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Clostridium tertium septicemia in patients with neutropenia
G Speirs1, R E Warren, A Rampling
1Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, England.
Abstract:
Eighteen adult patients with hematologic malignancy developed bacteremia due to Clostridium tertium while neutropenic. Fifteen had accompanying abdominal pain, colonic bleeding, or diarrhea, and three had perianal cellulitis. Fourteen recovered with antibiotic therapy alone; no patient was treated by surgery. C. tertium is an unusual Clostridium because it is resistant to many beta-lactam antibiotics and to metronidazole but is susceptible to vancomycin, trimethoprim-sulfamethoxazole, and ciprofloxacin. It is possible that use of third-generation cephalosporins (cefotaxime, ceftizoxime, ceftazidime) for treating febrile episodes in the absence of any selective intestinal decontamination with trimethoprim-sulfamethoxazole or ciprofloxacin may have resulted in selection for C. tertium in our patients.
Insights
Clostridium tertium bacteremia occurred in neutropenic patients with hematologic malignancy. Antibiotic therapy was effective, highlighting C. tertium
Area of Science:
- Infectious Diseases
- Hematology
- Microbiology
Background:
- Neutropenic patients with hematologic malignancy are susceptible to bloodstream infections.
- Clostridium tertium is an uncommon pathogen with specific antibiotic resistance patterns.
Purpose of the Study:
- To describe the clinical features, treatment, and outcomes of bacteremia caused by Clostridium tertium in neutropenic patients.
- To investigate potential risk factors and antimicrobial susceptibility of C. tertium.
Main Methods:
- Retrospective analysis of 18 adult patients with hematologic malignancy and C. tertium bacteremia.
- Review of clinical data, including symptoms, treatment regimens, and patient outcomes.
- Assessment of C. tertium antibiotic susceptibility patterns.
Main Results:
- Eighteen patients developed C. tertium bacteremia while neutropenic.
- Common symptoms included abdominal pain, colonic bleeding, or diarrhea.
- Fourteen patients recovered with antibiotic therapy alone; no surgical intervention was required.
- C. tertium demonstrated resistance to beta-lactams and metronidazole, but susceptibility to vancomycin, trimethoprim-sulfamethoxazole, and ciprofloxacin.
Conclusions:
- Clostridium tertium bacteremia in neutropenic patients can be successfully treated with antibiotics.
- The use of third-generation cephalosporins without selective intestinal decontamination may contribute to C. tertium selection.
- Understanding C. tertium's unique resistance profile is crucial for effective treatment strategies.