title: Extraintestinal Clostridium difficile infections: a single-center experience.
abstract: OBJECTIVE
  To evaluate the clinical burden of extraintestinal Clostridium difficile infection (CDI) seen at a single institution and to characterize the management and outcomes of these rare infections.
  
  
  METHODS
  A retrospective medical record review was conducted to identify patients with isolation of C difficile from extraintestinal sites from January 1, 2004, through December 31, 2013. Medical records were reviewed and data, including demographic characteristics, microbiology, clinical associations, management, and infection outcomes, were abstracted.
  
  
  RESULTS
  Overall, 40 patients with extraintestinal CDI were identified: 25 had abdominopelvic infections, 11 had bloodstream infections, 3 had wound infections, and 1 had pulmonary infection. C difficile was isolated with other organisms in 63% of cases. A total of 85% of infections were nosocomial. Factors associated with extraintestinal CDI included surgical manipulation of the gastrointestinal tract (88%), recent antibiotic exposure (88%), malignant tumors (50%), and proton pump inhibitor use (50%). Diarrhea was present in 18 patients (45%), 12 of whom had C difficile polymerase chain reaction (PCR)-positive stool samples. All isolates tested were susceptible to metronidazole and piperacillin-tazobactam. Management included both antimicrobial therapy and guided drainage or surgical intervention in all but one patient. The infection-associated mortality rate was 25%, with death a median of 16 days (range, 1-61 days) after isolation of C difficile.
  
  
  CONCLUSIONS
  Extraintestinal CDI is uncommon and often occurs in patients with surgical manipulation of the gastrointestinal tract and well-recognized risk factors for intestinal CDI. Management of extraintestinal CDI includes both antimicrobial and surgical therapies. Extraintestinal CDI is characterized by poor outcome with high mortality.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Arjun
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN; Division of Clinical Microbiology, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Robin
authors.initials: R
authors.lastname: Patel
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Darrell S
authors.initials: DS
authors.lastname: Pardi
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN. Electronic address: khanna.sahil@mayo.edu.
authors.forename: Sahil
authors.initials: S
authors.lastname: Khanna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology*; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000906:Antibodies