Corredoira Juan, Grau Imma, Garcia-Rodriguez José F, García-País María Jose, Rabuñal Ramón, Ardanuy Carmen, García-Garrote Fernando, Coira Amparo, Alonso Maria Pilar, Boleij Annemarie, Pallares Roman
Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, Lugo, Spain.
Infectious Disease and Microbiology Departments, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, L'Hospitalet, Barcelona, Spain.
Eur J Intern Med. 2017 Jun;41:68-73. doi: 10.1016/j.ejim.2017.02.009. Epub 2017 Feb 22.
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.
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.
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).
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.
败血性梭状芽孢杆菌（CS）和解脲链球菌亚种解脲链球菌（SGG）所致菌血症均与结直肠肿瘤（CRN）相关，建议进行结肠镜检查，然而结直肠检查结果的差异和相似性尚不清楚。
这是一项在西班牙三家医院进行的多中心、对比研究，研究对象为CS菌血症患者[664例梭状芽孢杆菌属病例中的44例（6.6%）]和SGG菌血症患者[596例牛链球菌组病例中的257例（44.2%）]。收集了与菌血症及相关CRN有关的临床结果。
CS菌血症的主要感染源为腹部（77.7%），SGG菌血症为血管内（75%）。CS菌血症更常与恶性肿瘤（72.6%对19.4%）和中性粒细胞减少症（29.5%对3.1%）相关，且更为急性，与SGG相比，表现为休克（63.6%对3.9%），30天死亡率更高（47.7%对9.7%）（所有P<0.05）。CS和SGG菌血症患者常伴有CRN（43.1%对49.8%），且大多数表现为隐匿性CRN（73.7%对91.4%；P=0.02）。与SGG病例相比，CS病例侵袭性癌更多见（94.7%对19.5%），CRN位于右半结肠更多（73.7%对23.4%），肿瘤更大（中位数7对1.5cm），且与CRN相关的总体死亡率更高（68.4%对7.8%）（所有P<0.05）。
CS和SGG菌血症均与隐匿性CRN相关。CS病例的晚期癌比SGG病例更常见，提示与CRN存在不同的时间关联。
