SHM Converge Scientific Abstract ePoster Gallery-Clostridiodes Difficile

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This poster describes a rare case of <strong>Clostridioides difficile bacteremia</strong> and extra-colonic infection in a 51-year-old woman with a complex surgical history. C. difficile is usually associated with antibiotic use and causes colitis, but bloodstream infection is exceedingly uncommon and has little formal treatment guidance.

The patient initially underwent surgery for a perforated marginal ulcer and later developed multiple complications, including an internal jugular thrombus, splenic hemorrhage requiring embolization, and a gastrojejunal perforation requiring stent placement. After prolonged antibiotic exposure, she developed colonic C. difficile infection, which improved with oral vancomycin.

About a month later, after antibiotics were stopped, she returned in <strong>septic shock</strong>. Imaging suggested an infected splenic hematoma/abscess. Interventional radiology drainage was performed, and cultures from both blood and the splenic abscess eventually grew <strong>C. difficile</strong>. Infectious disease was consulted, and she was treated with broad coverage including <strong>IV vancomycin, IV metronidazole, and IV tigecycline</strong>. Despite therapy, her condition worsened. She underwent an attempted emergent splenectomy for source control but became too unstable, coded in the operating room, and died from severe infection.

The case highlights several important points: extra-colonic C. difficile can occur even without active colitis, severe morbidity and mortality are common, and management often requires <strong>early recognition, broad-spectrum antibiotics, and aggressive source control</strong>. Because C. difficile bacteremia is often polymicrobial and rare, current evidence comes mainly from case reports, with IV vancomycin and metronidazole commonly recommended as core therapy.

Asset Subtitle

Dre Steinwehr

Meta Tag

Author List Dre Steinwehr, Dubert Guerrero

Category Clinical Vignettes

Concept Clostridioides difficile

Concept Extra-colonic infection

Concept Bacteremia

Concept Source Control

Concept Colonic infection

Distinguished Non-Finalist

Presenter Organization University of North Dakota

Presenting Author Dre Steinwehr

Track Adult

Keywords

Clostridioides difficile bacteremia

extra-colonic infection

septic shock

splenic abscess

splenic hematoma

oral vancomycin

IV vancomycin

IV metronidazole

IV tigecycline

source control

Clostridioides difficile

Extra-colonic infection

Bacteremia

Source Control

Colonic infection