MALIGNANCY, MORTALITY, AND MEDICOSURGICAL MANAGEMENT OF CLOSTRIDIUM-SEPTICUM INFECTION

Backgronud. Necrotizing Clostridium septicum infections (CSI) have a s trong association with malignancy or immunosuppression. To clarify thi s relationship and determine how it impacted mortality the experience with CSI at a single institution was reviewed. Methods. Records of all patients admitted to our hospital with culture proven. clostridial in fection from 1966 through 1993 were reviewed. Results. Among patients presenting with clinical gas gangrene, 281 had culture proven clostrid ial infection and 32 (11.4%) had CSI. The mortality among CSI patients was 56%, whereas 26% of all patients with clostridial infections died (p = 0.001). An associated malignancy was found in 50% of patients wi th CSI, whereas this was seen in only 11% of patients with other clost ridial infections (p = 0.0001 for CSI versus clostridial infection ove rall). The remaining patients with spontaneous CSI all had evidence of immunosuppression. Conclusions. The high mortality and likelihood of associated malignancy or hematologic disease underscore the importance of a high index of suspicion and the need to search for and treat ass ociated conditions in all patients with CSI.