Clostridium bacteremia and its implications: A case report

Bonda, Sruthi; Lee, Kevin; Rovig, John; Asad, Shadaba

doi:10.1016/j.idcr.2022.e01516

Cited by 4 publications

(1 citation statement)

References 10 publications

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“…Immunosuppression has been associated with an increased risk of Clostridium and Listeria monocytogenes bacteremia. 6 – 8 Patients may be predisposed through several mechanisms. Beyond dampening the robustness of an immune response, gut mucositis is a common complication of chemotherapy 9 and mucosal ulceration is a known side effect of prolonged corticosteroid therapy.…”

Section: Discussionmentioning

confidence: 99%

Patient predictors of pathogenic versus commensal Gram-positive bacilli organisms isolated from blood cultures

Sharma,

Elligsen,

Daneman

et al. 2023

ASHE

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Objective: Gram-positive bacilli represent a diverse species of bacteria that range from commensal flora to pathogens implicated in severe and life-threatening infection. Following the isolation of Gram-positive bacilli from blood cultures, the time to species identification may take upward of 24 hours, leaving clinicians to conjecture whether they may represent a contaminant (inadvertent inoculation of commensal flora) or pathogenic organism. In this study, we sought to identify patient variables that could help predict the isolation of contaminant versus pathogenic Gram-positive bacilli from blood cultures. Design: Retrospective cohort study. Settings: One quaternary academic medical center affiliated with the University of Toronto. Patients: Adult inpatients were admitted to hospital over a 5-year period (May 2014 to December 2019). Methods: A total of 260 unique Gram-positive bacilli blood culture results from adult inpatients were reviewed and analyzed in both a univariable and multivariable model. Results: Malignancy (aOR 2.78, 95% CI 1.33–5.91, p = 0.007), point increments in the Quick Sepsis Related Organ Failure Assessment score for sepsis (aOR 2.25, 95% CI 1.50–3.47, p < 0.001), peptic ulcer disease (aOR 5.63, 95% CI 1.43–21.0, p = 0.01), and the receipt of immunosuppression prior to a blood culture draw (aOR 3.80, 95% CI 1.86–8.01, p < 0.001) were associated with an increased likelihood of speciating pathogenic Gram-positive bacilli from blood cultures such as Clostridium species and Listeria monocytogenes. Conclusion: Such predictors can help supplement a clinician’s assessment on determining when empirical therapy is indicated when faced with Gram-positive bacilli from blood cultures and may direct future stewardship interventions for responsible antimicrobial prescribing.

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Section: Discussionmentioning

confidence: 99%