The role of encapsulated anaerobic bacteria in synergistic infections

Abstract: The effect of encapsulation on the virulence, survival, and protection of anaerobic bacteria from phagocytosis is reviewed. Support for the importance of encapsulated Gram-negative anaerobic rods ( Bacteroides sp., Prevotella sp. and Porphyromonas sp.), anaerobic and facultative Gram-positive cocci (AFGPC) was provided by their higher recovery rate in oropharyngeal infections, abscesses and blood, compared to their number in the normal flora. The pathogenicity of Bacteroides, Fusobacterium, Clostridium , and AFGPC was studied by inoculating them into mice and observing their ability to induce subcutaneous abscesses. Encapsulated Bacteroides, Fusobacteria , and AFGPC generally induced abscesses, whereas non-encapsulated organisms did not. However, many of the strains that had only a minimal number of encapsulated organisms (< 1%) survived in the abscesses, and they became heavily encapsulated when inoculated with other viable or non-viable encapsulated bacteria. Thereafter, these strains were able to induce abscesses when injected alone. Encapsulated Gram-negative anaerobic rods and AFGPC-induced bacteraemia and translocation, and increased the mortality of the infected animals more often than did the non-encapsulated form of the same strains. As determined by using selective antimicrobial therapy and quantitative cultures of abscesses induced in mice, possession of a capsule generally made Gram-negative anaerobic rods more important than their aerobic counterparts. Synergistic potentials were seen between encapsulated Gram-negative anaerobic rods and all tested aerobic bacteria and most AFGPC, and also between most AFGPC and Pseudomonas aeruginosa or Staphylococcus aureus . These studies demonstrated the importance of encapsulated anaerobes in mixed infections.     

Anaerobic bacteria in bronchoalveolar lavage fluid (BAL) after thoracic surgery

Purpose of this study was to find out what kind of anaerobic bacteria were in lower respiratory tract and how often they were present there considering patients after thoracic surgery. Also, what is susceptibility of bacteria to antibiotics. Research covered 30 patients after operation. Material for research was bronchoalveolar lavage (BAL) taken during bronchoscopy. Collected sample was cultivated in anaerobic and aerobic conditions. Anaerobic bacteria were found in 28 samples (93%). Totally there were 100 anaerobic bacteria strains. The most common Gram-negative rods were from genus Prevotella (24 strains, 24%) and Bacteroides (15 strains, 15%). Gram-negative bacteria except Bacteroides characterised biggest susceptibility to imipenem, piperacillin/tazobactam, amoxicillin/clavulanate, ampicillin/sulbactam, piperacillin, clindamycin and metronidazol. Bacteroides were susceptible to imipenem, piperacillin/tazobactam and metronidazol. Among Gram-positive anaerobic bacteria mostly were isolated from cocci Peptostreptococcus (18 strains, 18%) and were susceptible to all antibiotics. Gram-positive rods were in most cases represented by Actinomyces (12 strains 12%) and were highly susceptible to all antibacterial means except metronidazol (100% is resistant).     

The role of encapsulation in the pathogenesis of anaerobic gram-positive cocci

The pathogenicity of 22 anaerobic and facultative Gram-positive cocci (AFGPC) was investigated by inoculating them into mice and determining their ability to cause subcutaneous abscesses. Only 11 heavily encapsulated isolates (greater than 50% of the cells were encapsulated) induced abscesses. However, when the other 11 isolates were injected with Bacteroides sp. or facultative and aerobic bacteria, abscesses were formed in 8 of the 11 combinations. The AFGPC recovered from the mixed infections contained many encapsulated cells. Encapsulation also occurred in cocci injected with capsular material or with Formalin-killed cells of Klebsiella pneumoniae or capsule-positive Bacteroides sp. After acquisition of capsules, these strains could induce abscesses on reinoculation in mice.     

