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.
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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 |
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 |
Table 3.
Comparison of epidemiologic and clinical characteristics of polymicrobial and monomicrobial infection in patients with CB