Bacteroides Infection among Hospital Patients

Okubadejo, O. A.; Green, P. J.; Payne, D. J.

doi:10.1136/bmj.2.5860.212

Cited by 34 publications

(11 citation statements)

References 15 publications

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“…It is totally resistant to the aminoglycoside group of antibiotics such as gentamicin and kanamycin, and of the penicillins, only carbenicillin has consistent bactericidal activity because of the high blood levels that are achieved on standard parenteral therapy. Tetracycline has been used effectively in the past, but recent workers (Bodner et al, 1972;Kislak, 1972;Okubadejo et al, 1973) have found nearly 40 per cent of strains resistant to easily attainable serum concentrations. Clindamycin is the most active antibiotic against bacteroides and has been used with success in the treatment of infections (Bartlett et al, 1972), but it can only be given orally, and in severe infections parenteral lincomycin is the antibiotic of choice.…”

Section: Wound Infections Following Intestinal Surgerymentioning

confidence: 99%

Wound infections due to Bacteroides fragilis following intestinal surgery

Leigh

1975

Journal of British Surgery

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Ninety-six wound infections due to Bacteroides fragilis occurring after intestinal surgery are described. Most infections followed appendicectomy or colectomy for diverticulitis. B. fragilis was isolated in pure growth from 47 per cent of infections, and in mixed culture the other common bacteria were Klebsiella spp., Escherichia coli and Enterobacter spp. Fifty-three per cent of the infections responded rapidly to either non-specific measures or antibiotic therapy, but 47 per cent of patients developed complications, usually abscess formation. The successful isolation of bacteroides from clinical material requires special precautions. The specimen for bacteriological examination must be sent to the laboratory in a transport medium which maintains an anaerobic environment and the culture techniques must include a selective agar for the isolation of anaerobic bacteria. The role of antibiotic therapy in preventing postoperative wound infection after intestinal surgery is discussed. Bacteroides has an unusualy pattern of antibiotic susceptibility and it is essential that an effective antibiotic such as lincomycin is included in the treatment of infection originating from the intestinal tract.

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Section: Wound Infections Following Intestinal Surgerymentioning

confidence: 99%

Wound infections due to Bacteroides fragilis following intestinal surgery

Leigh

1975

Journal of British Surgery

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“…In this study clindamycin was the most effective antibiotic (table IV)), confirming the results of other workers (Bartlett et al, 1972;Tracy et al, 1972;Mitchell and Simpson, 1973). Some workers have used tetracycline (Ellner and Wasilauskas, 1971;Ledgeretal., 1971;Kagnoffetal., 1972) but its efficacy is now in question as many (Bodner et al, 1972;Kislak, 1972;Martin et al, 1972;Okubadejo et al, 1973) have reported a high incidence of resistance, and in this study only 65% of the strains were sensitive to easily attainable serum S3 a ,0 concentrations. In less acute infections metronidazole is indicated because of its high bactericidal activity at concentrations attained in the blood (Nastro and Finegold, 1972;Whelan and Hale, 1973).…”

Section: Discussionmentioning

confidence: 53%

Clinical Importance of Infections due to Bacteroides fragilis and Role of Antibiotic Therapy

Leigh¹

1974

BMJ

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SummaryOut of 200 infections due to Bacteroides fragilis occurring over a period of three years 133 were related to the intestinal tract, 55 to the genitourinary tract, and the remainder were in bedsores and ulcers; 56% occurred in patients undergoing major intestinal surgery.B. fragilis was isolated in pure culture from 56% of the infections. In mixed culture it was most commonly associated with Klebsiella and Enterobacter species.Other anaerobic bacteria were isolated in 9% of the mixed cultures.Altogether 131 (65-5%) of the patients recovered without antibiotic therapy or further surgery, but 59 (29 5%) developed complications and 10 (50') died. The commonest complication was abscess formation, and the incidence was highest with infections associated with malignancy (44%) and lowest with obstetric infections (5%). The mortality was 5% overall but in the presence of bacteraemia it rose to 33%.Only 43 patients received appropriate chemotherapy. Clindamycin was the most effective antibiotic, having a recovery rate of 78%, but this rate was little better than in untreated patients (65%). The role of prophylactic antibiotic therapy in preventing bacteroides infection remains to be studied.The incidence of the isolation of bacteroides from wound infections after major intestinal surgery rose from 13% in 1970 to 81% in 1973. This increase was due to both the accurate collection and care of specimens while in transit to the laboratory and the use of selective media for the isolation of bacteroides in laboratory culture. The importance of these precautions is emphasized.

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“…The presence of organisms resistant to the antibiotic in use for treatment was a disturbing observation and clearly there is a need for improved collaboration with the bacteriological service. The bacteroides group of organisms may prove to be of increasing significance in septic shock (Lancet, 1973;Okubadejo, Green and Payne, 1973). The frequency of sudden death of cardiac origin in nine of these patients underlines the problem of myocardial irritability and depression in established septic shock.…”

Section: Discussionmentioning

confidence: 99%