Fatal community-acquired ribotype 002 Clostridium difficile bacteremia

Area of Science:

• Infectious Diseases
• Microbiology
• Clinical Medicine

Background:

• Extra-colonic manifestations of Clostridium difficile infection, such as bacteremia, are uncommon.
• Clostridium difficile bacteremia is typically associated with healthcare settings and often involves multiple bacterial species (polymicrobial).

Observation:

• A case report details a patient experiencing Clostridium difficile colitis and a single-organism bloodstream infection (monomicrobial bacteremia) upon hospital admission.
• The patient was undergoing a hunger strike, a factor not commonly associated with C. difficile infections.

Findings:

• Genetic analysis (Multilocus variable number tandem repeat analysis) confirmed that the Clostridium difficile strains isolated from both stool and blood were identical (clonality).
• The identified strain belonged to ribotype 002, an emerging type linked to increased mortality.
• Despite treatment with intravenous amoxicillin-clavulanate and oral vancomycin, the patient succumbed to the infection.

Implications:

• This case underscores the potential for Clostridium difficile infection to cause severe, monomicrobial bacteremia, even in non-traditional healthcare-associated scenarios.
• The emergence of ribotype 002 as a cause of severe infection warrants further investigation into its virulence and clinical significance.
• The fatal outcome, complicated by pneumonia and pulmonary embolism, highlights the critical illness that can arise from C. difficile bacteremia.