Participation of gram-negative anaerobes in infections in hospitalized patients

The aim of the study was to assess the prevalence and antibiotic susceptibility profiles of strictly anaerobic Gram-negative bacteria isolated from clinical samples taken from hospitalized patients from 01.01.2007 to 31.12.2008. The specimens were cultured using media, incubated at 37 degrees C under anaerobic conditions. Biochemical identification and antibiotic susceptibility were done in an automated system ATB Expression (bioMerieux S.A, France). For selected strains of Bacteroides sp. sensitivity was determined using E-test (AB BIODISK, Sweden). Overall 1274 strains of obligate anaerobes were isolated. Gram-negative bacteria were cultured in number of 333 strains. Most frequently isolated was Bacteroides sp. (46,9%) and Prevotella sp. (29,7%). Isolated bacteria are still susceptible to imipenem (100%), metronidazole (100%) and beta-lactam antibiotics with beta-lactamase inhibitors: amoxicillin/clavulanate (97,8%) piperacillin/tazobactam (99,1%), ticarcillin/clavulanate (99,1%).     

Bacteriologic and therapeutic considerations in intra-abdominal surgical infections

The most important factor in the treatment of intra-abdominal infections are early diagnosis and prompt surgical intervention while antibiotics play a secondary role. The goals of surgical procedures should be to stop peritoneal contamination, to debride necrotic tissue, to remove debris and foreign bodies and to drain any pus collection. Antibiotics should be initiated before surgery and they must encompass both colonic aerobes and anaerobes including Bacteroides fragilis group but not necessary Enterococcus sp. Antibacterial agents with pure activity against anaerobes include chloramphenicol, clindamycin and the nitroimidazoles while ampicillin/sulbactam, amoxicillin/clavulanate, ticarcillin/clavulanate, cefoxitin, cefotetan, ceftizoxime imipenem/cilastatin, meropenem and some advanced quinolones like sparfloxacin, represent a single drug to cover both aerobic and anaerobic microflora. Although almost all clinical trials usually result in a 90% efficacy rate, the final outcome is dependant on the stage of the infection (early versus late), sepsis score, underlying diseases and the applied surgical procedures. On the other hand the choice of antibiotic(s) must be influenced by its toxicity, profiles local nosocomial susceptibility patterns, resistance inducing ability and price.     

Epidemiological characteristics of infections caused by Bacteroides, Prevotella and Fusobacterium species: a prospective observational study

In order to investigate differences among infections due to Gram-negative anaerobic bacteria (Bacteroides, Prevotella and Fusobacterium spp.), clinical, epidemiological, and microbiological data were collected and evaluated from 206 anaerobic infections. The most frequently isolated species was Bacteroides fragilis. The majority of the cases were intra-abdominal infections (49%) followed by skin and soft tissue infections (24.7%). Logistic regression analysis showed that Bacteroides spp. strains were more often isolated from intra-abdominal infections (p?=?0.002), whereas Prevotella spp. were isolated more frequently from cases with shorter duration of hospitalization (p?=?0.026), and less frequently from bloodstream infections (p?=?0.049). In addition, Bacteroides spp. were associated with coinfection due to Enterobacteriaceae species (p?=?0.007), whereas Prevotella spp. were associated with coinfection due to Staphylococcus spp. (p?=?0.002). Patients with an infection due to B.?fragilis, were more frequently admitted in a general surgical ward (p?=?0.017), or have been treated with a 2nd generation cephalosporin before anaerobic infection onset (p?=?0.05). Total mortality was 10.9% and was associated with bacteremia (p?=?0.026), and hematological (p?=?0.028), or solid organ malignancy (p?=?0.007). Metronidazole resistance was detected only among Prevotella spp. (16.2%) and B. fragilis group (0.8%) isolates. In conclusion, this study indicated differences between infections due to the most frequently isolated Gram-negative anaerobic species, differences that may affect the design and implementation of empirical antimicrobial chemotherapy guidelines.     

