The role of Clostridium septicum in paraneoplastic sepsis

Context-Clostridium septicum infections are rare but often associated with serious if not fatal outcomes. Clostridium septicum infection does not appe ar to be associated with a single specific defect in cellular or humoral im munity. It has been associated with multiple medical problems, including bu t not limited to leukemia, malignancy of the bowel, other solid tumors, cyc lic neutropenia with enterocolitis, diabetes mellitus, and severe arteriosc lerosis. Most cases of C septicum are associated with malignancy, and morta lity approaches 100% if care is not rendered within 12 to 24 hours. Objectives.-To evaluate outcomes of patients with C septicum bacteremia, wh ether treated medically or surgically or both, and to note associated condi tions. Design.-Retrospective evaluation of patients found to have C septicum bacte remia in the past 6 years. Setting.-Two teaching hospitals, Brooke Army Medical Center (250 beds) and Wilford Hall Medical Center (292 beds), were the source of our patients. Patients.-All patients found to have C septicum bacteremia during hospitali zation or postmortem examination were included in the study. There were no exclusion criteria. Main Outcome Measure.-Mortality associated with C septicum infection. Results.-In our case series, mortality was 33%, which is slightly lower tha n reported in prior studies (43%-70%). Conclusion.-Presumptive identification based on Cram stain, awareness of C septicum infection as a paraneoplastic syndrome, and prompt, clear communic ation between laboratory personnel and clinicians are necessary for early d iagnosis of C septicum infection. Early institution of antibiotic therapy i mproves prognosis.