1504 Case Report: A Rare Case of Community-Acquired Clostridium difficile Infection After Colonoscopy

Abstract

INTRODUCTION: Clostridium difficile (C.diff) infection (CDI) is commonly related to recent antibiotic use, usually occurring in hospitals and other health care facilities where a significantly higher percentage of people carry the bacteria. Here we reported a rare case of community acquired C.diff 3 days after colonoscopy in a low risk patient without a history of antibiotic use or recent hospitalization. CASE DESCRIPTION/METHODS: A 50-year-old healthy female with no past medical history presented for screening colonoscopy. She tolerated the bowel preparation regimen with polyethylene glycol well. The colonoscopy was unremarkable with one small tubular adenoma removed by snare polypectomy. Patient tolerated the procedure well without any complications. She ate raw blueberry from the local supermarket one day after colonoscopy. Then she presented with watery diarrhea up to 10 times per day with nocturnal symptoms 3 days after colonoscopy. Stool studies were ordered. Diarrhea gradually resolved with hydration and clear liquid diet after 3 days without antibiotics treatment. Stool studies came back with positive C. diff toxins. Patient has no risk factors include recent hospitalization, antibiotic use. She took proton pump inhibitor intermittently a few months prior to colonoscopy. All the other patients had procedures done on the same day in the endoscopy suite had no complications. DISCUSSION: The risk factors of CDI include antibiotics use, advanced age (>65), gastrointestinal surgery, IBD and immunosuppression, etc. The effect of anti-acid use remains unsure because the C. diff spores are acid resistant. Recent studies reported a 7-fold and 13-fold increase in C. diff infection rate after colonoscopy for patients with Crohn's disease and ulcerative colitis compared with non-IBD patients. Another study reported the preoperative use of mechanical bowel preparation was not associated with increased risk of C. diff infection after colectomy. Generally, mechanical bowel preparation and colonoscopy are not risk factors of CDI for a healthy population. This is a rare case with no traditional risk factors acquired CDI by eating raw blueberry 3 days after colonoscopy. Bowel preparation might be a risk factor to disturb the normal gut flora, which increases the risk of CDI. The use of probiotics afterward to prevent C. diff colonization could be a safe and easily adoptable control strategy, but the routine use for prevention or treatment of active infection is not recommended.