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[Bacteroides infection in surgical patients (author's transl)].

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.

Adolescent

[Bacteroides infections].

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.

Adolescent

Rapid diagnosis of Bacteroides infections by indirect immunofluorescence assay of clinical specimens.

43 specimens from a variety of sites were directly examined by indirect immunofluorescence assay (I.F.A.) with specific antisera against the capsular polysaccharide of Bacteroides fragilis and pooled antisera against a number of serotypes of Bacteroides sp. (all of the former B. fragilis subspecies). The findings were compared with those of routine anaerobic bacteriology and gas liquid chromatography for short chain fatty acids. Examination by I.F.A. was a sensitive (100%) and specific (90.3%) means of identifying B. fragilis. Use of the pooled serum was sensitive (100%) but less specific (64.3%) than the capsular antiserum (90.3%) although it had the advantage of detecting Bacteroides species other than B. fragilis. The capsular serum I.F.A. gave 9.7% false positives and no false negatives. The predictive value of a positive identification of B. fragilis in a clinical specimen using this anticapsular serum I.F.A. test was 80%; with the pooled Bacteroides group-serum it was 60%. The predictive value of a negative test was 100% for both sera, indicating that a negative I.F.A. test is a reliable index of the absence of Bacteroides from the culture I.F.A. of clinical material provides a rapid (less than 2 h) specific and sensitive means for the diagnosis of B. fragilis infections and would be of use in a clinical laboratory.

Abdomen

Rupture of a gravid bicornuate uterus in a primigravida associated with clostridial and bacteroides infection.

The case is presented of a primigravid patient with spontaneous rupture of a bicornuate uterus associated with significant anaerobic infection. Thinning of the myometrium at the site of the rupture was noted in the pathologic specimen. The anaerobic infection, primarily contained in the intact amniotic sac, resolved with total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic drainage and antibiotic therapy.

Adult

Metronidazole in prevention and treatment of bacteroides infections after appendicectomy.

The frequency of non-clostridial anaerobic infection was studied in 95 patients who had undergone acute appendicectomy: 49 received prophylactic metronidazole and 46 received placebo. Anaerobic infection did not develop in any of the metronidazole-treated patients, but infections did develop in nine (19%) of the 46 controls. Metronidazole is conveniently administered by suppository to patients who cannot take oral drugs. Five patients with intra-abdominal infections caused by non-clostridial anaerobes were successfully treated with metronidazole.

Adolescent

Diagnosis of Bacteroides fragilis infection with counter-immunoelectrophoresis.

In a study of 188 patients and 109 controls, the detection of antibody by counterimmunoelectrophoresis was used as a diagnostic aid in human infections with Bacteroides fragilis. It was found that positive results indicated current infection and negative results were not conclusive. The method used was simple, rapid, and easily performed in a routine laboratory, but further work is needed to enhance antigen potency.

Antibodies, Bacterial

Protective efficacy of immunization with capsular antigen against experimental infection with Bacteroides fragilis.

The protective efficacy afforded by immunization with the capsular antigen of Bacteroides fragilis against abscess formation and bacteremia due to this organism was studied in an experimental rat model of intraabdominal sepsis. Of unimmunized animals, animals immunized with methylated bovine serum albumin and complete Freund's adjuvant, and animals immunized with lipopolysaccharide of Bacteroides thetaiotaomicron, greater than 90% developed abscesses when challenged intraperitoneally with strains of B. fragilis or Bacteroides distasonis (given with an enterococcus) or with the cecal contents of meat-fed rats. In contrast, animals immunized with B. fragilis capsular polysaccharide, given with or without methylated bovine serum albumin and complete Freund's adjuvant, and animals immunized with the outer membrane of B. fragilis strain 23745 were protected to a significant degree from abscesses caused by challenge with B. fragilis or B. distasonis. Such immunization had no overall effect on the development of abscesses in animals challenged with the entire cecal contents of meat-fed rats; however, B. fragilis was eliminated from the abscesses of these animals. Animals immunized with the capsular polysaccharide were protected from early B. fragilis bacteremia.

Abscess

Antibody response in thirteen patients with Bacteroides fragilis infections.

13 patients with Bacteroides fragilis infections were studied for antibody response against the infecting strain using indirect immunofluorescence (IFL), passive hemagglutination (HA) and tube agglutination (TA). With indirect IFL significant titre changes in IgG were found in 12/13 cases, in IgA in 8/13 and in IgM in 4/13 cases. With passive HA significant titre changes were found in 11/13 cases and with TA in 6/11 cases. The rise in antibody titre was fast and persisted for a long time in most cases. Of the methods used the indirect IFL was the most convenient for clinical use.

Adult

Carbenicillin for treatment of Bacteroides fragilis infections: why not penicillin G?

Carbenicillin has been advocated for treatment of infections caused by Bacteroides fragilis and other anaerobic bacteria. Wide-scale use of the drug in this setting could result in a substantial increase in carbenicillin-resistant Pseudomonas aeruginosa, an effect that would have serious implications. Thirty-four strains of B. fragilis, one-half from bacteremic infections, were tested in vitro, and penicillin G was found to be twice as active as carbenicillin on an equal weight basis; 94% of the strains were inhibited by 32 microgram of penicillin/ml, a level easily achieved therapeutically. Penicillin killed B. fragilis organisms as rapidly as carbenicillin. In two subjects given equivalent doses (100 mg/kg intravenously) of carbenicillin and aqueous penicillin G, the bactericidal activity of serum against B. fragilis after administration of each drug was the same. Controlled clinical trials of treatment of anaerobic bacterial infections with penicillin G in high dosage, carbenicillin (or closely related ticarcillin), clindamycin, and chloramphenicol should be undertaken. Carbenicillin (and ticarcillin) for the present would seem better reserved for P. aeruginosa infections.

Bacteroides Infections