Malignancy, mortality, and medicosurgical management of Clostridium septicum infection.
BACKGROUND
Necrotizing Clostridium septicum infections (CSI) have a strong association with malignancy or immunosuppression. To clarify this 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 infection from 1966 through 1993 were reviewed.


RESULTS
Among patients presenting with clinical gas gangrene, 281 had culture proven clostridial 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 with CSI, whereas this was seen in only 11% of patients with other clostridial infections (p = 0.0001 for CSI versus clostridial infection overall). 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 associated conditions in all patients with CSI.
Larson
C M
CM
Department of Surgery, Hennepin County Medical Center, University of Minnesota, Minneapolis 55415, USA.
Bubrick
M P
MP
Jacobs
D M
DM
West
M A
MA
D000230:Adenocarcinoma / Q000150:complications; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents; D002430:Cecal Neoplasms / Q000150:complications; D003131:Combined Modality Therapy; D003646:Debridement; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005738:Gas Gangrene / Q000150:complications / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery / Q000628:therapy; D006402:Hematologic Diseases / Q000150:complications; D006801:Humans; D006931:Hyperbaric Oxygenation; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009369:Neoplasms / Q000150:complications*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents