1392. Characterizing Patients with both Clostridium difficile and Invasive Methicillin-Resistant Staphylococcus aureus Infections Identified by California Emerging Infections Program (CEIP) Surveillance, San Francisco County, 2010 2012
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • IDWEEK2013_Poster 1392.pdf (1.2 MB)
  • Background: Factors that put patients at risk for healthcare-associated infections, such as Clostridium difficile infection (CDI) and invasive methicillin-resistant Staphylococcus aureus infection (iMRSA), include underlying conditions, illness severity, recent hospitalization, and antibiotic exposure. Since iMRSA and CDI share risk factors, this analysis is aimed at describing the burden of CDI/iMRSA co-infections.

    Methods: San Francisco County residents with CDI and iMRSA were identified through active laboratory-based surveillance from 2010-2012. Patients were considered co-infected if CDI and iMRSA were detected at any time during the surveillance period. Clinical outcomes, history of previous healthcare exposures, and underlying conditions were collected via medical record review.

    Results: Sixty four patients had CDI/iMRSA co-infection, representing 2.5% of all CDI and 3.4% of all iMRSA patients. Forty five (70%) were hospitalized at the time of CDI and 57 (89%) at the time of iMRSA; both median lengths of stay were 13 days (CDI IQR: 6-20, iMRSA IQR: 8-26). Eight co-infected patients (13%) died. Most co-infected patients had healthcare-associated disease – 81% CDI and 89% iMRSA. One patient had concurrent CDI/iMRSA, 35 had iMRSA a median 49 days (IQR: 12-119) prior to CDI, and 28 had CDI a median 147 days (IQR: 64-365) prior to iMRSA. In the year prior to iMRSA, co-infected patients had a higher proportion of hospitalization (84% vs. 47%, p<0.0001), residency in a LTCF (34% vs. 23%, p=0.03), dialysis (31% vs. 14%, p=0.0002) and CVCs in place 2 days before culture (20% vs. 12%, p=0.04) than non co-infected iMRSA patients; they also had a higher proportion of congestive heart failure (27% vs. 16%, p=0.02), CVA/Stroke (20% vs. 11%, p=0.02), pressure ulcer (19% vs. 9%, p=0.006), diabetes (52% vs. 36%, p=0.01), and peripheral vascular disease (22% vs. 8%, p=0.0002). In the 12 weeks prior to CDI, co-infected patients had a higher proportion of chronic hemodialysis (26% vs. 5%, p<0.0001) and ER visits (63% vs. 35%, p=0.01) than non co-infected CDI patients.

    Conclusion: Co-infection with CDI and iMRSA was uncommon. Patients who were co-infected had higher rates of intensive healthcare exposures. Further study of CDI/iMRSA co-infections may help to elucidate additional intervention strategies.

    Ashley Williamson, MPH1, Joelle Nadle, MPH1, Erin P Garcia, MPH, CPH1, Erin Parker, MPH1 and Lisa G Winston, MD2, (1)California Emerging Infections Program, Oakland, CA, (2)University of California, San Francisco/San Francisco General Hospital, San Francisco, CA


    A. Williamson, None

    J. Nadle, None

    E. P. Garcia, None

    E. Parker, None

    L. G. Winston, None

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