title: Clostridium bacteraemia characterised by 16S ribosomal RNA gene sequencing.
abstract: BACKGROUND
  Owing to problems in accurate species identification of the diverse genus clostridium, the epidemiology and pathogenicity of many species are not fully understood. Moreover, previous studies on clostridium bacteraemia have been limited and relied only on phenotypic species identification.
  
  
  OBJECTIVE
  To characterise the epidemiology, disease spectrum, and outcome of clostridium bacteraemia using 16S ribosomal RNA (rRNA) gene sequencing.
  
  
  METHODS
  During a four year period (1998-2001), all cases of clostridium bacteraemia were prospectively studied and all "non-perfringens" clostridium isolates identified to the species level by 16S rRNA gene sequencing.
  
  
  RESULTS
  Fifty one blood culture isolates were identified as Clostridium perfringens and 17 belonged to 11 other clostridium species. The first case of C disporicum infection and two cases of clostridium bacteraemia in children with intussusception were also described. Of the 68 clostridium isolates from 68 different patients, 38 were associated with clinically relevant bacteraemia. The gastrointestinal and hepatobiliary tracts were common sites of both underlying disease and portal of entry in these patients. Clostridium perfringens accounted for 79% of all clinically relevant bacteraemia, with the remainder caused by a diversity of species. The attributable mortality rate of clinically relevant clostridium bacteraemia was 29%. Younger age and underlying gastrointestinal/hepatobiliary tract disease were associated with mortality (p < 0.05).
  
  
  CONCLUSIONS
  Patients with clinically relevant clostridium bacteraemia should be investigated for the presence of underlying disease processes in the gastrointestinal or hepatobiliary tracts. 16S rRNA gene analysis will continue to be useful in further understanding the pathogenicity of various clostridium species.
authors.affiliation: Department of Microbiology, University Pathology Building, Queen Mary Hospital, Pokfulam Road, Hong Kong, China.
authors.forename: P C Y
authors.initials: PC
authors.lastname: Woo
authors.forename: S K P
authors.initials: SK
authors.lastname: Lau
authors.forename: K-M
authors.initials: KM
authors.lastname: Chan
authors.forename: A M Y
authors.initials: AM
authors.lastname: Fung
authors.forename: B S F
authors.initials: BS
authors.lastname: Tang
authors.forename: K-Y
authors.initials: KY
authors.lastname: Yuen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D015373:Bacterial Typing Techniques / Q000379:methods; D002648:Child; D003013:Clostridium / Q000145:classification* / Q000302:isolation & purification / Q000472:pathogenicity; D003015:Clostridium Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D003016:Clostridium perfringens / Q000145:classification / Q000302:isolation & purification; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D011446:Prospective Studies; D012329:RNA, Bacterial / Q000235:genetics*; D012336:RNA, Ribosomal, 16S / Q000235:genetics*; D012307:Risk Factors; D017423:Sequence Analysis, RNA / Q000379:methods; D016019:Survival Analysis
chemical_list: D012329:RNA, Bacterial; D012336:RNA, Ribosomal, 16S
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