{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T07:33:56Z","timestamp":1788852836590,"version":"build-2803163510"},"reference-count":208,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T00:00:00Z","timestamp":1751414400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Introduction: Clostridioides difficile (C. difficile) is primarily associated with colonic disease, including pseudomembranous colitis. However, in rare instances, it may cause extraintestinal infectious and non-infectious manifestations, particularly in immunocompromised patients or those with significant underlying conditions. Search Methods: A literature review was performed using PubMed, Embase, and Researchgate databases up to 15 February 2025. The following search strings were used: \u201cextraintestinal manifestations\u201d, \u201cextracolonic manifestations\u201d, \u201cextraintestinal infections\u201d, \u201cextracolonic infections\u201d, \u201cClostridium difficile\u201d, and \u201cClostridioides difficile\u201d. Results: Extraintestinal manifestations of C. difficile appear to represent fewer than 1% of all reported infections. The most frequently reported infectious complications include bacteremia and abdominopelvic infections and abscesses, often involving polymicrobial cultures, with the isolation of C. difficile alongside microorganisms typically found in the normal intestinal microbiota. Rare non-infectious cases, such as reactive arthritis, have also been described. The underlying pathogenetic mechanism is believed to involve disruption of the intestinal barrier and translocation of bacteria or toxins to sterile sites. Conclusions: Though rare, extraintestinal C. difficile manifestations pose important clinical challenges. Better understanding of their mechanisms is essential for early recognition and appropriate management. Further research is warranted to define potential mechanisms and therapeutic approaches.<\/jats:p>","DOI":"10.3390\/antibiotics14070670","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T06:10:26Z","timestamp":1751436626000},"page":"670","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Extraintestinal Manifestations of Clostridioides difficile Infections: An Overview"],"prefix":"10.3390","volume":"14","author":[{"given":"Konstantinos","family":"Mpakogiannis","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fotios S.","family":"Fousekis","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9747-7405","authenticated-orcid":false,"given":"Stylianos","family":"Elemes","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Papageorgiou Hospital, School of Medicine, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelos","family":"Mantellos","sequence":"additional","affiliation":[{"name":"Division of Urology, Hippokration General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eirini","family":"Christaki","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos H.","family":"Katsanos","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"121","DOI":"10.4161\/gmic.19399","article-title":"Clostridium difficile Infection","volume":"3","author":"Vedantam","year":"2012","journal-title":"Gut Microbes"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1001\/archpedi.1935.01970020105010","article-title":"Intestinal flora in New-Born infants","volume":"49","author":"Hall","year":"1935","journal-title":"Am. J. Dis. Child."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Markovska, R., Dimitrov, G., Gergova, R., and Boyanova, L. (2023). Clostridioides difficile, a New \u201cSuperbug\u201d. Microorganisms, 11.","DOI":"10.3390\/microorganisms11040845"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"429","DOI":"10.7326\/0003-4819-81-4-429","article-title":"Clindamycin-Associated Colitis","volume":"81","author":"Tedesco","year":"1974","journal-title":"Ann. Intern. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2326","DOI":"10.1128\/AAC.02176-12","article-title":"Meta-Analysis of Antibiotics and the Risk of Community-Associated Clostridium difficile Infection","volume":"57","author":"Brown","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4182","DOI":"10.1172\/JCI72336","article-title":"Clostridium difficile and the Microbiota","volume":"124","author":"Seekatz","year":"2014","journal-title":"J. Clin. Investig."},{"key":"ref_7","first-page":"e39029","article-title":"Antibiotics Associated with Clostridium difficile Infection","volume":"15","author":"Rafey","year":"2023","journal-title":"Cureus"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Di Bella, S., Ascenzi, P., Siarakas, S., Petrosillo, N., and di Masi, A. (2016). Clostridium difficile Toxins A and B: Insights into Pathogenic Properties and Extraintestinal Effects. Toxins, 8.","DOI":"10.3390\/toxins8050134"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1586\/14787210.2014.866515","article-title":"Clostridium difficile Infection: Molecular Pathogenesis and Novel Therapeutics","volume":"12","author":"Rineh","year":"2014","journal-title":"Expert. Rev. Anti Infect. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2740","DOI":"10.1128\/iai.65.7.2740-2746.1997","article-title":"Clostridium difficile Toxin A Induces the Release of Neutrophil Chemotactic Factors from Rat Peritoneal Macrophages: Role of Interleukin-1beta, Tumor Necrosis Factor Alpha, and Leukotrienes","volume":"65","author":"Rocha","year":"1997","journal-title":"Infect. Immun."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1128\/mr.60.1.167-215.1996","article-title":"Enteric Bacterial Toxins: Mechanisms of Action and Linkage to Intestinal Secretion","volume":"60","author":"Sears","year":"1996","journal-title":"Microbiol. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"5254","DOI":"10.3390\/toxins7124874","article-title":"The Role of Rho GTPases in Toxicity of Clostridium difficile Toxins","volume":"7","author":"Chen","year":"2015","journal-title":"Toxins"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1128\/IAI.69.3.1329-1336.2001","article-title":"Clostridium difficile Toxins Disrupt Epithelial Barrier Function by Altering Membrane Microdomain Localization of Tight Junction Proteins","volume":"69","author":"Nusrat","year":"2001","journal-title":"Infect. Immun."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2177","DOI":"10.1001\/archinte.162.19.2177","article-title":"The Spectrum of Pseudomembranous Enterocolitis and Antibiotic-Associated Diarrhea","volume":"162","author":"Hurley","year":"2002","journal-title":"Arch. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.disamonth.2015.01.006","article-title":"Pseudomembranous Colitis","volume":"61","author":"Farooq","year":"2015","journal-title":"Dis.-A-Mon."