2026 Volume 46 Issue 1 Pages 41-45
An 88-year-old woman who was undergoing rehabilitation at a nearby facility following a femoral fracture was referred to our hospital with dyspnea. She was diagnosed as having heart failure complicated by pyelonephritis and started on treatment with antibiotics and diuretics, which led to clinical improvement. However, on the 8th day of hospitalization, she developed rectal perforation and underwent a Hartmann’s procedure. On the day after the surgery, she was diagnosed as having acute kidney injury, necessitating initiation of hemodialysis. Treatment for disseminated intravascular coagulation was also started. On postoperative day 3, Clostridioides difficile (CD) was isolated from blood cultures, based on which we made the diagnosis of CD bacteremia. Intravenous and oral vancomycin (VCM) therapy was added. On postoperative day 6, the patient developed diarrhea, and stool tests were positive for CD toxin, confirming the diagnosis of CD colitis. Subsequently, both the diarrhea and inflammatory markers improved with resolution of the CD bacteremia and CD colitis. CD is a major cause of antibiotic-associated colitis and can present with a wide spectrum of conditions ranging from asymptomatic carriage to severe infections. CD bacteremia is extremely rare, and there are no established treatment protocols. However, our case suggests the combination of oral and intravenous VCM may be an effective treatment for patients with CD bacteremia and enteritis.
