title: Beta Lactamase Producing Clostridium perfringens Bacteremia in an Elderly Man with Acute Pancreatitis.
abstract: Clostridium perfringens bacteremia is associated with adverse outcomes. Known risk factors include chronic kidney disease, malignancy, diabetes mellitus, and gastrointestinal disease. We present a 74-year-old man admitted with confusion, vomiting, and abdominal pain. Exam revealed tachycardia, hypotension, lethargy, distended abdomen, and cold extremities. He required intubation and aggressive resuscitation for septic shock. Laboratory data showed leukocytosis, metabolic acidosis, acute kidney injury, and elevated lipase. CT scan of abdomen revealed acute pancreatitis and small bowel ileus. He was started on vancomycin and piperacillin-tazobactam. Initial blood cultures were positive for C. perfringens on day five. Metronidazole and clindamycin were added to the regimen. Repeat CT (day 7) revealed pancreatic necrosis. The patient developed profound circulatory shock requiring multiple vasopressors, renal failure requiring dialysis, and bacteremia with vancomycin-resistant enterococci. Hemodynamic instability precluded surgical intervention and he succumbed to multiorgan failure. Interestingly, our isolate was beta lactamase producing. We review the epidemiology, risk factors, presentation, and management of C. perfringens bacteremia. This case indicates a need for high clinical suspicion for clostridial sepsis and that extended spectrum beta lactam antibiotic coverage may be inadequate and should be supplemented with use of clindamycin or metronidazole if culture is positive, until sensitivities are known.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, 1650 Grand Concourse, Bronx, NY 10457, USA.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Mishra
authors.affiliation: Division of Pulmonary and Critical Care, Community Hospital of the Monterey Peninsula, 23625 Pacific Grove-Carmel Highway, Monterey, CA 93942, USA.
authors.forename: Nupur
authors.identifier: 0000-0001-8573-3809
authors.initials: N
authors.lastname: Sinha
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, 1650 Grand Concourse, Bronx, NY 10457, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Duncalf