Non-C. difficile Clostridioides Bacteremia in Intensive Care Patients, France

Abstract

Usually responsible for soft tissue infections, Clostridioides species can also cause bacteremia, life-threatening infections often requiring intensive care unit (ICU) admission. We conducted a multicenter retrospective study to investigate Clostridioides bacteremia in ICUs to describe the clinical and biologic characteristics and outcomes in critically ill patients. We identified 135 patients with Clostridioides bacteremia, which occurred almost exclusively (96%) in patients with underlying conditions. Septic shock and digestive symptoms were the hallmarks of Clostridioides bacteremia in the ICU. We identified 16 different species of Clostridioides, among which C. perfringens accounted for 31% of cases. Despite the high sensitivity of Clostridioides to common antimicrobial drugs, mortality rates were high: 52% for ICU patients and 71% overall at 3 months. In multivariate analysis, the most important factor associated with increased risk for death was the presence of hemolysis. Clostridioides bacteremia often leads to multiple organ failures, which have high mortality rates.

Keywords: Clostridioides; Clostridium; France; ICU; bacteremia; bacteria; hemolysis; intensive care.

Figure 1

Survival analysis with Cox regression model for patients with Closteridiodes bacteremia, France. A) Forest plot of multivariate factors associated with overall survival. Predisposing conditions were trauma or surgery. B) Kaplan-Meier curve of mortality depending on hemolysis. HR, hazard ratio; ref, referent; SOFA, sequential organ failure assessment.

Figure 2

Flowchart of the repartition of Clostridioides bacteremia in patients in France according to the presence or absence of hemolysis. Hemolysis was associated with a high mortality rate.

Figure 3

Several examples of hematogenous spreads or myonecrosis related to Clostridioides bacteremia in patients in France. All these localizations were associated with air formation. A) Brain abscess associated with pneumocephalus and gas embolism in the superior sagittal sinus. B) Splenic abscess (asterisk) with gas formation. C) Hepatic abscess with gas formation. D) Massive pelvic gangrene identified as the origin of the bacteremia in a patient. E) Cervical cellulitis, identified as the origin of the bacteremia in a patient.