Diagnosis and Management of Anaerobic Infections of the Head and Neck

1992 ◽  
Vol 101 (1_suppl) ◽  
pp. 9-15 ◽  
Author(s):  
Itzhak Brook
Keyword(s):  
Head And Neck ◽  
Postoperative Infection ◽  
Chronic Sinusitis ◽  
Anaerobic Bacteria ◽  
Chronic Otitis Media ◽  
Cervical Adenitis ◽  
Penicillin Therapy ◽  
Bacteroides Fragilis Group ◽  
Anaerobic Infections ◽  
Head And Neck Infections

Anaerobic bacteria are important pathogens in head and neck infections such as chronic otitis media, chronic sinusitis, chronic mastoiditis, head and neck abscesses, cervical adenitis, parotitis, and postoperative infection. Bacteroides sp ( Bacteroides melaninogenicus group, Bacteroides oralis, and Bacteroides fragilis group), Peptostreptococcus sp, and Fusobacterium sp predominate. The observed recent increase in the number of β-lactamase—producing strains of Bacteroides sp isolated in head and neck infections has been associated with increased failure rates of the penicillins in the management of these infections. The pathogenicity of these organisms is expressed through their ability not only to survive penicillin therapy but also to shield penicillin-susceptible pathogens from the drug. Because of these direct and indirect virulent characteristics of anaerobic bacteria, appropriate antimicrobial therapy must be directed against all pathogens in mixed infections.

Anaerobic Bacteria in Upper Respiratory Tract and other Head and Neck Infections

2002 ◽  
Vol 111 (5) ◽  
pp. 430-440 ◽  
Author(s):  
Itzhak Brook
Keyword(s):  
Respiratory Tract ◽  
Head And Neck ◽  
Bacterial Infections ◽  
Antimicrobial Agents ◽  
Bacterial Flora ◽  
Anaerobic Bacteria ◽  
Chronic Otitis Media ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Head And Neck Infections

Anaerobic bacteria are common in chronic upper respiratory tract and head and neck infections. Anaerobes are the most predominant components of the normal human oropharyngeal bacterial flora, and are therefore a common cause of bacterial infections of the upper respiratory tract that are of endogenous origin. Because of their fastidious nature, anaerobes are difficult to isolate from infectious sites and are often overlooked. Anaerobic bacteria can be recovered in chronic otitis media and sinusitis, and play a role in tonsillitis. They are also important in complications of these infections. Anaerobes predominate in deep oral and neck infections and abscesses. In addition to their direct pathogenicity in these infections, they possess an indirect role through their ability to produce the enzyme β-lactamase. In this fashion, they are capable of “shielding” non–β-lactamase—producing bacteria from penicillins. The lack of directing adequate therapy against these organisms may lead to clinical failures. Their isolation requires appropriate methods of collection, transportation, and cultivation of specimens. Treatment of anaerobic infections is complicated by the slow growth of these organisms, by their polymicrobial nature, and by the growing resistance of anaerobic bacteria to antimicrobials. Antimicrobial therapy is often the only form of therapy required, whereas in other cases, it is an important adjunct to a surgical approach. Because anaerobic bacteria generally are recovered mixed with aerobic organisms, the choice of appropriate antimicrobial agents should provide for adequate coverage of both types of pathogens.

scholarly journals Microbiology and antimicrobial management of sinusitis

2005 ◽  
Vol 119 (4) ◽  
pp. 251-258 ◽  
Author(s):  
Itzhak Brook
Keyword(s):  
Chronic Sinusitis ◽  
Anaerobic Bacteria ◽  
Allergic Inflammation ◽  
Acute Sinusitis ◽  
High Dose ◽  
Beta Lactamase ◽  
Upper Respiratory Tract ◽  
Penicillin Therapy ◽  
Antimicrobial Management ◽  
Potential Pathogen

