Bacteremia due to Clostridium difficile—review of the literature

Abstract

Extracolonic Clostridium difficile infections have been infrequently reported. Extracolonic manifestations of C. difficile include bacteremia, intra-abdominal abscess, osteomyelitis, visceral abscess, empyema, reactive arthritis, and small bowel disease with formation of pseudomembranes on ileal mucosa. Most cases of extracolonic C. difficile have been preceded by gastrointestinal disease, either C. difficile colitis or surgical and anatomical disruption of the colon. Bacteremia due to C. difficile has previously been described in 14 patients with underlying gastrointestinal processes. We report a unique case of monomicrobial C. difficile bacteremia in a young woman with an underlying hematologic malignancy. The patient lacked gastrointestinal symptoms or radiologic findings suggestive of colitis or ongoing gastrointestinal pathology.

Clostridium difficileinfection

“…13 Clearly established risk factors include: age above 65 years, co-morbidities, immune-suppression, cancer, gastrointestinal disorders, previous antibiotic use, and previous hospitalization.…”

Mycotic Iliac Artery Aneurysm Caused by Clostridiumdifficile in a Patient with Axillobifemoral Bypass for Leriche Syndrome

“…C. difficile toxins might, therefore, cause mucosal damage resulting in bacteremia. 3) A review by Libby et al 6) found that all adult patients with C. difficile bacteremia had concomitant gastrointestinal pathology such as diarrhea, small bowel obstruction, or ischemic colitis, which may compromise the integrity of the gastrointestinal tract. They reported that C. difficile bacteremia was strongly associated with prior antibiotic exposure but that there was no significant association between C. difficile arteritis and colonic tumors.…”

“…In our patient, the atherosclerotic lesions in the occluded arteries, where oxygen delivery and pH were reduced, provided an environment where C. difficile was able to grow and form a mycotic aneurysm. Libby et al 6) reported that compromised immunological status was associated with extracolonic C. difficile infection. In our patient, chronic renal failure may have contributed to providing suitable conditions for C. difficile to infect the atherosclerotic lesions.…”

Bacteraemia and breast abscess: unusual extra-intestinal manifestations of Clostridium difficile infection

“…Intravenous vancomycin and metronidazole were commonly used (Lee et al, 2010;Libby & Bearman, 2009). A crude mortality rate of up to 50 % was reported by Libby & Bearman (2009) for C. difficile bacteraemia. It is, however, difficult to attribute this solely to the bacteraemia as most of the cases had severe underlying pathology that could have been the cause of death.…”

“…Most cases are usually preceded by gastrointestinal infection. Often, mixed infections with other gut pathogens are found (Libby & Bearman, 2009;Spencer et al, 1984). However, it is difficult to interpret the clinical relevance of such isolates from extra-intestinal sources and in some cases they may only represent contamination with faecal commensals.…”