Program Schedule

Extraintestinal Clostridium difficile infections: A Single Center Experience

Session: Poster Abstract Session: Clostridium difficile Infection: Epidemiology, Presentation, Treatment
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • EICDI poster_Gupta.pdf (196.7 kB)
  • Background: Clostridium difficile is the most common cause of infectious diarrhea in hospitalized patients, but is rarely isolated from sites outside the gastrointestinal tract.  Considering the increasing burden of infection due to this organism in both the community and health care settings, the increased virulence of some strains, and the expansion of “at risk” patient populations, an increasing number of extraintestinal C. difficile infections (CDI) might be anticipated. 

    Methods: A retrospective chart review was conducted to identify patients with extraintestinal C. difficile culture isolates from 01/01/2004 to 12/31/2013. Medical records were reviewed and data, including demographics, microbiology, risk factors, management and infection outcomes, were abstracted. 

    Results: Overall, 40 patients with extraintestinal CDI were identified; 25 had abdominopelvic infections; 11 had bloodstream infections; three had wound infections and one had pulmonary infection. C. difficile was isolated with other organisms in 63% of cases. A majority (85%) of infections were nosocomial. Risk factors associated with extra-intestinal CDI included surgical manipulation of the gastrointestinal (GI) tract (88%), recent antibiotic exposure (88%), malignancy (50%) and proton pump inhibitor (PPI) use (50%). Diarrhea was present in 18 patients (45%), 12 of whom had C. difficile PCR positive  stool samples. All isolates were susceptible to metronidazole and piperacillin-tazobactam. Management included both antimicrobial therapy and guided drainage or surgical intervention in all but one patient. The infection-associated mortality rate was 25%, with death occurring a median of 16 days (range 1-61 days) after isolation of C. difficile

    Conclusion: Extraintestinal CDI is uncommon, and often occurs in patients with surgical manipulation of the GI tract and well-recognized risk factors for intestinal CDI.  Management of extraintestinal CDI includes both antimicrobial and surgical therapies. Extraintestinal CDI is characterized by poor outcome with high mortality.  

    Arjun Gupta, MBBS1, Robin Patel, MD, FIDSA, FRCP(C), D(ABMM), FACP, F(AAM)2, Larry M. Baddour, MD3, Darrell Pardi, MD, MS4 and Sahil Khanna, MBBS, MS4, (1)Division of Infectious Diseases, Mayo Clinic, Rochester, MN, (2)Divisions Of Clinical Microbiology and Infectious Diseases, Mayo Clinic, Rochester, MN, (3)Infectious Diseases, Mayo Clinic, Rochester, MN, (4)Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN


    A. Gupta, None

    R. Patel, None

    L. M. Baddour, None

    D. Pardi, None

    S. Khanna, None

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