Abstract
Clostridium difficile bacteremia is rare. Here, we report two cases of C. difficile bacteremia in patients with significant underlying gastrointestinal pathology. In one case, the bacteremia was caused by the North American pulsed-field gel electrophoresis (PFGE) type 1 (NAP-1) strain, which is responsible for recent outbreaks of C. difficile infections of increased severity.
References
Delmée M. Laboratory diagnosis of Clostridium difficile disease. Clin Microbiol Infect. 2001;7:411–6.
Rupnik M, Wilcox MH, Gerding DN. Clostridium difficile infection: new developments in epidemiology and pathogenesis. Nat Rev Microbiol. 2009;7:526–36.
McMaster-Baxter NL, Musher DM. Clostridium difficile: recent epidemiologic findings and advances in therapy. Pharmacotherapy. 2007;27:1029–39.
Naggie S, Frederick J, Pien BC, Miller BA, Provenzale DT, Goldberg KC, Woods CW. Community-associated Clostridium difficile infection: experience of a veteran affairs medical center in southeastern USA. Infection. 2010;38:297–300.
Libby DB, Bearman G. Bacteremia due to Clostridium difficile—review of the literature. Int J Infect Dis. 2009;13:e305–9.
Limbago BM, Long CM, Thompson AD, Killgore GE, Hannett GE, Havill NL, Mickelson S, Lathrop S, Jones TF, Park MM, Harriman KH, Gould LH, McDonald LC, Angulo FJ. Clostridium difficile strains from community-associated infections. J Clin Microbiol. 2009;47:3004–7.
Denève C, Janoir C, Poilane I, Fantinato C, Collignon A. New trends in Clostridium difficile virulence and pathogenesis. Int J Antimicrob Agents. 2009;33:S24–8.
Kuijper EJ, Barbut F, Brazier JS, Kleinkauf N, Eckmanns T, Lambert ML, Drudy D, Fitzpatrick F, Wiuff C, Brown DJ, Coia JE, Pituch H, Reichert P, Even J, Mossong J, Widmer AF, Olsen KE, Allerberger F, Notermans DW, Delmée M, Coignard B, Wilcox M, Patel B, Frei R, Nagy E, Bouza E, Marin M, Akerlund T, Virolainen-Julkunen A, Lyytikäinen O, Kotila S, Ingebretsen A, Smyth B, Rooney P, Poxton IR, Monnet DL. Update of Clostridium difficile infection due to PCR ribotype 027 in Europe, 2008. Euro Surveill. 2008;13:1–7.
Loo VG, Poirier L, Miller MA, Oughton M, Libman MD, Michaud S, Bourgault A-M, Nguyen T, Frenette C, Kelly M, Vibien A, Brassard P, Fenn S, Dewar K, Hudson TJ, Horn R, René P, Monczak Y, Dascal A. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005;353:2442–9.
McDonald LC, Killgore GE, Thompson A, Owens RC Jr, Kazakova SV, Sambol SP, Johnson S, Gerding DN. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med. 2005;353:2433–41.
Dupuy B, Govind R, Antunes A, Matamouros S. Clostridium difficile toxin synthesis is negatively regulated by TcdC. J Med Microbiol. 2008;57:685–9.
Warny M, Pepin J, Fang A, Killgore G, Thompson A, Brazier J, Frost E, McDonald LC. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet. 2005;366:1079–84.
García-Lechuz JM, Hernangómez S, San Juan R, Peláez T, Alcalá L, Bouza E. Extra-intestinal infections caused by Clostridium difficile. Clin Microbiol Infect. 2001;7:453–7.
Zheng L, Citron DM, Genheimer CW, Sigmon SF, Carman RJ, Lyerly DM, Goldstein EJC. Molecular characterization and antimicrobial susceptibilities of extra-intestinal Clostridium difficile isolates. Anaerobe. 2007;13:114–20.
Elliott B, Reed R, Chang BJ, Riley TV. Bacteremia with a large clostridial toxin-negative, binary toxin-positive strain of Clostridium difficile. Anaerobe. 2009;15:249–51.
Brazier JS, Raybould R, Patel B, Duckworth G, Pearson A, Charlett A, Duerden BI; HPA Regional Microbiology Network. Distribution and antimicrobial susceptibility patterns of Clostridium difficile PCR ribotypes in English hospitals, 2007–08. Euro Surveill. 2008;13:1–4.
Spigaglia P, Barbanti F, Mastrantonio P, Brazier JS, Barbut F, Delmée M, Kuijper E, Poxton IR; European Study Group on Clostridium difficile (ESGCD). Fluoroquinolone resistance in Clostridium difficile isolates from a prospective study of C. difficile infections in Europe. J Med Microbiol. 2008;57:784–9.
Acknowledgments
We thank Dr. Limbago’s laboratory at the CDC for performing the molecular characterization of the C. difficile strains.
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Hemminger, J., Balada-Llasat, JM., Raczkowski, M. et al. Two case reports of Clostridium difficile bacteremia, one with the epidemic NAP-1 strain. Infection 39, 371–373 (2011). https://doi.org/10.1007/s15010-011-0115-7
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DOI: https://doi.org/10.1007/s15010-011-0115-7