title: Severe community onset healthcare-associated Clostridium difficile infection complicated by carbapenemase producing Klebsiella pneumoniae bloodstream infection.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: Simone
authors.initials: S
authors.lastname: Giuliano
authors.forename: Maurizio
authors.initials: M
authors.lastname: Guastalegname
authors.forename: Miryam
authors.initials: M
authors.lastname: Jenco
authors.forename: Andrea
authors.initials: A
authors.lastname: Morelli
authors.forename: Marco
authors.initials: M
authors.lastname: Falcone
authors.affiliation: Department of Public Health and Infectious Diseases Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy. mario.venditti@uniroma1.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Venditti
mesh_terms: D000617:Aminoglycosides / Q000737:chemistry / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000401:mortality; D001426:Bacterial Proteins / Q000737:chemistry*; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000097:blood / Q000188:drug therapy* / Q000401:mortality*; D060085:Coinfection; D003428:Cross Infection / Q000188:drug therapy* / Q000401:mortality*; D017809:Fatal Outcome; D000077732:Fidaxomicin; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000401:mortality; D007711:Klebsiella pneumoniae; D008297:Male; D008875:Middle Aged; D001618:beta-Lactamases / Q000737:chemistry*
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase; D000077732:Fidaxomicin