Sinusitis generally develops as a complication of viral or allergic inflammation of the upper respiratory tract. The bacterial pathogens in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, while anaerobic bacteria and Staphylococcus aureus are predominant in chronic sinusitis. Pseudomonas aeruginosa has emerged as a potential pathogen in immunocompromised patients and in those who have nasal tubes or catheters, or are intubated. Many of these organisms recovered from sinusitis became resistant to penicillins either through the production of beta-lactamase (H. influenzae, M. catarrhalis, S. aureus, Fusobacterium spp., and Prevotella spp) or through changes in the penicillin-binding protein (S. pneumoniae). The pathogenicity of beta-lactamase-producing bacteria is expressed directly through their ability to cause infections, and indirectly through the production of betalactamase. The indirect pathogenicity is conveyed not only by surviving penicillin therapy, but also by ‘shielding’ penicillin-susceptible pathogens from the drug. The direct and indirect virulent characteristics of these bacteria require the administration of appropriate antimicrobial therapy directed against all pathogens in mixed infections. The antimicrobials that are the most effective in management of acute sinusitis are amoxycillin-clavulanate (given in a high dose), the newer quinolones (gatifloxacin, moxifloxacin) and the second generation cephalosporins (cefuroxime, cefpodoxime, cefprozil or cefdinir). The antimicrobials that are the most effective in management of chronic sinusitis are amoxycillinclavulanate, clindamycin and the combination of metronidazole and a penicillin.

Anaerobic Infections in Otolaryngology

1981 ◽  
Vol 90 (3_suppl2) ◽  
pp. 13-16 ◽  
Author(s):  
Sydney M. Finegold
Keyword(s):  
Respiratory Tract ◽  
Head And Neck ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Anaerobic Infections ◽  
Head And Neck Infections

The role of anaerobes in head and neck infections is discussed. Data from several key studies are presented. It is emphasized that the source of anaerobic organisms in otolaryngological infections is the indigenous flora of the upper respiratory tract.

Anaerobic bacteria in 118 patients with deep-space head and neck infections from the University Hospital of Maxillofacial Surgery, Sofia, Bulgaria

2006 ◽  
Vol 55 (9) ◽  
pp. 1285-1289 ◽  
Author(s):  
Lyudmila Boyanova ◽  
Rossen Kolarov ◽  
Galina Gergova ◽  
Elitsa Deliverska ◽  
Jivko Madjarov ◽  
...  
Keyword(s):  
Head And Neck ◽  
Maxillofacial Surgery ◽  
Anaerobic Bacteria ◽  
Bacteroides Fragilis ◽  
Empirical Treatment ◽  
University Hospital ◽  
Detection Rates ◽  
Resistance Rates ◽  
The University ◽  
Head And Neck Infections

The aim of this study was to assess the incidence and susceptibility to antibacterial agents of anaerobic strains in 118 patients with head and neck abscesses (31) and cellulitis (87). Odontogenic infection was the most common identified source, occurring in 73 (77.7 %) of 94 patients. The incidence of anaerobes in abscesses and cellulitis was 71 and 75.9 %, respectively, and that in patients before (31 patients) and after (87) the start of empirical treatment was 80.6 and 72.4 %, respectively. The detection rates of anaerobes in patients with odontogenic and other sources of infection were 82.2 and 71.4 %, respectively. In total, 174 anaerobic strains were found. The predominant bacteria were Prevotella (49 strains), Fusobacterium species (22), Actinomyces spp. (21), anaerobic cocci (20) and Eubacterium spp. (18). Bacteroides fragilis strains were isolated from 7 (5.9 %) specimens. The detection rate of Fusobacterium strains from non-treated patients (32.2 %) was higher than that from treated patients (13.8 %). Resistance rates to clindamycin and metronidazole of Gram-negative anaerobes were 5.4 and 2.5 %, respectively, and those of Gram-positive species were 4.5 and 58.3 %, respectively. One Prevotella strain was intermediately susceptible to ampicillin/sulbactam. In conclusion, the start of empirical treatment could influence the frequency or rate of isolation of Fusobacterium species. The involvement of the Bacteroides fragilis group in some head and neck infections should be considered.

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