Clostridium perfringens necrotizing pancreatitis: an unusual pathogen in pancreatic necrosis infection

Abstract

Pancreatic necrosis infection (PNI) accounts for about 20–40 % of severe acute pancreatitis. PNI caused by anaerobic bacteria is unusual but when they present, Clostridium perfringens is the microorganism most commonly involved. We present a 60-year-old patient with a previous history of SARS-CoV-2, diagnosed with acute pancreatitis. During the hospitalisation he developed Clostridium perfringens bacteraemia. A CT-scan showed pancreatic gas gangrene and a surgical necrosectomy was performed. Clostridium perfringens was isolated in cultures of the pancreatic tissue and collections. The patient’s clinical status improved after surgery and the appropriate medical therapy. He was discharged 76 days after admission. Nowadays, the ‘step-up approach’ is an accepted therapeutic tool in treatment of pancreatic necrosis and peripancreatic fluid collections. However, most authors suggest that Clostridum perfringens infection requires a more aggressive approach due to the high mortality associated to clostridial infection.

The peripancreatic microbiota is associated with the severity of acute pancreatitis

“…16S rRNA sequencing technology has been validated for the identi cation and abundance of anaerobes in samples such as blood and sputum [21,22]. Case report studies by Tang [23] and Sánchez-Gollarte [24] revealed that anaerobic infections predict a poor prognosis for IPN patients. Similarly, this study revealed that anaerobic bacteria such as Anabaena fragilis were important ora in the microbial composition of localized necrotic material in both groups.…”

A Rare Case of Acute Necrotizing Pancreatitis Infected With Prevotella Species

“…Staphylococcal species accounted for 33% of isolates, followed by Escherichia coli (22%) and Klebsiella (13%) [ 12 ]. Infections with anaerobic bacteria are rare, and clostridium perfringens are usually the primary organism involved [ 13 ]. Prevotella is a genus of gram-negative anaerobic rods that usually colonizes human mucosal surfaces, including the oral cavity, skin, and gastrointestinal tract [ 14 ].…”

Acute pancreatitis with pancreatic gas gangrene

“…The pathogenesis of the disease has not yet been fully elucidated. C. perfringens and Klebsiella pneumoniae have been reported as causative agents of pancreatic gas gangrene [2] , [3] . Although antibiotics are not typically indicated for acute pancreatitis, we should promptly administer antibiotics since peripancreatic gas suggests a severe infection.…”

“…Although antibiotics are not typically indicated for acute pancreatitis, we should promptly administer antibiotics since peripancreatic gas suggests a severe infection. Moreover, treatment of pancreatic gas gangrene with antibiotics alone is insufficient [3] . Early surgical intervention is necessary in addition to antibiotics.…”