Clostridium cadaveris bacteremia in an immunocompetent host.

Clostridium cadaveris bacteremia is extremely rare; the few cases reported in the literature have occurred in immunocompromised patients. We describe a case of C. cadaveris bacteremia in an immunocompetent host with necrotic decubitus. A 42-year-old nursing home patient with paraplegia, secondary to a gun shot injury, was admitted to the hospital on 8 March 1999 for fever and hypotension. He had been in good health except for occasional urinary tract infections. At presentation, he appeared toxic, was febrile (temperature to 39.47C), and had tachypnea and tachycardia with a new onset of atrial fibrillation. Multiple necrotic decubitus with purulent discharge were noted, including a stage 4 ulcer ( cm) 6 3 4.5 over the right hip and a stage 3 ulcer ( cm) over the left 3 3 3 hip. Stage 3 ulcers were also noted over the right popliteal area, both heels, and both ankles. He had an indwelling suprapubic catheter; the insertion site appeared clean. Except for his neurological deficit (paraplegia), further physical examination was unremarkable. Laboratory studies disclosed the following: leukocytosis (leukocyte count, 22,700/mL) with a left shift; serum sodium level, 147 mEq/L; blood urea nitrogen level, 35 mg/dL; creatinine level, 1.9 mg/dL; and HCO3 2 level, 15 mEq/L. Urinalysis showed packed white clood cells; a chest x-ray was negative. He was treated with ciprofloxacin and gentamicin; this treatment was changed to ticarcillin/clavulanate and gentamicin in the intensive care unit. Surgical debridement of the decubitus was done the following day. Cultures of initial blood specimens obtained on 8 March 1999 yielded C. cadaveris. Blood cultures were incubated in the BACTEC 9240 System (Becton Dickinson, Sparks, MD), and subcultures were grown on blood agar plate (BAP) and Centers for Disease Control and Prevention’s BAP media by use of a gas pack pouch anaerobic system (BBL Becton Dickinson Microbiology Systems, Cockeysville, MD). The identity of the organism was established with the API 20 A anaerobic strip (bioMérieux, Hazelwood, MO).The specimen was subsequently sent to the reference laboratory of SmithKline Beecham (Philadelphia), which reported that it was susceptible to most antibiotics—including ampicillin/sulbactam, chloramphenicol, ticarcillin/clavulanate, cefotetan, cefotaxime, clindamycin, and penicillin.