Clostridium sordellii

# Overview
Clostridium sordellii is a rare bacterium that is capable of causing pneumonia, endocarditis, arthritis, peritonitis, and myonecrosis. C. sordellii bacteremia and sepsis occur rarely. Most cases of sepsis from C. sordellii occur in patients with underlying conditions. Severe toxic shock syndrome among previously healthy persons has been described in a small number of C. sordellii cases, most often associated with gynecologic infections in women and infection of the umbilical stump in newborns.

# Organism
Clostridium sordellii (also called C. sordellii) is a rare bacterium that causes pneumonia, endocarditis, arthritis, peritonitis, and myonecrosis. C. sordelliibacteremia and sepsis occur rarely. Most cases of sepsis from C. sordellii occur in patients with underlying conditions. Severe toxic shock syndrome among previously healthy persons has been described in a small number of C. sordellii cases, most often associated with gynecologic infections in women and infection of the umbilical stump in newborns. 

## Populations Susceptible to C. sordellii Infection
Women are at highest risk of infection from C. sordellii following the end of pregnancy, whether that pregnancy ended in a live birth, induced abortion (medical or surgical), or spontaneous abortion (miscarriage).  Fatal infections with C. sordellii and C. perfringens have occurred after medical abortion. In some cases, women can carry the bacteria, but not be infected (known as colonization).  The rate of vaginal colonization (when bacteria are present, but not causing an infection) with Clostridium species in the period after abortion has been reported to be as high as 29%, whereas these bacteria have been isolated in the vaginal secretions of 5%-10% of non-pregnant women. Researchers continue to study what percentage of women carries vaginal or rectal C. sordellii and C. perfringens before and after abortion, as well as during pregnancy.

## Symptoms of C. sordellii Infection
Symptoms of a C. sordellii infection include nausea, vomiting, diarrhea, and sometimes abdominal pain without fever. These symptoms often can occur in women after live birth or following a spontaneous, medical, or surgical abortion, so it is important to see a healthcare provider for further tests if someone is symptomatic.

## Transmission of C. sordellii iInfection
It is not known how C. sordellii is spread between persons or from the environment to persons. Other similar Clostridium species are spread from person to person and sometimes contaminated surfaces are involved in this transmission. Tests performed by the Food and Drug Administration (FDA) have not detected contamination with C. sordellii of either of the medications used in medical abortions.

# Medical Therapy

## Antimicrobial Regimen
- Clostridium sordelli toxic shock syndrome 
- Preferred regimen (1): Ampicillin 250-500 mg IV/IM  q4-8h
- Preferred regimen (2): Amoxicillin-clavulanate 250-500 mg PO bid/tid
- Preferred regimen (3): Piperacillin-tazobactam 4.5 g IV q8h
- Preferred regimen (4): Ticarcillin 3.1 g IV q8h
- Preferred regimen (5): Clindamycin 600 to 900 mg IV q8h
- Preferred regimen (6): Vancomycin 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose
- Preferred regimen (7): Imipenem 500 mg IV q6h
- Preferred regimen (8): Linezolid 600 mg IV/PO q12h
- Preferred regimen (9): Metronidazole 30 mg/kg/24 hr PO/IV q6h  (maximum dose: 4 g/24 hr)
- Note (1): Clostridium sordellii is a cause of toxic shock syndrome (CSTS) associated with gynecologic procedures, childbirth, and abortion (including spontaneous, surgical, and medical abortion). Gastrointestinal and vaginal colonization of Clostridium sordellii can occur in healthy individuals.
- Note (2): Treatment of Clostridium sordellii toxic shock syndrome consists of antibiotic therapy, surgical debridement, and aggressive resuscitation