title: Fatal community-acquired ribotype 002 Clostridium difficile bacteremia.
abstract: Extra-colonic infections, and especially bacteremia, are infrequent manifestations of Clostridium difficile infection. C. difficile bacteremia is generally health-care associated and polymicrobial. We report the case of a patient on hunger strike that presented a C. difficile colitis and mono-microbial bacteremia on its admission to the hospital. Multilocus variable number tandem repeat analysis of stool and blood isolates indicated clonality. The strain was characterized as a ribotype 002, an emerging ribotype previously associated with high fatality rate. The patient received treatment by intra-venous amoxicillin-clavulanate and oral vancomycin but eventually died on the seventh day of admission with concomitant pneumonia and pulmonary embolism.
authors.affiliation: Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium. Electronic address: Nicolas_dauby@stpierre-bru.be.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dauby
authors.affiliation: Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.
authors.forename: Agnès
authors.initials: A
authors.lastname: Libois
authors.affiliation: National Reference Center for Clostridium Difficile, Brussels, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Van Broeck
authors.affiliation: National Reference Center for Clostridium Difficile, Brussels, Belgium; IREC, Université Catholique de Louvain (UCL), Brussels, Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: Delmée
authors.affiliation: Center for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium; Department of Microbiology, LHUB - ULB, Pôle Hospitalier Universitaire de Bruxelles (PHUB), Brussels, Belgium.
authors.forename: Olivier
authors.initials: O
authors.lastname: Vandenberg
authors.affiliation: Department of Microbiology, LHUB - ULB, Pôle Hospitalier Universitaire de Bruxelles (PHUB), Brussels, Belgium; Faculty of Medicine and Pharmacy, Université de Mons, Mons, Belgium.
authors.forename: Delphine
authors.initials: D
authors.lastname: Martiny
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology; D001769:Blood / Q000382:microbiology; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology; D003092:Colitis / Q000150:complications; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology; D017809:Fatal Outcome; D005243:Feces / Q000382:microbiology; D006801:Humans; D008297:Male; D018598:Minisatellite Repeats; D058889:Molecular Typing; D021521:Ribotyping
keywords: Bacteremia; Clostridium difficile; Community-acquired infections; Fatal outcome; Malnutrition