Hemolytic uremic syndrome in a patient with Bacteroides fragilis infection.
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Bacteroides Infections↗
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In-vitro activity of peritoneal cells from rats after intra-abdominal infection with Bacteroides fragilis and Escherichia coli.
Peritoneal cells from rats infected intraperitoneally with Escherichia coli and Bacteroides fragilis, alone or in combination were examined in vitro. Cells were harvested 6 h after implantation of fibrin clots infected with E. coli or B. fragilis, separately or containing both species, and assayed for their bactericidal capacities, chemiluminescence and production of cidal metabolites. Peritoneal cell populations from rats with implants of any of the infected clots showed similar distribution of different subpopulations. Bactericidal activity of peritoneal cells did not differ with the bacterial species used. Chemiluminescence values of peritoneal cells from rats with mono-infected B. fragilis or mixed-infected implanted clots, after stimulation with either particles or chemical stimuli, were significantly higher than those of rats with mono-infected E. coli or sterile clots. The same tendency was seen with regard to the production of cidal metabolites such as hydrogen peroxide and superoxide anions although no significant differences were found.
Animals↗
The role of elastase in the differentiation of Bacteroides nodosus infections in sheep and cattle.
Eighty-seven Bacteroides nodosus isolates were examined for elastase production by clearing of elastin particles in TAS agar medium. These included 54 ovine virulent isolates, 28 ovine benign isolates and five bovine isolates. In addition 22 ovine virulent, 16 ovine benign and two bovine isolates were examined for decline in proteolytic activity over a 13-day period in the degrading proteinase test using hide power-azure as substrate. There was a remarkable correlation between elastase production, relative stability of proteolytic activity in the hide powder-azure test and virulence of B nodosus. Ovine virulent isolates invariably produced elastase whereas ovine benign isolates and bovine isolates were elastase negative. Bovine isolates produced only mild lesions in the feet of challenged sheep.
Animals↗
Comparative efficacy of ceftriaxone in experimental infections involving Bacteroides fragilis and Escherichia coli.
The in vivo activity of ceftriaxone was examined in an experimentally induced subcutaneous infection involving Bacteroides fragilis and Escherichia coli. Mice were challenged with 1 of 10 strains of B. fragilis or E. coli, or a dual combination of the two species. The efficacy was measured by a reduction in the count of viable organisms when antimicrobial treatment was initiated 1 h after challenge and continued for 5 days. Ceftriaxone exhibited impressive activity against E. coli but showed poor in vivo activity versus B. fragilis. The antimicrobial activity of ceftriaxone was influenced by the microbial interaction in our dual-isolate model. Pharmacokinetic studies showed that ceftriaxone penetrated into abscesses and achieved peak levels of about 40% of the peak serum levels. However, in abscesses infected with B. fragilis nearly all biological activity of ceftriaxone was lost.
Animals↗
Bacteroides fragilis infection of a knee prosthesis after haemorrhoidectomy.
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Aged↗
Metronidazole resistant Bacteroides fragilis infection of a prosthetic hip joint.
A case of infection involving a prosthetic joint in a patient with adult Still's Disease is described. The causative organism was a strain of Bacteroides fragilis which was resistant to metronidazole. The rarity of this occurrence is emphasised. Diagnostic difficulties which arose are described and the problems encountered with therapy discussed.
Administration, Oral↗
The effect of iron on mixed infection of Bacteroides fragilis and Escherichia coli in mice.
Survival of an infected animal is improved in a mixed infection when Bacteroides fragilis is the bacterial species acting as a microbial antagonist against Escherichia coli. The protective effect afforded an animal by B. fragilis against E. coli is altered when ferric ammonium citrate is added to the injected mixed culture. In mice an E. coli concentration of 10(9) produced zero survival; the concentration 10(8) produced 40% survival; the concentration 10(7) and less produced 100% survival. Bacteroides fragilis concentrations of 10(8) and less did not kill the 15- to 20-g mouse within 5 days. Mice were given ip injections of the constant amount of 10(8) E. coli and serially diluted amounts of B. fragilis beginning with 10(8) organisms/ml. There was 40% survival in the 10(8) E. coli controls and 96% survival in the animals receiving 10(8) E. coli plus B. fragilis. The addition of ferric ammonium citrate to 10(8) E. coli plus B. fragilis reduced animal survival from 96 to 63%.
