Table 2.
Age/sex. | Underlying conditions | Clinical presentation | Antimicrobial exposure1 | Strain toxicity from blood/stool | Other organisms in blood culture | Clinical management | Outcome | Year Reference |
---|---|---|---|---|---|---|---|---|
5 months/M | None | Cough, coryza, anorexia | NR | NR/NR | None | NR | NR | 1962 [29] |
19 months/M | Pseudomembranous NEC, systemic carnitine deficiency (recurrent hypoglycemia and cirrhosis) | Frequent sepsis, diarrhea, vomiting, peritonitis | ampicillin + gentamicin | Yes/NR | None | NR | Died | 1982 [40] |
68/M | Cirrhosis, chronic pancreatitis | Jaundice, ascites, encephalopathy, splenic abscess | None | NR/NR2 | None | Penicillin G, DAT | Died | 1983 [55] |
Neonate/M | Prematurity, neonatal NEC | Fever, respiratory distress, abdominal distension, necrotic bowel, peritonitis | Ampicillin + kanamycin | Yes3/NR | S. epidermidis3 (contaminant) | Ampicillin + kanamycin Surgery, DAT | Died | 1984 [56] |
65/M | Arteritis of legs and gangrene | Diarrhea and colitis 6th day, septicemia 10th day postoperative | Cefuroxime, vancomycin | Yes/No | B. fragilis | Cefuroxime,MTZ | Recovered | 1984 [57] |
35/F | AML, neutropenia | Fever, abdominal pain, diarrhea | Cefotaxime + gentamicin | Yes/Yes | Bacteroides sp., Gr. D streptococci | iv MTZ + oral VA | Died | 1985 [58] |
69/F | Acute lymphoblastic leukemia, chemotherapy corticosteroids | Abdominal distension, peritonitis, toxic megacolon, bilateral psoas abscesses | Yes | Yes/Yes | Bacteroides sp., E.coli | Cloxacillin, Co, iv MTZ, ampicillin, gentamicin | Died | 1985 [58] |
62/M | Hypertension, coronary surgery, appendectomy, cholecystectomy, aortofemoral bypass, C. difficile septicemia 5 months before | Fever, nausea, vomiting, left pleural effusion, splenic abscess | Piperacillin, netilmicin | NR/NR | None | Splenectomy MTZ, cefoxitin | Recovered | 1987 [59] |
39/M | Oropharynx cancer | Left mandible radionecrosis, hypotension, fever, acute diverticulitis | NR | Yes/Yes | E. coli, E. faecalis, B. vulgatus | iv MTZ, iv and oral VA, pefloxacin | Recovered | 1989 [47] |
85/F | Chronic pulmonary disease, heart failure, dementia, sinus bradycardia, ischemic attack, pneumonia | Recurrent diarrhea, fever hypotension | VA | NR/Yes | E. faecalis | iv VA, gentamicin | Recovered | 1995 [26] |
18/M | None | Treated for exudative sore throat, fever, chills, abdominal pain, vomiting, diarrhea | Erythromycin, lincomycin | NR/Yes | None | Oral VA | Recovered | 1996 [60] |
78/M | None | Trauma; pneumonia, fever, watery diarrhea | Ofloxacin, clindamycin, cefuroxime, amikacin | NR/No | None | Oral and iv VA | Recovered (died from nosocomial pneumonia) | 1996 [60] |
3/M | Thalassemia minor, 5 episodes of tonsillitis | Fever, odynophagia, acute pericarditis, pericardial effusion, mild GI signs | Amoxicillin-clavulanic acid, cefixime, cefotaxime | Yes/NT | None | iv VA | Discharged | 1998 [61] |
17/M | Duchenne muscular dystrophy | Ileus with small‐bowel obstruction | Yes | NT/NT | Candida parapsilosis | NR | Recovered | 1998 [31] |
33/F | Metastatic cervical cancer | Pelvic abscesses, recto-vaginal fistula after radiotherapy | Yes | NT/NT | C. cadaveris, B. melaninogenicus, Fusobacterium species | NR | Died | 1998 [31] |
77/M | Severe emphysema, corticosteroid therapy | Perforated sigmoid diverticulum | Yes | NT/NT | Eubacterium lentum | NR | Died | 1998 [31] |
66/M | Infiltrating bladder cancer | Intestinal invasion of the advanced bladder cancer, pyelonephritis | NR | NR/NT | E. faecium, B.fragilis | Imipenem | Died | 2001 [33] |
65/M | Obesity | Ischemic colitis after cardiac surgery, bacteremic peritonitis | NR | NR/NT | E. faecium, B. ovatus | Ceftriaxone, ciprofloxacin | Died | 2001 [33] |
66/M | AML, immunodepression, chemotherapy | Fever, pancytopenia, anal margin abscess and diarrhea | C3G+ FQ | NR/NR | None | Ofloxacin, MTZ, abscess drainage | Recovered | 2001 [62] |
69/F | 3rd degree burn injuries | Skin operation, fever, abdominal pain and severe diarrhea | Cefazolin, flomoxef | Yes/Yes | E. faecalis, E.casseliflavus | oral and iv VA | Recovered | 2004 [63] |
