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The source of sepsis was initially presumed to be the operated prosthetic joint, and this caused a delay in the correct diagnosis and institution of appropriate antimicrobial treatment which may have contributed to a poorer outcome. This case highlights the risk of patients arriving from the community manifesting life threatening CDI in the hospital.<\/jats:p>","DOI":"10.1136\/bcr.06.2009.2017","type":"journal-article","created":{"date-parts":[[2010,1,26]],"date-time":"2010-01-26T12:07:49Z","timestamp":1264507669000},"page":"bcr0620092017","source":"Crossref","is-referenced-by-count":4,"title":["Toxic megacolon from hypervirulent<i>Clostridium difficile<\/i>infection (ribotype 027) following elective total knee replacement: an emerging challenge in modern health care"],"prefix":"10.1136","volume":"2010","author":[{"given":"Buchi Rajendra Babu","family":"Arumilli","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prasanthi","family":"Koneru","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irfan","family":"Fayyaz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2010,1,26]]},"reference":[{"key":"2025042508242962000_2010.feb02_1.bcr0620092017.1","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2007.9978"},{"key":"2025042508242962000_2010.feb02_1.bcr0620092017.2","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1136\/gut.2003.028803","article-title":"Clostridum difficile associated diarrhea in hospitalized patients: onset in the community and hospital and role of flexible sigmoioscopy","volume":"54","author":"Johal S","year":"2004","journal-title":"Gut"},{"key":"2025042508242962000_2010.feb02_1.bcr0620092017.3","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2036.2003.01531.x"},{"key":"2025042508242962000_2010.feb02_1.bcr0620092017.4","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0b013e32830f9397"},{"key":"2025042508242962000_2010.feb02_1.bcr0620092017.5","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2006.056143"},{"key":"2025042508242962000_2010.feb02_1.bcr0620092017.6","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.2106\/00004623-199072070-00015","article-title":"Clostridium difficile infection in orthopaedic patients","volume":"72","author":"Clarke","year":"1990","journal-title":"J Bone Joint Surg Am"},{"key":"2025042508242962000_2010.feb02_1.bcr0620092017.7","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1302\/0301-620X.70B4.3403605","article-title":"Pseudomembranous colitis associated with antibiotic prophylaxis in orthopaedic surgery","volume":"70\u00e2\u0080\u0093B","author":"Cannon","year":"1988","journal-title":"J Bone Joint Surg Br"},{"key":"2025042508242962000_2010.feb02_1.bcr0620092017.8","first-page":"207","article-title":"Community-onset Clostridium difficile-associated diarrhea not associated with antibiotic usage","volume":"66","author":"Bauer","year":"2008","journal-title":"J Med"},{"key":"2025042508242962000_2010.feb02_1.bcr0620092017.9","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/41.suppl_3.13"},{"key":"2025042508242962000_2010.feb02_1.bcr0620092017.10","doi-asserted-by":"crossref","first-page":"827","DOI":"10.3201\/eid1205.051350","article-title":"Clostridium difficile ribotype 027, toxinotype III, the Netherlands","volume":"12","author":"Kuijper","year":"2006","journal-title":"Emerg Infect Dis"},{"key":"2025042508242962000_2010.feb02_1.bcr0620092017.11","doi-asserted-by":"crossref","unstructured":"Brazier JS Patel B Pearson A . Distribution of Clostridium difficile PCR ribotype 027 in British hospitals. 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