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A decisive period in cefoxitin prophylaxis of experimental synergistic wound infection produced by Bacteroides fragilis and Escherichia coli.

In an experimental model of synergistic infection produced by Escherichia coli and Bacteroides fragilis, a single injection of cefoxitin 1 h before inoculation of the bacteria was able to prevent both death and local wound infection (P less than 0.05). When cefoxitin was administered 1 h after the bacterial inoculum, death of the animals, but not the wound infection, was prevented (P greater than 0.1). Cefazolin, active against the E. coli only, could prevent death, but had no significant effect (P greater than 0.1) on the prevention of wound sepsis.

Animals↗

The kinetics of peritoneal clearance of Escherichia coli and Bacteroides fragilis and participating defense mechanisms.

In a study using pigs, we delineated the dynamic character and the interplay of defense mechanisms that operate in the peritoneal cavity and their effectiveness against Escherichia coli and Bacteroides fragilis. The bacteria were extensively cleared during the first three hours. The concentration of both organisms in the peritoneal fluid decreased by up to 300,000-fold, and the final concentration was a function of the inoculum given. Clearance efficiency did not differ between a bolus dose and prolonged bacterial administration. Peritoneal absorption was a major eliminating mechanism during the first three hours but was limited to bacterial concentrations exceeding approximately 10(9) colony-forming units per milliliter of peritoneal fluid. Intraperitoneal elimination started immediately and continued for approximately six hours. Thereafter, residual bacteria were not eliminated, even though the defense capacity was intact. Prolonged bacterial administration, however, protracted the period for active bacterial destruction.

Animals↗

Enhancement of survival from murine polymicrobial peritonitis with increased abdominal abscess formation.

Muramyl dipeptide (MDP), a purified synthetic immune adjuvant, has been shown to increase murine intraabdominal abscess formation in a monomicrobial model using Bacteroides fragilis. This effect required live bacteria and was abolished by appropriate antibiotics. A polymicrobial model of peritonitis and abdominal abscess formation using Streptococcus fecalis, Escherichia coli, and B. fragilis was initially used to determine mortality rates at various concentrations and obtain an appropriate LD50. Animals were then pretreated with MDP or its inert buffer and underwent intraperitoneal injection of the appropriate bacterial suspension. Mortality and abdominal abscess formation were then assessed at 2 weeks after injection. There was a significant reduction in mortality (P less than 0.03) in mice treated with MDP compared to the controls. In surviving animals, there was also a significant increase in the number of animals forming abscesses (P less than 0.05) following treatment with MDP. This study has shown that nonspecific immune stimulation by MDP provided enhanced protection against a polymicrobial intraperitoneal challenge and paradoxically increased the formation of abdominal abscesses at the same time. This may be regarded as enhancement of the natural history of survival from peritonitis via bacterial containment through intraabdominal abscess formation, a manifestation of beneficial outcome in experimental peritonitis.

Abdomen↗

Sepsis inhibits synthesis of myofibrillar and sarcoplasmic proteins: modulation by interleukin-1 receptor antagonist.

The breakdown of myofibrillar and sarcoplasmic (nonmyofibrillar) proteins are regulated independently in sepsis, however, the factors regulating their synthesis are unknown. In this study, we assessed the effects of sepsis and interleukin-1 receptor antagonist on sarcoplasmic and myofibrillar protein synthesis in gastrocnemius. The rate of sarcoplasmic protein synthesis was 3.5 times that of myofibrillar proteins in control and septic rats. The synthesis of both sarcoplasmic and myofibrillar proteins was diminished proportionately during sepsis (p < .05). Infusion of interleukin-1 receptor antagonist (2 mg.kg.-1.h.-1) prevented the sepsis-induced inhibition of total, sarcoplasmic, and myofibrillar protein synthesis. Changes in the abundance of messenger RNA could not account for the inhibition of protein synthesis observed in sepsis. Furthermore, in vitro translation of messenger RNA isolated from control and septic muscle revealed no major differences. These results suggest the following: 1) the inhibition of total mixed proteins during sepsis is a consequence of reduced synthesis of both myofibrillar and sarcoplasmic proteins; 2) IL-1ra maintains control values of protein synthesis by sparing the reduction in synthesis of both myofibrillar and sarcoplasmic proteins during sepsis; and 3) the abundance of messenger RNA is not a rate-limiting determinant of protein synthesis in muscle from septic rats. An alteration in the translational efficiency of existing mRNA appears to be the major mechanism responsible for the inhibition of protein synthesis during sepsis.

Abdominal Abscess↗

[A case of empyema with subphrenic abscess].

A 75-year-old female was admitted to our hospital with complaints of fever, cough and left hypochondralgia. She had been operated for cholecystectomy ten years ago. Chest roentgenogram indicated bilateral pleural effusion. Tube drainage was done to the left thorax and empyema was caused by Bacteroides fragilis and Escherichia coli (E. coli). Though antibiotic therapy was already being conducted, the left hypochondralgia persisted. A CT scan and MRI demonstrated local subphrenic abscess around the spleen due to E. coli. Tube drainage was conducted to the subphrenic abscess under ultrasound control and and the symptoms disappeared rapidly. The present results show that examination of the abdomen is necessary for empyema with complication of compromised host. The past history of abdominal surgery and disturbance in the biliary tract should also be considered.

Aged↗

Effects of Escherichia coli and Bacteroides fragilis on peritoneal host defenses.

Escherichia coli and Bacteroides fragilis are common copathogens in clinical intra-abdominal sepsis, yet it is unclear how they interact synergistically in vivo. We sought to determine whether E. coli and B. fragilis, in combination but not alone, could exert a detrimental effect on the peritoneal host defenses of translymphatic absorption and bacterial phagocytosis. Our data indicated that nonviable E. coli (O18ab:K56/K7:- and O111:B4), Klebsiella pneumoniae, B. fragilis, and Bacteroides thetaiotaomicron were handled in a similar fashion by both host defenses of the peritoneal cavity. The use of 2 X 10(8) nonviable radiolabeled E. coli as a tracer and either 2 X 10(9) B. fragilis or 2 X 10(9) E. coli (either viable or nonviable) as a competing agent to inhibit host defenses demonstrated that although clearance and phagocytosis could be inhibited, the inhibition occurred to a similar degree with either E. coli or B. fragilis. Thus, B. fragilis did not compete to any greater extent than E. coli did for peritoneal clearance or opsonization and phagocytosis in vivo. These data indicate that bacterial synergy probably does not occur on the basis of reduced peritoneal clearance or by a reduction in the opsonization and phagocytosis of either organism by the copathogen. These results provide indirect support for the hypothesis that in bacterial synergy, one organism directly stimulates the growth of the other, perhaps by providing a growth factor.

Animals↗

A multicomponent system is required for tetracycline-induced excision of Tn4555.

Bacteroides spp. are the predominant organisms in the intestinal tract, and they also are important opportunistic pathogens. Antibiotic therapy of Bacteroides infections often is complicated by the prevalence of drug-resistant organisms which acquire resistance genes from a variety of mobile genetic elements including conjugative transposons (CTns) and mobilizable transposons (MTns). Tn4555 is an MTn that encodes beta-lactam resistance, and it is efficiently mobilized by the Bacteroides CTns via a tetracycline (TET)-inducible mechanism. In this study a model system with CTn341 and a Tn4555 minielement was used to examine Tn4555 excision from the chromosome. Using PCR and mobilization assays it was established that excision was stimulated by TET in the presence of CTn341. In order to determine which Tn4555 genes were required for excision, int, tnpA, tnpC, xis, and mobA mutants were examined. The results indicated that int plus two additional genes, tnpC and xis, were required for optimal excision. In addition, there was no requirement for the mobA gene, as had been shown for another MTn, NBU1. The Xis protein sequence is related to a family of plasmid excisionases, but the TnpC gene product did not match anything in the sequence databases. Evidence also was obtained that suggested that Xis is involved in the control of TET-induced excision and in control of mobilization by CTn341. Overall, these results indicate that excision of MTns is a complex process that requires multiple gene products.

