[Symposium on asporogenic anaerobic bacterial infections. 3. Bacteroides infections in the field of surgery].
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Rabbits were infected with Bacteroides fragilis, B. macacae and B. gingivalis in monoinfection, mixed Bacteroides infection, and mixed infection of B. gingivalis with Streptococcus faecalis, Escherichia coli and Clostridium sporogenes. Monoinfection gave rise to localised, nodular abscesses at cell levels greater than 0.5 X 10(5) cfu ml-1, the severity of which was dose related. Mixed infections including B. gingivalis caused severe spreading lesions and affected organs distant from the injection site. Histopathological studies indicate an inflammatory response with gas vacuolation and local necrosis.
More than 80 cases of bacteroides infections are reported. 54 cases of these infections were postoperative complications. Relationships between bacteroides infection and diseases of the colon are significant. Not very impressive local symptoms made the diagnoses of abscesses difficult. In most cases bacteroides are susceptible to chloramphenicol and tetracycline. Patients develop agglutinable antibodies after bacteroides infection.
A double-blind randomised trial was carried out among 46 patients undergoing elective colonic surgery; 27 patients received prophylactic metronidazole and 19 received placebo. Anaerobic infections did not develop in any of the metronidazole-treated patients, but did develop in 11 (58%) of 19 controls who were subsequently successfully treated with metronidazole.
Fluoretec, a commercial kit for the rapid diagnosis by immunofluorescence of infections caused by Bacteroides spp was compared with a standard culture method. A total of 1010 specimens were tested for the presence of B fragilis group by Fluoretec F and B melaninogenicus-oralis and asaccharolytic groups by Fluoretec M. Fluoretec F was positive in 123/152 specimens culturing B fragilis group strains. Seventeen specimens were positive by Fluoretec F but negative on culture. Fluoretec M was positive in 21 of 22 specimens from which B melaninogenicus was cultured. The Fluoretec system was convenient in use, results being obtained within one hour of receipt of the specimen.
Eighteen patients with serious Bacteroides infections were treated with systemic clindamycin-2-phosphate. Sixteen patients recovered without complications while two patients died. Few side effects were noted. The infections treated included septic abortion, posthysterectomy infections, pelvic inflammatory disease, perforation of the bowel, postoperative complications of abdominal surgery and pancreatic abscess. The clinical usefulness of this drug in treating Bacteroides infection is confirmed.
The authors analyse 42 cases of bacteroides infection regrouping bacteremia and localised infection collected over a period of one year. The route of entry was almost always digestive. The prognosis seems mainly to depend on the background. The bacteriological diagnosis is now easy and germ-sensitivy is stereotyped.
Bacteroides were detected in pus and bioptates of the majority of 125 patients with purulent and purulent septic infections of various localization. In 90 per cent of the subjects the bacteroides were detected in association with aerobes, facultative and obligate anaerobic bacteria. The species of the bacteroides and concomitant microflora isolated from the cases with different diseases were defined by endogenic sources of the microbial contamination. Sensitivity of 112 bacteroide strains to antimicrobial agents was tested. Chloramphenicol, clindamycin, metronidazole, cefotaxime and heliomycin proved to be the most efficient. Efficacy of heliomycin was detected in hamsters with experimental bacteroide infection in the buccal sac. Thorough bacteriological examination is required for rational chemotherapy of bacteroide infections.
A case of fulminant bacteroides plus anaerobic streptococcus bacteraemia is reported. Therapy included the use of extracorporeal membrane oxygenation for the resultant acute respiratory failure. The problem of bacteroides infections is reviewed.
Bacteriophages infecting Bacteroides fragilis strains RYC2056 and HSP40 have been proposed as indicators of water quality. To accomplish this function, homogeneity of the group of phages detected by these strains is necessary to ensure that the final results are not due to the different kinetics of inactivation of the phages. To evaluate homogeneity, we observed by electron microscopy bacteriophages isolated from sewage with two Bacteroides fragilis strains (HSP40 and RYC2056). A predominant group of phages was observed, Siphoviridae with slightly curved tails. Detection of other minority groups, which could be present in the sample, was done with neutralization experiments by using antiserum against the majority group and with host mutants resistant to infection with the predominant phage. Although two other minority groups were observed, results showed that bacteriophages infecting B. fragilis strain HSP40 and strain RYC2056 form a homogeneous group, Siphoviridae with slightly curved tails being the most predominant in sewage.
Lincomycin, or the closely related derivative clindamycin, was used to treat six patients with bacteroides infection. In five of the six there was a rapid clinical response to the treatment. Lincomycin and clindamycin seem to be the antibiotics of choice for such infections.
Clindamycin, by intravenous or intramuscular administration, was used in the treatment of 18 patients seriously ill with infections due to bacteroides organisms. In 17 cases there was a rapid favourable clinical response to treatment. No serious toxic effects were observed. This study appears to confirm previous in vitro evidence that clindamycin is presently the antibiotic of choice for such infections.
A method for the detection and enumeration of bacteriophages infecting Bacteroides fragilis has been standardised. The recommended host strain is RYC2056 (ATCC 700786) because of the relatively high counts (10(4)-10(5) PFU/100ml) that it recovers in sewage from very different geographical areas. The addition of 0.25% bile to the culture and assay media and the manipulation of the host strain under strict anaerobic conditions resulted in a significant increase (more than 100%) in the number of phages detected. No other changes in the media and culture conditions resulted in changes in the phage counts detected. However, these increases do not justify changing the culture conditions and media described, taking into consideration that bile renders the media cloudy making it difficult to follow the host growth and that most laboratories do not have the facilities to work under strict anaerobic conditions. Nalidixic acid (100 microg/ml) and kanamycin (100 microg/ml) in the assay medium significantly reduce the background flora from polluted samples without affecting the phage counts. Freezing cultures just before the end of the log-phage growth at (-70+/-10) degrees C with BSA-sucrose as cryoprotector, storing of 1-2 ml in glass vials at (-70+/-10) degrees C and using them directly to inoculate fresh broth allows the obtention of cultures ready for phage enumeration in about 2.5 h. All these developments have been incorporated into a procedure that makes the method for detecting phages infecting B. fragilis as workable as the standardised methods available for the detection of coliphages.
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