both agents can be acquired in the hospital but clinical disease can develop in a community setting, after discharge. We report here a putative link between the above-mentioned healthcare associated infections that appeared as a dramatic community onset disease with a fulminant fatal outcome.Case presentationWe describe the case of a 63 year old man affected by severe CDI. Even though the patient underwent 72 hours of standard CDI antibiotic treatment, the clinical course was complicated by toxic megacolon and KPC-Kp BSI. The patient died 24 hours after total colectomy.ConclusionThe impact of HCA-BSIs in complicating CDI is still unknown. Intestinal inflammatory injury and disruption of intestinal flora by standard antibiotic treatment could be responsible for promoting difficult-to-treat infections in CDI. By preserving intestinal flora, Fidaxomicin could have a crucial role in preventing BSIs complicating severe CDI.

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Candidemia Subsequent to Severe Infection Due to Clostridium difficile: Is There a Link?

Cited by 31 publications

References 6 publications

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

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

Interspecies Interactions between Clostridium difficile and Candida albicans

Severe community onset healthcare-associated Clostridium difficile infection complicated by carbapenemase producing Klebsiella pneumoniae bloodstream infection

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