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"bcr2017222209","DOI":"10.1136\/bcr-2017-222209","article-title":"Clostridium difficile Enteritis: Diffuse Small Bowel Radiological Changes in a Patient with Abdominal Sepsis","volume":"2018","author":"Siddiqui","year":"2018","journal-title":"BMJ Case Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.14309\/ajg.0000000000001278","article-title":"ACG Clinical Guidelines: Prevention, Diagnosis, and Treatment of Clostridioides difficile Infections","volume":"116","author":"Kelly","year":"2021","journal-title":"Am. J. Gastroenterol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1046\/j.1469-0691.2001.00313.x","article-title":"Extra-Intestinal Infections Caused by Clostridium difficile","volume":"7","author":"Bouza","year":"2001","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/j.1469-0691.2005.01165.x","article-title":"Clinical Manifestations, Treatment and Control of Infections Caused by Clostridium difficile","volume":"11","author":"Bouza","year":"2005","journal-title":"Clin. Microbiol. Infect. Suppl."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1016\/j.mayocp.2014.07.012","article-title":"Extraintestinal Clostridium difficile Infections: A Single-Center Experience","volume":"89","author":"Gupta","year":"2014","journal-title":"Mayo Clin. Proc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"403","DOI":"10.2217\/ahe.13.37","article-title":"Clostridium difficile Infection in Older Adults","volume":"9","author":"Jump","year":"2013","journal-title":"Aging Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.anaerobe.2014.03.011","article-title":"The Role of the Humoral Immune Response to Clostridium difficile Toxins A and B in Susceptibility to C. Difficile Infection: A Case\u2013Control Study","volume":"27","author":"Islam","year":"2014","journal-title":"Anaerobe"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e305","DOI":"10.1016\/j.ijid.2009.01.014","article-title":"Bacteremia Due to Clostridium difficile-Review of the Literature","volume":"13","author":"Libby","year":"2009","journal-title":"Int. J. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1097\/00005792-200103000-00002","article-title":"Extracolonic Manifestations of Clostridium difficile Infections","volume":"80","author":"Jacobs","year":"2001","journal-title":"Medicine"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Urb\u00e1n, E., Terhes, G., and Gajd\u00e1cs, M. (2020). Extraintestinal Clostridioides difficile Infections: Epidemiology in a University Hospital in Hungary and Review of the Literature. Antibiotics, 9.","DOI":"10.3390\/antibiotics9010016"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1086\/313825","article-title":"Rapidly Progressive Necrotizing Fasciitis and Gangrene Due to Clostridium difficile: Case Report","volume":"30","author":"Bhargava","year":"2000","journal-title":"Clin. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1128\/jb.84.1.65-67.1962","article-title":"Occurrence of Clostridium difficile in infections of man","volume":"84","author":"Smith","year":"1962","journal-title":"J. Bacteriol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/0016-5085(81)90644-2","article-title":"Isolation Rates and Toxigenic Potential of Clostridium difficile Isolates from Various Patient Populations","volume":"81","author":"Viscidi","year":"1981","journal-title":"Gastroenterology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1128\/JCM.36.4.1167-1168.1998","article-title":"Clostridium difficile Bacteremia in an Immunocompetent Child","volume":"36","author":"Cid","year":"1998","journal-title":"J. Clin. Microbiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1093\/clinids\/20.6.1560","article-title":"Bacteremia Due to Clostridium difficile: Case Report and Review of Extraintestinal C. difficile Infections","volume":"20","author":"Feldman","year":"1995","journal-title":"Clin. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1097\/00003246-199506000-00024","article-title":"Clostridium difficile Causing Sepsis and an Acute Abdomen in Critically Ill Patients","volume":"23","author":"Chatila","year":"1995","journal-title":"Crit. Care Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1093\/clinids\/22.4.712","article-title":"Extraintestinal Clostridium difficile Infections","volume":"22","author":"Byl","year":"1996","journal-title":"Clin. Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1007\/BF02044130","article-title":"Clostridium difficile Infection as a Cause of Severe Sepsis","volume":"22","author":"Lowenkron","year":"1996","journal-title":"Intensive Care Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.anaerobe.2009.08.006","article-title":"Bacteremia with a Large Clostridial Toxin-Negative, Binary Toxin-Positive Strain of Clostridium difficile","volume":"15","author":"Elliott","year":"2009","journal-title":"Anaerobe"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"S2204","DOI":"10.4137\/CCRep.S2204","article-title":"Bacteremia Due to Clostridium difficile: Case Report and Review of the Literature","volume":"2","author":"Daruwala","year":"2009","journal-title":"Clin. Med. Case Rep."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.3201\/eid1608.100064","article-title":"Clostridium difficile Bacteremia, Taiwan","volume":"16","author":"Lee","year":"2010","journal-title":"Emerg. Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.jhin.2010.06.024","article-title":"Monomicrobial Clostridium difficile Bacteraemias and Relationship to Gut Infection","volume":"77","author":"McGill","year":"2011","journal-title":"J. Hosp. Infect."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1089\/sur.2013.055","article-title":"Clostridium difficile Bacteremia","volume":"14","author":"Kaufman","year":"2013","journal-title":"Surg. Infect."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"200","DOI":"10.3343\/alm.2013.33.3.200","article-title":"A Case of Clostridium difficile Bacteremia in a Patient with Loop Ileostomy","volume":"33","author":"Choi","year":"2013","journal-title":"Ann. Lab. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.1016\/j.amjmed.2015.05.014","article-title":"Monomicrobial vs Polymicrobial Clostridium difficile Bacteremia: A Case Report and Review of the Literature","volume":"128","author":"Kazanji","year":"2015","journal-title":"Am. J. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.anaerobe.2016.12.013","article-title":"Fatal Community-Acquired Ribotype 002 Clostridium difficile Bacteremia","volume":"44","author":"Dauby","year":"2017","journal-title":"Anaerobe"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e7969","DOI":"10.1097\/MD.0000000000007969","article-title":"Recurrent Bacteremia and Liver Abscess Caused by Clostridium difficile","volume":"96","author":"Morioka","year":"2017","journal-title":"Medicine"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.idcr.2017.03.012","article-title":"Clostridium difficile Bacteremia: Report of Two Cases in French Hospitals and Comprehensive Review of the Literature","volume":"8","author":"Doufair","year":"2017","journal-title":"IDCases"},{"key":"ref_44","first-page":"8472930","article-title":"Successful Treatment of Clostridium difficile Bacteremia with Aortic Mycotic Aneurysm in a Patient with Prior Endovascular Aortic Aneurysm Repair","volume":"2017","author":"Shah","year":"2017","journal-title":"Case Rep. Infect. