CLOSTRIDIAL BACTEREMIA - PATTERNS OF INFECTION

The records of 122 consecutive patients who, after admission to the Br igham and Women's Hospital over a period of 9 years, were found to hav e clostridial bacteremia, were studied. Clostridium perfringens organi sms were recovered in 63% of the cases; Clostridium septicum, Clostrid ium innocuum, Clostridium rectum, Clostridium bifermentans, or Clostri dium sordellii organisms were each isolated from five or more cultures of the blood. The overall fatality rate was 29%. Three groups of pati ents were identified. There were 37 patients in whom the clostridial b acteremia was self-limited and resolved without appropriate antibiotic s. In 12 of these patients, the clostridium isolated was possibly a co ntaminant, whereas in 25 others, the clostridial bacteremia was presum ably transient. Overall, blood samples from 30 of these 37 patients gr ew C. perfringens in culture. A second group included 35 patients with severe and well-documented clostridial infection. In this group, mali gnant lesions were present in 62.9%, diseases of the biliary tract wer e the underlying disorder in 14.3%, and the fatality rate was 65.7%. I mmunosuppressed patients were infected most often by non-perfringens s pecies of Clostridium. The third group was composed of those patients with less severe infections, possibly mediated by the effects of appro priate antibiotic treatment.