Le. Wolf et al., EXTRAINTESTINAL CLOSTRIDIUM-DIFFICILE - 10 YEARS EXPERIENCE AT A TERTIARY-CARE HOSPITAL, Mayo Clinic proceedings, 73(10), 1998, pp. 943-947
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.