Table 2.

Summary of the 58 well-documented C. difficile bacteremia cases (1962–2016) reviewed in this study and the present two cases.

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.

¹Antimicrobial exposure in the 3 months preceding CDB.

²Abscess toxin+.

³Heart Blood (Autopsy).

⁴A-B- Binary toxin+.

⁵Discharged: Home or hospice care.