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.