Molecular Characterization and Antibiotic Profile of Clostridium difficile Isolated from Bacteremia

Abstract

Introduction: Clostridium difficile infection always manifests as diarrhea associated with antibiotic use. Nevertheless, extraintestinal infections caused by C. difficile are reported. The current report was on a case of C. difficile bacteremia in a 51-year-old male patient with appendiceal perforation and abscess as well as confirmed cirrhosis. Case Presentation: The patient was admitted to the infectious diseases department with repeated abdominal pain associated with fever. His anaerobic blood culture was positive for C. difficile two days after transarterial chemoembolization. The same toxin strain was isolated from stool four days later. Both of the two isolates were confirmed positive for toxin A (tcd A) and toxin B (tcd B) genes by polymerase chain reaction, and identified as ST3 by multiple locus sequence typing. The two strains showed the same susceptibility to the tested antibiotics. The patient was treated with vancomycin intravenously, and got remitted shortly after that. The patient was discharged with good general health conditions and followed up. Conclusions: A patient with C. difficile bacteremia presenting with appendiceal perforation and abscess as well as confirmed cirrhosis was described, and the microbiological and molecular biological analysis suggested that C. difficile strains isolated from blood came from gut. It is necessary that clinicians detect C. difficile and/or toxins in patients with long terms antibiotic therapy, in case of transformation of intestinal flora, which could cause the infection outside the intestinal tract.