Extra-intestinal infections caused by Clostridium difficile

The objective of this paper was to investigate the incidence of extra-intes tinal infections caused by Clostridium difficile. During a 10-year period, the microbiology laboratory of our institution isolated 2034 isolates of C. difficile. Of the 2034 isolates, 21 (1.08%) were obtained from extra-intes tinal sources. This represents an incidence of extra-intestinal isolation o f four cases per 100 000 admissions. We were able to review the records of 17 patients for our study. The isolates in 12 patients were obtained from s tructures or fluids anatomically close to the colon and included the follow ing infections: peritonitis in five cases (three primary and two secondary) , infra-abdominal abscesses in three patients and abdominal wound infection s in four cases. The infections in the other five patients were not in the anatomic vicinity of the colon. They included one case with a brain abscess , two episodes of bacteremia and two cases of foot infections (one chronic osteomyelitis). In all but one case, C. difficile isolation was obtained as part of a polymicrobial flora. The isolates were frequently non-toxigenic and the extra-intestinal infections occurred without concomitant diarrhea o r prior anti-microbial therapy. Out of the 17 patients, eight died and nine survived. Death could not be directly attributed to C. difficile in any of the cases. The isolation of C. difficile outside the intestinal tract is v ery uncommon. Its clinical significance should be interpreted with caution.