A repeat offender: Recurrent extraintestinal Clostridium difficile infection following fecal microbiota transplantation. (June 2018)

• Record Type: Journal Article
• Authors: Gardiner, Bradley J.; Thorpe, Cheleste M.; Pinkham, Nicholas V.; McDermott, Laura A.; Walk, Seth T.; Snydman, David R.
• Is Part Of: Anaerobe. Volume 51(2018)
• Page Start: 68
• Page End: 72
• Publication Date: 2018-06
• Subjects: Extraintestinal Clostridium difficile -- Fecal microbiota transplantation -- Whole genome sequencing; FMT fecal microbiota transplantation -- CT computed tomography -- MIC minimum inhibitory concentration -- CLSI Clinical and Laboratory Standards Institute; Anaerobic infections -- Periodicals; Anaerobic bacteria -- Periodicals; Bacterial diseases -- Periodicals; Computer network resources; Anaerobic protozoa -- Periodicals; 579.3
• DOI: 10.1016/j.anaerobe.2018.04.007
• Languages: English
• ISSNs: 1075-9964

Abstract

Abstract: Extraintestinal infection with Clostridium difficile has been reported but remains uncommon. Treatment of this unusual complication is complex given the limitations of current therapeutic options. Here we report a novel case of recurrent extraintestinal C. difficile infection that occurred following fecal microbiota transplantation. Using whole genome sequencing, we confirmed recrudescence rather than reinfection was responsible. The patient ultimately responded to prolonged, targeted antimicrobial therapy informed by susceptibility testing. Highlights: Clostridium difficile is an increasingly common and important clinical problem with relatively limited treatment options. Extraintestinal infection has been reported but remains unusual. We report a novel strain, with proven recrudescence rather than reinfection, diagnosed with modern molecular techniques. Whole genome sequencing is increasingly accessible in real-time, allowing complex typing questions to be addressed. Antimicrobial susceptibility testing for anaerobes is difficult but increasingly important given increasing resistance.