Abstract
Vancomycin-resistant Clostridium innocuum was recently identified as an etiologic agent for antibiotic-associated diarrhea in humans. We conducted a case–control study involving 152 C. innocuum-infected patients during 2014–2019 in Taiwan, using 304 cases of Clostridioides difficile infection (CDI) matched by diagnosis year, age (+2 years), and sex as controls. The baseline characteristics were similar between the 2 groups. C. innocuum–infected patients experienced more extraintestinal clostridial infection and gastrointestinal tract–related complications than did patients with CDI. The 30-day mortality rate among C. innocuum–infected patients was 14.5%, and the overall rate was 23.0%. Chronic kidney disease, solid tumor, intensive care unit admission, and shock status were 4 independent risk factors for death. C. innocuum identified from clinical specimens should be recognized as a pathogen requiring treatment, and because of its intrinsic vancomycin resistance, precise identification is necessary to guide appropriate and timely antimicrobial therapy.
Highlights
Vancomycin-resistant Clostridium innocuum was recently identified as an etiologic agent for antibiotic-associated diarrhea in humans
More patients acquired the infection in the community in the CI group (33.6% vs. 16.8%; odds ratio [odds ratios (ORs)] 2.5, 95% CI 1.6–3.9; p
We identified chronic kidney disease, solid tumor, intensive care unit (ICU) admission, and shock status as 4 independent risk factors for both 30-day and overall mortality rates in the patients with C. innocuum infection
Summary
Vancomycin-resistant Clostridium innocuum was recently identified as an etiologic agent for antibiotic-associated diarrhea in humans. Of the >200 species of Clostridium, >30 are potential pathogens in humans, such as C. perfringens and Clostridioides difficile. C. innocuum has rarely been described as associated with human disease. It was challenging to distinguish C. innocuum from other Clostridium species (especially C. ramosum and C. clostridioforme, together called the RIC group) because of their similar phenotypes of atypical clostridial colonial morphology, rare spore-forming features, and fatty acid pattern [3–5]. The bacterium was considered less pathogenic and seldom caused infections previously, more and more clinical evidence has emerged since 2000s, suggesting C. innocuum might be a potential cause of antibiotic-associated diarrhea and of extraintestinal clostridial infection (EICI), such as bacteremia, intra-abdominal infection, and endocarditis [8–10]. We are not aware of a study of C. innocuum infection with a large enough cohort of patients to describe its clinical characteristics
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