, 39:371 | Cite as

Two case reports of Clostridium difficile bacteremia, one with the epidemic NAP-1 strain

  • J. Hemminger
  • J.-M. Balada-Llasat
  • M. Raczkowski
  • M. Buckosh
  • P. PancholiEmail author
Case Report


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.


Clostridium difficile Bacteremia BI/NAP-1 



We thank Dr. Limbago’s laboratory at the CDC for performing the molecular characterization of the C. difficile strains.

Conflict of interest



  1. 1.
    Delmée M. Laboratory diagnosis of Clostridium difficile disease. Clin Microbiol Infect. 2001;7:411–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Rupnik M, Wilcox MH, Gerding DN. Clostridium difficile infection: new developments in epidemiology and pathogenesis. Nat Rev Microbiol. 2009;7:526–36.PubMedCrossRefGoogle Scholar
  3. 3.
    McMaster-Baxter NL, Musher DM. Clostridium difficile: recent epidemiologic findings and advances in therapy. Pharmacotherapy. 2007;27:1029–39.PubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    Libby DB, Bearman G. Bacteremia due to Clostridium difficile—review of the literature. Int J Infect Dis. 2009;13:e305–9.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 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.PubMedCrossRefGoogle Scholar
  8. 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.Google Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    Dupuy B, Govind R, Antunes A, Matamouros S. Clostridium difficile toxin synthesis is negatively regulated by TcdC. J Med Microbiol. 2008;57:685–9.PubMedCrossRefGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    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.Google Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • J. Hemminger
    • 1
  • J.-M. Balada-Llasat
    • 1
  • M. Raczkowski
    • 1
  • M. Buckosh
    • 1
  • P. Pancholi
    • 1
    Email author
  1. 1.Clinical Microbiology, Department of PathologyThe Ohio State University Medical Center, University Hospitals EastColumbusUSA

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