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Severe infection with Clostridium difficile PCR ribotype 027 acquired in Melbourne, Australia

Michael Richards, James Knox, Briony Elliott, Kate Mackin, Dena Lyras, Lynette J Waring and Thomas V Riley
Med J Aust 2011; 194 (7): 369-371.

We report the first recognised case of infection with Clostridium difficile PCR ribotype 027 acquired in Australia. This pathogen has caused significant morbidity and mortality in widespread hospital-based outbreaks in the northern hemisphere. Clinicians need to be aware of the clinical picture, limitations of diagnostic tests, availability of further testing for epidemic strains, new therapeutic approaches, and in-hospital control strategies for this infection. (MJA 2011; 194: 369-371)

An 83-year-old Latvian man underwent an aortic valve replacement for aortic stenosis in late January 2010 at a hospital in Melbourne, Australia. He had a history of hypertension and chronic renal failure. He lived alone in his own home, and had not travelled outside Australia since September 2009 when he returned from a 3-month trip to Latvia. Between his return to Australia and the surgery, he had not received any antibiotics except for a single preoperative dose of cephalothin. His regular medications included various supplements, but no proton-pump inhibitor. He was admitted to the hospital the day before surgery. Two days after the surgery, he developed severe sepsis from a urinary tract infection, for which he received ticarcillin–clavulanate and a noradrenaline infusion. A coagulase-negative Staphylococcus was isolated from blood cultures, and he was given vancomycin. He later developed an infiltrate at the left lung base, but no change was made to his therapy.

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  • Michael Richards1
  • James Knox2,3
  • Briony Elliott3
  • Kate Mackin4
  • Dena Lyras5
  • Lynette J Waring6
  • Thomas V Riley4,6

  • 1 Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, VIC.
  • 2 Department of Infectious Diseases, Monash Medical Centre, Melbourne, VIC.
  • 3 Melbourne Pathology, Melbourne, VIC.
  • 4 University of Western Australia, Perth, WA.
  • 5 Monash University, Melbourne, VIC.
  • 6 PathWest Laboratory Medicine, Perth, WA.


Acknowledgements: 

Thanks to Grant Jenkin of the Department of Infectious Diseases, Monash Medical Centre for his assistance with collation of laboratory data.

Competing interests:

Thomas Riley has undertaken contract research for Cepheid.

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