921. Candida Co-infection among Adults with Clostridium difficile Infection in Metropolitan Atlanta, 2009„ź2013
Session: Poster Abstract Session: Clostridium difficile Infections: Epidemiology and Diagnostics
Friday, October 9, 2015
Room: Poster Hall
  • 15_259796-A_PTR_Vallabhaneni,S_IDWeek.pdf (131.1 kB)
  • Background: Candida and Clostridium difficile are important causes of healthcare-associated infections. Treatment of C. difficile infection (CDI) disrupts gut flora and may result in Candida overgrowth. Damage to intestinal epithelium caused by CDI itself may facilitate Candida translocation into the bloodstream. We describe the prevalence and characteristics of patients developing candidemia (CA) after CDI. 

    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.

    Snigdha Vallabhaneni, MD, MPH1,2, Olivia M. Almendares, MSPH3,4,5, Monica Farley, MD, FIDSA5,6, Jessica Reno, MPH3,4,5, Zirka Smith, MPH3, Betsy Stein, RN, BSN3,6, Shelley S. Magill, MD, PhD7, Rachel M. Smith, MD, MPH2, Angela Cleveland, MPH8 and Fernanda C. Lessa, MD7, (1)Epidemic Intelligence Service, Atlanta, GA, (2)Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (3)Georgia Emerging Infections Program, Decatur, GA, (4)Atlanta Research and Education Foundation, Decatur, GA, (5)Atlanta VA Medical Center, Decatur, GA, (6)Emory University School of Medicine, Atlanta, GA, (7)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (8)Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA


    S. Vallabhaneni, None

    O. M. Almendares, None

    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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