Clostridium innocuum

Characteristics and identification

Anaerobic gram-positive bacilli affecting human beings are generally divided into two distinct groups, those that form spores (Clostridium spp.) and those that do not form spores. Within the spore-forming group of Clostridium species, some are very pathogenic or toxigenic (C. perfringens) while others are rarely pathogenic. Identification and differentiation between anaerobic gram-positive bacteria in a clinical laboratory can be a very difficult task. When the class Clostridia was separated into Clostridia and Erysipelotrichia, Clostridium innocuum was reassigned as Erysipelotrichia Erysipelotrichales Erysipelotrichaceae Erysipelotrichaceae incertae sedis, but is still commonly referred to as Clostridium innocuum.

Clostridium innocuum forms white, glossy, raised colonies and exhibits a chartreuse fluorescence. It is a small, non-flagellated rod that does not swarm. However, human intestinal isolates can often exhibit twitching motility.{{Cite journal | display-authors = etal

Pathology

Although Clostridium innocuum are often present and harmless in healthy people, they have been isolated in various infections and predominantly in patients that are immunocompromised as an opportunistic bacteria. In one case, C. innocuum was isolated in an infected hematoma adjacent to a transplanted kidney in a 38-year-old hepatitis C patient. Originally, the bacteria was misidentified as another Clostridium species but was eventually correctly identified. This led the authors to state that C. innocuum infection post transplant may be severely underestimated. C. innocuum has also been implicated in cases of fatal bacteremia as reported in a retrospective study done by Newark Beth Israel Medical Center. Patients that succumbed to the infection (100% mortality) had underlying disease states (malignancy, diabetes or liver disease). While clostridial species only account for 2% of clinical bacteremia, C innocuum was among the three most commonly isolated bacteria in this study. C. innocuum has also been isolated in patients with recurrent diarrhea who had prior C. difficile associated diarrhea. One case of fatal bacterial endocarditis was also found in the literature. This is possibly the only confirmed case of C. innocuum endocarditis involving the pulmonary and tricuspid valves resulting in multiple emboli and death. C. innocuum is also commonly the signature bacterial species found in creeping fat from Crohn's disease patients. {{Cite journal | display-authors = etal

Drug resistance

In a study that identified clostridial species using commercial identification kits, it was found that as many as 10% of C. innocuum isolates were somewhat resistant to clindamycin. Most strains were found to be only moderately susceptible to vancomycin (MIC at which 90% of strains are inhibited, 4 micrograms/mL). In another study, where C innocuum was positively identified by gas-liquid chromatography, resistance to vancomycin was seen in all 28 strains isolated. All other clostridial species were at least 8 times more susceptible to vancomycin than C. innocuum, suggesting an intrinsic vancomycin resistance mechanism in C. innocuum.

References

References

1. (April 1962). "''Clostridium innocuum'', sp. n., a spore-forming anaerobe isolated from human infections.". [[Journal of Bacteriology]].
2. Crum-Cianflone MD, MPH, Nancy. (June 2009). "Clostridium innocuum bacteremia in a patient with acquired immune deficiency syndrome". American Journal of the Medical Sciences.
3. "NCBI taxonomy Browser".
4. Isenburg, Henry. (2007). "Clinical Microbiology Procedures Handbook 2nd Edition". ASM press.
5. Castiglioni, B. (2003). "Clostridium innocuum bacteremia secondary to infected hematoma with gas formation in a kidney transplant recipient.". Transplant Infectious Disease.
6. Shah, Monica. (February 2009). "Epidemiology and outcomes of clostridial bacteremia at a tertiary-care institution". Scientific World Journal.
7. Ackermann, G. (July 2001). "Isolation of Clostridium innocuum from cases of recurrent diarrhea in patients with prior Clostridium difficile associated diarrhea and". Diagnostic Microbiology and Infectious Disease.
8. Cutrona, AF. (Nov 1995). "Clostridium innocuum endocarditis". Clinical Infectious Diseases.
9. Alexander, CJ. (Dec 1995). "Identification and antimicrobial resistance patterns of clinical isolates of Clostridium clostridioforme, Clostridium innocuum, and Clostridium ramosum compared with those of clinical isolates of Clostridium perfringens.". Journal of Clinical Microbiology.
10. Mory, Francine. (June 1998). "Low-Level Vancomycin Resistance in Clostridium innocuum". Journal of Clinical Microbiology.