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Spectrum and Treatment of Anaerobic Infections

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Spectrum and Treatment of Anaerobic Infections J Infect Chemother 22 (2016) 1e13 Contents lists available at ScienceDirect Journal of Infection and Chemotherapy journal homepage: http://www.elsevier.com/locate/jic Review article Spectrum and treatment of anaerobic infections * Itzhak Brook Department of Pediatrics, Georgetown, University School of Medicine, Washington DC, USA article info abstract Article history: Anaerobes are the most predominant components of the normal human skin and mucous membranes Received 7 July 2015 bacterial flora, and are a frequent cause of endogenous bacterial infections. Anaerobic infections can Received in revised form occur in all body locations: the central nervous system, oral cavity, head and neck, chest, abdomen, 5 October 2015 pelvis, skin, and soft tissues. Treatment of anaerobic infection is complicated by their slow growth in Accepted 25 October 2015 culture, by their polymicrobial nature and by their growing resistance to antimicrobials. Antimicrobial Available online 24 November 2015 therapy is frequently the only form of therapy needed, whereas in others it is an important adjunct to drainage and surgery. Because anaerobes generally are isolated mixed with aerobes, the antimicrobial Keywords: Anaerobes chosen should provide for adequate coverage of both. The most effective antimicrobials against anaer- Infection obes are: metronidazole, the carbapenems (imipenem, meropenem, doripenem, ertapenem), chloram- Bacteroides fragilis phenicol, the combinations of a penicillin and a beta-lactamase inhibitors (ampicillin or ticarcillin plus Antimicrobial resistance clavulanate, amoxicillin plus sulbactam, piperacillin plus tazobactam), tigecycline, cefoxitin and Antibiotics clindamycin. © 2015, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved. Contents 1. Introduction . .................................................. 2 2. Microbiology . .................................................. 2 3. Predisposing conditions . .................................................. 4 4. Prevention . .................................................. 4 5. Signs and symptoms associated with anaerobic infections . ..................................... 4 6. Clinical infections . .................................................. 4 6.1. Central nervous system (CNS) . .........................4 6.2. Head and neck and upper respiratory tract . .........................5 6.3. Otitis media . .........................5 6.4. Rhinosinusitis . .........................6 6.5. Parotitis . .........................6 6.6. Cervical lymphadenitis . .........................6 6.7. Head and neck infection after surgery . .........................6 6.8. Tonsillitis . .........................6 6.9. Pleuropulmonary . .........................7 6.10. Intra-abdominal . .........................7 6.11. Female genital tract . .........................7 6.12. Skin and soft-tissue infections . .........................7 6.13. Osteomyelitis and septic arthritis . .........................8 6.14. Bacteremia .............................................................. ............................ .........................8 7. Management . .................................................. 8 * 4431 Albemarle St NW, Washington DC 20016, USA. Tel.: þ1 (202) 744 8211. E-mail address: [email protected]. http://dx.doi.org/10.1016/j.jiac.2015.10.010 1341-321X/© 2015, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved. 2 I. Brook / J Infect Chemother 22 (2016) 1e13 7.1. Hyperbaric oxygen . .........................................8 7.2. Surgical therapy . .........................................8 7.3. Antimicrobial treatment . .........................................8 7.4. Antimicrobials . ...................................................10 7.4.1. Penicillins . ........................................10 7.4.2. Cephalosporins . ........................................10 7.4.3. Carbapenems (imipenem, meropenem, doripenem, ertapenem) . ............................10 7.4.4. Chloramphenicol . ........................................10 7.4.5. Clindamycin . ........................................10 7.4.6. Metronidazole and tinidazole . ........................................10 7.4.7. Macrolides (erythromycin, azithromycin, clarithromycin) . ............................10 7.4.8. Glycopeptides (vancomycin, teicoplanin) . ......................................10 7.4.9. Tetracyclines . ........................................10 7.4.10. Tygecycline . ........................................10 7.4.11. Fluoroquinolones . ........................................10 7.4.12. Other agents . ........................................11 7.5. Choice of antimicrobial agents . ........................................11 8. Conclusions . ..................... 11 Conflict of interest . ..................... 11 References . ...................................................11 1. Introduction The recovery of anaerobes differs in various infectious sites (Table 2). Polymicrobial infections caused by aerobic and anaerobic Infections caused by anaerobic bacteria occur frequently, and organisms are common [2,3]. can be serious and life-threatening. Because anaerobes colonize the Anaerobes taxonomy has changed because of improved char- skin and are the main component of mucous membranes flora [1] acterization methods using genetic studies [4,6]. Recent advances they are endogenous in nature. Because of their fastidiousness, in direct detection of anaerobes from clinical samples include anaerobes are difficult to isolate and are often unrecognized. Delay 16rRNA gene based methods, DNA hybridization, Matrix-assisted in implementing appropriate therapy may lead to clinical failures. laser desorption/ionization time-of-flight mass spectrometry Their isolation requires proper methods of collection, trans- (MALDI-TOF MS) Biotyper, multiplex PCR and oligonucleotide array portation and cultivation of specimens [2e6]. Treatment is technologies [5]. The ability to differentiate between similar strains complicated by their slow in-vitro growth, the infection's poly- enables better characterization of types of infection and anticipate microbial nature and the organisms' mounting antimicrobial antimicrobial susceptibility [4]. resistance. Anaerobic spore-forming bacilli belong to the genus Clos- This review describes the clinical spectrum and treatment of tridium. They are highly pleomorphic, ranging from short, thick anaerobic infections. bacilli to long filamentous forms, and are either ramrod straight or slightly curved. The most frequent Clostridia in clinical infections are Clostridium perfringens, Clostridium septicum, Clostridium 2. Microbiology ramosum, Clostridium novyi, Clostridium sordellii, Clostridium histo- lyticum, Clostridium fallax, Clostridium bifermentans and Clostridium The clinically important anaerobes accounting to over 95% of innocuum[4e6]. infections are: C. perfringens is an often encapsulated stout gram-variable rods of varying length, found in soil and humans and animals intestines. Gram-negative rods (Bacteroides, Prevotella, Porphyromonas, It is the most commonly isolated histotoxic clostridia and produces Fusobacterium, Bilophila and Sutterella spp.); several necrotizing extracellular toxins. It can cause devastating Gram-positive cocci (mainly Peptostreptococcus spp.); illness with high mortality rate and bacteremia associated with Gram-positive spore-forming (Clostridium spp.) and no spore- extensive tissue necrosis, hemolytic anemia and renal failure. forming bacilli (Actinomyces, Propionibacterium, Eubacterium, C. septicum infection (mostly blood and subcutaneous tissue) is Lactobacillus and Bifidobacterium spp.); often association with occult colonic malignancy. C. sordellii Gram-negative cocci (mainly Veillonella.
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