Animals↗
Effect of prophylactic antibiotics upon mixed infections with Bacteroides fragilis.
Antimicrobial agents were used alone or in combinations to explore the effect of prophylactic antimicrobial therapy. Subcutaneous abscesses in mice were induced by single and mixed infections of Bacteroides fragilis, Staphylococcus aureus, Group A streptococci and Escherichia coli. The infected mice were treated with three doses of gentamicin, cefoxitin, metronidazole or clindamycin alone or else metronidazole or clindamycin in combination with gentamicin. Mice were sacrificed five days after inoculation and the bacterial contents of the abscesses were determined. Infection induced by a single bacteria always responded to appropriate antimicrobial therapy. However, in infections caused by two organisms, therapy directed at either the Bacteroides fragilis (with metronidazole or clindamycin) or Escherichia coli (with gentamicin) was effective in not only significantly reducing the colony forming units (CFU) of the target organism but also reducing the number of untreated bacteria. Clindamycin alone was effective in reducing the CFU of both components of mixed infections of Bacteroides fragilis with either Staphylococcus aureus or Group A streptococci. Cefoxitin alone and the combination of either clindamycin or metronidazole with gentamicin were effective against all mixed infections. These data support the need to provide coverage for all components of mixed infections with single or combination therapy.
Abscess↗
[Life threatening infection with bacteroides fragilis in connection with Dalkon shield (author's transl)].
A case of severe peritonitis in connection with the application of a Dalkon Shield is reported. By culturing the peritoneal exsudate a monoculture of Bacteroides fragilis was found as causing agens. The general aspects of severe infection in connection with IUD, particularly the Dalkon Shield, are discussed. By analysing the reports in the literature it cannot be ruled out, that Bacteroides fragilis may to be a major factor in cases with lethal outcome.
Adult↗
Detection of specific IgG antibody in sera from patients infected with Bacteroides fragilis by enzyme-linked immunosorbent assay.
During a period of 13 months, 28 serious infections caused by Bacteroides were seen in 27 patients. Sixteen patients yielded Bacteroides fragilis; sera from 13 (81%) of these 16 had increased levels of IgG specific for B. fragilis lipopolysaccharide (LPS) antigens by enzyme-linked immunosorbent assay (ELISA). Sera from 20 normal controls did not have increased specific IgG. Sera from 22 of 23 patients with bacteremia caused by other gram-negative rods also failed to yield increased levels of specific antibody (P less than 0.0012). Analysis of sera from patients with B. fragilis infections disclosed a significant correlation between the levels of specific IgG to B. fragilis LPS measured by ELISA and the IgG antibody to the infecting B. fragilis by indirect immunofluorescence (r = 0.84, P less than 0.012). Two of the remaining 12 infections caused by Bacteroides not apparently due to B. fragilis organisms were also associated with increased levels of specific IgG to B. fragilis LPS antigens. Specific IgG antibody response may be an important adjunct in diagnosis of common B. fragilis infections and may allow better management of antimicrobial agents.
Abscess↗
Letter: Antibiotics in bacteroides fragilis infections.
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Acute Disease↗
Inactivation of penicillin G during experimental infection with Bacteroides fragilis.
