Clostridium tertium Peritonitis and Concurrent Bacteremia in a Patient With a History of Alcoholic Cirrhosis

Abstract

Spontaneous bacterial peritonitis (SBP) is a recognized cause of morbidity and mortality in cirrhotic patients. Enterobacteriaceae have been isolated from the majority of peritonitis cases and the gram negative aerobe Escherichia coli is the most commonly isolated organism. Anaerobic organisms are rarely isolated because of the high oxygen tension in ascetic fluid. We report a patient with a history of alcoholic cirrhosis who developed SBP and concurrent bacteremia with the anaerobe Clostridium tertium. The patient was successfully treated with intravenous antibiotics and was discharged home on oral ciprofloxacin. This case report is unique in that it is the fourth documented Clostridium tertium SBP case, utilized MALDI-TOF mass spectrometry for organism identification, and susceptibility testing for select antibiotics was performed.

Keywords: Clostridium tertium; alcoholic cirrhosis; peritonitis.

Figure 1.

Gram stain of Clostridium tertium, which is an anaerobic, motile, gram-positive bacterium. It is easily decolorized in gram-stained smears and can be mistaken for a gram-negative organism.

Figure 2.

E-test of select antibiotics tested against Clostridium tertium. E-testing was performed to evaluate the susceptibility of C tertium to select antibiotics. The organism was susceptible to vancomycin, ciprofloxacin, sulfamethoxazole/trimethoprim, meropenem, and clindamycin.