胆道疾病患者343份胆汁细菌培养与药敏分析

了解胆汁中细菌分布及药敏情况,以指导临床合理用药。对343例胆道疾病手术患者抽取胆汁进行常规培养及应用英国OXID血液增菌瓶和ATB自动细菌鉴定统对标本进行细菌鉴定和药敏分析。343份胆汁中共培养出10种113株细菌(不包括厌养菌)阳性率为37.4%,主要菌种有大肠埃希菌、肺炎克雷伯菌、粪肠球菌、阴沟肠杆菌、铜绿假单胞菌比率较高。药敏结果显示,革兰阴性杆菌对亚胺培南、头孢三代、阿米卡星、庆大霉素敏感性较好;革兰阳性球菌对万古霉素、亚胺培南、利福平敏感性较好。胆道感染多由肠道细菌逆行感染引起的,为此,根据药敏试验结果指导临床用药是非常重要的。     

The range of antagonistic effects of Lactobacillus bacterial strains on etiologic agents of bacterial vaginosis

Bacterial vaginosis is caused by uncontrolled sequential overgrowth of some anaerobic bacteria: Gardnerella vaginalis, Prevotella bivia, Bacteroides spp., Peptostreptococcus spp., Mobiluncus sp. usually occurring in stable numbers in the bacterial flora of healthy women. On the other hand, different species of bacteria belonging to the genus Lactobacillus, most frequently L. plantarum, L. rhamnosus and L. acidophilus, form a group of aerobic bacteria dominating in the same environment. The diversity and density of their populations depend on the age and health conditions. Thanks to their antagonistic and adherence properties bacteria of the genus Lactobacillus can maintain a positive balance role in this ecosystem. The aim of this study was to assess the antagonistic properties of Lactobacillus strains isolated from the vagina of healthy women against most common agents of bacterial vaginosis. It was found that nearly all of the tested Lactobacillus strains exerted distinct antagonistic activity against anaerobic bacteria: Gardnerella vaginalis, Prevotella bivia and Peptostreptococcus anaerobius and quite a number also against Gram-negative rods, while only some of them were able to inhibit Gram-positive aerobic cocci as Enterococcus faecalis or Staphylococcus aureus.     

Anaerobic bacteria detected in inflammatory conditions of the respiratory tract

In this study a participation of anaerobic bacteria in respiratory tract diseases is presented. Bronchial washings collected by ++fibrobronchoscope constituted material for the study. Immediately after collection the material was plated onto two media for aerobic bacteria (hemomedium) and anaerobic bacteria (anaeromedium). Then, the samples were centrifuged and a sediment was plated on solid media suitable for aerobic and anaerobic bacteria. Bacterial anaerobic isolates were identified by using API 20E and their sensitivity to antibiotics was tested. From the material described above the most frequently isolated anaerobic bacteria were such as: Streptococcus intermedius, Bacteroides melaninogenicus, Veilonella sp. Among aerobic bacteria the most frequently isolated were Gram-negative rods, Streptococcus faecalis, Branhamella catarrhalis. It is worth to underline that in about 25% of cases anaerobic bacteria were the only isolates.     

In vitro activity of ramoplanin and comparator drugs against anaerobic intestinal bacteria from the perspective of potential utility in pathology involving bowel flora

Susceptibility of intestinal bacteria to various antimicrobial agents in vitro, together with levels of those agents achieved in the gut, provides information on the likely impact of the agents on the intestinal flora. Orally administered drugs that are poorly absorbed may be useful for treatment of intestinal infections and for certain other situations in which intestinal bacteria may play a role. The antimicrobial activity of ramoplanin (MDL 62,198) against 928 strains of intestinal anaerobic bacteria was determined using the NCCLS-approved Wadsworth brucella laked-blood agar dilution method. The activity of ramoplanin was compared with that of ampicillin, bacitracin, metronidazole, trimethoprim/sulfamethoxazole (TMP/SMX), and vancomycin. The organisms tested included Bacteroides fragilis group (n=89), other Bacteroides species (n=16), other anaerobic Gram-negative rods (n=56) anaerobic cocci (n=114), Clostridium species (n=426), and non-sporeforming anaerobic Gram-positive rods (n=227). The overall MIC(90)s of ramoplanin, ampicillin, bacitracin, metronidazole, and vancomycin were 256, 32, 128, 16, and 128 mcg/ml, respectively. Ramoplanin was almost always highly active vs. Gram-positive organisms and relatively poor in activity against Gram-negative organisms, particularly Bacteroides, Bilophila, Prevotella, and Veillonella. Vancomycin was quite similar to ramoplanin in its activity. Ampicillin was relatively poor in activity vs. organisms that often produce beta-lactamase, including most of the Gram-negative rods as well as Clostridium bolteae and C. clostridioforme. Bacitracin was relatively poor in activity against most anaerobic Gram-negative rods, but better vs. most Gram-positive organisms. Metronidazole was very active against all groups other than bifidobacteria and some strains of other types of non-sporeforming Gram-positive bacilli. TMP/SMX was very poorly active, with an MIC(90) of >2048 mcg/ml.     

