Extraintestinal Clostridium difficile infections: A Single Center Experience
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.
L. M. Baddour, None
D. Pardi, None
S. Khanna, None
See more of: Poster Abstract Session