Clinical Features of Clostridial Necrotizing Soft-Tissue Infections: Analysis of a Prospective Scandinavian Cohort Study

Abstract Background Necrotizing soft tissue infections (NSTI) caused by Clostridium spp. are rare. High rates of amputation and mortality are reported, but knowledge on clinical characteristics and outcome is largely based on retrospective cohorts. The role of Clostridium species as part of polymicrobial NSTI is also unclear. Method We identified all clostridial cases from the INFECT cohort, a prospective study including patients with confirmed NSTI admitted to five Scandinavian referral hospitals over a four-year period. Selected parameters were compared to a control group of non-clostridial polymicrobial infections. Additionally, we analyzed polymicrobial infections with clostridial species. Results Ten cases of clostridial NSTIs were identified, evenly divided between cases caused by C. perfringens and C. septicum. Immunodeficiency (4/10) and penetrating trauma (3/10) were significantly more frequent compared to polymicrobial controls. Clostridial NSTI was also associated with extremity involvement (10/10) and severe pain (7/9). Radiological evidence of gas (4/7) did not distinguish clostridial from polymicrobial infections. Two patients underwent amputation, and two others died within 30 days. The cohort also included seven polymicrobial NSTIs with Clostridium spp, with higher rates of both comorbidity (7/7) and 30-day mortality (4/7). Conclusions Clostridial NSTIs were associated with extremity infection, immunodeficiency, and penetrating trauma. The cases demonstrate a wide spectrum of severity. In polymicrobial NSTIs involving clostridium species, the mortality was particularly high, but the pathogenetic role of clostridia in these infections is unclear.