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"ofx278","DOI":"10.1093\/ofid\/ofx278","article-title":"Bacteremia and Septic Arthritis Due to a Nontoxigenic Strain of Clostridium difficile in a Patient with Sickle Cell Disease","volume":"5","author":"Hill","year":"2018","journal-title":"Open Forum Infect. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1007\/s10096-020-03975-9","article-title":"Clinical Characteristics and Prognostic Factors of Extraintestinal Infection Caused by Clostridioides difficile: Analysis of 60 Consecutive Cases","volume":"39","author":"Chung","year":"2020","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"102195","DOI":"10.1016\/j.anaerobe.2020.102195","article-title":"Bacteremia Due to a Toxin A-Negative, B-Positive Clostridioides difficile Ribotype 017 Strain","volume":"63","author":"Kachrimanidou","year":"2020","journal-title":"Anaerobe"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1177\/10600280211065045","article-title":"Successful Treatment of Concomitant Colitis and Bacteremia Due to Clostridioides difficile","volume":"56","author":"Yates","year":"2022","journal-title":"Ann. Pharmacother."},{"key":"ref_49","first-page":"236","article-title":"Early Diagnosis of Monomicrobial Clostridioides difficile Bacteremia in a Patient without Colitis","volume":"8","author":"Tat","year":"2023","journal-title":"J. Assoc. Med. Microbiol. Infect. Dis. Can."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e248844","DOI":"10.1136\/bcr-2022-248844","article-title":"Polymicrobial Bacteraemia with Clostridioides difficile and Pseudomonas aeruginosa in an Elderly Man Following Antibiotic Use","volume":"15","author":"Zhang","year":"2022","journal-title":"BMJ Case Rep."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1159\/000531892","article-title":"Clostridium difficile Bacteremia as a Rare Presentation of Polymicrobial Pyogenic Liver Abscesses and Its Management Challenges","volume":"17","author":"Lim","year":"2023","journal-title":"Case Rep. Gastroenterol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"943","DOI":"10.4065\/73.10.943","article-title":"Extraintestinal Clostridium difficile: 10 Years\u2019 Experience at a Tertiary-Care Hospital","volume":"73","author":"Wolf","year":"1998","journal-title":"Mayo Clin. Proc."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1007\/BF01963455","article-title":"Polymicrobial Septicemia with Clostridium difficile in Acute Diverticulitis","volume":"8","author":"Defresne","year":"1989","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1136\/bmj.289.6444.531","article-title":"Polymicrobial Septicaemia Due to Clostridium difficile and Bacteroides fragilis","volume":"289","author":"Spencer","year":"1984","journal-title":"Br. Med. J."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1099\/jmm.0.027409-0","article-title":"Bacteraemia and Breast Abscess: Unusual Extra-Intestinal Manifestations of Clostridium difficile Infection","volume":"60","author":"Durojaiye","year":"2011","journal-title":"J. Med. Microbiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s15010-011-0115-7","article-title":"Two Case Reports of Clostridium difficile Bacteremia, One with the Epidemic NAP-1 Strain","volume":"39","author":"Hemminger","year":"2011","journal-title":"Infection"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e148","DOI":"10.1093\/cid\/cit392","article-title":"Extraintestinal Clostridium difficile Infections","volume":"57","author":"Mattila","year":"2013","journal-title":"Clin. Infect. Dis."},{"key":"ref_58","first-page":"389","article-title":"Splenic Abscess Due to Clostridium difficile and Pseudomonas paucimobilis","volume":"82","author":"Studemeister","year":"1987","journal-title":"Am. J. Gastroenterol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1128\/iai.34.3.1036-1043.1981","article-title":"Comparison of Two Toxins Produced by Clostridium difficile","volume":"34","author":"Taylor","year":"1981","journal-title":"Infect. Immun."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1001\/archsurg.1990.01410150125024","article-title":"The Role of Intestinal Barrier Failure and Bacterial Translocation in the Development of Systemic Infection and Multiple Organ Failure","volume":"125","author":"Deitch","year":"1990","journal-title":"Arch. Surg."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"102202","DOI":"10.1016\/j.anaerobe.2020.102202","article-title":"Clinical Relevance of Clostridium Bacteremia: An 8-Year Retrospective Study","volume":"63","author":"Stabler","year":"2020","journal-title":"Anaerobe"},{"key":"ref_62","first-page":"003489","article-title":"European Journal of Case Reports in Internal Medicine Treatment of Extra-Intestinal Clostridioides difficile Abscess Following Acute Appendicitis","volume":"9","author":"Chatterjee","year":"2022","journal-title":"Eur. J. Case Rep. Intern. Med."},{"key":"ref_63","first-page":"709","article-title":"The Immune Response in a Patient To an Infection with Bacteroides fragilis SS. Fragilis And Clostridium difficile","volume":"80B","author":"Danielsson","year":"1972","journal-title":"Acta Pathol. Microbiol. Scand. Sect. B Microbiol. Immunol."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Chinnappan, J., Murtaza Hussain, M.H., Dominic Awuah, D.A., Ekwevugbe Ogbon, E.O., Ghassan Bachuwa, G.B., and Philip McDonald, P.M. (2023). Extraintestinal Clostridioides difficile Infection (CDI): A Recurrent Battle with Resilient Abdominal Wall Abscess. Eur. J. Case Rep. Intern. Med., 10.","DOI":"10.12890\/2023_003711"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"e936528","DOI":"10.12659\/AJCR.936528","article-title":"Atypical Splenic Abscesses Due to Clostridioides difficile","volume":"23","author":"Komeno","year":"2022","journal-title":"Am. J. Case Rep."},{"key":"ref_66","first-page":"E5","article-title":"Clostridioides difficile Pyogenic Liver Abscess with an Empyema","volume":"121","author":"Dasari","year":"2022","journal-title":"WMJ"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"ofac085","DOI":"10.1093\/ofid\/ofac085","article-title":"Splenic Abscess in the New Millennium: A Descriptive, Retrospective Case Series","volume":"9","author":"Radcliffe","year":"2022","journal-title":"Open Forum Infect. Dis."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"bcr2018225252","DOI":"10.1136\/bcr-2018-225252","article-title":"Secondary Bacterial Peritonitis and Pelvic Abscess Due to Clostridium difficile","volume":"2018","author":"Herberts","year":"2018","journal-title":"BMJ Case Rep."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"bcr2017220240","DOI":"10.1136\/bcr-2017-220240","article-title":"Invading beyond Bounds: Extraintestinal Clostridium difficile Infection Leading to Pancreatic and Liver Abscesses","volume":"2017","author":"Roy","year":"2017","journal-title":"BMJ Case Rep."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"bcr2017219957","DOI":"10.1136\/bcr-2017-219957","article-title":"Clostridium difficile Extraintestinal Abscess: A Rare Complication","volume":"2017","author":"Kantamaneni","year":"2017","journal-title":"BMJ Case Rep."