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198 Clostridium subterminale bacteremia in an immunocompetent host

Purpose of study The Clostridium species are gram-positive anaerobes originating from gastrointestinal tract and can cause serious spectrum of infections usually in immunocompromised host. Subterminale is a subspecies of the Clostridium family that can form botulinum toxin G. This toxin has not been studied to prove its efficacy in causing harm to humans, and thus rendering the subspecies less virulent when compared to the more common Perfringens or Difficile. Other rare subspecies such as Clostridium Innocuum have been found to cause osteomyelitis and treated successfully with oral metronidazole for 4 weeks to 6 months in immunocompromised hosts. This case presents a patient with stage 4 decubitus ulcers with Clostridium Subterminale bacteremia treated with metronidazole. Methods used Retrospective case report. Summary of results 36-year-old immunocompetent African American male status post gunshot wound in September 2015 sustaining bilateral lower extremity paraplegia from a lesion at T9-T10 level which lead to chronic pressure ulcers of the bilateral gluteal region as well as chronic osteomyelitis of the right femur and acetabulum. He had inconsistent follow-up with wound care and was unable to obtain hospital discharge antibiotics which subsequently led to multiple admissions for septicemia. During his recent admission, blood cultures isolated Clostridium Subterminale, presumably from his multiple uncleaned pressure ulcers, chronic osteomyelitis, or his indwelling suprapubic catheter. The next day CT scan of the pelvis revealed destructive lesions in the acetabulum and proximal right femur as well as small collections of air in the hip suggestive of septic arthritis and osteomyelitis. The presence of air in the joint raised suspicion for the involvement of gas-forming bacteria. Once blood cultures were finalised, the isolated organism was found to be Clostridium Subterminale which coincided with the imaging of the right hip lesions. Patient received 6 weeks of Metronidazole orally without any further complications. Conclusions Clostridium Subterminale is a rare cause of bacteremia and osteomyelitis in immunocompetent patients. Our patient was treated with oral metronidazole for 6 weeks without complications.