The first case of antibiotic-associated colitis by Clostridium difficile PCR ribotype 027 in Korea

Area of Science:

• Infectious Diseases
• Microbiology
• Gastroenterology

Background:

• Clostridium difficile (C. difficile) is a significant cause of antibiotic-associated diarrhea and colitis.
• A hypervirulent strain, C. difficile polymerase chain reaction (PCR) ribotype 027, has emerged globally.
• This strain is associated with more severe disease and higher mortality rates.

Observation:

• A 52-year-old woman with underlying conditions presented with recurrent C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis (PMC).
• She experienced multiple episodes refractory to standard treatments, including oral metronidazole.
• The causative pathogen was identified as C. difficile PCR ribotype 027, a strain previously un reported in Korea.

Findings:

• Genetic analysis confirmed the isolated C. difficile strain as PCR ribotype 027, matching the epidemic hypervirulent B1/NAP1 strain.
• The patient required prolonged intensive care unit management and treatment with oral vancomycin, inotropics, and probiotics.
• Successful management was achieved with probiotics and rifaximin post-discharge, with no relapse for six months.

Implications:

• This case marks the first documented occurrence of the C. difficile PCR ribotype 027 strain in Korea.
• Highlights the importance of recognizing and managing infections caused by hypervirulent C. difficile strains.
• Suggests potential therapeutic strategies involving probiotics and rifaximin for refractory cases.