Coinfection with 2 Clostridium difficile ribotypes in China: A case report

Rationale:Clostridium difficile infections (CDIs) have been reported in China, but detailed clinical symptoms of coinfection by 2 C difficile ribotypes have not been documented.Patients concerns:An 83-year-old male with a 10-day history of diarrhea and urinary tract infection was admitted to the hospital. The patient had received ofloxacin for several days, but his clinical response was poor. Laboratory workup revealed high white blood cell (WBC), serum creatinine (Scr), and C-reactive protein (CRP) levels. Based on these abnormal lab results, rapid detection of glutamate dehydrogenase and toxin A and B was performed.Diagnosis:Severe CDI.Interventions:Oral vancomycin was administered for 8 days.Outcomes:Diarrhea symptoms improved and C difficile culture was negative after oral vancomycin administration for 8 days. Clostridium difficile was isolated from 3 consecutive stool samples at 2-day intervals because the patient was admitted to the hospital. Polymerase chain reaction ribotyping revealed ribotype (RT) 017 in the first 2 samples and RT 001 in the third sample. RT 017 caused significantly higher increases in the levels of WBC, Scr, and CRP than RT 001.Lessons:It is necessary to improve clinicians' awareness of CDI and reduce the severity of CDI caused by RT 017 in China.