We describe a case of
bacteremia due to Clostridium difficile, which was successfully treated by intravenous
vancomycin. A 69-year-old woman was admitted to our hospital because of third degree
burn injuries. She was treated with
cefazolin for two weeks followed with
flomoxef for one week before the operation (
debridement and grafting of skin). On the third postoperative day high
fever (temperature 40 degrees C),
abdominal pain and severe watery
diarrhea developed.
Antibiotic-associated colitis with
bacteremia was diagnosed presumptively,
flomoxef was stopped, and oral and intravenous
therapy with
vancomycin was started. A blood culture taken before the administration of
vancomycin yielded C. difficile accompanied with Enterococcus faecalis and Enetrococcus casseliflavus. A stool culture taken on the next day yielded C. difficile, and a stool
latex agglutination test was also positive. The patient improved slowly. Parenteral
vancomycin was discontinued after two weeks. One week later, the patient developed
pneumonia, and
imipenem/cilastatin was added. Soon after addition of the agent, she developed recurrent
diarrhea despite continual oral
vancomycin therapy. The fecal samples obtained at this time were positive for C. difficile by culture and positive for toxins A & B. She was satisfactorily treated with oral
vancomycin for a total of four weeks. After the following two weeks, however, recurrence of
diarrhea developed again, which rapidly decreased with oral
vancomycin for seven days. The patient did well thereafter and was discharged. All three C. difficile isolates from blood and fecal specimens were positive for toxins A & B, and identified the same PCR ribotyping pattern.