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.anaerobe.2016.09.007","article-title":"Clostridium difficile: A Rare Cause of Pyogenic Liver Abscess","volume":"42","author":"Balkose","year":"2016","journal-title":"Anaerobe"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1089\/sur.2012.104","article-title":"Puerperal Retroperitoneal Abscess Caused by Clostridium difficile: Case Report and Review of the Literature","volume":"15","author":"Wataganara","year":"2014","journal-title":"Surg. Infect."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1016\/S0002-9343(03)00184-0","article-title":"Recurrent Extraintestinal Clostridium difficile Infection","volume":"114","author":"Bedimo","year":"2003","journal-title":"Am. J. Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1080\/003655401750064112","article-title":"Liver Abscess Caused by Clostridium difficile","volume":"33","year":"2001","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1046\/j.1440-1622.2000.01777.x","article-title":"Clostridium difficile splenic abscess","volume":"70","author":"Shedda","year":"2000","journal-title":"Aust. N. Z. J. Surg."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1007\/BF01700564","article-title":"Splenic Abscess Caused By Clostridium difficile","volume":"16","author":"Kumar","year":"1997","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1093\/clinids\/20.1.160","article-title":"Elevated Serum Antibody Response to Toxin a Following Splenic Abscess Due to Clostridium difficile","volume":"20","author":"Stieglbauer","year":"1995","journal-title":"Clin. Infect. Dis."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1007\/BF01962606","article-title":"Pancreatic Abscess Caused by Clostridium difficile","volume":"7","author":"Sofianou","year":"1988","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1093\/infdis\/147.6.1105","article-title":"Splenic Abscess Due to Clostridium difficile","volume":"147","author":"Saginur","year":"1983","journal-title":"J. Infect. Dis."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"102147","DOI":"10.1016\/j.anaerobe.2019.102147","article-title":"Extraintestinal Clostridium difficile Infection: Scrotal Abscess","volume":"61","author":"Basnet","year":"2020","journal-title":"Anaerobe"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1089\/sur.2008.099","article-title":"Unusual Manifestations of Clostridium difficile Infection","volume":"11","author":"Malkan","year":"2010","journal-title":"Surg. Infect."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"102432","DOI":"10.1016\/j.jiac.2024.05.012","article-title":"Tubo-Ovarian Abscess Caused by Clostridioides difficile after Eight Months of Surgery: Case Report and Review of Extraintestinal Abdominal Abscess Cases","volume":"31","author":"Nakayama","year":"2025","journal-title":"J. Infect. Chemother."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1089\/sur.2011.122","article-title":"Isolation of Clostridium difficile from Peritoneal Fluid","volume":"13","author":"Nissan","year":"2012","journal-title":"Surg. Infect."},{"key":"ref_84","first-page":"e76754","article-title":"Rare Presentation of Splenic Abscess Secondary to Clostridioides difficile Infection in a Patient with Systemic Sclerosis: A Case Report","volume":"17","author":"Nalla","year":"2025","journal-title":"Cureus"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1097\/IPC.0000000000000240","article-title":"Perisplenic Abscess Due to Clostridium difficile","volume":"23","author":"Ball","year":"2015","journal-title":"Infect. Dis. Clin. Pract."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"3945","DOI":"10.1128\/JCM.02021-15","article-title":"Successful Treatment of Peritoneal Dialysis Catheter-Related Polymicrobial Peritonitis Involving Clostridium difficile","volume":"53","author":"Bharti","year":"2015","journal-title":"J. Clin. Microbiol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1177\/08968608221132431","article-title":"Clostridium difficile Colitis and Peritoneal Dialysis Associated Peritonitis: \u2018Difficile\u2019 Treatment Considerations","volume":"43","author":"Giuliani","year":"2023","journal-title":"Perit. Dial. Int."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"35372830","DOI":"10.1155\/2018\/3537283","article-title":"Clostridium difficile Peritonitis: An Emerging Infection in Peritoneal Dialysis Patients","volume":"2018","author":"Chaughtai","year":"2018","journal-title":"Case Rep. Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1097\/MEG.0b013e3282eeb53b","article-title":"Pyogenic Liver Abscesses: Mortality-Related Factors","volume":"19","year":"2007","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_90","unstructured":"Akhondi, H., and Sabih, D.E. (2025). Liver Abscess, StatPearls."},{"key":"ref_91","first-page":"e3977","article-title":"The Hypervirulent Strain of Clostridium difficile: NAP1\/B1\/027\u2014A Brief Overview","volume":"11","author":"Fatima","year":"2019","journal-title":"Cureus"},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Yakob, L., Riley, T.V., Paterson, D.L., Marquess, J., Magalhaes, R.J.S., Furuya-Kanamori, L., and Clements, A.C.A. (2015). Mechanisms of Hypervirulent Clostridium difficile Ribotype 027 Displacement of Endemic Strains: An Epidemiological Model. Sci. Rep., 5.","DOI":"10.1038\/srep12666"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.anaerobe.2009.10.004","article-title":"Rare Extraintestinal Infection Caused by Toxin-Producing Clostridium difficile","volume":"16","author":"Terhes","year":"2010","journal-title":"Anaerobe"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1128\/JCM.41.1.509-511.2003","article-title":"Clostridium difficile Brain Empyema after Prolonged Intestinal Carriage","volume":"41","author":"Gravisse","year":"2003","journal-title":"J. Clin. Microbiol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1136\/jcp.49.2.172","article-title":"Nosocomial Empyema Caused by Clostridium difficile","volume":"49","author":"Simpson","year":"1996","journal-title":"J. Clin. Pathol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/01.ccm.0000551346.61371.e7","article-title":"594: Empyema due to Clostridium difficile","volume":"47","author":"Vo","year":"2019","journal-title":"Crit. Care Med."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/0002-9343(75)90471-4","article-title":"Necrotizing Pneumonia and Empyema Due to Clostridium perfringens","volume":"59","author":"Bayer","year":"1975","journal-title":"Am. J. Med."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1378\/chest.78.4.622","article-title":"Clostridial Pleuropulmonary Infection","volume":"78","author":"Spagnuolo","year":"1980","journal-title":"Chest"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.eimc.2022.06.008","article-title":"Clostridioides difficile Recovered in Pleural Fluid: Contamination or Infection? A Case Report of a Proven Empyema and a Literature Review","volume":"41","year":"2023","journal-title":"Enfermedades Infecc. Y Microbiol. Clin. (Engl. Ed.)"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1086\/516893","article-title":"Pleural Empyema Due to Clostridium difficile and Clostridium cadaveris","volume":"25","author":"Verwiel","year":"1997","journal-title":"Clin. Infect. Dis."