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Postoperative Intra-Abdominal Clostridium tertium Infection Following Obstructed Obturator Hernia Repair: A Case

Jin Lu1,2, Guanjun Zhan3, Zhongjing Meng1,2

  • 1Department of Pharmacy, Jiangbei District of Zhongda Hospital Affiliated to Southeast University, Nanjing 210048, China.

Pathogens (Basel, Switzerland)
|May 4, 2026
PubMed

Insights

Clostridium tertium can cause severe infections in non-neutropenic patients, particularly after surgery. Early consideration and specific antibiotic therapy are crucial for successful outcomes in these cases.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Clinical Case Study

Background:

  • Clostridium tertium is an emerging opportunistic pathogen.
  • While often linked to immunocompromised individuals, it can infect non-neutropenic hosts.
  • Intestinal barrier disruption is a common factor in non-neutropenic C. tertium infections.

Purpose of the Study:

  • To report a case of C. tertium peritonitis and bacteremia in a non-neutropenic patient.
  • To analyze patterns of C. tertium infections in neutropenic versus non-neutropenic individuals.
  • To guide empirical therapy and treatment strategies for C. tertium infections.

Main Methods:

  • Case presentation of a 75-year-old woman with postoperative peritonitis and bacteremia.
  • Diagnosis confirmed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS).
  • Literature review of 128 cumulative cases of C. tertium infections.

Main Results:

  • Successful treatment of the case with piperacillin-tazobactam, levornidazole, and surgical source control.
  • Identified two infection patterns: bacteremia in neutropenic patients and diverse infections in non-neutropenic patients.
  • Mortality associated with comorbidities and polymicrobial sepsis.

Conclusions:

  • C. tertium should be suspected in non-neutropenic patients with postoperative or GI barrier-disruptive infections.
  • Empirical therapy should consider C. tertium's resistance patterns, favoring carbapenems, vancomycin, or piperacillin-tazobactam with a nitroimidazole.
  • Urgent source control is essential for managing C. tertium infections.
Keywords:
Clostridium tertiumintra-abdominal infectionnon-neutropenic hostobturator herniapostoperative complication

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