Journal List > Ann Clin Microbiol > v.18(4) > 1078526

TOOLS
Kim, Yun, Chun, Huh, and Lee: Eleven-Year Experience of Clostridial Bacteremia at a Tertiary Care Hospital in South Korea
Original Article

Ann Clin Microbiol 2015;18(4):126-132.

Published online: 5 December 2015

DOI: https://doi.org/10.5145/ACM.2015.18.4.126

Eleven-Year Experience of Clostridial Bacteremia at a Tertiary Care Hospital in South Korea

Yeongbin Kim1, Jae Won Yun2, Sejong Chun1, Hee Jae Huh1, Nam Yong Lee1

1Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

2Samsung Genome Institute, Samsung Medical Center, Seoul, Department of Molecular Cell Biology, Sungkyunkwan Universitiy School of Medicine, Suwon, Korea

Correspondence: Nam Yong Lee, Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. (Tel) 82-2-3410-2706, (Fax) 82-2-3410-2719, (E-mail) micro.lee@samsung.com

Received 31 August 201515 October 2015       Accepted 16 October 2015

Copyright © 2015 The Korean Society of Clinical Microbiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Background

Clostridial bacteremia (CB) is the second most frequent anaerobic bacteremia, and CB patients show high mortality without prompt antimicrobial therapy. We retrospectively reviewed 11 years of CB cases in a tertiary care hospital to describe the clinical and microbiological characteristics of CB and to de fi ne the risk factors of fatal CB.

Methods

All patients with CB from January 2002 to December 2012 were included in the study. Age, sex, underlying diseases, antibiotic use, and clinical outcome were reviewed. Antibiotic therapy was clas-sified as either ‘appropriate’ or ‘inappropriate’ based on the activity against Clostridium species.

Results

A total of 118 Clostridium isolates (0.79% of all blood culture isolates) were recovered from the blood cultures of 114 patients. The underlying con-ditions of patients with CB were neoplasm in 87 cases (76.3%), gastrointestinal symptoms in 84 cases (73.7%), diabetes in 17 cases (14.9%), and hemodialysis in six cases (5.3%). Of the 118 Clostridium isolates, C. perfringens was the most frequent species (42 isolates,35.6%). Thirty-two patients (28.1%) showed polymicrobial bacteremia, which was most commonly combined with Escherichia coli. Two patients harbored more than two Clostridium species. ‘Appropriate’ antibiotics were given to 97 (85.1%) patients. The mortality rate of CB at days 2, 8, and 30 was 7.9% (9/114), 14.0% (16/114), and 26.3% (30/114), respectively.

Conclusion

Neoplasm, especially in the gastrointestinal tract or of hematologic origin, and hemodialysis were considered to be risk factors of blood stream clostridial infection. Early appropriate antibiotic coverage of CB was not definitely associated with lower mortality in our study.

Keywords: Anaerobic bacteria, Bacteremia, Clostridium, Sepsis

REFERENCES

1.Goldstein EJ. Anaerobic bacteremia. Clin Infect Dis. 1996. 23(Suppl 1):S97–101.
crossref
2.Lassmann B., Gustafson DR., Wood CM., Rosenblatt JE. Reemer-gence of anaerobic bacteremia. Clin Infect Dis. 2007. 44:895–900.
crossref
3.Brook I. Anaerobic bacterial bacteremia: 12-year experience in two military hospitals. J Infect Dis. 1989. 160:1071–5.
crossref
4.Ingram CW., Cooper JN. Clostridial bloodstream infections. South Med J. 1989. 82:29–31.
crossref
5.Chen YM., Lee HC., Chang CM., Chuang YC., Ko WC. Clostridium bacteremia: emphasis on the poor prognosis in cirrhotic patients. J Microbiol Immunol Infect. 2001. 34:113–8.
6.de Virgilio C., Klein S., Chang L., Klassen M., Bongard F. Clostridial bacteremia: implications for the surgeon. Am Surg. 1991. 57:388–93.
7.Bodey GP., Rodriguez S., Fainstein V., Elting LS. Clostridial bacteremia in cancer patients. A 12-year experience. Cancer. 1991. 67:1928–42.
crossref
8.Gorbach SL., Thadepalli H. Isolation of Clostridium in human infections: evaluation of 114 cases. J Infect Dis. 1975. 131(Suppl):S81-5.
9.Benjamin B., Kan M., Schwartz D., Siegman-Igra Y. The possible significance of Clostridium spp. in blood cultures. Clin Microbiol Infect. 2006. 12:1006–12.
10.Rechner PM., Agger WA., Mruz K., Cogbill TH. Clinical features of clostridial bacteremia: a review from a rural area. Clin Infect Dis. 2001. 33:349–53.
crossref
11.Johnson S., Driks MR., Tweten RK., Ballard J., Stevens DL., Ander-son DJ, et al. Clinical courses of seven survivors of Clostridium septicum infection and their immunologic responses to alpha toxin. Clin Infect Dis. 1994. 19:761–4.
12.Shah M., Bishburg E., Baran DA., Chan T. Epidemiology and outcomes of clostridial bacteremia at a tertiary-care institution. Scien-tificWorldJournal. 2009. 9:144–8.
crossref
13.Stevens DL., Bryant AE., Carroll KC. Clostridium. Jorgensen JH, Pfaller MA, Carroll KC, Funke G, Landry ML, Richter SS, editors. Manual of Clinical Microbiology. 11th ed. Washington, D.C.: ASM Press;2015. p. 940–66.
14.CLSI. Performance standards for antimicrobial susceptibility testing; twenty-fourth informational supplement. CLSI document M100-S24. Wayne, PA: Clinical and Laboratory Standards Institute. 2014.
15.Haddy RI., Nadkarni DD., Mann BL., Little DR., Domers TD., Clover RD, et al. Clostridial bacteremia in the community hospital.
16.Leal J., Gregson DB., Ross T., Church DL., Laupland KB. Epidemiology of Clostridium species bacteremia in Calgary, Canada, 2000-2006. J Infect. 2008. 57:198–203.
17.Zahar JR., Farhat H., Chachaty E., Meshaka P., Antoun S., Nitenberg G. Incidence and clinical significance of anaerobic bacteraemia in cancer patients: a 6-year retrospective study. Clin Microbiol Infect. 2005. 11:724–9.
crossref
18.Schreckenberger PC., Celig DM., Janda WM. Clinical evaluation of the Vitek ANI card for identification of anaerobic bacteria. J Clin Microbiol. 1988. 26:225–30.
crossref
19.Lee EH., Degener JE., Welling GW., Veloo AC. Evaluation of the Vitek 2 ANC card for identification of clinical isolates of anaerobic bacteria. J Clin Microbiol. 2011. 49:1745–9.
crossref

