title: Candidemia, and infections by Clostridium difficile and carbapenemase-producing Enterobacteriaceae: new enteropathogenetic opportunistic syndromes?
abstract: In this paper we analyze three enteropathogenetic opportunistic infections represented by Candida spp., C. difficile and carbapenemase-producing K. pneumoniae. The common pathogenetic pathway is based on an alteration of the intestinal flora, now mainly referred as the human microbiome, with secondary opportunism for infections caused by Candida, C. difficile and carbapenemase-producing Enterobacteriaceae ("CCC"). We highlight the epidemiology, risk factors, clinical syndromes associated with the pathogens and we propose some new issues related to the epidemiology and diagnosis of candidemia, also using hierarchical cluster analysis, definitions of levels of interventions in patients colonized or infected by carbapenemase-producing bacteria. The "enteropathogenetic" opportunistic syndromes are best prevented with antimicrobial stewardship programs aiming at increasing diagnostic specificity of infectious syndromes to reduce the antimicrobial use and costs. Appropriate guidelines for infection control should also be implemented to reduce the nosocomial spread of enteropathogenetic microbes.
authors.affiliation: Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
authors.forename: Francesco Giuseppe
authors.initials: FG
authors.lastname: De Rosa
authors.affiliation: Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Corcione
authors.affiliation: Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Raviolo
authors.affiliation: Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Montrucchio
authors.affiliation: Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Aldieri
authors.affiliation: Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
authors.forename: Nicole
authors.initials: N
authors.lastname: Pagani
authors.affiliation: Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Perri
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000096:biosynthesis* / Q000378:metabolism; D058387:Candidemia / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D016360:Clostridioides difficile / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D003015:Clostridium Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D003428:Cross Infection / Q000517:prevention & control*; D004756:Enterobacteriaceae Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D009894:Opportunistic Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D013577:Syndrome; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase