Microbiology of infected pustular psoriasis lesions

BACKGROUND: Bacterial infections can occur in lesions of pustular psoriasis (PP). The objective of this study was to establish the aerobic and anaerobic microbiology of secondarily infected PP. METHODS: A retrospective 10-year review was carried out of clinical and microbiology laboratory records from patients with secondarily infected PP lesions, whose specimens of infected sites were processed for the presence of aerobic and anaerobic bacteria. RESULTS: Bacterial growth was noted in 23 specimens. Aerobic or facultative anaerobic bacteria only were present in 12 patients (52%), anaerobic bacteria only in four (17%), and mixed anaerobic-aerobic flora was present in seven (30%). Thirty-six isolates were recovered (1.6 per specimen), 23 aerobic or facultative bacteria and 13 strict anaerobes. The predominant aerobic and facultative bacteria were Staphylococcus aureus (15 isolates), Group D Enterococcus (two isolates), and Escherichia coli (two isolates). The predominant anaerobes were Peptostreptococcus spp. (six isolates) and Bacteroides fragilis group, Propionibacterium acnes, and pigmented Prevotella spp. in two each. Single bacterial isolates were recovered in 14 patients (61%), 11 of which were S. aureus. Nineteen of the organisms isolated from 18 patients (78%) produced the enzyme beta-lactamase. S. aureus was isolated from all body sites. Organisms that resided in the mucous membranes close to the lesions predominated in these infections. Enteric Gram-negative rods and Bacteroides fragilis group predominated in lesions on the legs and buttocks. Group A beta-hemolytic streptococci, pigmented Prevotella, and Fusobacterium spp. were most frequently recovered in lesions of the hand. CONCLUSIONS: The polymicrobial etiology of secondarily infected PP lesions and the association of bacterial flora with the anatomic site of the lesions were demonstrated.     

Microbiology of infected poison ivy dermatitis

We report the aerobic and anaerobic microbiology of secondarily infected poison ivy dermatitis. The study involved retrospective review of clinical and microbiology laboratory records of patients with secondarily infected poison ivy lesions. Bacterial growth was noted in 33 specimens. Aerobic or facultative anaerobic bacteria only were present in 18 (55%) patients, anaerobic bacteria only in seven (21%), and mixed anaerobic-aerobic bacteria in eight (24%). Forty-five isolates were recovered (1.4 per specimen): 27 aerobic or facultative anaerobic bacteria, and 18 strict anaerobes. The predominant aerobic and facultative anaerobic bacteria were Staphylococcus aureus (13 isolates) and group A beta-haemolytic streptococci (six). The predominant anaerobes were Peptostreptococcus spp. (seven isolates), pigmented Prevotella and Porphyromonas spp. (four) and Fusobacterium spp. (two). Single bacterial isolates were recovered in 18 (55%) patients, eight of which were S. aureus. Nineteen of the organisms isolated from 16 (48%) patients produced the enzyme beta-lactamase. Organisms that resided in the mucous membranes close to the lesions predominated in those infections. Enteric gram-negative rods and Bacteroides fragilis group predominated in leg and buttock lesions. Group A beta-haemolytic streptococci, pigmented Prevotella and Porphyromonas and Fusobacterium spp. were most frequently recovered from lesions of the finger, face and neck. The polymicrobial aetiology of secondarily infected poison ivy lesions, and the association of bacterial flora with the anatomical site of the lesions, are demonstrated.     

MICROBIOLOGY OF SECONDARILY INFECTED DIAPER DERMATITIS

Specimens obtained from 67 infants with secondarily infected diaper dermatitis were cultured for aerobic and anaerobic bacteria. Bacteria growth was obtained in 58. Aerobic facultative bacteria or Candida sp. only were present in 28 patients (48%), anaerobic bacteria only in 11 (19%), and mixed anaerobic with aerobic, facultative, or yeast flora was present in 19 (33%). Ninety-one bacterial or fungal isolates were recovered (1.6 per specimen), 54 (0.9 per specimen) aerobic or facultative bacteria, 8 (0.1 per specimen) Candida sp., and 31 (0.6 per specimen) strict anaerobes. The predominant aerobic and facultative bacteria were Staphylococcus aureus (23 isolates), Streptococcus sp. (16), and Escherichia coli (6). The predominant anaerobes included Bacteroides sp. (12, including 9 Bacteroides fragilis group) and Peptostreptococcus sp. (11). Single bacterial isolates were recovered in 32 (55%) patients, 18 of which were S. aureus. Twenty-five beta-lactamase-producing bacteria were detected in 22 (51%) of the 43 tested patients. These included 16 S. aureus and 6 B. fragilis group. These data highlight the importance of anaerobic bacteria in the polymicrobial nature of secondarily infected diaper dermatitis.     

