title: Management of candidemia in patients with Clostridium difficile infection.
abstract: Patients with C. difficile infection (CDI) experience intestinal microflora changes that can promote the overgrowth and subsequent translocation of gut resident pathogens into the blood. Consistently, CDI due to PCR-ribotype 027 strain, severe or relapsing CDI, and treatment with high-dosage vancomycin are independent risk factors for candidemia.
  
  
  
  We review the role played by the gut microbiota during CDI and its treatment, as well as the clinical profile of CDI patients who are at risk of developing candidemia. Also, we discuss the management of these patients by focusing on pre-emptive strategies aimed at reducing the risk of candidemia, and on innovative anti-C. difficile therapies that may mitigate CDI-related effects such as the altered gut microbiota composition and prolonged intestinal mucosa damage. Expert commentary: A closer clinical and diagnostic monitoring of patients with CDI should help to limit the CDI-associated long-term consequences, including Candida infections, which worsen the outcome of hospitalized patients.
authors.affiliation: a Department of Public Health and Infectious Diseases , Sapienza University of Rome , Rome , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Falcone
authors.affiliation: a Department of Public Health and Infectious Diseases , Sapienza University of Rome , Rome , Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Venditti
authors.affiliation: b Institute of Microbiology , Università Cattolica del Sacro Cuore , Rome , Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Sanguinetti
authors.affiliation: c Institute of Public Health (Section of Hygiene) , Università Cattolica del Sacro Cuore , Rome , Italy.
authors.forename: Brunella
authors.initials: B
authors.lastname: Posteraro
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D058387:Candidemia / Q000097:blood / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D016360:Clostridioides difficile / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D004761:Enterocolitis, Pseudomembranous / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects / Q000382:microbiology*; D064307:Microbiota / Q000187:drug effects* / Q000235:genetics; D009761:Nystatin / Q000008:administration & dosage / Q000627:therapeutic use; D012307:Risk Factors; D047071:beta-Glucans / Q000097:blood
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D047071:beta-Glucans; D009761:Nystatin; C033363:beta-1,3-glucan
keywords: Candida bloodstream infection; Candida colonization; Clostridium difficile infection; PCR-ribotype 027; oral vancomycin