A Case of Clostridium difficile Bacteremia in a Patient with Loop Ileostomy
A 60-yr-old Korean man had been diagnosed with prostate cancer 4 yr ago and was followed up after chemotherapy. The cancer recurred after 2 yr and eventually metastasized to multiple sites, causing hydronephrosis, obstructive acute kidney injury, and rectal stricture. External compression of the rectum due to metastasis was suspected as the cause of rectal stricture. Consequently, the patient underwent nephrostomy in the pelvic region in conjunction with insertion of a stent in the colon. On hospitalization day (HD) 98, the patient developed fever, and antibiotic therapy with vancomycin/meropenem was initiated. On HD 113, loop ileostomy was performed, and antibiotic therapy involving ticarcillin was initiated. On HD 141, the fever recurred and blood culture revealed the presence of Escherichia coli. As a result, the antibiotic therapy was changed to piperacillin/metronidazole. On HD 146, the patient showed hematochezia through the site of ileostomy. On HD 157, the patient's blood culture showed the presence of Enterococcus faecium, and the patient was again treated with meropenem. Subsequently, blood culture on HD 163 showed the absence of pathogens in the patient's blood.\nBlood cultures on HD 186 revealed the presence of anaerobic gram-positive bacilli, which were subcultured on blood agar and incubated anaerobically. They were identified as C. difficile by using the VITEK 2 system (bioMerieux, Marcy-I'Etoil, France), with 99% probability. The presence of these microorganisms was further confirmed with commercial 16S rRNA gene sequencing (Macrogen, Seoul, Korea), for which 2 primers were used: 518F (5'-CCAGCAGCCGCGGTAATACG-3') and 800R (5'-TACCAGGGTATCTAATCC-3'). The sequence thus obtained (1,466 bp) was compared with published sequences in the Gen-Bank database by using the basic local alignment search tool (BLAST)n algorithm (), and the isolate showed 99.05% similarity to C. difficile and 95.47% to C. irregulare. A Clostridium toxin assay was performed for a stool specimen by using the VIDAS system (bioMerieux), and the results was negative. Subsequently, the patient's general condition worsened, and his family wished to have him close to home. He was discharged with no hope for recovery, and we were unable to investigate the C. difficile infection (CDI) further.