Bacteriological study of otogenic cerebral abscesses: chemotherapeutic role of metronidazole.

In nine consecutive patients with otogenic cerebral abscesses a mixed growth of aerobic and obligate anaerobic bacteria was isolated from the pus in five patients, and in the remaining four obligate anaerobes were the sole isolates. The commonest obligate anaerobe isolated was Bacteroides fragilis, which was present in all but one patient. The patients were all treated with metronidazole for the anaerobic organisms and with appropriate chemotherapy against the aerobic organisms isolated. All the patients recovered and only one was left with a neurological deficit. As otogenic cerebral abscesses constitute a major proportion of all cerebral abscesses, the use of metronidazole against obligate anaerobic bacteria, which tend to dominate in such abscesses, should reduce the high mortality from this condition.     

Ultrastructure of bacteria and the proportion of Gram-negative bacteria in marine sediments

Bacteria in sediments from the surface aerobic layer (0–1 cm) and a deeper anaerobic layer (20–21 cm) of a seagrass bed were examined in section by transmission electron microscopy. Bacteria with a Gram-negative ultrastructure made up 90% of bacteria in the surface layer, and Gram-positive bacteria comprised 10%. In the anaerobic zone, Gram-negative bacteria comprised 70% and Gram-positive bacteria 30% of the bacterial population. These differences were highly significant and support predictions of these proportions made from muramic acid measurements and direct counting with fluorescence microscopy. Most cells were enveloped in extracellular slime layers or envelopes, some with considerable structural complexity. The trophic value to animals of these envelopes is discussed. A unique organism with spines was observed.     

Gram-positive and Gram-negative bacteria elicit different patterns of pro-inflammatory cytokines in human monocytes

Pro-inflammatory cytokines secreted by tissue macrophages recruit polymorphonuclear leukocytes and evoke fever, cachexia and production of acute phase proteins. This study investigates whether Gram-positive and Gram-negative bacteria equally and efficiently trigger production of the pro-inflammatory cytokines IL-1 beta, IL-6, IL-8 and TNF-alpha in human monocytes. A range of aerobic and anaerobic Gram-positive and Gram-negative bacteria were killed by UV-light and added in different concentrations to human monocytes. Cytokines were measured in 24 h supernatants by ELISA. Gram-positive and Gram-negative bacteria were equally efficient inducers of IL-1 beta, but Gram-positive bacteria generated twice as much TNF-alpha as did Gram-negative bacteria (p<0.001 for 25 and 250 bacteria/cell). In contrast, Gram-negative bacteria induced at least twice as much IL-6 and IL-8 as did Gram-positive bacteria (p<0.001 for 2.5, 25 and 250 bacteria/cell). While the cytokine responses to LPS were similar to those induced by the corresponding amount of Gram-negative bacteria, the strong IL-1 beta and TNF-alpha responses to Gram-positive bacteria could not be induced by soluble peptidoglycan or lipotheicoic acid. The particular nature of the bacteria, thus seem to modify the response to Gram-positive bacterial components. The different cytokine profiles evoked by Gram-positive and Gram-negative bacteria might optimize clearance of bacteria that differ in cell wall structure.     

