Candidemia and Clostridium difficile Coinfection Common in Certain High-Risk Groups

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Investigators shed light on the need for increased research and clinical priority on the occurrence of coinfection of Candidemia and CDI.
Investigators shed light on the need for increased research and clinical priority on the occurrence of coinfection of Candidemia and CDI.

Candidemia and Clostridium difficile infection (CDI) are both common healthcare-associated infections with overlapping risk factors, and approximately 1 in 10 patients with candidemia are coinfected with CDI, according to new findings published in Clinical Infectious Diseases.

Risk factors for candidemia and CDI include broad-spectrum antibiotic use and prolonged hospitalization. In addition, candidemia has been linked to CDI, because the latter can cause damage to the gastrointestinal mucosa, and the subsequent antibiotics used to treat CDI are associated with Candida overgrowth and spread into the bloodstream. In the current study, the investigators identify factors that are associated with coinfection and describe the prevalence and clinical characteristics of patients who are coinfected.

Using data from a population-based surveillance for candidemia that was conducted between 2014 and 2016 in 23 counties across 5 states, 2026 cases of candidemia were identified. Of these, 189 (9%) had CDI coinfection. In a bivariable analysis, the odds of CDI coinfection vs candidemia alone were significantly greater for patients who were black (51% vs 42%; odds ratio [OR], 1.45), who had diabetes (43% vs 32%; OR, 1.56), who had undergone solid organ transplant (6% vs 2%; OR, 4.08), who had received antibiotics in the prior 14 days (86% vs 75%; OR, 2.05), who were undergoing hemodialysis (23% vs 12%; OR, 2.15), and who had been previously hospitalized within the past 90 days (71% vs 58%; OR, 1.78).

In multivariable analysis, only the categories of solid organ transplant (adjusted OR [aOR], 2.95; 95% CI, 1.45-6.00), antibiotics given in the prior 14 days (aOR, 1.84; 95% CI, 1.20-2.81), hemodialysis (aOR, 1.86; 95% CI, 1.28-2.72), and prior hospitalization (aOR, 1.61; 95% CI, 1.16-2.25) remained significantly associated with coinfection.

"Even though we did not see evidence of increased mortality among those with coinfection compared with candidemia alone in our study, having both infections adds to the complexity of illness and healthcare costs," conclude the investigators.

Reference

Tsay S, Williams SR, Benedict K, et al. A tale of two healthcare-associated infections: Clostridium difficile coinfection among patients with Candidemia [published online July 27, 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy607

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