1779. Prevalence of and Factors Associated with Clostridium difficile Co-infection Among Patients with Candidemia, United States, 2014–2016.
Session: Oral Abstract Session: The Fungus Among-us - Clinical Advances
Saturday, October 7, 2017: 9:35 AM
Room: 01AB
Background: Candidemia and Clostridium difficile infection (CDI) are two common healthcare-associated infections (HAIs) and share risk factors such as antibiotic use and prolonged hospitalization. CDI and CDI treatment disrupt gut microbial diversity, allowing Candida overgrowth and translocation to the bloodstream. We describe CDI co-infection among patients with candidemia.

Methods: Population-based surveillance for candidemia was conducted through CDC’s Emerging Infections Program during 2014–2016. A case of candidemia was defined as a blood culture positive for Candida species collected from a surveillance area resident. Demographic and medical information, including occurrence of CDI was collected. We defined co-infection as CDI within 90 days of candidemia and performed bivariable analysis to assess factors associated with co-infection.

Results: Among 2129 cases of candidemia, 190 (9%) had CDI co-infection; 116 (5%) had CDI in the 90 days before candidemia (median: 10 days) and 60 (3%) had CDI following candidemia (median: 8 days). The median age of those with CDI-candidemia co-infection was 61 years and 100 (53%) were male. Compared with candidemia alone, the odds of CDI-candidemia co-infection was significantly greater for patients of black race (OR 1.41, 95% CI 1.05–1.90), those with diabetes (OR 1.68, 1.24–2.27), pancreatitis (OR 1.91, 1.01–3.61), or solid organ transplant (OR 4.15, 2.09–8.22). Those with co-infection had higher odds of certain healthcare exposures: hemodialysis (OR 2.27, 1.57–3.28), hospital stay in the past 90 days (OR 1.9, 1.37–2.64), ICU admission in the past 14 days (OR 1.78, 1.20–2.66), and central venous catheter (CVC) at the time of candidemia (OR 1.71, 1.19–2.46). There were no significant differences in 30-day mortality or in type of Candida species, although C. parapsilosis was less common in the co-infection group (8% vs. 13%).

Conclusion: Nearly one in ten patients with candidemia also had CDI co-infection. Black race, certain underlying conditions, hemodialysis, previous hospitalization, ICU stay, and presence of a CVC were associated with co-infection. Clinicians should be vigilant for coinfection of CDI and candidemia, particularly in situations with associated risk factors.

Sharon Tsay, MD1,2, Kaitlin Benedict, MPH1, Zintars G. Beldavs, MS3,4, Monica M. Farley, MD, FIDSA5,6, Lee H. Harrison, MD7,8, William Schaffner, MD, FIDSA, FSHEA9,10, Taryn Gerth, MPH1, Tom Chiller, MD, MPH1 and Snigdha Vallabhaneni, MD, MPH1, (1)Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (2)Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, (3)Oregon Health Authority, Portland, OR, (4)Oregon Emerging Infections Program, Portland, OR, (5)Georgia Emerging Infections Program, Atlanta, GA, (6)Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, GA, (7)Maryland Emerging Infections Program, Baltimore, MD, (8)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (9)Vanderbilt University School of Medicine, Nashville, TN, (10)Tennessee Emerging Infections Program, Nashville, TN


S. Tsay, None

K. Benedict, None

Z. G. Beldavs, None

M. M. Farley, None

L. H. Harrison, None

W. Schaffner, Pfizer: Scientific Advisor , Consulting fee
Merck: Scientific Advisor , Consulting fee
Novavax: Consultant , Consulting fee
Dynavax: Consultant , Consulting fee
Sanofi-pasteur: Consultant , Consulting fee
GSK: Consultant , Consulting fee
Seqirus: Consultant , Consulting fee

T. Gerth, None

T. Chiller, None

S. Vallabhaneni, None

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