title: Toxin A-producing Clostridium difficile as an aetiological factor of post-traumatic wound infection.
abstract: Clostridium difficile is a well-known cause of hospital-acquired infection such as antibiotic associated diarrhoea or pseudomembranous colitis. Extraintestinal infections caused by this pathogen are described rarely. A case of post-traumatic wound infection caused by C. difficile in an immunocompetent, young and otherwise healthy trauma patient is reported. A 31-year-old female, a car accident victim, was admitted to hospital because of polytrauma. After open reduction and internal fixation of a supracondylar femoral fracture by means of the dynamic condylar screw (DCS) system, a purulent fistula occurred. Microbiological examination of the pus revealed C. difficile as the single aetiological factor of this infection. Empirical antibiotic treatment with cefazoline and metronidazole had been administered right after the surgery, but was found to be ineffective. The strain isolated from the patient was sensitive to most antimicrobials except for clindamycin, and amoxicillin/clavulanic acid was chosen for the guided therapy. Such treatment combined with the removal of the DCS system produced a desirable effect.
authors.affiliation: Department of Microbiology, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, ul. M. Skłodowskiej-Curie 9, 85094 Bydgoszcz, Poland.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Deptuła
authors.affiliation: Department of Microbiology, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, ul. M. Skłodowskiej-Curie 9, 85094 Bydgoszcz, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Kruszyńska
authors.affiliation: Department of Microbiology, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, ul. M. Skłodowskiej-Curie 9, 85094 Bydgoszcz, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Mikucka
authors.affiliation: Department of Microbiology, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, ul. M. Skłodowskiej-Curie 9, 85094 Bydgoszcz, Poland.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Gospodarek
authors.affiliation: Department of Orthopaedics and Traumatology, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, ul. M. Skłodowskiej-Curie 9, 85094 Bydgoszcz, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Olszewski
authors.affiliation: Department of Orthopaedics and Traumatology, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, ul. M. Skłodowskiej-Curie 9, 85094 Bydgoszcz, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kruczyński
authors.affiliation: Department of Orthopaedics and Traumatology, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, ul. M. Skłodowskiej-Curie 9, 85094 Bydgoszcz, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Mątewski
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001427:Bacterial Toxins / Q000096:biosynthesis*; D001863:Bone Screws; D016360:Clostridioides difficile / Q000187:drug effects / Q000302:isolation & purification / Q000378:metabolism*; D003015:Clostridium Infections / Q000188:drug therapy / Q000382:microbiology*; D004768:Enterotoxins / Q000096:biosynthesis*; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D006620:Hip Fractures / Q000150:complications / Q000601:surgery; D006801:Humans; D009104:Multiple Trauma / Q000150:complications* / Q000601:surgery; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile