title: Epidemiology of Clostridium species bacteremia in Calgary, Canada, 2000-2006.
abstract: OBJECTIVE
  To define the incidence, risk factors for acquisition, and outcomes associated with clostridial bacteremia in a large Canadian health region.
  
  
  METHODS
  Retrospective population-based surveillance for clostridial bacteremia was conducted among all residents of the Calgary Health Region (population 1.2 million) during 2000-2006.
  
  
  RESULTS
  One hundred and thirty-eight residents had incident Clostridium species bacteremia (1.8 per 100,000/year); 45 (33%) were nosocomial, 55 (40%) were healthcare-associated community onset, and 38 (28%) were community acquired. Older age and a number of underlying conditions were risk factors for acquiring Clostridium species bacteremia most importantly hemodialysis [relative risk (RR) 212.3; 95% confidence interval (CI) 106.5-385.5], malignancy (RR 40.2; 95% CI 27.6-58.1), and Crohn's disease (RR 11.2; 95% CI 3.0-29.4). Clostridium perfringens was most commonly identified with 58 (42%) isolates followed by Clostridium septicum (19; 14%), Clostridium ramosum (13; 9%), Clostridium clostridiiforme (8; 6%), and Clostridium difficile (7; 5%). Reduced susceptibility to penicillin occurred in 14/135 (10%), to metronidazole in 2/135 (1%), and to clindamycin in 36/135 (27%) isolates. The median length of stay was 12.7 days and 39/130 (30%) patients died in hospital for mortality rate of 0.5 per 100,000/year.
  
  
  CONCLUSIONS
  Clostridium species bacteremia is associated with a significant burden of illness and hemodialysis and cancer patients are at highest risk.
authors.affiliation: Department of Medicine, University of Calgary, Calgary Health Region, Calgary, Alberta, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Leal
authors.forename: D B
authors.initials: DB
authors.lastname: Gregson
authors.forename: T
authors.initials: T
authors.lastname: Ross
authors.forename: D L
authors.initials: DL
authors.lastname: Church
authors.forename: K B
authors.initials: KB
authors.lastname: Laupland
mesh_terms: D000367:Age Factors; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D002170:Canada / Q000453:epidemiology; D003013:Clostridium / Q000145:classification / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010403:Penicillin Resistance; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D016896:Treatment Outcome