Methods: Adult patients presenting with primary or recurrent CDI (n=88) identified on a two-step GI multiplex assay (Biofire) followed by toxin A/B EIA, were classified into CDIM (n=66), CDIB (n=12), and CDIV (n=10) groups. Demographic and clinical data were collected and risk factors and outcomes compared by Fisher’s exact test, ANOVA, and the Kruskal-Wallis test. CDI severity was determined using Zar’s criteria, presence of bacteremia, and ICU stay.
Results: During the study period, 2,017 diarrheal samples were submitted to the microbiology laboratory. An enteric pathogen was identified in 311 (15%) patients. CDI was identified in 88 cases of which 22 (25%) had a second pathogen. CDIM was found in 66 (21%), CDIB in 12 (4%), and CDIV in 10 (3%) subjects. The most common co-pathogens identified were diarrheagenic E. coli in the CDIB group (9/12, 75%) and norovirus in the CDIV group (8/10, 80%). Groups were similar in terms of demographics, number of recurrences, health care acquisition, co-morbidities, disease severity, serum creatinine at presentation, presence of toxin by EIA, and mortality. Patients with CDIM were more likely to have a recent hospitalization than the CDIB group (44/66 67% vs. 3/12 25%, p=0.01). Clinical symptoms at presentation were similar for the three groups except for nausea which was more common in the CDIV group when compared to CDIM (8/10, 80% vs. 25/66, 38%; p=0.02). The use of proton pump inhibitors was similar in the three groups. There was however, a higher proportion of patients taking GABA-like drugs within 90 days among the CDIB patients (10/12, 83%) than the group with CDIM (26/66, 40%) p=0.01.
Conclusion: In CDI cancer patients, co-infection with other enteropathogens is common. Patients with CDIB were less likely to have a recent admission to a health care facility. The use of GABA-like drugs was associated with a higher risk of bacterial co-infection.
E. Yepez Guevara, None
S. L. Aitken, None
M. Bhatti, None
P. C. Okhuysen, None