title: Colorectal neoplasm in cases of Clostridium septicum and Streptococcus gallolyticus subsp. gallolyticus bacteraemia.
abstract: BACKGROUND
  Bacteremia with Clostridium septicum (CS) and Streptococcus gallolyticus subsp. gallolyticus (SGG) have both been associated with colorectal neoplasms (CRN) and colonoscopic examination is advised, however the differences and similarities in colorectal findings are not well known.
  
  
  METHODS
  This is a multicenter, comparative study of patients with CS bacteremia [44 of 664 cases (6.6%) of Clostridium spp.] and SGG bacteremia [257 of 596 cases (44.2%) of S. bovis group], carried out in three hospitals from Spain. Clinical findings related to bacteremia and associated CRN were collected.
  
  
  RESULTS
  The main sources of infection were abdominal (77.7%) for CS bacteremia and endovascular (75%) for SGG bacteremia. CS bacteremia was more often associated with malignancies, (72.6% vs. 19.4%) and neutropenia (29.5% vs. 3.1%), and was more acute, with shock at presentation (63.6% vs. 3.9%) and higher 30-day mortality (47.7% vs. 9.7%) compared to SGG (P<0.05 for all). Both, patients with CS and SGG bacteremia often had concomitant CRN (43.1% vs. 49.8%) and most of them presented as occult CRN (73.7% vs. 91.4%; P=0.02). CS cases more often had invasive carcinomas (94.7% vs. 19.5%), location of CRN in the right colon (73.7% vs. 23.4%), larger tumor size (median 7 vs. 1.5cm), and a higher overall CRN related mortality rate (68.4% vs. 7.8%) compared to SGG cases (P<0.05 for all).
  
  
  CONCLUSIONS
  Both, CS and SGG bacteremia are associated with occult CRN. CS cases more often had advanced carcinomas than SGG cases, suggesting a distinct temporal association with CRN.
authors.affiliation: Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, Lugo, Spain. Electronic address: juan.corredoira.sanchez@sergas.es.
authors.forename: Juan
authors.initials: J
authors.lastname: Corredoira
authors.affiliation: Infectious Disease and Microbiology Departments, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, L'Hospitalet, Barcelona, Spain. Electronic address: igrau@ub.edu.
authors.forename: Imma
authors.initials: I
authors.lastname: Grau
authors.affiliation: Infectious Disease Unit, Complexo Hospitalario Universitario de Ferrol, Ferrol, Spain. Electronic address: jose.francisco.garcia.rodriguez@sergas.es.
authors.forename: José F
authors.initials: JF
authors.lastname: Garcia-Rodriguez
authors.affiliation: Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, Lugo, Spain. Electronic address: maria.jose.garcia.pais@sergas.es.
authors.forename: María Jose
authors.initials: MJ
authors.lastname: García-País
authors.affiliation: Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, Lugo, Spain. Electronic address: ramon.rabunal.rey@sergas.es.
authors.forename: Ramón
authors.initials: R
authors.lastname: Rabuñal
authors.affiliation: Infectious Disease and Microbiology Departments, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, L'Hospitalet, Barcelona, Spain. Electronic address: c.ardanuy@bellvitgehospital.cat.
authors.forename: Carmen
authors.initials: C
authors.lastname: Ardanuy
authors.affiliation: Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, Lugo, Spain. Electronic address: garciagarrote@yahoo.es.
authors.forename: Fernando
authors.initials: F
authors.lastname: García-Garrote
authors.affiliation: Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, Lugo, Spain. Electronic address: amparo.coira.nieto@sergas.es.
authors.forename: Amparo
authors.initials: A
authors.lastname: Coira
authors.affiliation: Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, Lugo, Spain. Electronic address: pilar.alonso.garcia@sergas.es.
authors.forename: Maria Pilar
authors.initials: MP
authors.lastname: Alonso
authors.affiliation: Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Annemarie.Boleij@radboudumc.nl.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Boleij
authors.affiliation: Infectious Disease and Microbiology Departments, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, L'Hospitalet, Barcelona, Spain. Electronic address: rpallares@ub.edu.
authors.forename: Roman
authors.initials: R
authors.lastname: Pallares
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000150:complications*; D052557:Clostridium septicum / Q000302:isolation & purification*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D009780:Occult Blood; D013030:Spain; D000070197:Streptococcus gallolyticus subspecies gallolyticus / Q000302:isolation & purification*
keywords: Bacteraemia; Clostridium septicum; Colorectal neoplasia; Streptococcus bovis; Streptococcus gallolyticus