Bacteraemia from an unrecognized source (occult bacteraemia) occurring during Clostridium difficile infection

Area of Science:

• Infectious Diseases
• Microbiology
• Gastroenterology

Background:

• Clostridium difficile infection (CDI) is known to damage the colonic epithelium.
• Secondary bacterial invasion by enteric organisms can potentially lead to bacteraemia.

Purpose of the Study:

• To investigate the association between colonic epithelial disruption during CDI and bacteraemia.
• To determine if CDI leads to secondary bacterial invasion by enteric organisms.

Main Methods:

• Retrospective review of medical records for 505 patients with positive C. difficile toxin tests.
• Analysis of bacteraemias in pre-CDI and post-CDI periods, excluding staphylococcal infections.
• Identification of infection sources for bacteraemia cases.

Main Results:

• The incidence of non-staphylococcal bacteraemia remained similar before and during CDI (5.5% vs. 5.9%).
• During CDI, a source was less frequently identified (63.3% vs. 85.7% in pre-CDI).
• Enterococcal bacteraemias increased during CDI (50% vs. 25% in pre-CDI).

Conclusions:

• CDI-associated bacteraemias frequently lack an identifiable source and may involve organisms of uncertain pathogenicity.
• The findings support the hypothesis that CDI can lead to bacteraemia through bacterial invasion of the damaged colonic epithelium.
• CDI-associated bacteraemias may not always require antimicrobial therapy.