EXTRAINTESTINAL CLOSTRIDIUM-DIFFICILE - 10 YEARS EXPERIENCE AT A TERTIARY-CARE HOSPITAL

Objective: To determine the clinical characteristics of patients with extraintestinal Clostridium difficile (ECD). Material and Methods: All cultures obtained during a 10.5-year period (from Jan. 1, 1985, to Ju n. 30, 1995) at a tertiary-care hospital were retrospectively examined . The medical records of patients from whom ECD was isolated were then reviewed. Results: Fourteen patients from whom ECD was cultured were identified. Thirteen of these patients (93%) had underlying systemic d isease. All but one patient had recent exposure to antibiotics, and al l had major bowel pathologic conditions. Nine patients had colon perfo ration. Of the eight patients in whom the colonic mucosa was directly inspected at operation or endoscopy, only two had evidence of pseudome mbranous colitis. Five patients (36%) had documentation of recent diar rhea, ECD was isolated from intraperitoneal sites (in nine patients), blood cultures (in three), a perianal abscess, and a prosthetic hip jo int. In 13 patients (93%), the infection was polymicrobial, Seven of t he 13 inpatients (54%) survived to dismissal. Conclusion: C. difficile is a rare isolate outside of the gastrointestinal tract. ECD is found in patients with systemic illness who have been hospitalized (usually for an extended period), have intestinal pathologic conditions, and h ave received antibiotics. The isolation of ECD portends a poor prognos is.