A 62-month retrospective epidemiological survey of anaerobic bacteraemia in a university hospital

Abstract

The incidence of anaerobic bacteraemia was studied retrospectively over 62 months at Mont-Godinne University Hospital, Yvoir, Belgium. The distribution of organisms, clinical presentations, choice of antimicrobial therapy and clinical outcome were analysed. The proportion of positive blood cultures yielding obligate anaerobes was 3.3%. The overall incidence of clinically significant anaerobic bacteraemia was 0.51 cases/1,000 patient admissions (0.61 cases/10,000 hospital-days), but was significantly higher in patients with active haematological malignancies than in other groups (5.97/10,000 vs. 0.33/10,000 hospital-days; p < 0.05). The Bacteroides fragilis group accounted for 61% of isolates, followed by Clostridium spp. (12.2%), Peptostreptococcus spp. and Leptotrichia spp. (7.3% each) and Fusobacterium spp. (4.8%). The most common risk-factors were gastrointestinal surgery (49%) and active haematological malignancies with chemotherapy and/or bone marrow graft (47%). One or more co-morbidities were present in 30 (77%) of 39 patients. The lower gastrointestinal tract (41%) and the oropharynx (23%) were the two most frequent presumed or proven sources for bacteraemia, with the origin remaining unknown in eight (20.5%) cases. The overall mortality rate (evaluated 7 days after the occurrence of bacteraemia) was 13%. Fatal outcome correlated with the severity of underlying diseases and the immunosuppressed status of the patients rather than with the causative pathogen or the effectiveness of antimicrobial therapy. Likewise, there was no difference in the mortality rate between patients with monomicrobial and polymicrobial bacteraemia. Overall, the data re-emphasise the importance of anaerobic bacteraemia, especially in patients with haematological malignancies.

Leptotrichia species in human infections II

“…Leptotrichia species have been recovered from the blood of patients with liver abscesses, mucositis, neutropenic sepsis, diabetes, respiratory distress, community-acquired pneumonia (CAP), bilateral lung crackles, mild anemia, and vasculitis (Table 2) [7,22,33–35]. They were also recovered from oral plaque of guinea pigs [21] and feces of piglets [54], dental plaque from healthy individuals, plaque and saliva from patients with various types of caries, gingivitis, chronic periodontitis, and peri-implantitis [23,25–27,34,35,37,38,44,45,47,49,52,59,60,62,66–69,91,94], decayed tooth surfaces and discordant caries from intact enamel surfaces [53].…”

“…Further, Leptotrichia species were recovered from healthy patients with oral cancer, premalignant oral lesion [18,28,33,56,91], edentulous infants [29], human vaginal fluid of sexually active and inactive individuals [30,32], HIV-seropositive and -seronegative patients [46], pancreatic cancer patients [18,66], black pigmented stain caries patients [63], and patients with halitosis (Table 2) [42,65,81,82]. Besides, Leptotrichia species were isolated from the blood [4,5,22,74], the amniotic fluid of a patient with a wound and respiratory difficulties [4], breast milk of obese women with gestational diabetes and normal weight [36], oral samples of a patient with new-onset rheumatoid arthritis [20], oral lichen planus patients [88], and even from fermenting Lees liquor [39]. Leptotrichia species were equally isolated from the blood and gastric fluid of patients with coronary artery disease (CAD), candidal esophagitis, chronic kidney disease, diabetic, duodenal ulcer, erythematous gastropathy, gastroesophageal reflux disease, gastric ulcer, hiatal hernia, reflux esophagitis, upper gastrointestinal bleeding, renal transplant, and sarcoidosis (Table 2) [16].…”

“…Bacteremia caused by Leptotrichia species were found among neutropenic patients with various forms of predisposing diseases such as bone-marrow transplants, infective endocarditis, and sepsis associated with mucositis. The latter served as an oral or orodental portal of entry [2,3,22]. In fact, neutropenic fever coupled with mucositis is an established predisposing factor for development of sepsis by Leptotrichia species [4,7,87].…”

“…In fact, neutropenic fever coupled with mucositis is an established predisposing factor for development of sepsis by Leptotrichia species [4,7,87]. Peripheral blood stem-cell transplant patients (PBSCT) with fever due to mucosal disruptions and lesions have a portal of entry for bacteria that causes bacteremia [5,9,22,33]. Mucositis, esophageal ulcer, or diverticulitis are possible risk factors for infected patients [7,9,13,15–17,33,85].…”

“…L. trevisanii was involved in 15 incidences of bacteremia. Eight cases each also involved Leptotrichia species and L. buccalis , six L. goodfellowii , three L. wadei , two L. hongkongensis , and one with L. shahii (Table 2) [4–6,9–15,17,21,22,33,42,74,78,85–88]. In cases involving L. trevisanii , seven were also associated with neutropenic fever [5,13,14,17,87], while five were associated with PBSCT [9,10], four had acute myelogenous leukemia (AML) [5,7 9,10,15] and multiple myelomas (MM) [4,9,13], two had stomatitis [10,14], three had NHL [9,87], and one had a catheter-related bloodstream infection [17].…”