An animal model implanted with intraperitoneal plastic reservoirs was used for study of the penetration of penicillin G into sites infected with Bacteroides fragilis. Penicillin G was given to rabbits, and its concentration in uninfected reservoirs and in those infected with B. fragilis was determined. The mean percentage penetration ([concentration in capsule divided by peak concentration in serum] X 100) of penicillin into uninfected capsules was 19.9%, whereas that into heavily infected capsules was 1.5%. The percentage penetration of radiolabeled penicillin into infected capsules was 12.5%, whereas the proportion of bioactive drug in the same capsules was again very low (1%). These results show that there is a modest reduction in penetration of penicillin into infected sites and a striking inactivation of the drug by B. fragilis in this experimental model.
Animals↗
Migration of rat peritoneal cells after intra-abdominal infection with Bacteroides fragilis and Escherichia coli.
A fibrin clot model for intra-abdominal abscess formation was used to study the migratory properties of peritoneal cells from rats during the early stages of infection. Peritoneal cells and fibrin clot remnant were harvested 6 h after implantation of a sterile, singly infected (Escherichia coli or Bacteroides fragilis) or mixed infected (E. coli and B. fragilis) fibrin clot. Histological study of fibrin clots, removed 6 h after implantation, showed a deeper infiltration by host cells of B. fragilis infected clots compared to the others. This difference in infiltration by peritoneal cells was not due to differences in fibrinolytic activity of the bacterial strains. Differential cell counts of the peritoneal cells from rats implanted with sterile, singly and mixed infected fibrin clots showed distribution over subpopulations to be independent of the bacterial content of the infected clots used. In vitro migration assays showed no significant differences in migration by peritoneal cells from rats implanted with clots containing a different bacterial composition. Since B. fragilis infected fibrin clots were more deeply infiltrated by host defence cells than the other clots, and only mixed infected clots led to persistent abscesses in this model, we conclude that local conditions within the fibrin matrix rather than intrinsic cellular capacities of the host cells are important for the process of abscess formation.
Animals↗
The effect of antimicrobial therapy on mixed infections with Bacteroides species. Is eradication of the anaerobes important?
Antimicrobial agents were used alone or in combinations in order to explore their effect on mixed aerobic-anaerobic infections. Subcutaneous abscesses were induced in mice by single and mixed infections of Bacteroides fragilis, Bacteroides melaninogenicus, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus faecalis, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. The infected animals were treated for 5 days with spiramycin, gentamicin or metronidazole alone, or metronidazole combined with spiramycin or gentamicin. Animals were killed 5 days after inoculation and the bacterial contents of the abscesses determined. Infection induced by a single species of bacteria always responded to appropriate antimicrobial therapy. In infections caused by two species of organisms, however, therapy directed at either the Bacteroides sp. (with metronidazole) or the aerobes or facultative anaerobes (with spiramycin or gentamicin) was effective not only in significantly reducing the numbers of the target organism but also, in 13 of 24 instances, in reducing to a small extent the numbers of the other bacteria. Despite this phenomenon, in no instance did therapy with a single agent eliminate the infection and eradicate the untargeted organism. The combination of spiramycin and metronidazole increased the reduction in numbers of B. melaninogenicus in single-organism infections and of Bacteroides sp. in mixed infections with S. aureus and S. pyogenes. These findings support the need to aim treatment at all components of mixed infections.
Abscess↗
Enzyme linked immunosorbent assay & indirect fluorescence assay for rapid diagnosis of Bacteroides fragilis infections.
