Clinical characteristics and prognostic factors of extraintestinal infection caused by Clostridioides difficile : analys
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ORIGINAL ARTICLE
Clinical characteristics and prognostic factors of extraintestinal infection caused by Clostridioides difficile: analysis of 60 consecutive cases Hyemin Chung 1 & Jiwon Jung 1 & Min Jae Kim 1 & Heungsup Sung 2 & Mi-Na Kim 2 & Yong Pil Chong 1 & Sung-Han Kim 1 & Sang-Oh Lee 1 & Yang Soo Kim 1 & Jun Hee Woo 1 & Sang-Ho Choi 1 Received: 27 April 2020 / Accepted: 30 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Data regarding extraintestinal Clostridioides difficile infections (ECDIs) remain scarce and anecdotal. We conducted a retrospective cohort study to investigate characteristics and prognostic factors in patients with ECDI. From January 1997 through December 2018, 60 patients were enrolled and divided into three groups as follows: group A (gastrointestinal [GI] disruption caused by malignancy, n = 13); group B (GI disruption from causes other than malignancy, n = 25); group C (no GI disruption, n = 22). GI disruption was defined as compromised integrity of the GI tract caused by abdominal surgery, perforation, malignancy, enterocolitis, or bleeding. The incidence of ECDI was 2.53 per 100,000 admissions. The most common specimens yielded C. difficile were blood (36.7%), peritoneal fluid (20.0%), and abscesses (16.7%). Six patients (10.0%) had confirmed C. difficile enterocolitis, and 36 patients (60.0%) had a polymicrobial infection. C. difficile bacteremia was significantly more common in group A patients than those in groups B or C (53.8% vs. 48.0% vs. 13.6%, p = 0.02), as was the 30-day mortality rate (69.2% vs. 12.0% vs. 18.2%, respectively; p < 0.001). In multivariate analysis, group A (adjusted odds ratio [aOR], 17.32; 95% confidence interval [CI], 2.96–101.21; p = 0.002) and an age of > 65 years (aOR, 7.09; 95% CI, 1.31–38.45; p = 0.02) were independent risk factors for 30-day mortality. ECDI was uncommonly associated with C. difficile enterocolitis. Two factors, GI disruption caused by malignancy, and old age, were associated with significantly poorer short-term outcomes. Keywords Clostridioides difficile . Bacteremia . Enterocolitis . Malignancy
Introduction Clostridioides difficile (formerly Clostridium difficile) is one of the leading causes of nosocomial infection, contributing to an estimated 10–25% of antibiotic-associated diarrhea [1]. It is recognized that the rate of community-associated C. difficile infections (CDIs) has also been rising [2–5]. CDIs can lead to Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10096-020-03975-9) contains supplementary material, which is available to authorized users. * Sang-Ho Choi [email protected] 1
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul 05505, Republic of Korea
2
Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
a mortality rate of up to 30% [6, 7] and represent a significant economic burden on the gl
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