1270. Clostridium difficile Infection as a Risk Factor for Blood Stream Infection
Session: Poster Abstract Session: Bacteremia and Endocarditis
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • Poster24.pdf (1.0 MB)
  • Background: Intestinal Clostridium difficile infection (CDI) has been hypothesized to be a risk factor for development of blood stream infection (BSI) due to breaches in the intestinal mucosa. There are no published data regarding the risk of development of BSI after an episode of CDI.

    Methods:   We conducted a retrospective chart review of hospitalized patients with and without CDI at the Veterans Affairs Medical Center in Dayton Ohio, from January 1st 2006 until December 31st 2011. All hospitalized adult patients with symptoms of CDI and stool sample positive for Clostridium difficile toxin A or B were reviewed. We collected demographic and clinical information as well as the outcome (i.e., development of BSI within 90 days of hospitalization). BSI was defined as any positive blood culture, excluding a single blood culture with coagulase negative staphylococci or diphtheroids. The comparison group was an age and sex matched cohort of hospitalized patients without CDI.

    Results: We identified 181 patients with CDI and 270 age and sex matched patients without CDI. 118 patients in the CDI group and 98 patients in the non CDI group had blood culture data and thus composed the study’s sample. The mean age of patients in the CDI and non CDI groups was 70.4 and 71.0 years, respectively (p = 0.72). Males comprised 96% of the CDI group and 99% of the non CDI group (p = 0.22).  16 patients (13.6%) in the CDI group and 11 patients (11.2%) in the non CDI group developed BSI (p = 0.61). Thus, CDI was not a risk factor for development of BSI (odds ratio = 1.24 [95% CI = 0.55 to 2.82], p = 0.61).  We also found that other clinical variables, including alcohol abuse, tobacco use, diabetes mellitus, proton pump inhibitor use and atherosclerosis, were not risk factors for BSI.  Bacterial etiologies of each case of BSI were reviewed. There were a total of 19 isolates from 16 patients in the CDI group and 14 isolates from 11 patients in the non CDI group. 47% and 36% of isolates causing BSI in the CDI and non CDI groups, respectively, were not found to have a primary focus.

    Conclusion:  We found that CDI is not a risk factor for development of BSI.  Among 47% of patients with CDI and bacteremia of unknown source, 71% were organisms that are generally considered to be enteric flora. Further evaluation in larger studies is needed to investigate this observation.

    Walid Almuti, MD1,2, Mustafa Musleh, MD1,2, Joseph Baber, DO, FACP1,2, Mohamed Fayed, MD1,2, Ronald Markert, PhD2, Salma Akram, MD1,2, Jack Bernstein, MD1,2 and Laila Castellino, MD1,2, (1)Veterans Affairs Medical Center, Dayton, OH, (2)Wright State University, Boonshoft School of Medicine, Dayton, OH


    W. Almuti, None

    M. Musleh, None

    J. Baber, None

    M. Fayed, None

    R. Markert, None

    S. Akram, None

    J. Bernstein, None

    L. Castellino, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.