},{"key":"ref_101","first-page":"170","article-title":"Empyema Caused by Clostridium difficile","volume":"10","author":"Hudson","year":"1999","journal-title":"Can. J. Infect. Dis."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1159\/000493184","article-title":"Clostridium difficile Causing Empyema","volume":"12","author":"Mohamed","year":"2018","journal-title":"Case Rep. Gastroenterol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"98A","DOI":"10.1378\/chest.2251858","article-title":"A Rare Case of Pleural Empyema Secondary to Clostridium difficile","volume":"148","author":"PANDYA","year":"2015","journal-title":"Chest"},{"key":"ref_104","unstructured":"Rodriguez, D., and Wood, B. (2018, January 8\u201311). Diarrhea in My Lung? A Rare Case of Clostridium difficile Empyema. Proceedings of the Hospital Medicine 2018, Orlando, FL, USA."},{"key":"ref_105","first-page":"330","article-title":"Polymicrobial Clostridioides difficile Lung Empyema","volume":"6","author":"Parmar","year":"2021","journal-title":"J. Assoc. Med. Microbiol. Infect. Dis. Can."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"621A","DOI":"10.1378\/chest.2271680","article-title":"An Unusual Manifestation of a Common Bug!","volume":"148","author":"Saha","year":"2015","journal-title":"Chest"},{"key":"ref_107","first-page":"003243","article-title":"Clostridioides difficile Bacteraemia and Septic Arthritis in a Sickle Cell Disease Patient","volume":"9","author":"Alqurashi","year":"2022","journal-title":"Eur. J. Case Rep. Intern. Med."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"102293","DOI":"10.1016\/j.anaerobe.2020.102293","article-title":"Septic Arthritis Post Anterior Cruciate Ligament Reconstruction Due to Clostridioides difficile","volume":"66","author":"Eustace","year":"2020","journal-title":"Anaerobe"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1097\/INF.0b013e3181b05449","article-title":"Native Joint Septic Arthritis Caused by Clostridium difficile in an 11-Year Old with Hemoglobin SS Disease","volume":"28","author":"Gregg","year":"2009","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"102318","DOI":"10.1016\/j.anaerobe.2021.102318","article-title":"Extraintestinal Clostridioides difficile Infection: Septic Arthritis 12 Months after Colitis","volume":"69","author":"Amaya","year":"2021","journal-title":"Anaerobe"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"638","DOI":"10.37201\/req\/037.2023","article-title":"Prosthesis Joint Infection Due to Clostridioides difficile and Literature Review","volume":"36","year":"2023","journal-title":"Rev. Espa\u00f1ola Quimioter."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1097\/00003072-199410000-00002","article-title":"Periprosthetic Clostridium difficile Hip Abscess Imaged with In-111 WBCs","volume":"19","author":"ACHONG","year":"1994","journal-title":"Clin. Nucl. Med."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/S0163-4453(99)90110-X","article-title":"Clostridium difficile Infection of a Prosthetic Joint Presenting 12 Months after Antibiotic-Associated Diarrhoea","volume":"39","author":"McCarthy","year":"1999","journal-title":"J. Infect."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1089\/sur.2012.098","article-title":"Clostridium difficile Infection of a Prosthetic Knee Joint Requiring Amputation","volume":"14","author":"Curtis","year":"2013","journal-title":"Surg. Infect."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1097\/MAJ.0b013e3182987d05","article-title":"Unusual Case of Prosthetic Shoulder Joint Infection Due to Clostridium difficile","volume":"346","author":"Ranganath","year":"2013","journal-title":"Am. J. Med. Sci."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.anaerobe.2014.03.007","article-title":"Early Infection of Hip Joint Prosthesis by Clostridium difficile in an HIV-1 Infected Patient","volume":"27","author":"Brassinne","year":"2014","journal-title":"Anaerobe"},{"key":"ref_117","doi-asserted-by":"crossref","unstructured":"Karczewski, D., M\u00fcllner, M., Perka, C., and M\u00fcller, M. (2021). Clostridium difficile Septic Arthritis and Periprosthetic Joint Infection in a Patient with Acute Lymphoblastic Leukaemia, T-\/B-Lymphocytopenia and Hypogammaglobulinemia\u2014A Case Report and Review of the Literature. Access Microbiol., 3.","DOI":"10.1099\/acmi.0.000233"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1007\/BF01690732","article-title":"Chronic Septic Arthritis and Osteomyelitis in a Prosthetic Knee Joint Due ToClostridium difficile","volume":"14","author":"Pron","year":"1995","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1136\/bmj.284.6324.1217","article-title":"Chronic Osteomyelitis Due to Clostridium difficile","volume":"284","author":"Riley","year":"1982","journal-title":"Br. Med. J."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1097\/00006454-199611000-00029","article-title":"Chronic Osteomyelitis Caused by Clostridium difficile in an Adolescent with Sickle Cell Disease","volume":"15","author":"Gaglani","year":"1996","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1097\/INF.0b013e318185a068","article-title":"Chronic Multifocal Osteomyelitis Due to Clostridium difficile in an Adolescent with Sickle Cell Anemia","volume":"27","author":"Bachmeyer","year":"2008","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_122","doi-asserted-by":"crossref","unstructured":"Al-Tawfiq, J.A., and Babiker, M.M. (2020). Multi-Focal Clostridioides (Clostridium) Difficile Osteomyelitis in a Patient with Sickle Cell Anemia: Case Presentation and Literature Review. Diagn. Microbiol. Infect. Dis., 96.","DOI":"10.1016\/j.diagmicrobio.2019.114915"},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1097\/INF.0b013e318296b424","article-title":"Clostridium difficile Vertebral Osteomyelitis","volume":"32","author":"Hoang","year":"2013","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/00007632-198801000-00027","article-title":"Vertebral Osteomyelitis Caused by Clostridium difficile","volume":"13","author":"Incavo","year":"1988","journal-title":"Spine"},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/S0196-4399(84)80093-8","article-title":"Frontal Bone Osteomyelitis Due to Clostridium difficile","volume":"6","author":"Towns","year":"1984","journal-title":"Clin. Microbiol. Newsl."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/S0163-4453(83)90863-0","article-title":"Sickle Cell Disease and Infection","volume":"7","author":"Onwubalili","year":"1983","journal-title":"J. Infect."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"e00921","DOI":"10.1016\/j.idcr.2020.e00921","article-title":"Extraintestinal Clostridioides difficile Infection","volume":"22","author":"Hai","year":"2020","journal-title":"IDCases"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.anaerobe.2017.05.018","article-title":"Extraintestinal Clostridium difficile Infection Due to a Ribotype Different from That Isolated from the Feces of the Patient: A Case Report","volume":"47","author":"Onada","year":"2017","journal-title":"Anaerobe"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1007\/s12223-015-0392-0","article-title":"Clostridium difficile Ribotype 078 Cultured from Post-Surgical Non-Healing Wound in a Patient Carrying Ribotype 014 in the Intestinal Tract","volume":"60","author":"Nyc","year":"2015","journal-title":"Folia Microbiol."