title: Clostridium tertium in neutropenic patients: case series at a cancer institute.
abstract: OBJECTIVE
  Clostridium tertium is considered an uncommon pathogen in humans, but is a cause of bacteremia in patients with underlying hematological malignancies and neutropenia. A case series highlighting 10 years of experience with C. tertium as a cause of bacteremia in this population is presented; the cases were seen at a National Cancer Institute designated cancer center.
  
  
  METHODS
  Institutional review board approval was obtained prior to the start of the study. All cases of C. tertium bacteremia seen at H. Lee Moffitt Cancer Center and Research Institute from 2005 to 2015 were reviewed. The study population was identified by positive blood cultures obtained from the microbiology laboratory over the same time period.
  
  
  RESULTS
  Seven patients were found to have had C. tertium bacteremia. These patients had a temperature of >38.3°C at the time of diagnosis and severe neutropenia. All patients had a history of hematological malignancy, five having acute myeloid leukemia and two having myelodysplastic syndrome. All of the patients' blood cultures cleared within ≤3 days of antibiotic therapy.
  
  
  CONCLUSIONS
  The unusual susceptibility pattern of C. tertium, with resistance to beta-lactams and clindamycin, likely explains its presence in immunosuppressed patients. Vancomycin remains the drug of choice. The pathogen continues to have a low virulence and a low mortality when treated appropriately.
authors: University of South Florida College of Medicine, Tampa, Florida, USA.
authors: Sweta
authors: S
authors: Shah
authors: University of South Florida College of Medicine, Tampa, Florida, USA.
authors: Jennifer
authors: J
authors: Hankenson
authors: Department of Internal Hospital Medicine, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612-9416, USA.
authors: Smitha
authors: S
authors: Pabbathi
authors: Department of Internal Hospital Medicine, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612-9416, USA.
authors: John
authors: J
authors: Greene
authors: Department of Internal Hospital Medicine, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612-9416, USA. Electronic address: Sowmya.Nanjappa@Moffitt.org.
authors: Sowmya
authors: S
authors: Nanjappa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000209:etiology / Q000382:microbiology*; D003015:Clostridium Infections / Q000175:diagnosis / Q000276:immunology*; D048010:Clostridium tertium; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000209:etiology / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bacteremia; Clostridium tertium; Malignancy; Neutropenic fever; Sepsis