The possible significance of Clostridium spp. in blood cultures

Abstract

The significance of Clostridium spp. in blood cultures was evaluated by two methods. In the first part of the study, a group of 80 patients with Clostridium spp. bacteraemia was compared with a group of 100 patients with Bacillus spp. in blood cultures, making the assumption that Bacillus almost invariably represents contamination (pseudobacteraemia). Significant differences were found between the two groups, suggesting that growth of Clostridium did not represent pseudobacteraemia. Patients with Clostridium bacteraemia were older, had a higher frequency of gastrointestinal disease (especially colorectal tumours), were associated more frequently with polymicrobial bacteraemia, and had a higher mortality rate. In the second part of the study, each of the 80 cases of Clostridium bacteraemia was evaluated individually for clinical relevance by an infectious diseases expert. In two-thirds of the cases, isolates of Clostridium from blood were considered to be of clinical relevance, whereas in one-third of cases, the clinical significance of this finding was doubtful. It was concluded that growth of Clostridium spp. in blood cultures, even in the absence of one of the histotoxic syndromes, is often of clinical significance, and that such findings should be properly evaluated and not ignored.

Epidemiology of Clostridium species bacteremia in Calgary, Canada, 2000–2006

“…15,38 However, several more recent investigations have demonstrated that Clostridium species are usually pathogenic and that failure to institute appropriate antimicrobial therapy is associated with an adverse mortality outcome. 5,39 Thus, our rates of bacteremia reported in this study likely overestimate to at least some degree the true incidence of clinically significant clostridial bloodstream infections. A second limitation of our study is that we used hospital discharge coding data to identify clinical details and did not access individual patient charts.…”

Medical and surgical management of an intra-abdominal abscess of hepatic origin in a horse

“…20 In human medicine, organism identification is considered one of the primary factors in clinical discrimination between true causes of bacteremia and contamination of blood submitted for bacteriologic culture. However, unlike human medicine, where clostridial species have been documented as causative pathogens in true bacteremia in the hospitalized adult population and some debate exists as the to the clinical importance of a positive culture result, 21 to the authors' knowledge, there are no reports of a clostridial species implicated in bacteremia of an immunocompetent adult horse. Although the presence of the gas stippling during the initial ultrasonographic examination and aspiration of fetid fluid from the abscess on day 21 supported an anaerobic infection, unfortunately, culture of anaerobic organisms from the fetid abscess fluid or from the necrotic hepatic tissue was not successful.…”

“…Findings on CBC revealed leukopenia with a marked neutropenia and a left shift with moderate toxic changes. Serum biochemical analysis revealed marked hyperfibrinogenemia, hypoalbuminemia, hyperglobulinemia, and mildly high serum amyloid A concentration (Table 1; day21). Initial abdominal ultrasonography at the time of hospital readmission revealed a return of the marked hepatic parenchymal abnormalities in the region of the left lateral liver lobe.…”

Clostridium glycolicum Bacteremia in a Bone Marrow Transplant Patient

“…are also found as normal inhabitants of the human colon and may similarly cause bacteremic disease in patients with perturbed host defense mechanisms (22). Polymicrobial bacteremia is frequently observed in patients with Clostridium bloodstream infections, particularly in the setting of severe sepsis or septic shock (2,21,22,25), whereby Clostridium spp. and infectious agents such as Enterococcus spp.…”

“…Severe sepsis or septic shock occurs in approximately 40% of patients with Clostridium bacteremia and, in this setting, is associated with a mortality rate of over 50% (3). Patients with hematological malignancies, particularly those experiencing partial failure of chemotherapy, have been shown to be at increased risk for Clostridium bacteremia, with or without sepsis or septic shock (2,3,25). The rigorous chemotherapeutic regimens used for the treatment of hematological malignancies are typically associated with damage to the mucosa of the gastrointestinal tract, leading to potential translocation of anaerobic bacteria such as Clostridium spp.…”