Evaluation of Clostridium Bacteremia in the Cancer Population: A Case Series

Introduction Clostridium species are gram-positive or gram-variable anaerobic organisms that have been known to cause different kinds of infections of varying scope and severity. Clostridium species have been associated with high in-hospital mortality rates, particularly in immunocompromised patients with malignancies. Despite the potential severity of these infections in the oncologic population, primary literature on the topic is relatively scarce. Methods A retrospective chart review was performed to identify all patients older than 18 years with positive Clostridium species blood cultures at the H. Lee Moffitt Cancer Center and Research Institute from April 10, 2005, to September 30, 2016. Data were analyzed to identify underlying risk factors, clinical presentation, and treatment of Clostridium bacteremia in the cancer population. Results A total of 18 patients had bacteremia with Clostridium species. The patients' ages ranged from 26 to 79 years (median, 62.5 years), and 6 of the patients were female (33%). The predominant Clostridium species in our sample was Clostridium perfringens, which was found in 7 patients (38%), followed by Clostridium septicum found in 4 patients (22%). A gastrointestinal source was identified in 11 patients (66%). Three patients died of the infection (16%). Conclusions The potential severity of Clostridium infections in the oncologic population warrants a thorough evaluation in every patient with positive blood cultures, with focus on the gastrointestinal tract as a potential source of infection. Further studies about susceptibility testing would provide valuable information and may serve to reduce mortality rates among patients with Clostridium bacteremia. Correspondence to: John N. Greene, MD, FACP, H. Lee Moffitt Cancer Center, 12902 Magnolia Dr, FOB-3, Tampa, FL 33612. E-mail: John.Greene@moffitt.org. The authors have no funding or conflicts of interest to disclose. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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