Characterization of psychrotolerant heterotrophic bacteria from Finnish Lapland

A total of 331 aerobic heterotrophic bacterial strains were isolated from various ecosystems of Finnish Lapland (68-69 degrees N) including forest soil, arctic alpine-tundra soil, stream water, lake and mire sediments, lichen and snow algae. Whole cell fatty acid and 16S rRNA gene sequence analysis and microscopy indicated that the isolates were dominated by Gram-negative bacteria, while only 20 Gram-positive strains were isolated. Based on 16S rRNA gene sequences the isolates were members of alpha-, beta-, gamma-Proteobacteria, Gram-positives with low G+C content, Actinobacteria and the Cytophaga/Flexibacter/Bacteroides group. More than one-third of the isolates could be tentatively identified as Pseudomonas spp. which were particularly abundant in the alpine-tundra soils where they represented 60% of all isolates. Other frequently isolated Gram-negative taxa were Burkholderia sp., Collimonas sp., Pedobacter sp., Janthinobacter sp., Duganella sp., Dyella sp. and Sphingomonas sp. Growth temperature ranges and hydrolytic enzyme activities of selected ca.100 strains were screened. The strains were psychrotolerant growing generally at temperatures ranging from 0 to 30 degrees C, as 82% of the isolates grew at 0 degrees C while only 7% grew at 35 degrees C. Protease and lipase activities at 5 degrees C were detected in more than half of the strains while approximately 20% of the strains possessed amylase and/or cellulase activities.     

重庆地区儿童2000年至2004年首位革兰阴性细菌和阳性细菌的耐药性监测

目的了解重庆地区儿童感染的分离至临床标本的首位革兰阴性细菌和阳性细菌对常用抗生素的耐药趋势,指导临床合理使用抗生素。方法常规方法分离、培养细菌,应用美国德灵公司WalkAway-40细菌鉴定仪对2000年至2004年我院细菌室分离至临床标本的首位革兰阴性细菌和阳性细菌共2854株进行细菌鉴定及药敏试验。结果2000年至2004年检出的首位革兰阴性细菌和阳性细菌分别为大肠埃希菌和金黄色葡萄球菌。2000年至2004年前5位革兰阴性菌5777株,革兰阳性菌1565株,其中大肠埃希菌2090株,金黄色葡萄球菌764株,分别占36.2%和48.8%;5年间大肠埃希菌对氨苄西林、头孢吡肟、头孢西丁、庆大霉素、亚胺培南、环丙沙星、头孢噻肟、头孢他啶的总耐药率分别为80.9%、37.5%、15.4%、54.0%、0.8%、34.0%、46.6%、46.2%;金黄色葡萄球菌对青霉素、红霉素、复方新诺明、万古霉素、阿莫西林/克拉维酸的总耐药率分别为95.6%、63.4%、5.8%、0%、11.0%。结论通过细菌耐药监测发现：大肠埃希菌对常用抗生素的总耐药率变化不大,金黄色葡萄球菌对常用抗生素的总耐药率有下降趋势,应引起临床医生重视。     

Beta-lactamases with a wide substrate spectrum in gram negative strictly anaerobic rods

This study was performed to determine the susceptibility of the clinical strains of Gram-negative strictly anaerobic rods to newer beta-lactam antibiotics. Also, the trial was undertaken to detect strains producing extended-spectrum beta-lactamases (ESBLs) and inducible beta-lactamases (IBLs) among Bacteroides spp. and Prevotella spp. rods isolated from hospitalized patients. One hundred strains of Gram-negative, obligatory anaerobic rods were applied in the study. The strains were identified in automatic ATB system using API 20 A strips. beta-lactamase-positive strains were determined with disc nitrocefin test. ESBL-producing strains were detected with double disc test according to Jarlier et al. (1988). Clavulanate was applied as the inhibitor of these beta-lactamases (AMO/CLAV disc). ESBL-positive strains were confirmed with the use of E test (TZ/TZL strip). Inducible beta-lactamases were determined by double disc method according to Sanders and Sanders (1979). Cefoxitin was the inducer of these beta-lactamases (FOX disc). Among 93 Bacteroides spp. strains and 7 Prevotella spp. strains, 91 strains (91%) produced beta-lactamases. Two ESBL-producing strains (2%) were detected. Strains producing inducible beta-lactamases (IBL) were not found. A high activity of the examined beta-lactam antibiotics against strains of Gram-negative anaerobes was found. The majority of strains were susceptible to piperacillin (95%), piperacillin combined with tazobactam (99%), ticarcillin combined with clavulanic acid (99%), meropenem (97%) and imipenem (99%). The obtained results indicate the necessity of ESBL determination among strains of the genus Bacteroides, isolated from clinical specimens. Newer beta-lactam antibiotics, especially penicillins in combination with beta-lactamase inhibitors and carbapenems, are useful in empiric therapy of infections caused by Bacteroides spp. and Prevotella spp. anaerobic rods.     

