Prevalence of and Factors Associated with Clostridium difficile Co-infection Among Patients with Candidemia, United States, 2014–2016

Abstract

Background. Candidemia and Clostridium difcile 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). Tose 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 the 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.