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Volume 16, Number 8—August 2010

CME ACTIVITY

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.

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Table 2

Summary of clinical characteristics of 12 patients with Clostridium difficile bacteremia in the current series from Taiwan, 1989–2009, and of 20 additional cases published since 1962*

Characteristic Total, n = 32 Reported cases, n = 20 Current series, n = 12 p value
Age, y, mean ± SD 51.4 ± 26.1 46.2 ± 27.5 59.9 ± 22.2 0.14
Elderly, age >60 y 18 (56.3) 11 (55.0) 7 (58.3) 1.0
Male
19 (59.4)
14 (70.0)
5 (41.7)
0.15
Place of acquisition 0.70
Community 12/28 (42.9) 5/16 (73.3) 7 (58.3)
Hospital
16/28 (57.1)
11/16 (26.7)
5 (41.7)

Calendar year range 0.001
1962–1990 8 (25) 8 (40.0) 0
1991–2000 8 (25) 7 (35.0) 1 (8.3)
After 2000
16 (50)
5 (25.0)
11 (91.7)

Comorbidity
Malignancy 9 (28.1) 6 (30.0) 3 (25.0) 1.0
Congestive heart failure 4 (12.5) 3 (15.0) 1 (8.3) 1.0
Immunosuppression 7 (21.9) 2 (10.0) 5 (41.7) 0.07
Chronic obstructive pulmonary disease 3 (9.4) 2 (10.0) 1 (8.3) 1.0
Chronic kidney disease 3 (9.4) 1 (5.0) 2 (16.7) 0.54
Liver cirrhosis 7 (21.9) 1 (5.0) 6 (50.0) 0.006
Cerebrovascular accident 2 (6.3) 1 (5.0) 1 (8.3) 1.0
Diabetes mellitus 4 (12.5) 0 4 (33.3) 0.014
Organ transplant 2 (6.3) 0 2 (16.6) 0.13
None
6 (18.8)
6 (30.0)
0
0.06
Clinical signs and symptoms
Fever 19/27 (70.4) 10/15 (66.7) 9 (75.0) 0.70
Abdominal pain 14/29 (48.3) 8/17 (47.1) 6 (50.0) 1.0
Diarrhea
12/28 (42.9)
8/16 (50.0)
4 (33.3)
0.46
Gastrointestinal disease or condition 10/28 (35.7) 5/16 (31.3) 5 (41.7) 0.7
Gastrointestinal bleeding 5/27 (18.5) 0/15 (0.0) 5 (41.7) 0.01
Gastrointestinal perforation 3/28 (10.7) 2/16 (12.5) 1 (8.3) 1.0
Pseudomembranous colitis
5/27 (18.5)
3/15 (20.0)
2 (16.7)
1.0
Recent antimicrobial drug exposure
18/26 (69.2)
13/14 (92.9)
5 (41.7)
0.009
Sources of bacteremia
Primary 17 (53.1) 10 (50.0) 7 (58.3) 0.73
Intraabdominal infection 11 (34.4) 7 (35.0) 4 (33.3) 1.0
Urosepsis 2 (6.3) 2 (10.0) 0 0.52
Skin and soft tissue infection 2 (6.3) 1 (5.0) 1 (8.3) 1.0
Bone and joint infection 1 (3.1) 0 1 (8.3) 0.38
Polymicrobial bacteremia
20 (62.5)
14 (70.0)
6 (50.0)
0.29
Positive clostridial toxin assay result 14/22 (63.6) 9/12 (75.0) 5/10 (50.0) 0.42
Crude death rate 15/31 (48.4) 10/19 (52.6) 5 (41.7) 0.72

*Values are no. patients (%) or no. patients/total no. patients evaluated (%), except for age. Patients may have >1 morbidity, clinical sign or symptom, and gastrointestinal disease or condition.

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