50/M | Crohn's disease with chemotherapy | Nausea, abdominal abscess, small-bowel obstruction, bowel surgery, jejunum adenocarcinoma | Ampicillin/sulbactam + gentamicin | NR/No | None | Pip-Taz | Recovered | 2009 [45] |
40/F | AML, Dermatomyositis, corticosteroid treatment | Fatigue, weight loss, fever, tachycardia | Yes, unknown antimicrobials | NR/NT | None | Cefepime, MTZ, iv VA | Died | 2009 [27] |
40/M | Alcoholism, liver failure, bone marrow suppression, pancreatitis, and recurrent pneumonia. | Vomiting, diarrhea, abdominal pain, fever | Cephalexin | No4/NR | Staphylococcus epidermidis (contaminant) | Ceftriaxone | Discharged5 | 2009 [46] |
1989–2009 | Taiwan, 12 patients [43]: | |||||||
69/F | Liver cirrhosis | NR (Dead on arrival) | NR | Yes/NR | None | None | Died | 2010 |
38/M | Wilson’s disease | Abdominal pain | NR | No/NR | None | Cefmetazole | Died | 2010 |
65/F | Perforated peptic ulcer | Fever, abdominal pain | NR | NR/NR | None | MTZ | Died | 2010 |
58/M | Liver cirrhosis | Fever, abdominal pain | NR | No/NR | None | MTZ | Recovered | 2010 |
12/M | Biliary atresia, liver transplantation | Fever, dyspnea | NR | No/NR | None | Pip-Taz, VA | Recovered | 2010 |
41/F | Pulmonary fibrosis | Fever, dyspnea | NR | No/NR | None | Ceftazidime, gentamicin, VA | Recovered | 2010 |
45/M | Liver cirrhosis | Abdominal pain | NR | Yes/NR | CNS spp. | Ceftriaxone | Died | 2010 |
83/M | None | GI bleeding, hypovolemic shock, fever, bloody stool |
NR | No/NR | E. coli | Imipenem | Died | 2010 |
87/F | Congestive heart failure, end-stage renal disease, pseudomembranous colitis | Bloody stool | NR | Yes/NR | P. aeruginosa, E.faecium, E. coli, ESBL-K. oxytoca | VA, meropenem | Recovered | 2010 |
80/F | Liver cirrhosis, pseudomembranous colitis | Bloody stool | NR | Yes/NR | CNS spp. | MTZ | Recovered | 2010 |
66/F | Femoral neck fracture (hip replacement with prosthetic infections), chronic kidney disease | Fever, lower GI bleeding, abdominal pain | NR | No/NR | E. cloacae | Debridement cefepime, MTZ | Recovered | 2010 |
75/F | Lymphoma, biliary tract infection | Fever, chills, nausea, vomiting, abdominal pain | NR | NR/NR | K. pneumoniae, C.perfringens | Cefepime, MTZ | Recovered | 2010 |
39/M | Alcohol dependency | Jaundice, vomiting, fecal incontinence | None | NR/NR | None | Cefuroxime, MTZ | Discharged | 2011 [36] |
20/M | Juvenile polyposis syndrome, elective subtotal colectomy | UTI, small-bowel resection and end-ileostomy, CD ileitis | Cephradine, Pip-Taz | NR/Yes | None | Oral VA, meropenem, iv MTZ | Discharged | 2011 [36] |
67/M | Ulcerative colitis | GI bleed | None | NR/Yes | None | None | Discharged | 2011 [36] |
39/F | Chronic hepatitis, chronic alcoholic liver disease | Menorrhagia, spontaneous bruising, jaundice. 3rd week: fever, rectal bleed, varices, gastritis, breast abscess | Cefotaxime | NR/NR | None | MTZ + amoxicillin/clavulanic | Recovered | 2011 [48] |
83/M | CAD, chronic hemodialysis, diverticulitis and peptic ulcer disease | Fever, abdominal pain, nausea, vomiting, bleeding post gastrostomy tube placement | Amikacin, VA, Pip-Taz | Yes/No | None | MTZ | Recovered | 2011 [49] |
39/M | Gastric adenocarcinoma, chemotherapy and chemoradiation | Abdominal pain, vomiting and obstipation | None | Yes/NT | Candida glabrata | NR | Recovered then discharged | 2011 [49] |
60/M | Metastatic prostate cancer | Fever, abdominal pain, hematochezia, hydronephrosis, rectal stricture, loop ileostomy | VA + meropenem, ticarcillin, piperacillin + MTZ | NR/No | None | NR | Discharged | 2013 [64] |
72/F | Colon cancer with peritoneal carcinosis | Tumor resection, colon fistula to skin and bladder, diarrhea | NR | NR/NR | B. fragilis | NR | Died | 2013 [54] |
69/M | Paraparesis, recurrent UTI | Ischemic colitis, diarrhea, operation for abdominal aneurysm | Yes for UTI | NR/NR | None | Surgery (Aneurysm prosthesis) | Recovered | 2013 [54] |