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1099\/jmm.0.45825-0","article-title":"Coexistence of Multiple PCR-Ribotype Strains of Clostridium difficile in Faecal Samples Limits Epidemiological Studies","volume":"54","author":"Ameen","year":"2005","journal-title":"J. Med. Microbiol."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1099\/jmm.0.008797-0","article-title":"Toxin A-Producing Clostridium difficile as an Aetiological Factor of Post-Traumatic Wound Infection","volume":"58","author":"Mikucka","year":"2009","journal-title":"J. Med. Microbiol."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s10156-007-0568-X","article-title":"Surgical-Site Infection with Toxin A-Nonproducing and Toxin B-Producing Clostridium difficile","volume":"14","author":"Kikkawa","year":"2008","journal-title":"J. Infect. Chemother."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1016\/j.bjps.2012.04.006","article-title":"Necrotising Fasciitis of the Thigh Secondary to Colonic Perforation: The Femoral Canal as a Route for Infective Spread","volume":"65","author":"Wiberg","year":"2012","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_134","doi-asserted-by":"crossref","unstructured":"Duburcq, T., Parmentier-Decrucq, E., Poissy, J., and Mathieu, D. (2013). Pseudomembranous Colitis Due to Clostridium difficile as a Cause of Perineal Necrotising Fasciitis. BMJ Case Rep., bcr2012008153.","DOI":"10.1136\/bcr-2012-008153"},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"36","DOI":"10.2174\/157340309787048095","article-title":"Anaerobic Bacteria as a Cause of Mycotic Aneurysm of the Aorta: Microbiology and Antimicrobial Therapy","volume":"5","author":"Brook","year":"2009","journal-title":"Curr. Cardiol. Rev."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1177\/000331977602701007","article-title":"Gas-Forming Clostridial Mycotic Aneurysm of the Abdominal Aorta","volume":"27","author":"Babenco","year":"1976","journal-title":"Angiology"},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/S0741-5214(03)00612-8","article-title":"Mycotic Aneurysm of the Infrarenal Abdominal Aorta Infected by Clostridium septicum: A Case Report of Surgical Management and Review of the Literature","volume":"38","author":"Takano","year":"2003","journal-title":"J. Vasc. Surg."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.anaerobe.2012.01.006","article-title":"Mycotic Abdominal Aortic Aneurysm Caused by Toxigenic Clostridium difficile","volume":"18","author":"Sathyendran","year":"2012","journal-title":"Anaerobe"},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"102350","DOI":"10.1016\/j.anaerobe.2021.102350","article-title":"Clostridioides difficile from Intracardiac Vegetation","volume":"69","author":"Chaudhry","year":"2021","journal-title":"Anaerobe"},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"87","DOI":"10.3400\/avd.cr.12.00090","article-title":"Mycotic Iliac Artery Aneurysm Caused by Clostridium difficile in a Patient with Axillobifemoral Bypass for Leriche Syndrome","volume":"6","author":"Tsukioka","year":"2013","journal-title":"Ann. Vasc. Dis."},{"key":"ref_141","first-page":"e7802","article-title":"Endovascular Intervention of a Mycotic Pseudoaneurysm of Accessory Left Hepatic Artery Arising from the Left Gastric Artery Presenting Secondary to Clostridium difficile Colitis: A Case Report","volume":"12","author":"Serena","year":"2020","journal-title":"Cureus"},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jiac.2016.08.002","article-title":"Infective Thoracic Aortic Aneurysm Caused by Clostridium difficile after Endovascular Aortic Repair","volume":"23","author":"Hagiya","year":"2017","journal-title":"J. Infect. Chemother."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"ofaa487","DOI":"10.1093\/ofid\/ofaa487","article-title":"Clostridioides (Clostridium) Difficile Pacemaker Infection","volume":"7","author":"Berkefeld","year":"2020","journal-title":"Open Forum Infect. Dis."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1177\/17085381211053689","article-title":"Abdominal Aortic Endograft Infection with Clostridium difficile","volume":"31","author":"Lyle","year":"2023","journal-title":"Vascular"},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"168","DOI":"10.14503\/THIJ-14-4946","article-title":"Getting to a Man\u2019s Heart through His Colon","volume":"43","author":"Samsky","year":"2016","journal-title":"Tex. Heart Inst. J."},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1097\/01.TA.0000088859.47719.C8","article-title":"Clostridium difficile Pericarditis Complicating Pseudomembranous Colitis in a Trauma Patient","volume":"55","author":"Koehler","year":"2003","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1086\/506942","article-title":"Frequency of Permanent Pacemaker or Implantable Cardioverter-Defibrillator Infection in Patients with Gram-Negative Bacteremia","volume":"43","author":"Uslan","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1016\/j.jvs.2008.11.058","article-title":"Clostridium septicum Aortitis: Report of Two Cases and Review of the Literature","volume":"49","author":"Seder","year":"2009","journal-title":"J. Vasc. Surg."},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1086\/321883","article-title":"Clinical Features of Clostridial Bacteremia: A Review from a Rural Area","volume":"33","author":"Rechner","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.acvd.2008.08.008","article-title":"Infective Endocarditis Caused by Anaerobic Bacteria","volume":"101","author":"Brook","year":"2008","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1177\/014107688007300714","article-title":"Arthritis in Pseudomembranous Colitis Associ Ated with an Antibody to Clostridium difficile Toxin","volume":"73","author":"Fainveather","year":"1980","journal-title":"J. R. Soc. Med."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1136\/bmj.283.6298.1023","article-title":"Acute Arthritis Associated with Clostridium difficile Colitis","volume":"283","author":"Bolton","year":"1981","journal-title":"BMJ"},{"key":"ref_153","first-page":"287","article-title":"Reactive Arthritis Due to Clostridium difficile","volume":"95","author":"Abbott","year":"1982","journal-title":"N. Z. Med. J."},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1111\/j.1445-5994.1982.tb03841.x","article-title":"Reactive Arthritis Associated with Clostridium difficile","volume":"12","author":"McCluskey","year":"1982","journal-title":"Aust. N. Z. J. Med."},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1001\/archinte.1984.00350150229045","article-title":"Acute Oligoarthritis Associated with Clostridium difficile Pseudomembranous Colitis","volume":"144","author":"Lofgren","year":"1984","journal-title":"Arch. Intern. Med."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1002\/art.1780300920","article-title":"Arthritis and Non-antibiotic-associated Pseudomembranous Colitis","volume":"30","author":"Paty","year":"1987","journal-title":"Arthritis Rheum."