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Nearly 10% of Americans with Candidemia have Clostridium difficile Co-infection

The similarities between the 2 patients group extended to underlying conditions including liver disease, inflammatory bowel disease, pancreatitis, heme malignancy or stem cell transplantation, and infection with HIV. Differences in underlying conditions between the co-infected and candidemia groups included the prevalence of diabetes (42% vs 31%; OR 1.61, 95% CI 1.19-2.18) and solid organ transplant (6% vs 2%; OR 4.07, 95% CI 2.06-8.07). 

Comparison of healthcare exposure revealed difference between the co-infected and candidemia groups concerning hemodialysis (23% vs 12%; OR 2.19, 95% CI 1.52-3.16), prior hospitalization (72% vs 57%; OR 1.89, 95% CI 1.37-2.62), and central venous catheterization (79% vs 69%; OR1.63, 95% CI 1.14-2.33). The groups were comparable concerning the Candida species isolated and the 30-day mortality rate (both 25%).

Multivariate logistic regression analysis revealed 4 risk factors of co-infection: diabetes (OR 1.41, 95% CI 1.03-1.92), solid organ transplant (OR 2.95, 95% CI 1.46-6.00), hemodialysis (OR 1.82, 95% CI 1.24-2.67), and prior hospital stay (OR 1.74, 95% CI 1.26-2.43).

Because the data were collected from case report forms, no other information on the C. difficile infections including treatment was available.

“In patients with C. difficile infection, 1 in 100 developed candidemia. In patients with candidemia, nearly 1 in 10 had C. difficile infection. The message for clinicians is to be vigilant. Look for candidemia and C. difficile infection occurring together. Clinicians should identify patients at greater risk and review best practice for antibiotic prescribing,” said Dr. Tsay.
Sharon Tsay: none
  • Photos and tape of presentation
Oral Abstract Session: The Fungus Among-us - Clinical Advances
Prevalence of and Factors Associated with Clostridium difficile Co-infection Among Patients with Candidemia, United States, 2014–2016. Sharon Tsay, MD, Mycotic Diseases Branch and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA.
Brian Hoyle, PhD, is a medical and science writer and editor from Halifax, Nova Scotia, Canada. He has been a full-time freelance writer/editor for over 15 years. Prior to that, he was a research microbiologist and lab manager of a provincial government water testing lab. He can be reached at
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