Methods: A retrospective, case control study was conducted at a 900-bed tertiary care teaching hospital. All adults with hospital-onset CDI (HO-CDI, LabID methodology) between January 2011 and December 2014 were cross-referenced with existing Epidemiology surveillance records (NHSN) of hospital-onset bloodstream infections. CD-BSI cases were defined as patients with bacteremia secondary to gastrointestinal (GI) tract infection source that developed the day of or within 14 days after CDI diagnosis. Patients with recent GI surgery or bacteremia preceding CDI diagnosis were excluded as cases. Patients with HO-CDI without CD-BSI served as controls. Chart review was performed to identify risk factors and clinical outcomes.
Results: Among 1,374 patients with HO-CDI, CD-BSI was identified in 25 (incidence 1.8%). Most case patients had undergone recent chemotherapy (19/25, 76%) and many were neutropenic at time of CDI diagnosis (11/25, 44%). Bloodstream pathogens were E. coli, Klebsiella, or Enterococcus in 72% of cases (18/25). Risk factors associated with CD-BSI included younger age (mean 59 vs. 67 years, p=0.03), higher Charlson co-morbidity index (mean 5.0 vs. 3.8, p=0.046), history of malignancy (OR 13.2, p<0.0001), and presence of neutropenia at time of CDI diagnosis (OR 13.2, p<0.0001). Patients with CD-BSI had a higher incidence of colectomy (12% vs. 0.6%, p<0.001), longer hospitalization (39.5 days vs. 24.0 days, p=0.02), and a non-significant trend towards more frequent ICU admission post-CDI (44% vs. 28%, p=0.07) and higher in-hospital mortality (20% vs. 11%, p=0.18).
Conclusion: At our facility, the incidence of bacteremia associated with HO-CDI is 1.8% and is associated with worse clinical outcomes. An elevated Charlson comorbidity score, the diagnosis of malignancy, and neutropenia appear to be significant risk factors. Evaluation of additional risk factors is underway.
M. Madhusudhan, None
R. Murthy, None
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