Microbiology of Nonbullous Impetigo

Abstract: Our objective was to establish the aerobic and anaerobic microbiology of nonbullous impetigo (Nl) in children. We used a retrospective review of clinical microbiology laboratory and patients'records. Specimens were obtained from 40 patients with Nl lesions and showed bacteriai growth. Aerobic or facultative anaerobic bacteria only were present in 24 patients (60%), strict anaerobic bacteria only in 5 patients (12.5%), and mixed anaerobic-aerobic flora was present in 11 patients (27.5%). Sixty-four isolates were recovered (1.6 per specimen): 43 aerobic or facultative, and 21 anaerobic. The predominant aerobic and facultative bacteria were Staphylococcus aureus (29 isolates). Group A beta hemolytic streptococcus (GABHS) (13 Isolates), and Escherichia coli (1 isolate). The predominant anaerobes were Peptostreptococcus spp. (12), pigmented Prevotella spp. (5), Fusobacterium spp. (2), and Bacteroides fragilis (1). Single bacterial isolates were recovered in 17 patients (42.5%), 13 of which were S. aureus. S. aureus alone or mixed with GABHS or Peptostreptococcus spp. were isolated from all body sites. Mixed flora of Peptostreptococcus spp. with Prevotella spp. or Fusobacterium spp. was mostly found in infections of the head and neck, while E. coli mixed with B. fragills and Peptostreptococcus spp. were isolated from one infection of the buttocks area. Thirty-three organisms isolated from 32 patients (80%) produced the enzyme beta-lactamase. This study demonstrates the polymicrobial aerobic-anaerobic microbiology of Nl lesions.     

Microbiology of infected epidermal cysts

Specimens from 231 epidermal cyst abscesses were inoculated on media supportive for growth of aerobic and anaerobic bacteria. Of these, 192 yielded bacterial growth. Aerobic or facultative bacteria only were recovered in 84 specimens (44%), anaerobic bacteria only in 57 specimens (30%), and mixed aerobic and anaerobic bacteria in 51 specimens (26%). A total of 315 isolates (162 anaerobes and 153 aerobes) were recovered. An average of 0.8 aerobic or facultative isolates per infected cyst were recovered, and this number was unrelated to the cysts' anatomic sites. However, the number of anaerobic bacteria varied; they were isolated more frequently in perirectal (1.5 isolates per specimen), vulvovaginal (1.4), and head (1.1) infections, and less frequently in trunk (0.7) and extremities (0.4) infections. The predominant aerobic or facultative bacteria were Staphylococcus aureus (81 isolates), group A streptococcus (9 isolates), and Escherichia coli (7 isolates). The predominant anaerobic organisms were Peptostreptococcus species (85 isolates) and Bacteroides species (55 isolates, including 12 Bacteroides melaninogenicus and 9 Bacteroides fragilis groups). The study highlights the polymicrobial nature and predominance of anaerobes in cyst abscesses in the perirectal, vulvovaginal, and head areas.     

MICROBIOLOGY OF INFECTED ATOPIC DERMATITIS

Background. Bacterial infections occur frequently in lesions of atopic dermatitis (AD). The objectives of the study were to establish the aerobic and anaerobic microbiology of secondarily infected AD. Methods. A retrospective review was carried out of clinical and microbiology laboratory records and of data obtained from patients with secondarily infected AD lesions, whose specimens of infected sites were processed for the presence of aerobic and anaerobic bacteria. Results. Bacterial growth was noted in 41 specimens. Aerobic or facultative anaerobic bacteria only were present in 15 patients (36%), anaerobic bacteria only in eight (20%), and mixed anaerobic-aerobic flora was present in 18 (44%). Seventy- two isolates were recovered (1.8 per specimen), 34 aerobic or facultative bacteria, 35 strict anaerobes, and three Candida sp. The predominant aerobic and facultative bacteria were Staphylococcus aureus (12 isolates). Group A beta hemolytic streptococcus in five isolates, and Escherichia coli in four. The predominant anaerobes were peptostreptococcus spp. (13 isolates), pigmented Prevotella and Porphyromonas spp. in eight, and Fusobacterium spp. in four isolates. Single bacterial isolates were recovered in 14 patients (34%), seven of which were S. aureus. Twenty-one of the organisms isolated from 16 patients (39%) produced the enzyme beta-lactamase. Organisms that resided in the mucous membranes close to the lesions predominated in these infections. Enteric gram-negative rods and bacteroides fragilis group predominated in lesions on legs and buttocks. Group A beta-hemolytic streptococci, pigmented Prevotella, and Porphyromonas and Fusobacterium spp. were most frequently recovered in lesions of the finger, scalp, face, and neck. Conclusions. The polymicrobial etiology of secondarily infected AD lesions and the association of bacterial flora with the anatomic site of the lesions are demonstrated.     

