Clostridium difficile bacteremia: Report of two cases in French hospitals and comprehensive review of the literature

Mouna Doufair; Catherine Eckert; Laurence Drieux; Come Amani-Moibeni; Liliane Bodin; Michel Denis; Jean Didier Grange; Guillaume Arlet; Frédéric Barbut

doi:10.1016/j.idcr.2017.03.012

Clostridium difficile bacteremia: Report of two cases in French hospitals and comprehensive review of the literature

IDCases. 2017 Mar 28:8:54-62. doi: 10.1016/j.idcr.2017.03.012. eCollection 2017.

Authors

Mouna Doufair¹, Catherine Eckert^{2

3}, Laurence Drieux⁴, Come Amani-Moibeni⁵, Liliane Bodin⁶, Michel Denis⁷, Jean Didier Grange⁵, Guillaume Arlet¹, Frédéric Barbut^{2

3

8}

Affiliations

¹ AP-HP, HUEP (Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Est Parisien), Bacteriology Department, Paris, France.
² UPMC, Univ Paris 06, GRC n°2 EPIDIFF, Paris, France.
³ AP-HP, Saint-Antoine Hospital, National Reference Laboratory for C. Difficile, France.
⁴ AP-HP, la Pitié-Salpétrière Hospital, Bacteriology Department, Paris, France.
⁵ AP-HP, Tenon Hospital, Hepato-Gastro-Enterology Unit, Paris, France.
⁶ AP-HP, la Pitié-Salpétrière Hospital, Intensive Care Unit, Paris, France.
⁷ AP-HP, Tenon Hospital, Infection Diseases Unit, Paris, France.
⁸ AP-HP, Saint-Antoine Hospital, UHLIN, Paris, France.

Abstract

We report two cases of bacteremia due to Clostridium difficile from two French hospitals. The first patient with previously diagnosed rectal carcinoma underwent courses of chemotherapy, and antimicrobial treatment, and survived the C. difficile bacteremia. The second patient with colon perforation and newly diagnosed lung cancer underwent antimicrobial treatment in an ICU but died shortly after the episode of C. difficile bacteremia. A review of the literature allowed the identification of 137 cases of bacteremia between July 1962 and November 2016. Advanced age, gastro-intestinal disruption, severe underlying diseases and antimicrobial exposure were the major risk factors for C. difficile bacteremia. Antimicrobial therapy was primarily based on metronidazole and/or vancomycin. The crude mortality rate was 35% (21/60).

Keywords: Clostridium difficile bacteremia; Outcome; Toxin; Treatment.

Publication types

Case Reports