Clostridium difficile infection of a prosthetic joint presenting 12 months after antibiotic-associated diarrhoea

Clostridium difficile is a common cause of antibiotic-associated diarrhoea, but it rarely causes extra-colonic disease. An 83-year-old woman who developed culture-positive C. difficile-associated diarrhoea following pneumonia and a total hip replacement was treated successfully with oral metronidazole therapy. She was readmitted 12 months later for revision of the hip prosthesis because of increasing pain. At surgery an abscess associated with the prosthesis was discovered. Culture of the pus grew C. difficile. When the surgical isolate and the cryopreserved faecal isolates were compared using Pulsed Field Gel Electrophoresis (PFGE), an identical banding pattern was observed. This case extends the clinical spectrum of C. difficile infection by documenting a prolonged interval between the initial infection, and diagnosis of the prosthetic joint infection. The importance of molecular typing to show strain relatedness is demonstrated.