Extra-intestinal infections caused by Clostridium difficile

Abstract

The objective of this paper was to investigate the incidence of extra-intestinal infections caused by Clostridium difficile. During a 10-year period, the microbiology laboratory of our institution isolated 2034 isolates of C. difficile. Of the 2034 isolates, 21 (1.08%) were obtained from extra-intestinal sources. This represents an incidence of extra-intestinal isolation of four cases per 100 000 admissions. We were able to review the records of 17 patients for our study. The isolates in 12 patients were obtained from structures or fluids anatomically close to the colon and included the following infections: peritonitis in five cases (three primary and two secondary), intra-abdominal abscesses in three patients and abdominal wound infections in four cases. The infections in the other five patients were not in the anatomic vicinity of the colon. They included one case with a brain abscess, two episodes of bacteremia and two cases of foot infections (one chronic osteomyelitis). In all but one case, C. difficile isolation was obtained as part of a polymicrobial flora. The isolates were frequently non-toxigenic and the extra-intestinal infections occurred without concomitant diarrhea or prior anti-microbial therapy. Out of the 17 patients, eight died and nine survived. Death could not be directly attributed to C. difficile in any of the cases. The isolation of C. difficile outside the intestinal tract is very uncommon. Its clinical significance should be interpreted with caution.

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

“…In our patient, colonoscopy performed after intensive antibiotic therapy for septic shock showed pseudomembranous colitis, which is well known to be caused by C. difficile infection, but stool toxin testing and blood cultures were negative. García-Lechuz et al 8) reported that extracolonic C. difficile infection does not always produce toxins, and that blood cultures are…”

Infecciones extra-intestinales por Clostridium difficile

“…Si bien, se han publicado casos aislados o series cortas 1,2 , el resto de las comunicaciones son escasas y muy heterogéneas.Objetivos: Evaluar la relevancia clínica de la infección extra-intestinal por Clostridium difficile (IECD) en una institución de salud, describiendo el manejo de estas raras infecciones y sus resultados.Método: Se realizó una revisión retrospectiva de registros médicos de la Clínica Mayo Rochester para identificar a los pacientes con aislamiento de CD en sitios extra-intestinales entre los años 2004 y 2013. Se extrajeron datos como las características demográficas, cultivos microbiológicos, asociaciones clínicas y resultados del manejo de tales infecciones.…”

“…Si bien, se han publicado casos aislados o series cortas 1,2 , el resto de las comunicaciones son escasas y muy heterogéneas.…”

Spondylodiscitis Due to Clostridium ramosum Infection in an Immunocompetent Elderly Patient

“…C. perfringens is the Clostridium species most frequently isolated from blood culture, and Clostridium septicum is the Clostridium species most frequently isolated from intra-abdominal specimens (2, 4, 5, 16). Bone infection is uncommon: to the best of our knowledge, C. difficile is the bacterium most frequently isolated from bone specimens (4,5,14,16,26). However, no more than six cases of clearly established osteomyelitis due to Clostridium spp.…”

“…However, no more than six cases of clearly established osteomyelitis due to Clostridium spp. have been reported (14). As is true for other endogenous infections due to anaerobes, the development of clostridial disease is usually associated with common predisposing factors, including underlying illness such as cancer, leukemia, and diabetes mellitus (2).…”