Microbiology of infected hemangiomas in children

Bacterial infections are a common complication of hemangiomas in children. The objective of this study was to establish the aerobic and anaerobic microbiology of infected hemangiomas. A retrospective 8-year review of clinical and microbiology laboratory records from patients with secondarily infected hemangiomas was carried out. Specimens from infected sites were processed for the presence of aerobic and anaerobic bacteria. Bacterial growth was present in 32 of 38 specimens. Aerobic bacteria alone were recovered in 12 infected hemangiomas (37.5%), anaerobic bacteria alone in 8 (33%), and mixed aerobic and anaerobic flora in 12 (37.5%). A total of 80 isolates (47 aerobes and 33 anaerobes) were recovered, giving an average of 2.5 isolates per specimen (1.5 aerobes and 1.0 anaerobes). The highest number of isolates were recovered in infections of the perineum (3.7 per site) and the legs (2.8 per site). The predominant aerobic isolates were Staphylococcus aureus, group A beta-hemolytic streptococci, and Enterobacteriaceae. The predominant anaerobes were Peptostreptococcus sp., gram-negative bacilli, and Fusobacterium sp. Organisms that belong to the mucous membranes close to the lesions predominated in infections next to those membranes. The polymicrobial etiology of secondarily infected hemangiomas and the association of bacterial flora with the anatomic site of the lesions is thereby demonstrated.     

Aerobic and Anaerobic Microbiology of Necrotizing Fasciitis in Children

Abstract: Specimens obtained from eight children with necrotizing fasciitis (NF) were cultured for aerobic and anaerobic bacteria. A total of 21 isolates were recovered, 13 anaerobic and 8 aerobic or facultatives. The facultative organism Streptococcus pyogenes was present alone in two (25%) instances, and mixed aerobic and anaerobic bacteria were isolated in six (75%). The predominant isolates were Peptostreptococcus spp. (6 isolates, including 3 Peptostreptococcus magnus ). S. pyogenes (4), Bacteroides fragilis group (3), Clostridium perfringens (2), Escherichia coli (2), and Prevotella spp. (2). Organisms similar to the ones isolated from the NF aspirates were recovered in the blood of all patients except one. These included S. pyogenes (3 isolates). B. fragilis group (2), E. coli (1), and P. magnus (1) and Clostridium perfringens (1). All patients underwent surgical fasciotomy, and four required skin grafting. Antimicrobials were administered to all children. Despite extensive resection and intense supportive therapy, three patients died from sepsis accompanied by shock acidosis and disseminated intravascular coagulation. These findings illustrate the polymicrobial aerobic-anaerobic flora of NF in children.     

Anaerobes in genitourinary infections in men.

Urethral and sub-preputial swabs from 150 men were examined. There was a strong association between the isolation of anaerobic bacteria, particularly Bacteroides spp, and a clinical diagnosis of balanoposthitis, non-specific urethritis (NSU), or both. Aerobic bacteria formed the predominant flora in 28 healthy controls whereas anaerobes were predominant in specimens from 79 patients with balanoposthitis, from 24 with NSU, and from 19 with both. Bacteroides spp were the commonest isolates in all patient groups; B asaccharolyticus, B melaninogenicus ss intermedius, B ureolyticus, and B bivius were the most common species. The results obtained with the two swabs were identical except that Gardnerella vaginalis was isolated from the urethral swab only in five patients.     

Microbiology of perianal cellulitis in children: comparison of skin swabs and needle aspiration

Objective To establish the aerobic and anaerobic microbiology of perianal cellulitis in children, comparing skin swab and needle aspirate methodology. Method Swabs of involved skin and needle aspirates of cellulitis were studied for aerobic and anaerobic bacteria. Results Specimens obtained from 10 patients with perianal cellulitis showed bacterial growth. Polymicrobial aerobic–anaerobic flora was found in all skin surface cultures, where the predominate isolates were Peptostreptococcus spp., Escherichia coli, and alpha hemolytic streptococci. The number of isolates in needle aspirates varied between one and two. The predominant ones were E.coli (3), Peptostreptococcus spp. (3), Staphylococcus aureus (2), and Bacteroides fragilis group (2). Complete or partial concordance in microbiology between skin swabs and needle aspirates was present in six instances. In four instances, isolates recovered from needle aspirates were not isolated from the skin surface. Conclusions This study demonstrates the diversity of aerobic and anaerobic organisms isolated from perianal cellulitis, and the superiority of needle aspirates in establishing the microbiology of the infection.     

