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Toxin A-producing Clostridium difficile as an aetiological factor of post-traumatic wound infection

Aleksander Deptua¹, Ewa Kruszyska¹, Agnieszka Mikucka¹, Eugenia Gospodarek¹, Krzysztof Olszewski², Jacek Kruczyski² and Dariusz Mtewski²

¹ Department of Microbiology, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, ul. M. Skodowskiej-Curie 9, 85094 Bydgoszcz, Poland

² Department of Orthopaedics and Traumatology, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, ul. M. Skodowskiej-Curie 9, 85094 Bydgoszcz, Poland

Correspondence
Aleksander Deptua
deptul{at}o2.pl

Received December 15, 2008
Accepted March 10, 2009

Clostridium difficile is a well-known cause of hospital-acquired infection such as antibiotic associated diarrhoea or pseudomembranous colitis. Extraintestinal infections caused by this pathogen are described rarely. A case of post-traumatic wound infection caused by C. difficile in an immunocompetent, young and otherwise healthy trauma patient is reported. A 31-year-old female, a car accident victim, was admitted to hospital because of polytrauma. After open reduction and internal fixation of a supracondylar femoral fracture by means of the dynamic condylar screw (DCS) system, a purulent fistula occurred. Microbiological examination of the pus revealed C. difficile as the single aetiological factor of this infection. Empirical antibiotic treatment with cefazoline and metronidazole had been administered right after the surgery, but was found to be ineffective. The strain isolated from the patient was sensitive to most antimicrobials except for clindamycin, and amoxicillin/clavulanic acid was chosen for the guided therapy. Such treatment combined with the removal of the DCS system produced a desirable effect.