},{"key":"ref_157","first-page":"520","article-title":"Reactive Arthritis Associated with Clostridium difficile Enteritis","volume":"15","author":"Atkinson","year":"1988","journal-title":"J. Rheumatol."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"57","DOI":"10.3109\/03009748909095404","article-title":"Reactive Oligoarthritis Associated with Clostridium difficile Colitis","volume":"18","author":"Hannonen","year":"1989","journal-title":"Scand. J. Rheumatol."},{"key":"ref_159","first-page":"133","article-title":"Clostridium difficile Associated Reactive Arthritis in an HLA-B27 Positive Female: Report and Literature Review","volume":"16","author":"Mermel","year":"1989","journal-title":"J. Rheumatol."},{"key":"ref_160","first-page":"752","article-title":"Relapsing Clostridium difficile Colitis and Reiter\u2019s Syndrome","volume":"85","author":"Hayward","year":"1990","journal-title":"Am. J. Gastroenterol."},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/BF01971269","article-title":"Clostridium difficile Toxin-Induced Reactive Arthritis in a Patient with Chronic Reiter\u2019s Syndrome","volume":"11","author":"Cope","year":"1992","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1097\/00004836-199306000-00020","article-title":"Clostridium difficile-Associated Reactive Arthritis in an HLA-B27 Negative Male","volume":"16","author":"Sensini","year":"1993","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_163","first-page":"171","article-title":"Reactive Arthritis Induced by Clostridium difficile","volume":"160","author":"Boice","year":"1994","journal-title":"West. J. Med."},{"key":"ref_164","first-page":"61","article-title":"Reactive Arthritis Following Clostridium difficile Colitis","volume":"162","author":"Keating","year":"1995","journal-title":"West. J. Med."},{"key":"ref_165","first-page":"419","article-title":"V Reactive Arthritis to Clostridium difficile in a Child","volume":"166","author":"Cron","year":"1997","journal-title":"West. J. Med."},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/00124743-199704000-00007","article-title":"Reactive Arthritis Following Clostridium difficile Colitis in a 3-Year-Old Patient","volume":"3","author":"Finger","year":"1997","journal-title":"JCR J. Clin. Rheumatol."},{"key":"ref_167","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1080\/03009749850154384","article-title":"Clostridium difficile Infection in Patients with Reactive Arthritis of Undetermined Etiology","volume":"27","author":"Kocar","year":"1998","journal-title":"Scand. J. Rheumatol."},{"key":"ref_168","first-page":"795","article-title":"Reactive Oligoarthritis in a Patient with Clostridium difficile Pseudomembranous Colitis. Review of the Literature","volume":"65","author":"Veillard","year":"1998","journal-title":"Rev. Rhum. Engl. Ed."},{"key":"ref_169","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/S0049-0172(05)80033-2","article-title":"Reactive Arthritis Associated with Clostridium difficile Pseudomembranous Colitis","volume":"22","author":"Putterman","year":"1993","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_170","first-page":"476","article-title":"[Joint Manifestations Related to Clostridium difficile]","volume":"29","author":"Vermeulen","year":"2000","journal-title":"Presse Med."},{"key":"ref_171","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/S1297-319X(03)00056-3","article-title":"Clostridium difficile-Associated Reactive Arthritis in Two Children","volume":"71","author":"Pron","year":"2004","journal-title":"Jt. Bone Spine"},{"key":"ref_172","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.medmal.2005.04.003","article-title":"Arthrite R\u00e9actionnelle a Clostridium difficile","volume":"35","author":"Genet","year":"2005","journal-title":"Med. Mal. Infect."},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1024\/0369-8394.94.12.471","article-title":"Monoarthrite Associ\u00e9e \u00e0 Une Ent\u00e9rocolite \u00e0 Clostridium difficile","volume":"94","author":"Guillemin","year":"2005","journal-title":"Praxis"},{"key":"ref_174","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1007\/s10067-007-0710-2","article-title":"Clostridium difficile: An under-Recognized Cause of Reactive Arthritis?","volume":"27","author":"Birnbaum","year":"2008","journal-title":"Clin. Rheumatol."},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1097\/INF.0b013e31819bdaa3","article-title":"Severe Clostridium difficile colitis and reactive arthritis in a ten-year-old child","volume":"28","author":"Durand","year":"2009","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_176","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.1016\/j.revmed.2009.03.352","article-title":"Arthrite R\u00e9actionnelle \u00e0 Clostridium difficile","volume":"31","author":"Morel","year":"2010","journal-title":"Rev. Med. Interne"},{"key":"ref_177","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.jbspin.2010.01.007","article-title":"Reactive Arthritis Due to Clostridium difficile","volume":"77","author":"Prati","year":"2010","journal-title":"Jt. Bone Spine"},{"key":"ref_178","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.arcped.2012.03.011","article-title":"Polyarthrite R\u00e9actionnelle \u00e0 Clostridium difficile Chez Un Enfant de 7ans","volume":"19","author":"Dacheux","year":"2012","journal-title":"Arch. De P\u00e9diatrie"},{"key":"ref_179","first-page":"1591753","article-title":"Clostridium difficile Enterocolitis and Reactive Arthritis: A Case Report and Review of the Literature","volume":"2016","author":"Cappella","year":"2016","journal-title":"Case Rep. Pediatr."},{"key":"ref_180","doi-asserted-by":"crossref","first-page":"30151","DOI":"10.3402\/jchimp.v6.30151","article-title":"A Case of Reactive Arthritis Due to Clostridium difficile Colitis","volume":"6","author":"Essenmacher","year":"2016","journal-title":"J. Community Hosp. Intern. Med. Perspect."},{"key":"ref_181","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.anaerobe.2015.12.011","article-title":"Clostridium difficile Associated Reactive Arthritis: Case Report and Literature Review","volume":"38","author":"Legendre","year":"2016","journal-title":"Anaerobe"},{"key":"ref_182","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.revmed.2016.12.015","article-title":"Arthrite R\u00e9actionnelle \u00e0 Clostridium difficile: \u00c0 Propos de Deux Observations et Revue de La Litt\u00e9rature","volume":"38","author":"Garrigues","year":"2017","journal-title":"Rev. Med. Interne"},{"key":"ref_183","doi-asserted-by":"crossref","first-page":"2324709618767689","DOI":"10.1177\/2324709618767689","article-title":"Clostridium difficile Colitis Leading to Reactive Arthritis: A Rare Complication Associated with a Common Disease","volume":"6","author":"Marwat","year":"2018","journal-title":"J. Investig. Med. High. Impact Case Rep."