988. Successful Treatment of Serious Clostridium septicum Infections
Session: Poster Abstract Session: Clinical Studies of Bacterial Infection
Saturday, October 22, 2011
Room: Poster Hall B1
Background: The Gram-positive spore-forming anaerobe Clostridium septicum is a rare cause of fulminant infections including sepsis, myonecrosis, and aortitis.  Reported risk factors include bowel and hematologic malignancies, diabetes mellitus, and penetrating wounds.  Most reports describe one to 3 new cases and mortality rates approaching 70%.  We present 6 patients with C. septicum infection, including 5 diagnosed antemortem and successfully treated.

Methods: Retrospective chart review for patients from whom C. septicum was isolated from blood or sterile body sites between 1/2006 – 12/2010.

Results: All C. septicum infections occurred in elderly (mean age = 78 y, range 68 to 91 y), debilitated patients.  Underlying diseases included hypertension (5 cases) with overt coronary artery disease (2 cases) or peripheral vascular disease (1 case); malignancy, including lymphoma and past renal cancer (1 case) and colon cancer (1 diagnosed and 1 presumptive case); nephrolithiasis (1 case); and Alzheimer’s dementia (1 case).  No patients had diabetes mellitus.   C. septicum was isolated from the blood in 5 cases, including one post-mortem, and from aortic tissue from 1 patient with clinical periaortitis complicated by a pseudoaneurysm. Localized infection was present in one patient with soft tissue infection and later osteomyelitis complicating a lower extremity ulcer, and as pneumonia in the patient diagnosed at autopsy.  Common symptoms were fever (5/6), gastrointestinal complaints (4/6) and fatigue (3/6).  Except for one patient who expired before diagnosis and treatment, all patients with bacteremia received at least 10 d of antibiotics including combinations of B-lactam/B-lactamase inhibitor, clindamycin, and metronidazole. The patient with periaortitis was treated with 8 wks of antibiotics and underwent axillary bi-femoral bypass graft.  All treated patients were alive at last follow-up (range 14 d to 177 d after diagnosis).

Conclusion: Our series adds pneumonia to the clinical spectrum of C. septicum infections.  In addition, we demonstrate that rapid institution of antibiotic results in clearance of the infection and survival, although the long term prognosis remains poor due to underlying disease processes in these patients.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Mary Clarisse Kilayko, MD, Infectious Diseases, St. Luke's - Roosevelt Hospital Center, New York, NY, Emilia Sordillo, MD, PhD, Pathology & Medicine (Infectious Diseases), St. Luke's- Roosevelt Hospital Center, New York, NY and Bruce Polsky, MD, Medicine (Infectious Diseases) & Pathology, St. Luke's-Roosevelt Hospital Center and Columbia University College of Physicians & Surgeons, New York, NY

Disclosures:

M. C. Kilayko, None

E. Sordillo, None

B. Polsky, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.