Clostridium difficile Bacteremia, Taiwan1

EID Journal Home > Volume 16, Number 8–August 2010

Volume 16, Number 8–August 2010
Synopsis
Clostridium difficile Bacteremia, Taiwan1
Nan-Yao Lee, Yu-Tsung Huang, Po-Ren Hsueh,2 and Wen-Chien Ko2

Author affiliations: National Cheng Kung University Hospital and Medical College, Tainan, Taiwan (N.-Y. Lee, W.-C. Ko); and National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (Y.-T. Huang, P.-R. Hsueh)

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Abstract
To determine clinical characteristics and outcome of patients with Clostridium difficile bacteremia (CDB), we identified 12 patients with CDB in 2 medical centers in Taiwan; all had underlying systemic diseases. Five had gastrointestinal diseases or conditions, including pseudomembranous colitis (2 patients); 4 recalled diarrhea, but only 5 had recent exposure to antimicrobial drugs. Ten available isolates were susceptible to metronidazole and vancomycin. Five isolates had C. difficile toxin A or B. Of 5 patients who died, 3 died of CDB. Of 8 patients treated with metronidazole or vancomycin, only 1 died, and all 4 patients treated with other drugs died (12.5% vs. 100%; p = 0.01). C. difficile bacteremia, although uncommon, is thus associated with substaintial illness and death rates.

Clostridium difficile is well recognized as the etiologic agent of pseudomembranous colitis and has been implicated as the cause of 10%–25% of cases of antimicrobial drug–associated diarrhea (1 ). The pathogen has been responsible for numerous recent hospital-based epidemics and is also emerging in the community (2 ). The clinical features, disease spectrum and pathogenesis, and optimal treatments of C. difficile–associated diarrhea have been well studied. In contrast, reports of the isolation of C. difficile in body sites other than the intestines, or extraintestinal infections, have been anecdotal (3,4 ). Extracolonic manifestations of C. difficile infections reported were variable, including bacteremia, osteomyelitis, visceral abscess, empyema, reactive arthritis, pyelonephritis, prosthetic joint infection, and skin and soft tissue infection (3–10 ). Most cases of extracolonic C. difficile infections have been preceded by gastrointestinal events, either C. difficile colitis or surgical and anatomic disruption of the colon (4 ).

Recently, Libby and Bearman reviewed the literature on bacteremia caused by C. difficile (6 ). Most cases were identified from individual case reports. However, as the incidence of C. difficile infection increases, an increase in cases of C. difficile bacteremia (CDB) is likely (10 ). Knowledge of the clinical signs and symptoms of these extracolonic manifestations of bloodstream infections will be useful in patient care and could improve clinical outcomes (4 ). To outline the spectrum and clinical significance of CDB, we report 12 cases of CDB over a recent 10-year period at 2 medical centers in Taiwan and review the literature published in English.

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Suggested Citation for this Article
Suggested citation for this article: Lee N-Y, Huang Y-T, Hsueh P-R, Ko W-C. Clostridium difficile bacteremia, Taiwan. Emerg Infect Dis [serial on the Internet] 2010 Aug [ date cited]. http://www.cdc.gov/EID/content/16/8/1204.htm

DOI: 10.3201/eid1608.100064

1This study was presented in part at the Annual Meeting of the Infectious Disease Society of Taiwan, Taipei, Taiwan, January 9–10, 2010.
2These authors contributed equally to this article.