Methods: We used CA and CDI laboratory- and population-based surveillance data in the Atlanta area (population: 3.8 million) during 2009-2013 to identify persons ≥ 18 years who developed CA within 120 days after CDI (co-infected case [COI]). For each COI, we attempted to identify up to 3 controls (CDI without CA) matched on age and location of CDI onset. Conditional logistic regression was performed to identify factors associated with co-infection.
Of 13,615 adults with CDI, 113 (0.8%) had CA co-infection. Median time from CDI to CA-onset was 19 days (IQR: 8-45). Among COI, median age was 62 years (range: 20-98), 54% were female, 54% were black, 48% had diabetes, 65% received proton-pump inhibitors (PPI) in the 12 weeks before CDI, and 88% had a central venous catheter. Severe CDI (ileus, toxic megacolon, pseudomembranous colitis, or WBC≥ 15,000cells/µL), occurred in 44%, and 4% had a colectomy. The most common CDI treatment was vancomycin plus metronidazole (40%). Candida species found in COI included C. albicans (37%), C. glabrata (28%), and C. parapsilosis (19%). Twenty-nine percent died within 30 days of candidemia. Compared with 257 matched controls, COI were more likely to be black (matched odds ratio: 1.9; 95% confidence interval: [1.2-3.1]), have diabetes (1.7;[1.1-2.8]) or inflammatory bowel disease 5.1;[1.3-23.7], have received PPIs (2.1;[1.3-3.5]), have severe CDI (2.1;[1.3-3.4]), or colectomy (13.3;[1.5-114.1]), require intensive care unit stay (2.31;[1.0-5.39]) and receive CDI treatment with vancomycin plus metronidazole vs metronidazole alone (2.1;[1.2-3.7]).
Conclusion: The prevalence of CA among CDI patients is low, but co-infection is associated with substantial mortality. In addition to previously recognized risk factors for CA, severe CDI and selected treatment regimens were associated with co-infection. Further study is warranted to investigate these associations.
M. Farley, None
J. Reno, None
Z. Smith, None
B. Stein, None
S. S. Magill, None
R. M. Smith, None
A. Cleveland, None
F. C. Lessa, None
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