Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
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 3

In vitro antimicrobial drug susceptibilities of 10 bacteremic Clostridium difficile isolates, Taiwan, 1989–2009*

Antimicrobial agent MIC, μg/mL
 Resistance breakpoint, μg/mL No. (%) resistant isolates
Range MIC50 MIC90
Vancomycin† 0.5–1 0.5 1 >2 0
Metronidazole 0.25–8 1 4 >32 0
Clindamycin 0.03–>256 4 >256 >8 3 (30)
Penicillin 0.25–8 4 4 >2 9 (90)
Ampicillin/sulbactam 0.5–8 2 4 >32/16 0
Cefmetazole 0.25–32 16 32 >64 0
Meropenem 0.12–2 1 2 >16 0
Imipenem 0.12–16 8 16 >16 4 (40)
Ertapenem 0.06–16 8 8 >16 0
Doripenem 0.12–8 4 4 NA NA
Daptomycin 0.12–2 0.5 2 NA NA
Tigecycline 0.03–0.12 0.03 0.06 NA NA
Fusidic acid 1–8 1 2 NA NA

*MIC50, 50% MIC; MIC90, 90% MIC, NA, not available.
†Vancomycin MIC breakpoint was recommended by the European Committee on Antimicrobial Susceptibility Testing (www.eucast.org); otherwise by the Clinical and Laboratory Standards Institute (22).

