Giuliano Simone, Guastalegname Maurizio, Jenco Miryam, Morelli Andrea, Falcone Marco, Venditti Mario
Department of Public Health and Infectious Diseases Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
BMC Infect Dis. 2014 Sep 1;14:475. doi: 10.1186/1471-2334-14-475.
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.
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.
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.
艰难梭菌感染（CDI）和产肺炎克雷伯菌碳青霉烯酶的肺炎克雷伯菌（KPC-Kp）血流感染（BSI）是新出现的与医疗保健相关（HCA）的疾病，在发病率、死亡率以及对抗生素治疗反应不足方面引发了公共卫生关注。这两种病原体都可在医院获得，但临床疾病也可能在出院后的社区环境中发生。我们在此报告上述与医疗保健相关感染之间的一种假定联系，该感染表现为一种具有暴发性致命结局的严重社区发病疾病。
我们描述了一名63岁患有严重CDI的男性病例。尽管患者接受了72小时的标准CDI抗生素治疗，但临床病程因中毒性巨结肠和KPC-Kp BSI而复杂化。患者在全结肠切除术后24小时死亡。
HCA-BSIs在使CDI复杂化方面的影响仍不清楚。标准抗生素治疗导致的肠道炎性损伤和肠道菌群破坏可能是促使CDI中出现难以治疗的感染的原因。通过保护肠道菌群，非达霉素在预防BSIs使严重CDI复杂化方面可能具有关键作用。
