Clostridial sepsis and malignant disease.

To address the significance of clostridial bacteremia in surgical patients, the bacteriologic records of the New York Hospital from an eight year period were reviewed. Of 1,708 patients who underwent surgical treatment with positive blood cultures, 23 (1.3 per cent) with clostridial bacteremia were identified. Twenty-one of the 23 patients manifested clinical signs of sepsis at the time of clostridial bacteremia consisting of fever, leukocytosis or hypotension. Fourteen patients had intra-abdominal sources of bacteremia and eight of these had either a diverticular abscess or colorectal perforation. The over-all mortality rate was 43 per cent, with all deaths resulting from uncontrolled sepsis. An association between clostridial bacteremias and malignant disease has been described. Thirteen malignant diseases were identified in 12 of the 23 patients reported herein. Carcinoma of the colon and rectum was the most frequently associated malignant condition, but a wide variety of other malignant diseases were also identified. The diagnosis of underlying malignant disease was known prior to the clostridial bacteremia in ten patients and unknown in two. None of the patients were receiving chemotherapy or radiation therapy at the time of bacteremia. Three different Clostridium species were isolated in patients with underlying malignant disease, supporting an association between malignant conditions and other Clostridium species as well as Clostridium septicum. The identification of clostridial bacteremia in surgical patients warrants both aggressive treatment of the septic state and a thorough search for associated malignant lesions.