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1033. Thinking Outside the Bowel: Clostridium difficile Bacteremia Case Series

BACKGROUND: While Clostridium difficile gastrointestinal infection (CDI) is the most common hospital-acquired infectious disease, C. difficile bacteremia (CDB) is exceedingly rare and its risk factors, mortality rate, and modalities of treatment are not well defined. METHODS: We conducted a retrospe...

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Autores principales: Pettigrew, Adam, Jariwala, Ripal, Zeitler, Kristen, Montero, Jose, Gompf, Sandra, Toney, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255364/
http://dx.doi.org/10.1093/ofid/ofy210.870
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author Pettigrew, Adam
Jariwala, Ripal
Zeitler, Kristen
Montero, Jose
Gompf, Sandra
Toney, John
author_facet Pettigrew, Adam
Jariwala, Ripal
Zeitler, Kristen
Montero, Jose
Gompf, Sandra
Toney, John
author_sort Pettigrew, Adam
collection PubMed
description BACKGROUND: While Clostridium difficile gastrointestinal infection (CDI) is the most common hospital-acquired infectious disease, C. difficile bacteremia (CDB) is exceedingly rare and its risk factors, mortality rate, and modalities of treatment are not well defined. METHODS: We conducted a retrospective, IRB approved, chart review of adult patients with a diagnosis of CDB admitted to our institutions from 2011 through 2017. Variables catalogued included previous antibiotic and proton pump inhibitor (PPI) use, co-morbid conditions, prior history of CDI, diarrhea at the time of CDB, active malignancy, and gastrointestinal (GI) disruption (e.g., perforated viscous, GI bleeding, abdominal malignancy). Treatment courses and outcomes for CDB were also gleaned. RESULTS: Seven patients with CDB were identified, with ages ranging from 35 to 81 years (median 65 years). Six (85.7%) patients had evidence of GI disruption and three (42.9%) were noted to have active cancer. Three (42.9%) patients had previous CDI by testing and three (42.9%) had complaints of diarrhea at the time of diagnosis. Six (85.7%) patients had exposure to PPIs before CDB diagnosis, and five (71.4%) had prior antibiotic exposure in the past 30 days. Five (71.4%) patients had a polymicrobial bloodstream infection, with the majority of organisms being enteric in nature. In terms of CDB treatment, the majority of patients received intravenous (IV) metronidazole and/or IV vancomycin in addition to broad-spectrum antibiotics due to the polymicrobial nature of their infection. Three (42.9%) patients died during their hospitalization, only one who had polymicrobial bacteremia. CONCLUSION: CDI is the most common cause of hospital acquired infection, although rarely causes bacteremia. Notable findings in our population included older age, concomitant malignancy, evidence of GI disruption, and prior exposure to PPIs and antibiotics. Antibiotics chosen to treat CDB were IV metronidazole and/or IV vancomycin, with other broad-spectrum antibiotics utilized due to polymicrobial bacteremia. CDB is associated with a high mortality rate and is commonly manifested as a polymicrobial bloodstream infection. This is one of the larger case series that adds to the scant literature characterizing patients diagnosed with CDB. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62553642018-11-28 1033. Thinking Outside the Bowel: Clostridium difficile Bacteremia Case Series Pettigrew, Adam Jariwala, Ripal Zeitler, Kristen Montero, Jose Gompf, Sandra Toney, John Open Forum Infect Dis Abstracts BACKGROUND: While Clostridium difficile gastrointestinal infection (CDI) is the most common hospital-acquired infectious disease, C. difficile bacteremia (CDB) is exceedingly rare and its risk factors, mortality rate, and modalities of treatment are not well defined. METHODS: We conducted a retrospective, IRB approved, chart review of adult patients with a diagnosis of CDB admitted to our institutions from 2011 through 2017. Variables catalogued included previous antibiotic and proton pump inhibitor (PPI) use, co-morbid conditions, prior history of CDI, diarrhea at the time of CDB, active malignancy, and gastrointestinal (GI) disruption (e.g., perforated viscous, GI bleeding, abdominal malignancy). Treatment courses and outcomes for CDB were also gleaned. RESULTS: Seven patients with CDB were identified, with ages ranging from 35 to 81 years (median 65 years). Six (85.7%) patients had evidence of GI disruption and three (42.9%) were noted to have active cancer. Three (42.9%) patients had previous CDI by testing and three (42.9%) had complaints of diarrhea at the time of diagnosis. Six (85.7%) patients had exposure to PPIs before CDB diagnosis, and five (71.4%) had prior antibiotic exposure in the past 30 days. Five (71.4%) patients had a polymicrobial bloodstream infection, with the majority of organisms being enteric in nature. In terms of CDB treatment, the majority of patients received intravenous (IV) metronidazole and/or IV vancomycin in addition to broad-spectrum antibiotics due to the polymicrobial nature of their infection. Three (42.9%) patients died during their hospitalization, only one who had polymicrobial bacteremia. CONCLUSION: CDI is the most common cause of hospital acquired infection, although rarely causes bacteremia. Notable findings in our population included older age, concomitant malignancy, evidence of GI disruption, and prior exposure to PPIs and antibiotics. Antibiotics chosen to treat CDB were IV metronidazole and/or IV vancomycin, with other broad-spectrum antibiotics utilized due to polymicrobial bacteremia. CDB is associated with a high mortality rate and is commonly manifested as a polymicrobial bloodstream infection. This is one of the larger case series that adds to the scant literature characterizing patients diagnosed with CDB. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6255364/ http://dx.doi.org/10.1093/ofid/ofy210.870 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Pettigrew, Adam
Jariwala, Ripal
Zeitler, Kristen
Montero, Jose
Gompf, Sandra
Toney, John
1033. Thinking Outside the Bowel: Clostridium difficile Bacteremia Case Series
title 1033. Thinking Outside the Bowel: Clostridium difficile Bacteremia Case Series
title_full 1033. Thinking Outside the Bowel: Clostridium difficile Bacteremia Case Series
title_fullStr 1033. Thinking Outside the Bowel: Clostridium difficile Bacteremia Case Series
title_full_unstemmed 1033. Thinking Outside the Bowel: Clostridium difficile Bacteremia Case Series
title_short 1033. Thinking Outside the Bowel: Clostridium difficile Bacteremia Case Series
title_sort 1033. thinking outside the bowel: clostridium difficile bacteremia case series
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255364/
http://dx.doi.org/10.1093/ofid/ofy210.870
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