Clostridial Bacteremia Research Articles

Clostridial Bacteremia: Patterns of Infection

The records of 122 consecutive patients who, after admission to the Brigham and Women's Hospital over a period of 9 years, were found to have clostridial bacteremia, were studied. Clostridium perfringens organisms were recovered in 63% of the cases; Clostridium septicum, Clostridium innocuum, Clostridium rectum, Clostridium bifermentans, or Clostridium sordellii organisms were each isolated from five or more cultures of the blood. The overall fatality rate was 29%. Three groups of patients were identified. There were 37 patients in whom the clostridial bacteremia was self-limited and resolved without appropriate antibiotics. In 12 of these patients, the clostridium isolated was possibly a contaminant, whereas in 25 others, the clostridial bacteremia was presumably transient. Overall, blood samples from 30 of these 37 patients grew C. perfringens in culture. A second group included 35 patients with severe and well-documented clostridial infection. In this group, malignant lesions were present in 62.9%, diseases of the biliary tract were the underlying disorder in 14.3%, and the fatality rate was 65.7%. Immunosuppressed patients were infected most often by non-perfringens species of Clostridium. The third group was composed of those patients with less severe infections, possibly mediated by the effects of appropriate antibiotic treatment.

Commentary: Clostridial Bacteremia

Commentary: Clostridial Bacteremia

Clostridial Bacteremia and Death Following Chemoembolization for Hepatocellular Carcinoma

Clostridial Bacteremia and Death Following Chemoembolization for Hepatocellular Carcinoma

Successful antibiotic therapy of clostridial septic arthritis in a patient with bilateral total hip prostheses

We report a case of clostridial bacteraemia with infection of a prosthetic hip joint. The patient was successfully treated with IV benzyl penicillin and fucidin followed by oral amoxycillin and probenecid, without surgical intervention. She had no recurrence of her infection in the 19 months before her death. This is believed to be the first reported case of clostridial infection affecting a prosthetic joint.

Clostridial bacteremia in cancer patients. A 12-year experience

Over 12 years, 136 episodes of bacteremia caused by clostridial species were documented. Eighty-three were monomicrobial, and 53 were polymicrobial. Gastrointestinal, genitourinary carcinomas, and acute leukemia were the most common underlying malignancies. Septic shock occurred in 29% of monomicrobial bacteremias and 45% of polymicrobial bacteremias and was associated with a high mortality rate. Acute hemolysis, gas gangrene, and diffuse spreading cellulitis occurred infrequently but were associated with a 100% fatality rate. Many infections caused by Clostridium perfringens and C. septicum were associated with abdominal disease. The most commonly isolated organism was C. perfringens, followed by C. septicum and C. sporogenes. Overall survival was 58%, but it was 66% for monomicrobial episodes and 45% for polymicrobial infections. All of the patients with bacteremia due to an aerobic gram-negative bacillus in addition to the clostridial species died of their infection. The most effective antibiotics were clindamycin, penicillin, metronidazole, and moxalactam. Surgical drainage of abscesses was an important component of therapy.

Clostridial pleuropulmonary infections: Case report and review of the literature

Clostridia rarely cause pleuropulmonary infections in the absence of trauma. We report a case of intermittent bowel obstruction, clostridial bacteraemia and pneumonia with a fatal outcome. Only 16 cases have previously been reported. Clostridial infection of the lung has many features of an acute pneumonia and is almost always associated with a pleural effusion. Most cases are caused by Clostridium perfringens, though infections with other species have been reported. The prognosis is generally more favourable than in clostridial infection secondary to aspiration pneumonia or complicating empyema.

Sudden visual loss associated with clostridial bacteraemia.

Sudden visual loss associated with clostridial bacteraemia.

Non-Spore-Forming Clostridial Bacteremia

The significance of the non-spore-forming clostridium as a blood-borne pathogen has been underemphasized. Over a 7-year period, these bacteria were cultured 40 times in 30 patients. Overall mortality rate for non-spore-forming clostridial bacteremia was 39%. Patients with polymicrobial infections had a 58% mortality rate, while those with only clostridium in their blood had a mortality of 23%. Mortality increased as the number of positive cultures. Patients who were clinically septic at the time of their cultures fared poorly. Advanced age and underlying malignant disease were associated with increased mortality. Patients who have positive blood cultures for non-spore-forming clostridium are at a significant risk and should be treated aggressively.

Non-spore-forming clostridial bacteremia.

The significance of the non-spore-forming clostridium as a blood-borne pathogen has been underemphasized. Over a 7-year period, these bacteria were cultured 40 times in 30 patients. Overall mortality rate for non-spore-forming clostridial bacteremia was 39%. Patients with polymicrobial infections had a 58% mortality rate, while those with only clostridium in their blood had a mortality of 23%. Mortality increased as the number of positive cultures. Patients who were clinically septic at the time of their cultures fared poorly. Advanced age and underlying malignant disease were associated with increased mortality. Patients who have positive blood cultures for non-spore-forming clostridium are at a significant risk and should be treated aggressively.

