Risk factors and outcomes for bloodstream infections secondary to Clostridium difficile infection

Purpose. To determine the incidence, risk factors, and outcomes of bloodstream infections (BSI) subsequent to Clostridium difficile infection (CDI). Methods. Retrospective study of all patients with definite diagnosis of CDI admitted from January 2014 to December 2014 in two large Hospitals in Rome. Two groups of patients were analyzed: those with CDI and subsequent BSI (CDI/BSI+), and those with CDI and no evidence of primary BSI (CDI/BSI-). Data about clinical features, microbiology, treatments and mortality were obtained. Results. Overall, 393 cases of CDI were included in the final analysis: 72 developed a primary nosocomial BSI while 321 had CDI without microbiological and clinical evidence of BSI. Etiologic agents of BSI were Candida species (47.3%), Enterobacteriaceae (19.4%), enterococci (13.9%), and mixed infections (19.4%). In multivariate analysis ribotype 027 (odds ratio [OR] 6.5), CDI recurrence (OR 5.5), severe CDI infection (OR 8.3), and oral vancomycin >500 mg/day (OR 3.1) were recognized as factors independently associated to the development of nosocomial BSI. Compared to controls, 30-day mortality from CDI diagnosis was higher in patients of CDI/BSI+ group (38.9 vs 13.1%, p<0.001). Among patients of the CDI/BSI+ group mortality attributable to primary BSI was as high as 57%. Conclusions. Our findings suggest that severe CDI may be complicated by development of nosocomial BSI. Candida and enteric bacteria appear as the leading causative pathogens and are associated with poor outcome.