title: Clinical characteristics and outcomes of clostridial bacteraemia in cancer patients.
abstract: Clostridial bacteraemia is usually associated with substantial morbidity and mortality in cancer patients. However, clinical characteristics and risk factors for early mortality in this population are poorly described. We retrospectively studied cancer patients with clostridial bacteraemia treated between January 1996 and December 2011. We compared clinical manifestations between patients with solid tumour and haematological malignancy and assessed risk factors for 7-day mortality. In all, 164 cancer patients developed clostridial bacteraemia during the study period-85 (52%) with solid tumour and 79 (48%) with haematological malignancy. Common isolates were Clostridium perfringens (27%), Clostridium septicum (19%) and Clostridium tertium (14%). Solid tumour malignancy patients were more likely to have a focal gastrointestinal source for bacteraemia and were more likely to undergo subsequent surgery. Haematological malignancy patients were more often neutropenic and more often had no focal source of bacteraemia. Seven-day mortality was 20% (33/164) and did not vary based on malignancy type. The adjusted odds ratio of dying within 7 days of clostridial bacteraemia among patients with hypotension (40/164) was 7.2 (95% CI, 2.9-18.1) and in patients with acute haemolysis (7/164) was 10.5 (95% CI, 1.3-85.2). Clostridial species also impacted mortality; no patient with C. tertium bacteraemia died within 7 days. In conclusion, clinical manifestations of clostridial bacteraemia differed between patients with solid tumour and haematological malignancy, but 7-day mortality was similar. Patients with hypotension and haemolysis at time of bacteraemia were at increased risk for early death.
authors.affiliation: Division of Infectious Diseases, Brigham & Women's Hospital, Boston, MA, 02115, USA; Dana-Farber Cancer Institute, Boston, MA, 02115, USA; Harvard Medical School, Boston, MA, 02115, USA. Electronic address: shammond2@partners.org.
authors.forename: S P
authors.initials: SP
authors.lastname: Hammond
authors.affiliation: Division of Infectious Diseases, Brigham & Women's Hospital, Boston, MA, 02115, USA.
authors.forename: M W
authors.initials: MW
authors.lastname: Buckley
authors.affiliation: Division of Infectious Diseases, Brigham & Women's Hospital, Boston, MA, 02115, USA.
authors.forename: G
authors.initials: G
authors.lastname: Petruzziello
authors.affiliation: Division of Infectious Diseases, Brigham & Women's Hospital, Boston, MA, 02115, USA; Dana-Farber Cancer Institute, Boston, MA, 02115, USA; Harvard Medical School, Boston, MA, 02115, USA.
authors.forename: S
authors.initials: S
authors.lastname: Koo
authors.affiliation: Division of Infectious Diseases, Brigham & Women's Hospital, Boston, MA, 02115, USA; Dana-Farber Cancer Institute, Boston, MA, 02115, USA; Harvard Medical School, Boston, MA, 02115, USA.
authors.forename: F M
authors.initials: FM
authors.lastname: Marty
authors.affiliation: Division of Infectious Diseases, Brigham & Women's Hospital, Boston, MA, 02115, USA; Dana-Farber Cancer Institute, Boston, MA, 02115, USA; Harvard Medical School, Boston, MA, 02115, USA.
authors.forename: L R
authors.initials: LR
authors.lastname: Baden
keywords: Cancer; Clostridia; Clostridium septicum; Clostridium tertium; neutropenia