Fig. 1.
The frequency of each Clostridium species in 118 clostridial isolates.
acm-18-126f1.tif
Table 1.
The frequency of clinical condition and 2-, 8-, 30-day mortality in each Clostridium species
Type of Clostridium species (Total number) DM GI Symptom HD Neoplasms Polymicrobial bacteremia Healthcare-associated Community-acquired Mortality (2 day) Mortality (8 day) Mortality (30 day)
Clostridium perfringens (42) 3 (7.1%) 25 (59.5%) 1 (2.4%) 31 (73.8%) 16 (38.1%) 18 (42.9%) 24 (57.1%) 7 (16.7%) 9 (21.4%) 15 (35.7%)
Clostridium clostridioforme (20) 3 (15%) 16 (80%) 2 (10%) 16 (80%) 3 (15%) 7 (35%) 13 (65%) 0 (0%) 5 (25%) 7 (35%)
Clostridium species∗ (14) 4 (28.6%) 10 (71.4%) 0 (0%) 12 (85.7%) 4 (28.6%) 6 (42.9%) 8 (57.1%) 0 (0%) 0 (0%) 2 (14.3%)
Clostridium bifermentans (10) 1 (10%) 7 (70%) 0 (0%) 9 (90%) 3 (30%) 7 (70%) 3 (30%) 1 (10%) 1 (10%) 2 (20%)
Clostridium histolyticum (7) 0 (0%) 7 (100%) 0 (0%) 6 (85.7%) 1 (14.3%) 4 (57.1%) 3 (42.9%) 0 (0%) 0 (0%) 0 (0%)
Clostridium difficile (6) 1 (16.7%) 6 (100%) 1 (16.7%) 5 (83.3%) 3 (50%) 3 (50%) 3 (50%) 0 (0%) 0 (0%) 1 (16.7%)
Clostridium septicum (5) 1 (20%) 4 (80%) 0 (0%) 3 (60%) 1 (20%) 1 (20%) 4 (80%) 0 (0%) 0 (0%) 0 (0%)
Clostridium paraputrificum (3) 1 3 0 1 2 2 1 0 0 1
Clostridium baratii (2) 0 2 0 1 1 2 0 0 0 0
Clostridium butyricum (2) 1 2 1 0 0 0 2 0 0 0
Clostridium sporogenes (2) 2 2 1 1 0 2 0 0 0 0
Clostridium hastiforme (1) 0 1 0 1 0 1 0 1 1 1
Clostridium sordellii (1) 0 1 0 1 0 0 1 0 0 0
Clostridium subterminale (1) 0 1 0 1 0 1 0 0 0 0
Clostridium symbiosum (1) 0 1 0 1 0 0 1 0 0 1
Clostridium tertium (1) 0 0 0 1 1 1 0 0 0 0

Percentages were described in Clostridium species with more than 5 cases.

∗ Clostridium species: Clostridium species that were not definitely identified to the species level.

Abbreviations: DM, diabetes mellitus; GI, gastrointestinal; HD, hemodialysis.

Table 2.
The proportion of patients with neoplasms in CB and non- CB cases during the 11-years study period
Patient No. CB non-CB Total
With neoplasms 87 (76.3%) 5,237 (51.1%) 5,324 (51.4%)
Without neoplasms 27 (23.7%) 5,005 (48.9%) 5,032 (45.6%)
Total 114 10,242 10,356

P＜0.01, Chi-square test. Abbreviation: CB, clostridial bacteremia.

Table 3.
Comparison of epidemiologic and clinical characteristics of polymicrobial and monomicrobial infection in patients with CB
Patient group (n) Mean Age (SD) Male Neoplasms GI Symptoms DM HD Mortality (2 day) Mortality (8 day) Mortality (30 day)
Polymicrobial bacteremia (32) 57.5 (13.8) 24 (75.0%) 22 (68.8%) 24 (75.0%) ) 5 (15.6%) 1 (3.1%) 2 (6.3%) 3 (9.4%) 8 (25.0%)
Monomicrobial bacteremia (82) 58.5 (15.9) 54 (65.9%) 65 (79.3%) 60 (73.2%) ) 12 (14.6%) ) 5 (6.1%) 7 (8.5%) 13 (15.9%) 22 (26.8%)
Total (114) 58.2 (15.2) 78 (68.4%) 87 (76.3%) 84 (73.7%) ) 17 (14.9%) ) 6 (5.3%) 9 (7.9%) 16 (14.0%) 30 (26.3%)

Abbreviations: CB, clostridial bacteremia; SD, standard deviation; GI, gastrointestinal; DM, diabetes mellitus; HD, hemodialysis.

TOOLS
Similar articles