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Variable spectrum of disease and risk factors of peripartum Clostridium difficile infection: report of 14 cases from French hospitals and literature review

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Abstract

Our aim was to study Clostridium difficile infection (CDI) in peripartum women in France and compare them to cases published in the literature. We characterize these infections regarding clinico-biological features and specific risk factors in order to raise awareness for obstetricians and midwifes. Eight antepartum and six post-partum CDI cases were retrospectively studied in 6 French centers during the period between 2008 and 2013. In addition, 59 literature cases were reviewed. Cases were identified with CDI clinical symptoms associated to characteristic imagery or detection of C. difficile toxins. The key risk factors of CDI (antibiotherapy, hospitalization) and other risk factors (cesarean section, obstetric complications, corticotherapy, and underlying disease) were retrospectively collected. Most of the cases were exposed to at least one key risk factor of CDI: previous exposure to antibiotics and/or hospitalization. The post-partum cases often had cesarean section: 67% (4/6) in French cases and 89% (31/35) in literature cases. Metronidazole was the most used antibiotic. Relapses occurred in two French cases and in nine published cases. Two French cases and 15 literature cases were reported to have complications (pseudomembranous colitis, toxic megacolon, death…). Diverse C. difficile PCR ribotypes were involved, but the BI/NAP1/027 strain was not detected in the French case series contrary to the literature cases. The delay for diagnosis CDI could be long and peripartum CDI could be severe. In case of unexplained diarrhea in pregnant women, clinicians need to consider CDI and ask for research of C. difficile and its toxins in stool.

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Acknowledgements

We sincerely thank Miranda Craft for proofreading and English corrections.

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Authors and Affiliations

  1. Service de Biologie, Unité de Microbiologie, Centre Hospitalier de Versailles, Le Chesnay, France

    Claire de Curraize & Alban Le Monnier

  2. EA 4043, Unités Bactéries Pathogènes et Santé, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France

    Claire de Curraize, Anne Collignon & Alban Le Monnier

  3. Laboratoire de bactériologie – Plateau Technique de Biologie, CHU de Dijon, 2 rue Angélique Ducoudray, 21000, Dijon, France

    Claire de Curraize

  4. Laboratoire de Microbiologie, Hôpital Jean Verdier, Assistance Publique-Hôpitaux de Paris, Bondy, France

    Clotilde Rousseau & Anne Collignon

  5. Service de Bactériologie-Hygiène Hospitalière, Centre Hospitalo-Universitaire de Nantes, Nantes, France

    Stéphane Corvec

  6. Service de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France

    Najoua El-Helali

  7. Service de Microbiologie-Hygiène, Unité de Bactériologie-Hygiène, Hôpitaux Universitaires Paris Val de Seine, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, Paris, France

    Vincent Fihman

  8. Centre National de Référence des Clostridium difficile, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France

    Frédéric Barbut

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  1. Claire de Curraize
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  2. Clotilde Rousseau
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  3. Stéphane Corvec
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  4. Najoua El-Helali
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  5. Vincent Fihman
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  7. Anne Collignon
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  8. Alban Le Monnier
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Correspondence to Claire de Curraize.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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de Curraize, C., Rousseau, C., Corvec, S. et al. Variable spectrum of disease and risk factors of peripartum Clostridium difficile infection: report of 14 cases from French hospitals and literature review. Eur J Clin Microbiol Infect Dis 37, 2293–2299 (2018). https://doi.org/10.1007/s10096-018-3372-x

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  • DOI: https://doi.org/10.1007/s10096-018-3372-x

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