Clostridium difficileBacteremia, Taiwan1

To determine clinical characteristics and outcome of patients with Clostridium diffi cile bacteremia (CDB), we identifi ed 12 patients with CDB in 2 medical centers in Taiwan; all had underlying systemic diseases.Five had gastrointestinal diseases or conditions, including pseudomembranous colitis (2 patients); 4 recalled diarrhea, but only 5 had recent exposure to antimicrobial drugs.Ten available isolates were susceptible to metronidazole and vancomycin.Five isolates had C. diffi cile toxin A or B. Of 5 patients who died, 3 died of CDB.Of 8 patients treated with metronidazole or vancomycin, only 1 died, and all 4 patients treated with other drugs died (12.5% vs. 100%; p = 0.01).C. diffi cile bacteremia, although uncommon, is thus associated with substantial illness and death rates.C lostridium diffi cile is well recognized as the etiologic agent of pseudomembranous colitis and has been implicated as the cause of 10%-25% of cases of antimicrobial drug-associated diarrhea (1).The pathogen has been responsible for numerous recent hospital-based epidemics and is also emerging in the community (2).The clinical features, disease spectrum and pathogenesis, and optimal treatments of C. diffi cile-associated diarrhea have been well studied.In contrast, reports of the isolation of C. diffi cile in body sites other than the intestines, or extraintestinal infections, have been anecdotal (3,4).Extracolonic manifestations of C. diffi cile infections reported were variable, including bacteremia, osteomyelitis, visceral abscess, empyema, reactive arthritis, pyelonephritis, prosthetic joint infection, and skin and soft tissue infection (3-10).Most Clostridium diffi cile Bacteremia, Taiwan