57/M | Mantle cell lymphoma | Abdominal pain, intra-abdominal tumor and cecum perforation | None | NR/NR | None | iv VA + MTZ | Recovered then discharged | 2013 [65] |
2004–2013 | USA, 11 patients: | 10/11 had diarrhea | All of them | 11NT/5Yes (10 stools tested) | 3 Monomicrobial | 1 ATB/10 surgery + ATB | 3 Died/8 Recovered | 2014 [28] |
88/F | Peptic ulcer disease after partial gastrectomy | C. difficile colitis, lower gastro-intestinal bleed | Yes | B. fragilis, E. coli, P. aeruginosa | oral MTZ, iv cefepime, iv ciprofloxacin | Recovered | 2014 | |
75/F | Squamous cell carcinoma of mouth after resection | Cecal impaction and rupture after laparotomy | Yes | Candida tropicalis | Abdominal washouts, meropenem | Died 17 days later | 2014 | |
46/F | Hepatic adenoma after resection | Alcoholic hepatitis and ascites | Yes | Enterococcus species, Candida species, Klebsiella species | Paracentesis, MTZ, cefepime | Recovered | 2014 | |
41/F | Alcohol abuse after inguinal hemia repair | Recurrent groin cellulitis | Yes | Clostridium orbiscindens | Debridement of groin infection, meropenem, linezolid | Recovered | 2014 | |
47/F | Crohn disease, multiple suicide attempts after self-stab to abdomen leading to liver laceration | Self-inflicted abdominal wounds, suspicion for factitious contamination | Yes | Enterococcus species, Clostridium ramosum, Bacteroides species | Wound debridement Pip-Taz | Recovered | 2014 | |
79/F | Colorectal cancer after resection, C. difficile colitis | Ovarian cyst after oophorectomy, postoperative confusion, ascites | Yes | None | Paracentesis, VA, Pip-Taz | Died 7 days later | 2014 | |
80/F | Diabetes mellitus, congestive heart failure, COPD, stroke | Diverticulitis after laparotomy | Yes | E. coli | Abdominal washout, cefepime | Died 6 days later | 2014 | |
51/F | Ileal neuroendocrine tumor, Crohn disease after ileal and sigmoid resection, C. difficile colitis | Anastomotic breakdown and postoperative fever | Yes | None | Anastomotic takedown, colostomy, washout, levofloxacin, MTZ | Recovered | 2014 | |
35/M | Congenital pancreatic duct abnormality after pancreatectomy, splenectomy, C. difficile colitis | Recurrent polymicrobial bacteremia and skin abscesses | Yes | Blautia coccoides, K. pneumoniae, E. coli | Skin debridement meropenem, linezolid | Recovered | 2014 | |
56/F | COPD, concurrent C. difficile colitis, small intestinal bowel obstruction after adhesiolysis | Abdominal compartment syndrome, surgical wound infection | Yes | None | Wound debride, MTZ, VA | Recovered | 2014 | |
27/F | Crohn disease, recurrent C. difficile colitis | Previous right hemicolectomy and ileostomy | Yes | Citrobacter species, Streptococcus anginosus | Anastomotic takedown, washout, MTZ, VA, ertapenem | Recovered | 2014 | |
40/M | Alcohol liver disease | Abdominal pain, vomiting, cirrhosis, gastrohepatic varices, colitis | None | NR/Yes | None | iv VA + Pip-Taz | Died | 2015 [51] |
Neonate/NR | NEC | Large bowel wall pneumatosis with out perforation | None | NT/NT | None | VA+ MTZ +gentamicin, Pip-Taz + MTZ | Recovered | 2016 [66] |
54/M | Rectal adeno-carcinoma, colostomy, chemotherapy | Severe sepsis | Imipenem | Yes/Yes | None | iv and oral MTZ | Recovered | Present Case 1 |
62/F | Lung cancer with cancerous lesions of liver, vertebrae and pelvis | Colon perforation, hemicolectomy and end colostomy | Cefotaxime + spiramycin, Pip-Taz, ciprofloxacin | Yes/Yes | B. fragilis | iv VA, oral MTZ, other antimicrobials | Died | Present Case 2 |
NR (Not reported), NT (Not tested).
CNS: Coagulase-negative Staphylococcus spp., DAT: diagnosis at autopsy, UTI: urinary tract infection, iv: intravenous, GI: gastrointestinal, NEC: Necrotizing enterocolitis, AML: Acute myeloid leukemia, CAD: Coronary artery disease, COPD: Chronic obstructive pulmonary disease, VA: Vancomycin, MTZ: Metronidazole, Co: Cotrimoxazole, Pip-Taz: Piperacillin − Tazobactam, C3G: Third cephalosporin generation, FQ: Fluoroquinolone, ATB: antibacterial.
Antimicrobial exposure in the 3 months preceding CDB.
Abscess toxin+.
Heart Blood (Autopsy).
A-B- Binary toxin+.
Discharged: Home or hospice care.