Volume 16, Number 8—August 2010
CME ACTIVITY - Synopsis
Clostridium difficile Bacteremia, Taiwan1
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.