Bacterial Proteins↗

Effect of sepsis on activity of pyruvate dehydrogenase complex in skeletal muscle and liver.

The effect of chronic sepsis on the concentration of active pyruvate dehydrogenase complex has been investigated in liver and skeletal muscle of normal, sterile inflammatory, and chronic septic (small and large abscess) animals. Hyperdynamic sepsis was induced by the intraperitoneal introduction of a rat fecal-agar pellet of known size and bacterial composition (Escherichia coli + Bacteroides fragilis). Total pyruvate dehydrogenase complex activity was not altered in either liver or skeletal muscle in any of the conditions studied. In hepatic tissue, sterile inflammation increased the proportion of active complex 2.5-fold compared with control. The same increase in the concentration of active complex was observed in animals with a small abscess. When the abscess size was increased (large abscess), the concentration of active complex was decreased relative to sterile inflammatory or small abscess septic animals. In contrast to liver, sterile inflammation did not alter the proportion of active complex in skeletal muscle. Sepsis (either small or large septic abscess) resulted in threefold decrease in the concentration of active complex relative to control or sterile inflammatory animals. Changes in the concentration of active complex did not appear to be dependent on the ATP/ADP concentration ratio or tissue pyruvate levels but were consistent with changes in the acetyl-coenzyme A-to-coenzyme A concentration ratio. The mechanism responsible for altered concentration of active complex may be mediated through changes in the activity of the pyruvate dehydrogenase kinase, secondary to alterations in the effector concentration ratios.

Abscess↗

Bacteriological evaluation of 194 adult patients with acute frontal sinusitis and findings of simultaneous maxillary sinusitis.

In a prospective study bacteriological findings from frontal and maxillary sinus secretes were analyzed. Frontal sinus trephination was performed to 103 and maxillary irrigation to 192 patients. Main pathogens in the frontal as well as in the maxillary sinus secretes were Haemophilus influenzae and Streptococcus pneumoniae. beta-lactamase production of H. influenzae was found in 17% of frontal and in 16% of maxillary sinus samples. Bacteriological findings were supported by the staining results. The portion of anaerobic pathogens in cultures were poor, though Bacteroides fragilis antigen was detected in 8 frontal and 6 maxillary sinus samples. The acute frontal sinusitis should be treated with respective antibiotics. Complications seem not to develop in the acute phase and the disease can primarily be treated conservatively. It should however be controlled properly to avoid prolonged disease and late complications.

Acute Disease↗

[Surgical treatment of acute bacteroid purulent cholangitis].

The results of treatment of 40 patients with acute purulent cholangitis developed against the background of choledocholithiasis are presented. Bacteroid of the kind B. fragilis (67.5% of cases), Fusobacterium, Lactobacillus sp. (30%) are the leading etiological factor of cholangitis. The indications for external and internal drainage of the bile ducts are substantiated. The ineffectiveness of internal drainage in this disease is demonstrated.

Acute Disease↗

[Psoas abscess in Crohn's disease. Preoperative evaluation and surgical attitude].

Three patients with psoas abscess secondary to Crohn's diseases are reported with the aim of discussing the diagnosis and surgical management of these patients. It is concluded that computerized tomography is the method of choice for the diagnosis and follow up of this complication. Surgery should be individualized but in stable patients abscess drainage should be attempted in addition to resection of the intestine involved. Finally, given the great risk of pulmonary thromboembolism in these patients, intensive prophylactic anticoagulant therapy is required.

Adolescent↗