Nonclostridial obligate anaerobes--the main causative agents of lung abscesses

The use of the anaerobic technique in bacteriological investigations has made it possible to establish the leading role of asporogenous anaerobes in the etiological structure of the causative agents of pulmonary abscesses. Asporogenous anaerobes have been isolated from 93% of all examined patients, and in 54.4% of such patients these microorganisms have proved to be an independent etiological factor. Among asporogenous anaerobes, the main causative agents of pulmonary abscesses have been found to belong to four genera: Bacteroides, Fusobacterium, Peptococcus and Peptostreptococcus. Pulmonary abscesses of purely aerobic etiology are rather rare (5.3%). The schemes of the antibacterial treatment of patients with pulmonary abscesses, developed with regard to the leading etiological role of asporogenous anaerobes and clinically approved, have permitted achieving a considerable improvement in the results of treatment and an essential economic effect.     

需氧菌阴道炎、细菌性阴道病阴道菌群分析

用阴道分泌物直接涂片、革兰染色、选择性培养分离和细菌预成酶谱分析等微生物学方法和生物化学方法,分析了正常女性、AV、BV患者的阴道菌群。正常女性阴道中以乳酸杆菌为主,产H2O2乳酸杆菌的检出率89%,AV的致病菌主要是革兰阳性率需氧菌、检出率可达80%,其中金黄色葡萄球菌,粪肠球菌和埃希氏大肠菌较为常见,B族链球菌的检出率较低;BV的致病菌主要是厌氧菌,以革兰阴性厌氧菌的检出率最高,加德纳菌的检出率不足40%。48例BV患者中有8例合并AV感染,31例AV患者中有6例合并BV感染。细菌谱分析发现,AV患者易感染消化链球菌、普雷沃菌等厌氧菌和加德纳菌,BV患者易感染粪肠球菌、大肠埃希菌等需氧菌。     

Comparison of the Activity of Meropenem and Imipenem Against Anaerobic Bacteria in Bulgaria

The in vitro activities of meropenem and imipenem were compared against 154 clinical isolates of anaerobic bacteria representing 23 species of 10 genera. The NCCLS-recommended agar dilution method with Brucella agar from the Wadsworth Anaerobic Laboratory was used. Meropenem proved to be more active than imipenem with an MIC range of ≤0.125–4 μg/mL, MIC₅₀=0.25 μg/mL, MIC₉₀=1 μg/mL with 100% of strains susceptible at the breakpoint=4 μg/mL. Imipenem showed a lower activity with an MIC range of ≤0.125 to 16 μg/mL, MIC₅₀of 2 μg/mL and MIC₉₀of 4 μg/mL with 10% of the strains not inhibited at this concentration. Ninety-six per cent were susceptible at 8 μg/mL and 100% at 16 μg/mL. The MIC of both antibiotics (especially of imipenem) were higher for the Bacteroides fragilis group than for the rest of the Gram-negative organism higher still than the Gram-positive anaerobes.     

Clindamycin plus gentamicin as expectant therapy for presumed mixed infections.

The prevalence of obligate anaerobes was studied prospectively in 60 patients with severe sepsis of intra-abdominal, soft tissue, female genital or oropulmonary origin. In addition, the efficacy of clindamycin (for anaerobes) plus gentamicin (for aerobic bacteria, especially coliforms) as initial empiric therapy in these patients was evaluated. Among 54 patients with cultural proof of infection, anaerobic pathogens were recovered from 52%. Nineteen patients had bacteremia; Bacteroides fragilis and Klebsiella pneumoniae were the most prevalent pathogens, being isolated in five patients each. Infection was eradicated in 56 of the 60 patients (93%). Mortality related to sepsis was 7% in the entire group, 16% in patients with bacteremia and 2% in patients without bacteremia. Eighty-five percent of aerobic isolates tested were susceptible in vitro to either gentamicin or clindamycin; 97% of anaerobic isolates were inhibited by 5 mug/ml of clindamycin.