Isolation of Clostridium in human infections: evaluation of 114 cases

Non-spore-forming clostridial bacteremia

The significance of the non-spore-forming clostridium as a blood-borne pathogen has been underemphasized. Over a 7-year period, these bacteria were cultured 40 times in 30 patients. Overall mortality rate for non-spore-forming clostridial bacteremia was 39%. Patients with polymicrobial infections had a 58% mortality rate, while those with only clostridium in their blood had a mortality of 23%. Mortality increased as the number of positive cultures. Patients who were clinically septic at the time of their cultures fared poorly. Advanced age and underlying malignant disease were associated with increased mortality. Patients who have positive blood cultures for non-spore-forming clostridium are at a significant risk and should be treated aggressively.

Clinical laboratory evaluation of a reverse CAMP test for presumptive identification of Clostridium perfringens

Ninety-six percent of Clostridium perfringens isolates from clinical specimens were reverse CAMP test positive, whereas several other Clostridium species tested were reverse CAMP test negative. C. perfringens was detected by direct inoculation of clinical specimens to reverse CAMP plates, and the reverse CAMP procedure provided reliable presumptive identification of this organism.

Gangrenous and crepitant cellulitis

A dangerous and little-discussed group of soft tissue (skin, subcutaneous tissue, fascia, and skeletal muscle) infections are characterized by the presence of extensive gangrene and/or discernible tissue gas. The identifying characteristics of these infections, as well as diagnostic measures and therapy, are reviewed.

Penicillin-binding proteins in Clostridium perfringens

The penicillin-binding proteins (PBPs) of Clostridium perfringens were studied. Six PBPs ranging in molecular weight from approximately 42,000 to 100,000 were detected in the cytoplasmic membrane. The relative affinities of the PBPs for 16 beta-lactam antibiotics were determined. Most of the drug saturated PBP 3 and 4 at concentrations equal to their minimal inhibitory concentrations, suggesting that these PBPs are the killing targets for beta-lactams. Mecillinam showed unique properties; it had a higher affinity for PBP 5 than for other PBPs, and it was the only agent tested which caused inhibition of growth without saturating PBP 4. Interestingly, all beta-lactam antibiotics tested induced filament formation despite having different binding patterns to the PBPs of C. perfringens.

Clostridial pleuropulmonary infection

Primary clostridial pleuropulmonary infection occurred in two patients. The pathogenesis of infection was related to aspiration of oropharyngeal contents or hematogenous seeding of infarcted lung tissue. One patient was cured with penicillin; the other died secondary to sepsis and respiratory failure. Review of 13 additional cases from the literature demonstrated pulmonary infection due to Clostridia to be characterized by lobar or multilobar disease with uniform involvement of the pleura. Iatrogenic contamination of the pleural space may play some role in the pathogenesis of infection. The treatment of choice is penicillin and drainage of infected pleural fluid. The disease appears similar to other forms of bacterial empyema, although in some patients, a fulminant, fatal course may be seen.

Clostridial sepsis following hepatic arterial infusion chemotherapy

Three patients with clostridial sepsis during or following hepatic arterial infusions for the regional chemotherapy of hepatic metastatic tumors are described. In all patients abdominal roentgenograms revealed lucencies in the right upper quadrant consistent with gas-containing hepatic abscesses at the time of clinically apparent sepsis and positive blood cultures. The occurrence of three such cases in one year and the low incidence of clostridial infections in non-catheterized oncology patients at our institution suggest that clostridial infection is a previously unrecognized complication of hepatic arterial infusion chemotherapy. The possible sources of the infecting organisms and pathogenesis of this infection are discussed.

Emphysematous cystitis associated with Clostridium perfringens bacteremia

Anaerobes are recognized rarely as the cause of urinary tract infection. A case is reported in which there were clinical signs of sepsis, positive blood culture for Clostridium perfringens and radiographic demonstration of emphysematous cystitis without any other recognized source of infection.

Clostridium septicum bacteremia. Its clinical significance

The medical records of 59 patients with Clostridium septicum bacteremia were reviewed; 42 (71 per cent) of these patients had malignancies. One half had hematologic malignancies, and one half had solid tumors. Of the 21 patients with solid tumors, 14 (67 per cent) had cancer of the colon. Among these patients, the cecum was the most frequent site of malignancy. The cecum and distal ileum were the most probable portals of entry for C. septicum bacteremia among the 28 patients examined at autopsy. Patients admitted to the hospital with C. septicum bacteremia usually have fulminating clinical courses and, unless the appropriate antibiotics are administered soon after admission, the outcome is fatal. The results of this study demonstrate the high association of C. septicum bacteremia and malignancy, and the need for early recognition and therapy.

Clostridium pseudotetanicum bacteremia in a patient with Pasteurella multocida conjunctivitis

Clostridium pseudotetanicum only once previously has been identified as causing disease. Pasteurella multocida has been identified only three times as the cause of purulent conjunctivitis. A very debilitated patient had C. pseudotetanicum bacteremia and P. multocida conjunctivitis from which she recovered only to die of a nosocomial Staphylococcus epidermidis septicemia, originating in a site for the administration of intravenous fluids.