},{"key":"ref_184","doi-asserted-by":"crossref","unstructured":"Zimmermann, O., K\u00f6chel, H., Bohne, W., Pollok-Kopp, B., Passenberg, P., and Gro\u00df, U. (2022). A Case Report and Review of the Literature: Reactive Arthritis Caused by Clostridioides difficile Ribotype 027. Front. Microbiol., 13.","DOI":"10.3389\/fmicb.2022.837422"},{"key":"ref_185","doi-asserted-by":"crossref","first-page":"e240890","DOI":"10.1136\/bcr-2020-240890","article-title":"Reactive Arthritis: An Unusual Presentation of Acute Clostridioides difficile Colitis","volume":"14","author":"Reinholz","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref_186","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1177\/00099228221098977","article-title":"Pediatric Reactive Arthritis Due to Clostridioides difficile Infection","volume":"61","author":"Rand","year":"2022","journal-title":"Clin. Pediatr."},{"key":"ref_187","first-page":"e54647","article-title":"Reactive Arthritis as a Consequence of Infection by Clostridium difficile in a Pediatric Patient","volume":"16","year":"2024","journal-title":"Cureus"},{"key":"ref_188","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.eimc.2021.09.006","article-title":"Clostridium difficile Associated Reactive Arthritis: An Unusual Clinical Case and Review of the Literature","volume":"40","year":"2022","journal-title":"Enfermedades Infecc. Y Microbiol. Clin. (Engl. Ed.)"},{"key":"ref_189","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/0049-0172(94)90075-2","article-title":"Reiter\u2019s Syndrome and Reactive Arthritis: A Current View","volume":"24","author":"Hughes","year":"1994","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_190","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1099\/jmm.0.47678-0","article-title":"Enhancement of the Cytotoxic Activity of Clostridium difficile Toxin A by Surface-Associated Antigens","volume":"57","author":"Poxton","year":"2008","journal-title":"J. Med. Microbiol."},{"key":"ref_191","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.tim.2022.08.008","article-title":"The Microbiome in HLA-B27-Associated Disease: Implications for Acute Anterior Uveitis and Recommendations for Future Studies","volume":"31","author":"Parthasarathy","year":"2023","journal-title":"Trends Microbiol."},{"key":"ref_192","first-page":"456","article-title":"Repeat Ileocolonoscopy in Reactive Arthritis","volume":"14","author":"Mielants","year":"1987","journal-title":"J. Rheumatol."},{"key":"ref_193","first-page":"124","article-title":"Reactive Arthritis: Update","volume":"7","author":"Bentaleb","year":"2020","journal-title":"Bacteriology"},{"key":"ref_194","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1128\/CVI.00770-13","article-title":"Colonic Immunopathogenesis of Clostridium difficile Infections","volume":"21","author":"Darkoh","year":"2014","journal-title":"Clin. Vaccine Immunol."},{"key":"ref_195","doi-asserted-by":"crossref","first-page":"IV4","DOI":"10.1093\/rheumatology\/keab266","article-title":"IL-23 Orchestrating Immune Cell Activation in Arthritis","volume":"60","author":"Najm","year":"2021","journal-title":"Rheumatology"},{"key":"ref_196","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1038\/nrrheum.2015.128","article-title":"Erratum: The IL-23-IL-17 Axis in Inflammatory Arthritis","volume":"11","author":"Lubberts","year":"2015","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_197","doi-asserted-by":"crossref","unstructured":"Wang, S., Courreges, M.C., Xu, L., Gurung, B., Berryman, M., and Gu, T. (2024). Revealing Roles of S-Layer Protein (SlpA) in Clostridioides difficile Pathogenicity by Generating the First SlpA Gene Deletion Mutant. Microbiol. Spectr., 12.","DOI":"10.1128\/spectrum.04005-23"},{"key":"ref_198","doi-asserted-by":"crossref","unstructured":"Daquigan, N., Seekatz, A.M., Greathouse, K.L., Young, V.B., and White, J.R. (2017). High-Resolution Profiling of the Gut Microbiome Reveals the Extent of Clostridium difficile Burden. NPJ Biofilms Microbiomes, 3.","DOI":"10.1038\/s41522-017-0043-0"},{"key":"ref_199","first-page":"59","article-title":"A Longitudinal Study of Calprotectin as an Inflammatory Marker in Patients with Reactive Arthritis","volume":"13","author":"Hammer","year":"1995","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_200","doi-asserted-by":"crossref","first-page":"916","DOI":"10.3899\/jrheum.121192","article-title":"Antibiotics for Treatment of Reactive Arthritis: A Systematic Review and Metaanalysis","volume":"40","author":"Barber","year":"2013","journal-title":"J. Rheumatol."},{"key":"ref_201","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1136\/gut.46.4.481","article-title":"Clostridium difficile Toxin A Excites Enteric Neurones and Suppresses Sympathetic Neurotransmission in the Guinea Pig","volume":"46","author":"Xia","year":"2000","journal-title":"Gut"},{"key":"ref_202","first-page":"e53449","article-title":"Atypical Clostridium difficile Infection in a Pregnant Patient: A Case Study on Non-Diarrheal Presentation and Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Complication","volume":"16","author":"Ismail","year":"2024","journal-title":"Cureus"},{"key":"ref_203","first-page":"193","article-title":"Takotsubo Syndrome and Colitis Due to Clostridium difficile: Is There a Relationship?","volume":"26","author":"Haydar","year":"2024","journal-title":"Isr. Med. Assoc. J."},{"key":"ref_204","first-page":"256","article-title":"Fatal Course of Takotsubo Cardiomyopathy in a Female with Recurrent Clostridium difficile Infection","volume":"42","author":"Elikowski","year":"2017","journal-title":"Pol. Merkur. Lek."},{"key":"ref_205","doi-asserted-by":"crossref","first-page":"S918","DOI":"10.14309\/00000434-201810001-01596","article-title":"Clostridium difficile Colitis Causing Takotsubo Cardiomyopathy","volume":"113","author":"Megan","year":"2018","journal-title":"Am. J. Gastroenterol."},{"key":"ref_206","doi-asserted-by":"crossref","first-page":"316","DOI":"10.4103\/1947-2714.187156","article-title":"Clostridium difficile Infection and Takotsubo Cardiomyopathy: Is There a Relation?","volume":"8","author":"Virk","year":"2016","journal-title":"N. Am. J. Med. Sci."},{"key":"ref_207","doi-asserted-by":"crossref","first-page":"12","DOI":"10.22516\/25007440.500","article-title":"Vasculitis Leucocitocl\u00e1sticas Como Manifestaci\u00f3n Extraintestinal Dermatol\u00f3gica Rara de La Enfermedad Inflamatoria Intestinal Asociada Con Clostridium: Reporte de Un Caso","volume":"36","year":"2021","journal-title":"Rev. Colomb. Gastroenterol."},{"key":"ref_208","doi-asserted-by":"crossref","first-page":"e262106","DOI":"10.1136\/bcr-2024-262106","article-title":"Extraintestinal Clostridium difficile Infection Presenting as Spontaneous Bacterial Peritonitis","volume":"18","author":"Hafeez","year":"2025","journal-title":"BMJ Case Rep."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/7\/670\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:02:48Z","timestamp":1760032968000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/7\/670"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,2]]},"references-count":208,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["antibiotics14070670"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14070670","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,2]]}}}