Significance of clostridial bacteremia

In the absence of overt tissue necrosis, clostridial bacteremia has been considered a bacteriologic finding of little clinical significance. This study was done to examine this belief and determine the incidence and significance of clostridial bacteremia. In the past 6 years in a referral hospital, 6,030 positive blood cultures were seen in 2,542 patients. Fifty-three of the positive isolates contained spore-forming Clostridium species. They were found in 29 patients, for an incidence of 0.88 percent in all positive cultures in 1.14 percent in all patients. Mortality rates were 60 percent in patients with mixed (polymicrobial) positive blood cultures and 42 percent in patients with Clostridium alone in their blood. The mortality rate increased with an increasing number of positive blood cultures both in patients with mixed positive cultures and in patients with Clostridium alone in their blood. The mortality rate for patients with one positive blood culture, for Clostridium alone was 17 percent; however, when more than one culture was positive, the mortality rate increased to 67 percent. Sixteen patients (60 percent) had evidence of systemic sepsis at the time blood cultures were drawn, and 56 percent of them died. Eight patients (30 percent) with evidence of sepsis had Clostridium alone in their blood, and 38 percent of them died. Most patients with clostridial bacteremia had solid tumor malignancies, significant gastrointestinal bleeding or myeloproliferative disorders. No patient with biliary tract disease as the primary diagnosis had polymicrobial infections. Clostridium alone was isolated from their blood, and none died. Three general groups of patients were defined. The first group with biliary tract disease carried a good prognosis regardless of therapy. The second group, the elderly nursing home patients who presented with a septic picture, responded well to supportive therapy and treatment of their associated infection, usually pneumonia or urinary tract infection. The third group, patients with malignant disease, did the poorest and had the highest mortality rate with antibiotics or surgical intervention not affecting the outcome. These findings vary considerably from those in previously reported studies which consider the presence of Clostridium in the blood an incidental finding with minimal clinical significance.

Isolation of Clostridium in human infections: evaluation of 114 cases.

One hundred fifty-two strains of Clostridium were isolated from 144 patients over a 14-month-peroid. These included 23 recognized species and 23 strains that were unclassified. Soft tissues or abscesses yielded 84 strains of Clostridium. Intraabdominal sites predominated, but clostridia were recovered from empyema, carcinoma, frostbite with gas gangrene, muscle abscess, aortic graft, and brain abscess. Blood cultures yielded 65 strains of Clostridium from 49 patients, representing 0.3% of 16,314 blood cultures (or 2.6% of 2,168 positive cultures). Clostridium perfringens was most common in blood, accounting for 37 isolates (57%). Clostridial bacteremia was often unrelated to the clinical setting and was found in alcoholics with aspiration or Streptococcus pneumoniae pneumonia, pulmonary tuberculosis, empyema, meningococcemia, and infantile gastroenteritis. In 20 of the 49 patients (41%), aerobic or other anaerobic bacteria were cultured concurrently from the blood. Thus, clostridial bacteremia should be interpreted with caution since there may be little correlation with the patient's clinical condition.

Clostridial cystitis emphysematosa

Two cases of cystitis emphysematosa with clostridial bacteremia are presented, and the potential importance of anaerobic organisms in producing this condition is emphasized.

Polymicrobial bacteremia.

Polymicrobial bacteremia, defined as a bacteremic episode due to at least two different organisms isolated from the same blood sample, occurred in 46 patients (6% of all patients with bacteriologically established bacteremia) in an 18-month period. The mortality was 37%. Patients with gastrointestinal, biliary, or hepatic abnormalities represented the single largest group (30%); in this group and in patients with urinary tract abnormalities pathologic processes causing obstruction were common. A relatively benign clostridial bacteremia without underlying gas gangrene was found in four patients and should be differentiated from the clostridial bacteremia with hemolysis which may be seen as a terminal event in patients with gas gangrene. The rare entity of polymicrobial endocarditis or endarteritis can easily be overlooked; it was seen in three patients.

Clostridial Bacteremia Without Hemolysis

Clostridial bacteremia without hemolysis occurred in 20 patients with serious chronic diseases and in patients with postabortal and postpartum sepsis. The underlying chronic disease was the cause of ulcerated or necrotic processes such as decubitus ulcers, malignant tumors, or gangrenous extremities that were heavily contaminated with commensal organisms, and bacteremia appeared to originate from them. Lesions did not have the characteristics of gas gangrene. The bacteremia was manifested by fever and leukocytosis and responded well to appropriate surgical treatment and antibiotics. Four of the 20 patients died within three days of the positive blood culture. Death resulted from the infection in three patients. On five occasions, the blood cultures were positive for multiple organisms. None of the patients died.

Clostridial pericarditis diagnosed antemortem

This report describes a case of spontaneous gas gangrene of the pericardium in a patient who survived 4 months. The diagnosis was established antemortem, and the patient was treated with broad-spectrum antibiotics, injected intramuscularly, penicillin, given parenterally and by local instillation, and surgical drainage. He rapidly developed constrictive pericarditis and died, probably from septic embolism to the spleen, with subsequent peritonitis and toxic shock, before pericardictomy could be performed. It is postulated that the process arose as a primary infection in a mural thrombus or in an area of ischemic myocardium after clostridial bacteremia.