Severe community onset healthcare-associated Clostridium difficile infection complicated by carbapenemase producing Klebsiella pneumoniae bloodstream infection

BMC Infectious Diseases

Mario Venditti¹  Marco Falcone¹  Andrea Morelli²  Miryam Jenco³  Maurizio Guastalegname¹  Simone Giuliano¹ 

[1] Department of Public Health and Infectious Diseases Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy;Department of Anesthesiology and Intensive Care, “Sapienza” University of Rome, Rome, Italy;Department of Anesthesiology and Intensive Care, “Villa San Pietro-Fatebenefratelli” Hospital, Rome, Italy

关键词: Fidaxomicin;    Intestinal flora;    Bloodstream infections;    KPC;    Klebsiella pneumoniae;    Clostridium difficile;   

Others  :  1125692
DOI  :  10.1186/1471-2334-14-475

 received in 2014-04-14, accepted in 2014-08-18,  发布年份 2014

【 摘 要 】

Background

Clostridium difficile infection (CDI) and Klebsiella pneumoniae carbapenemase producing-Klebsiella pneumoniae (KPC-Kp) bloodstream infection (BSI) are emerging health-care associated (HCA) diseases of public health concern, in terms of morbidity, mortality, and insufficient response to antibiotic therapy. Both agents can be acquired in the hospital but clinical disease can develop in a community setting, after discharge. We report here a putative link between the above-mentioned healthcare associated infections that appeared as a dramatic community onset disease with a fulminant fatal outcome.

Case presentation

We describe the case of a 63 year old man affected by severe CDI. Even though the patient underwent 72 hours of standard CDI antibiotic treatment, the clinical course was complicated by toxic megacolon and KPC-Kp BSI. The patient died 24 hours after total colectomy.

Conclusion

The impact of HCA-BSIs in complicating CDI is still unknown. Intestinal inflammatory injury and disruption of intestinal flora by standard antibiotic treatment could be responsible for promoting difficult-to-treat infections in CDI. By preserving intestinal flora, Fidaxomicin could have a crucial role in preventing BSIs complicating severe CDI.

【 授权许可】

   
2014 Giuliano et al.; licensee BioMed Central Ltd.

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