1071. Clostridal Bacteremia in Solid Tumor Patients
Session: Poster Abstract Session: Infection in Immunocompromised Patients
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Clostridial bacteremia, C. septicum bacteremia in particular, is associated with gastrointestinal (GI) and other solid tumors. 

Methods: We reviewed clinical characteristics and outcomes of all solid tumor patients with clostridial bacteremia at our institution between 1/1992 and 5/2011. Covariates were compared using Fisher’s exact and Wilcoxon rank sum tests where appropriate. 

Results: 94 patients had clostridial bacteremia, including 55 (59%) women.  Median age was 57 (range 18, 86).  23 (24%) had colorectal cancer (CA), 14 (15%) ovarian CA, 13 (14%) sarcoma, 10 (11%) pancreatic CA or cholangiocarcinoma, 11 (12%) other GI adenocarcinomas, 5 (5%) endometrial or cervical CA, 5 (5%) testicular or prostate CA, and 13 (14%) other CA. CA was newly diagnosed at bacteremia in 7 (7%).  There were 29 (31%) C. perfringens, 16 (17%) C. septicum, 9 (10%) C. ramosum, 7 (7%) C. clostridiiforme, 6 (6%) C. paraputrificum, 5 (5%) C. innocuum, 3 (3%) C. cadaveris, 3 (3%) C. hastiforme, 3 (3%) C. subterminale, and 13 (14%) other clostridial isolates.  36 episodes of bacteremia were polymicrobial.  Common copathogens were Klebsiella spp. (9), Bacteroides spp. (8), coagulase-negative staphylococci (8), and E. coli (6). At the time of bacteremia, 8 (9%) patients were neutropenic, 21 (22%) required vasopressors for hypotension, and 2 (2%) had hemolysis.  Bacteremia sources included GI perforation in 16 (17%), GI abscess in 14 (15%), bowel obstruction in 13(14%), urinary tract obstruction or infection in 9 (10%), tumor fistula or compromise of GI integrity in 8 (9%), GI bleeding in 6 (6%), necrotizing fasciitis in 1 (1%) and other issues in 17 (18%); no underlying cause was found in 10 (11%).  24 (26%) patients underwent surgery for anatomical issues.  33 (35%) died within 7 days of bacteremia.  Those who died within 7 days were younger (median age 53 vs. 58, p = 0.05).  7-day mortality was higher in those with hypotension (14/33 vs. 7/61, p = 0.001), polymicrobial bacteremia (19/33 vs. 17/61, p = 0.007), and bacteremia with non-C. septicum isolates (31/33 vs. 47/61, p = 0.05).

Conclusion: Clostridial bacteremia is a rare but important cause of infection in CA patients.  Predictors of 7-day mortality include hypotension, polymicrobial bacteremia and non-C.septicum clostridial bacteremia. 


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

Mary Buckley, BS1, Sophia Koo, MD2,3,4 and Sarah Hammond, MD1,2,3, (1)Brigham & Women's Hospital, Boston, MA, (2)Dana-Farber Cancer Institute, Boston, MA, (3)Harvard Medical School, Boston, MA, (4)Brigham and Women's Hospital, Boston, MA

Disclosures:

M. Buckley, None

S. Koo, None

S. Hammond, 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.