Main Article

References
  1. Aslam  S, Hamill  RJ, Musher  DM. Treatment of Clostridium difficile–associated disease: old therapies and new strategies. Lancet Infect Dis. 2005;5:549–57. DOIPubMedGoogle Scholar
  2. Rupnik  M, Wilcox  MH, Gerding  DN. Clostridium difficile infection: new developments in epidemiology and pathogenesis. Nat Rev Microbiol. 2009;7:526–36. DOIPubMedGoogle Scholar
  3. Garcia-Lechuz  JM, Hernangomez  S, Juan  RS, Pelaez  T, Alcala  L, Bouza  E. Extra-intestinal infections caused by Clostridium difficile. Clin Microbiol Infect. 2001;7:453–7. DOIPubMedGoogle Scholar
  4. Jacobs  A, Barnard  K, Fishel  R, Gradon  JD. Extracolonic manifestations of Clostridium difficile infections. Presentation of 2 cases and review of the literature. Medicine (Baltimore). 2001;80:88–101. DOIPubMedGoogle Scholar
  5. Byl  B, Jacobs  F, Struelens  MJ, Thys  JP. Extraintestinal Clostridium difficile infections. Clin Infect Dis. 1996;22:712. DOIPubMedGoogle Scholar
  6. Libby  DB, Bearman  G. Bacteremia due to Clostridium difficile–review of the literature. Int J Infect Dis. 2009;13:e305–9. DOIPubMedGoogle Scholar
  7. Saginur  R, Fogel  R, Begin  L, Cohen  B, Mendelson  J. Splenic abscess due to Clostridium difficile. J Infect Dis. 1983;147:1105. DOIPubMedGoogle Scholar
  8. Rampling  A, Warren  RE, Bevan  PC, Hoggarth  CE, Swirsky  D, Hayhoe  FG. Clostridium difficile in haematological malignancy. J Clin Pathol. 1985;38:445–51. DOIPubMedGoogle Scholar
  9. Feldman  RJ, Kallich  M, Weinstein  MP. Bacteremia due to Clostridium difficile: case report and review of extraintestinal C. difficile infections. Clin Infect Dis. 1995;20:1560–2. DOIPubMedGoogle Scholar
  10. Wolf  LE, Gorbach  SL, Granowitz  EV. Extraintestinal Clostridium difficile: 10 years’ experience at a tertiary-care hospital. Mayo Clin Proc. 1998;73:943–7. DOIPubMedGoogle Scholar
  11. McCabe  WR, Jackson  GG. Gram-negative bacteremia: I. Etiology and ecology. Arch Intern Med. 1962;110:847–55.
  12. Charlson  ME, Pompei  P, Ales  KL, MacKenzie  CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83. DOIPubMedGoogle Scholar
  13. Knaus  WA, Draper  EA, Wagner  DP, Zimmerman  JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29. DOIPubMedGoogle Scholar
  14. Le Gall  JR, Lemeshow  S, Saulnier  F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270:2957–63. DOIPubMedGoogle Scholar
  15. Yu  VL, Chiou  CC, Feldman  C, Ortqvist  A, Rello  J, Morris  AJ, An international prospective study of pneumococcal bacteremia: correlation with in vitro resistance, antibiotics administered, and clinical outcome. Clin Infect Dis. 2003;37:230–7. DOIPubMedGoogle Scholar
  16. Bone  RC, Balk  RA, Cerra  FB, Dellinger  RP, Fein  AM, Knaus  WA, Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101:1644–55. DOIPubMedGoogle Scholar
  17. Garner  JS, Jarvis  WR, Emori  TG, Horan  TC, Hughes  JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128–40. DOIPubMedGoogle Scholar
  18. Baron  EJ, Weissfeld  AS, Fuselier  PA, Brenner  DJ. Classification and identification of bacteria. In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, editors. Manual of clinical microbiology, 6th ed. Washington: American Society for Microbiology Press; 1995. p. 249–64.
  19. Persson  S, Torpdahl  M, Olsen  KE. New multiplex PCR method for the detection of Clostridium difficile toxin A (tcdA) and toxin B (tcdB) and the binary toxin (cdtA/cdtB) genes applied to a Danish strain collection. Clin Microbiol Infect. 2008;14:1057–64. DOIPubMedGoogle Scholar
  20. Klaassen  CH, van Haren  HA, Horrevorts  AM. Molecular fingerprinting of Clostridium difficile isolates: pulsed-field gel electrophoresis versus amplified fragment length polymorphism. J Clin Microbiol. 2002;40:101–4. DOIPubMedGoogle Scholar
  21. Spigaglia  P, Mastrantonio  P. Evaluation of repetitive element sequence-based PCR as a molecular typing method for Clostridium difficile. J Clin Microbiol. 2003;41:2454–7. DOIPubMedGoogle Scholar
  22. Clinical and Laboratory Standards Institute. Methods for antimicrobial susceptibility testing of anaerobic bacteria. Approved standard, 7th ed. M11–A7. Wayne (PA): The Institute; 2007.
  23. Bedimo  R, Weinstein  J. Recurrent extraintestinal Clostridium difficile infection. Am J Med. 2003;114:770–1. DOIPubMedGoogle Scholar
  24. Cid  A, Juncal  AR, Aguilera  A, Regueiro  BJ, Gonzalez  V. Clostridium difficile bacteremia in an immunocompetent child. J Clin Microbiol. 1998;36:1167–8.PubMedGoogle Scholar
  25. Genta  VM, Gilligan  PH, McCarthy  LR. Clostridium difficile peritonitis in a neonate. A case report. Arch Pathol Lab Med. 1984;108:82–3.PubMedGoogle Scholar
  26. Studemeister  AE, Beilke  MA, Kirmani  N. Splenic abscess due to Clostridium difficile and Pseudomonas paucimobilis. Am J Gastroenterol. 1987;82:389–90.PubMedGoogle Scholar
  27. Spencer  RC, Courtney  SP, Nicol  CD. Polymicrobial septicaemia due to Clostridium difficile and Bacteroides fragilis. Br Med J (Clin Res Ed). 1984;289:531–2. DOIPubMedGoogle Scholar
  28. Smith  LD, King  EO. Occurrence of Clostridium difficile in infections of man. J Bacteriol. 1962;84:65–7.PubMedGoogle Scholar
  29. Gerard  M, Defresne  N, Van der Auwera  P, Meunier  F. Polymicrobial septicemia with Clostridium difficile in acute diverticulitis. Eur J Clin Microbiol Infect Dis. 1989;8:300–2. DOIPubMedGoogle Scholar
  30. Elliott  B, Reed  R, Chang  BJ, Riley  TV. Bacteremia with a large clostridial toxin-negative, binary toxin-positive strain of Clostridium difficile. Anaerobe. 2009;15:249–51. DOIPubMedGoogle Scholar
  31. Benjamin  B, Kan  M, Schwartz  D, Siegman-Igra  Y. The possible significance of Clostridium spp. in blood cultures. Clin Microbiol Infect. 2006;12:1006–12. DOIPubMedGoogle Scholar
  32. Rechner  PM, Agger  WA, Mruz  K, Cogbill  TH. Clinical features of clostridial bacteremia: a review from a rural area. Clin Infect Dis. 2001;33:349–53. DOIPubMedGoogle Scholar
  33. Pietrafitta  JJ, Deckers  PJ. Significance of clostridial bacteremia. Am J Surg. 1982;143:519–22. DOIPubMedGoogle Scholar
  34. Balzan  S, de Almeida Quadros  C, de Cleva  R, Zilberstein  B, Cecconello  I. Bacterial translocation: overview of mechanisms and clinical impact. J Gastroenterol Hepatol. 2007;22:464–71. DOIPubMedGoogle Scholar
  35. Chen  YM, Lee  HC, Chang  CM, Chuang  YC, Ko  WC. Clostridium bacteremia: emphasis on the poor prognosis in cirrhotic patients. J Microbiol Immunol Infect. 2001;34:113–8.PubMedGoogle Scholar
  36. Kelly  CP, Pothoulakis  C, LaMont  JT. Clostridium difficile colitis. N Engl J Med. 1994;330:257–62. DOIPubMedGoogle Scholar
  37. Salonen  JH, Eerola  E, Meurman  O. Clinical significance and outcome of anaerobic bacteremia. Clin Infect Dis. 1998;26:1413–7. DOIPubMedGoogle Scholar
  38. Bartlett  JG. Narrative review: the new epidemic of Clostridium difficile–associated enteric disease. Ann Intern Med. 2006;145:758–64.PubMedGoogle Scholar

Main Article

Page created: March 30, 2011
Page updated: March 30, 2011
Page reviewed: March 30, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external