Antibodies for B. fragilis (NCTC 9343) were detected in sera of 121 patients and 37 controls using four methods viz., enzyme linked immunosorbent assay (ELISA), indirect fluorescence test (JFA), countercurrent immunoelectrophoresis (CIE) and indirect haemagglutination test (IHA). Of 121 patients, 57 were culture positive for B. fragilis, 38 positive for anaerobes other than B. fragilis and 26 were negative for anaerobes. In the B. fragilis culture positive group, antibodies to B. fragilis were positive in 82.5, 84.2, 85.90 and 91.2 per cent patients by CIE, ELISA, IHA and IFA respectively. In B. fragilis positive patients IFA was more sensitive than IHA, which for other groups IHA was found to be more sensitive than IFA. When all groups were taken together IHA was found more sensitive than IFA. ELISA and IFA tests are recommended for rapid serological diagnosis of B. fragilis infections, where facilities for these tests are not available, CIE and IHA could be done. Cross reactivity with other Gram negative anaerobic and aerobic bacteria should be kept in mind since seropositivity varied for B. fragilis (82-91%). In infections with microbes other than B. fragilis seropositivity varied between 23.7 to 63.2 per cent and in patients having cultures sterile or positive for other organisms seropositivity was 30.8 to 42.3 per cent. This nonspecificity could be due to other antigens that cross react between B. fragilis and other anaerobes and aerobes or the use of an antigen lacking high purity.
Antibodies, Bacterial↗
In vivo efficacies of quinolones and clindamycin for treatment of infections with Bacteroides fragilis and/or Escherichia coli in mice: correlation with in vitro susceptibilities.
Therapy with ofloxacin, ciprofloxacin, and lomefloxacin (alone or in combination with clindamycin) and therapy with sparfloxacin, clinafloxacin, and temafloxacin alone were given to mice with subcutaneous abscesses. The abscesses were caused by two Bacteroides fragilis isolates, one of which was susceptible and one of which was resistant to ofloxacin, ciprofloxacin, and lomefloxacin, alone or in combination with Escherichia coli. The abscesses were examined 5 days after inoculation. Numbers of B. fragilis organisms reached log10 10.2 to 11.8 per abscess, and numbers of E. coli organisms reached log10 10.6 to 11.8 per abscess. All of the quinolones reduced the number of susceptible B. fragilis isolates (log10 3.6 to 6.9) and E. coli isolates (log10 5.7 to 6.8). However, ciprofloxacin and lomefloxacin failed to reduce the number of resistant B. fragilis organisms in single-organism or mixed infections. The addition of clindamycin to either ofloxacin, ciprofloxacin, or lomefloxacin reduced the numbers of both susceptible and resistant B. fragilis organisms (log10 3.8 to 7.8). In contrast, sparfloxacin, clinafloxacin, and temafloxacin were effective as single therapy in eradicating B. fragilis resistant to ofloxacin, ciprofloxacin, and lomefloxacin. These in vivo data confirm the in vitro activity of these quinolones and suggest that although ofloxacin, ciprofloxacin, and lomefloxacin are occasionally effective as single agents in eradicating mixed infection by susceptible strains of B. fragilis and E. coli, addition of an agent with activity against anaerobic organisms will ensure their efficacy. Quinolones with good efficacy against B. fragilis may be effective as single-agent therapy of mixed infections.
4-Quinolones↗
[Surgical infections with anaerobic bacteria (splenic abscess ruptured into the peritoneum].
A case is presented, of a patient aged 19, who, in the course of otic suppuration treated by tetracycline administration, developed a septicemic condition with a gigantic splenic abscess followed by generalized peritonitis. The initially unfavourable evolution had an improved course following splenectomy and peritoneal drainage, especially after the identification of the anaerobic germs that determined the infection (Bacteroides clostridii formis and Clostridium bifermentans) and the introduction of an adequate therapy.
Abscess↗
Radioimmunoassay for Bacteroides fragilis infections.
Radioimmunoassay methods were evaluated for immunoglobulin G and immunoglobulin M antibodies against Bacteroides fragilis antigen. Of 12 serum samples from patients with B fragilis infections, 9 had higher concentrations of immunoglobulin G antibodies than any from 11 control subjects. Of 9 serum samples from infected patients, 6 had higher concentrations of immunoglobulin M than any from control subjects. Six serum samples from patients with Escherichia coli bacteremia did not contain elevated concentrations of immunoglobulin G or immunoglobulin M antibodies against B. fragilis antigen.
Antibodies, Bacterial↗