Secondary bacterial peritonitis and pelvic abscess due to Clostridium difficile

Abstract

A 70-year-old man with a history of hepatic cirrhosis presented with abdominal discomfort and distention. Physical examination revealed abdominal distention, positive fluid wave and abdominal tenderness. Due to concerns for spontaneous bacterial peritonitis (SBP), paracentesis was performed. Fluid analysis revealed 5371 total nucleated cells with 48% neutrophils. Ceftriaxone was then initiated for the treatment of SBP. Bacterial cultures of the fluid, however, grew Clostridium difficile. Therefore, metronidazole was added. An abdominal ultrasound revealed a pelvic fluid collection that was suspicious for an abscess on an abdominal CT scan. The patient underwent CT-guided drain placement into the pelvic fluid collection. The fluid aspirate was consistent with an abscess. However, cultures were negative in the setting of ongoing antibiotic therapy. The patient was treated with a 10-day course of ceftriaxone and metronidazole and was discharged home with outpatient follow-up.

Extraintestinal Clostridioides difficile Infection (CDI): A Recurrent Battle with Resilient Abdominal Wall Abscess

“…We treated based on the usual resistance patterns with empiric broad-spectrum antibiotics despite the initial monomicrobial culture due to the potential for unrecognised polymicrobial infection. Similar antibiotic regimens were used in other case reports as well [ 2 , 14 , 15 ] . Our patient subsequently developed proven polymicrobial infection, possibly from translocation of organisms from the exterior through the drainage catheter tract.…”

A Difficult Microbiologic Diagnosis of Spontaneous Peritonitis

“…1,[3][4][5][6][7][8][9] Several cases of secondary bacterial peritonitis due to C. difficile have been previously described in the literature, but only 11 cases of SBP have been reported. 1,3,4,10 Most reported infections of extracolonic C. difficile have been polymicrobial. 5 Chung et al 3 reported 60% of extracolonic cultures of C. difficile as polymicrobial.…”

“…Extraintestinal manifestations include peritoneal infections, osteomyelitis, wound infection, perianal abscess, bacteremia, urinary tract infections, lung infections, and reactive arthritis 1,3–9 . Several cases of secondary bacterial peritonitis due to C. difficile have been previously described in the literature, but only 11 cases of SBP have been reported 1,3,4,10 …”