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Volume 16, Number 8—August 2010

CME ACTIVITY - Synopsis

Clostridium difficile Bacteremia, Taiwan1

Nan-Yao Lee, Yu-Tsung Huang, Po-Ren Hsueh2, and Wen-Chien Ko2Comments to Author 
Author affiliations: National Cheng Kung University Hospital and Medical College, Tainan, Taiwan (N.-Y. Lee, W.-C. Ko); National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (Y.-T. Huang, P.-R. Hsueh); 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.

Main Article

Table 1

Clinical manifestations, antimicrobial drug therapy, and outcome of 12 patients with Clostridium difficile bacteremia, Taiwan, 1989–2009*

Patient no. Age, y/sex Clinical signs and symptoms Sources of bacteremia Coexisting condition(s) Copathogen(s) Clostridial toxin assay result Treatment/
outcome
Monomicrobial bacteremia
1 69/F Dead on arrival Primary bacteremia Liver cirrhosis None Positive None/died
2 38/M Abdominal pain IAI (primary peritonitis) Wilson disease None Negative Cefmetazole for 22 d/died
3 65/F Fever, abdominal pain IAI (secondary peritonitis) Perforated peptic ulcer with exploratory laparotomy None NA Metronidazole† for 10 d/died
4 58/M Fever, abdominal pain IAI (primary peritonitis) Liver cirrhosis None Negative Metronidazole† for 12 d/survived
5 12/M Fever, dyspnea Primary bacteremia Biliary atresia, liver transplantation None Negative Piperacillin- tazobactam and vancomycin† for 15 d/survived
6
41/F
Fever, dyspnea
Primary bacteremia
Pulmonary fibrosis
None
Negative
Ceftazidime and gentamicin for 13 d; vancomycin† for 10 d/survived
Polymicrobial bacteremia
7 45/M Abdominal pain Primary bacteremia Liver cirrhosis Coagulase- negative Staphylococcus spp. Positive Ceftriaxone for 3 d/died
8 83/M Fever, bloody stool Primary bacteremia Gastrointestinal bleeding, hypovolemic shock Escherichia coli Negative Imipenem for 1 d/died
9 87/F Bloody stool Primary bacteremia Congestive heart failure, end-stage renal disease, pseudomembranous colitis Pseudomonas aeruginosa, Enterococcus faecium, E. coli, ESBL–Klebsiella oxytoca Positive Vancomycin† and meropenem for 7 d/survived
10 80/F Bloody stool Primary bacteremia Liver cirrhosis, pseudomembranous colitis Coagulase- negative Staphylococcus spp. Positive Metronidazole† for 13 d/survived
11 66/F Fever, lower gastrointestinal bleeding, abdominal pain SSTI/septic arthritis Femoral neck fracture (received total hip replacement with prosthetic infections), chronic kidney disease Enterobacter cloacae Negative Debridement, cefepime and metronidazole† for 12 d/survived
12 75/F Fever, chills, nausea, vomiting, abdominal pain IAI (primary peritonitis) Lymphoma, biliary tract infection K. pneumoniae, Clostridium perfringens NA Cefepime for 10 d and metronidazole† for 7 d/survived

* IAI, intra-abdominal infection; NA, not available; SSTI, skin and soft tissue infection; ESBL, extended-spectrum β-lactamase.
†In vitro active against C. difficile.

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