The microbiology of infected and noninfected leg ulcers

BACKGROUND: A clinical study was undertaken to investigate and compare specifically the aerobic and anaerobic microbiology of infected and noninfected leg ulcers. METHODS: Leg ulcers, defined as being infected on the basis of clinical signs, were swab sampled and investigated for aerobic and anaerobic microorganisms using stringent isolation and identification techniques. RESULTS: Two hundred and twenty isolates were cultured from 44 infected leg ulcers, in comparison with 110 isolates from 30 noninfected leg ulcers. Statistical analysis indicated a significantly greater mean number of anaerobic bacteria per infected ulcer (particularly Peptostreptococcus spp. and Prevotella spp.) in comparison with the noninfected ulcer group (2.5 vs. 1.3, respectively) (P < 0.05). Also, anaerobes represented 49% of the total microbial composition in infected leg ulcers compared with 36% in noninfected leg ulcers. The mean numbers of aerobes per wound in the two ulcer groups were not statistically different (P > 0.05). The study failed to demonstrate a clear correlation between commonly implicated facultative pathogens and wound infection. The isolation rate of Pseudomonas aeruginosa was generally low and, although Staphylococcus aureus was a frequent isolate in both wound types, it was more prevalent in noninfected leg ulcers. CONCLUSIONS: This study has demonstrated the complex aerobic-anaerobic microflora which exists in leg ulcers, the prevalence of anaerobes in infected wounds, and a poor correlation between the presence of specific aerobic pathogens and wound infection. In view of these findings, the role of microbial synergistic interactions in the pathogenesis of chronic wound infection may be of greater clinical importance than the isolated involvement of any specific potential pathogen.     

Anaerobic flora in trophic ulcers in leprosy patients

Material from 108 trophic ulcers from leprosy cases were studied bacteriologically. 4 cases showed growth of pure anaerobes and 69 showed mixed growth of aerobic and anaerobic bacteria. The predominant anaerobes were Fusobacteria (41), anaerobic cocci (30) and Bacteroides (25). Clostridia were isolated only in 10 cases. Metronidazole, chloramphenicol, penicillin and ampicillin were found effective against anaerobes in in-vitro studies.     

A comparative evaluation of vaginal, cervical and peritoneal flora in normal, healthy women: a preliminary report.

Twelve healthy women undergoing laparoscopic tubal sterilization were studied. Specimens were obtained for culture of aerobic and anaerobic bacteria, Mycoplasma hominis, Ureaplasma urealyticum, and Chlamydia trachomatis. The sites cultured included cul-de-sac (through a laparoscope), cul-de-sac (by transvaginal culdocentesis), the vaginal wall, and the endocervical canal. Anaerobic bacteria were isolated from the peritoneal cavity of three (25%) of the subjects. These isolates included B. melaninogenicus from two specimens obtained by laparoscope from the peritoneal cavity and from two peritoneal specimens obtained by culdocentesis. The data suggest that the peritoneal cavity of normal healthy women is not always sterile. We did not encounter contamination of transvaginal culdocentesis specimens with vaginal flora.     

Bacteriological examination of inflamed epidermal cysts: a survey between 2008 and 2009 at a hospital in southern Taiwan

BackgroundInflamed epidermal cysts are common clinical conditions, and they frequently form abscesses. We designed a study to delineate the bacteriology of inflamed epidermal cysts.MethodsWe enrolled 61 adult patients with inflamed epidermal cysts characterized by surface erythema, with or without tenderness, or localized abscess formation within the cyst cavity. Incision and drainage of the cysts were performed, and the contents were sent for aerobic and anaerobic bacterial culture. The locations of the cyst and culture results were recorded for statistical analysis.ResultsA total of 61 cysts and 122 cultures were obtained. The most common locations of the inflamed cysts were the face, neck, and scalp (34.4%), followed by the trunk (32.8%), then the buttocks, inguinal areas, perineum, and axillae (16.4%), and the extremities (16.4%). The culture results were positive in 88.5% of patients, and anaerobes were more frequently isolated than were aerobes. Pure aerobes represented 31.1% of the cultures; pure anaerobes, 36.1%, and combined aerobes and anaerobes, 21.3% (n = 13). The most common anaerobic organisms found were Propionibacterium spp (40.8%), followed by Peptostreptococcus spp (36.7%), Staphylococcus saccharolyticus (14.4%), Prevotella (4.1%), Bacteroides fragilis (2.0%), and Fusobacterium spp (2.0%). The most commonly isolated aerobes were Staphylococcus spp (40%), followed by Enterobacter spp (11.3%), Proteus mirabilis (8.5%), Citrobacter diversus (8.5%), Klebsiella pneumoniae (5.7%), Corynebacterium (5.7%), Morganella morganii (2.9%), Enterococcus faecalis (2.9%), group A β-hemolytic streptococcus (2.9%), Pseudomonas aeruginosa (2.9%), and Providencia rettgeri (2.9%).ConclusionsBoth aerobic and anaerobic microorganisms were present in the inflamed epidermal cysts, although the anaerobic bacteria, specifically, Propionibacterium spp and Peptostreptococcus spp, were isolated slightly more frequently. Antibiotics directed against anaerobes may be considered in the treatment regimen for inflamed epidermal cysts.     

