Epidemiology, aetiology and clinical characteristics of clostridial bacteraemia: a 6-year population-based observational study of 386 patients.

The objective of this study is to provide a population-based clinical, epidemiological and microbiological overview of clostridial bacteraemia. All cases of bacteraemia in the Skåne Region between 2014 and 2019 with a species currently belonging to the Clostridium genus were identified in the regional clinical microbiology database. Clinical data were retrieved by medical chart-review. A total of 386 unique episodes of clostridial bacteraemia were found resulting in an incidence rate of 4.9/100.000 person-years. The median age was 76 with 56% males. The incidence rate ratio was 34.3 for those aged 80 + vs 0-59. The minimum inhibitory concentrations varied between species but were universally low for metronidazole and carbapenems. Malignancy was the most common co-morbidity, in 47% of patients and most pronounced for C. septicum. Criteria for sepsis and septic shock were met in 69% and 17%, respectively. The 28-day mortality was 26%. High age, absence of fever, high C-reactive protein and high SOFA-score were all significantly associated with mortality. We present the highest incidence rate of clostridial bacteraemia to date. Clostridial bacteraemia is a severe condition with acute onset, affecting elderly with co-morbidities, most pronounced malignancies. Mortality is related to acute manifestations rather than to background factors.

[Sepsis with intravascular hemolysis caused by Clostridium perfringens]. / Bakteriemi med C perfringens ­ ovanligt men livshotande tillstånd.

Clostridium perfringens is a gram-positive anaerobic rod commonly found in our natural environment as well as in human intestinal and vaginal microflora. Due to its production of several toxins it may cause numerous infections of varying degrees of severity. Bacteremia, albeit uncommon, is potentially lethal owing to the disruption of red blood cells leading to hemolysis and septic shock in which mortality is very high. Immunosuppression, malignancy and diabetes are the most common risk factors for developing bacteremia induced by C. perfringens.  The most effective treatment is most likely a combination of a beta-lactam antibiotic and clindamycin or metronidazole and, if possible, surgical drainage.  This case study presents a female 67-year old patient with undiagnosed diabetes who developed septic shock with massive intravascular hemolysis caused by C. perfringens. The status of the patient was rapidly deteriorating and death followed three hours after her arrival at the emergency department. An autopsy was performed during which a liver abscess was discovered and assessed to be the source of infection. Diabetes is a well-known risk factor for both liver abscess and C. perfringens infection.  Conclusively it can be stated that the combination of hemolysis and infection should lead to consideration of C. perfringens as the possible pathogen and thus immediate suitable antibiotic treatment must ensue.