title: Clinical significance and outcomes of Clostridium perfringens bacteremia--a 10-year experience at a tertiary care hospital.
abstract: BACKGROUND
  The mortality rate of patients with Clostridium perfringens bacteremia is 27-44%. Typically, the clinical characteristics of this infection are non-specific, which leads to considerable difficulty with the diagnosis and early initiation of appropriate therapy.
  
  
  METHODS
  A retrospective cohort study of patients who were hospitalized between August 2002 and July 2011 with C. perfringens bacteremia was conducted within a 3715-bed teaching hospital in northern Taiwan. The patients identified in this search were included when they had fever or other clinical features suggestive of systemic infection. Multiple logistic regression analysis was applied to determine the independent risk factors of 30-day mortality.
  
  
  RESULTS
  A total of 93 patients were identified. Elderly patients with comorbid illnesses, especially renal insufficiency or malignancy, were at risk of developing C. perfringens bacteremia, and 23 patients (24.7%) had nosocomial bacteremia. The 30-day and attributed mortalities were 26.9% (25/93) and 8.6% (8/93), respectively. Nosocomial infection was a significant predictor for mortality within 30 days (odds ratio 19.378, 95% confidence interval 2.12-176.99; p=0.009), independent of other disease parameters. Other independent risk factors included the Charlson weighted index of comorbidity, length of hospitalization, and stay in the intensive care unit.
  
  
  CONCLUSIONS
  Early recognition of this critical infection and early initiation of appropriate antibiotic treatment by surgical intervention or drainage is essential.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Shin Street, Gueishan, Taoyuan 333, Taiwan.
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Yang
authors.forename: Po-Chang
authors.initials: PC
authors.lastname: Hsu
authors.forename: Hong-Jyun
authors.initials: HJ
authors.lastname: Chang
authors.forename: Chun-Wen
authors.initials: CW
authors.lastname: Cheng
authors.forename: Ming-Hsun
authors.initials: MH
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D003016:Clostridium perfringens / Q000187:drug effects / Q000302:isolation & purification*; D015897:Comorbidity; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bacteremia; Clostridium perfringens; Hepatocellular carcinoma; Nosocomial