Evaluation of crew skin flora under conditions of a full quarantine lunar-exploration mission

Crew-members of the Apollo 14 lunar exploration mission underwent a pre-flight seclusion designed to stabilize their health by freeing them from exposure to potentially infectious agents. After the flight, the crew-members were quarantined to protect the biosphere from possible lunar contamination. These isolations, along with the complete isolation of the spaceflight itself, provided the opportunity for a skin flora survey which included the sampling of seven sites at five different times. Quantification and identification of all aerobic and anaerobic bacteria from each sire were performed. The results indicated that the pre-flight quarantine measures resulted in a decrease in total numbers of isolates as well as a decrease in the anaerobes. This was followed by a continued decrease throughout the flight with a return to the pre-flight norm within 16 days after the flight. The quantitative load of aerobic bacteria increased during the flight, due largely to an increass in coryneforms and micrococcaceae. The quantitative load of anaerobic bacteria decreased before and during the flight. No instance of microbial shock or intercrew transfer of micro-organisms was demonstrated. These findings indicate that alterations in the skin flora do not pose any unusual problem during short duration space flights. Further, there are no indications that problems will arise on longer missions.     

Aerobic and anaerobic bacterial flora of crural ulcers

In a group of 600 patients treated in the Metropolitan Dermatological Hospital in Warsaw bacteriological examination were carried out of swabs from the untreated crural ulcers. In 95% of these cultures growth of pathological aerobic organisms was obtained. Coagulase-positive staphylococci (St. aureus) and Gram-negative bacteria (Pseudomonas aeruginosa, Proteus vulgaris, Enterobacter sp and E. coli) prevailed. In 27% of cases the cultured strains were resistant to the generally available antibiotics. In the second group in 70 patients no growth of anaerobes exclusively was noted. Pathological aerobes and anaerobes in the same case were found in 45% of cultures. In the remaining ones pathogenic aerobes were present with a similar frequency as in the preceding group. Of the anaerobes the most frequently cultured species were Gram-negative bacteria such as Bacteroides melaninogenicus, Bacteroides sp, and Bacteroides fragilis. Among pathogenic anerobic cocci Peptostreptococcus and Peptococcus were most frequent. In 2 cases spore-forming anaerobic bacteria (Clostridium perfringens) were obtained. Forty-eight percent of anaerobes were resistant to the commonly used antibiotics.     

Quantitative studies of vaginal bacteria.

A quantitative method of culture, based on a weighed sample and with results expressed as colony forming units (cfu)/g was assessed and used to investigate the vaginal flora of normal women and that of women with vaginal disease. Samples were collected by means of disposable plastic loops into modified proteose peptone water transport medium in preweighed bottles. Counts expressed as cfu/g of secretion were consistent, whereas counts expressed as cfu/ml were inconsistent. Results obtained with specimens manipulated on the open bench were the same as those from duplicate samples processed in an anaerobic chamber. The normal vaginal flora was predominantly aerobic--lactobacilli, coryneforms, and coagulase negative staphylococci--with counts of greater than or equal to 10(8) cfu/g for lactobacilli. These were also present in patients with candidosis, but the flora in patients with trichomoniasis, bacterial vaginosis, gonorrhoea, or chlamydial infection was predominantly anaerobic. The commonest anaerobes were Bacteroides spp, particularly B bivius; they were found in 55% of controls but at counts of 10(2) cfu/g lower than in the patients, most of whom had high counts of anaerobes (greater than 10(8) cfu/g). The isolation rate of Gardnerella vaginalis was not appreciably greater from patients with bacterial vaginosis, and the quantitative cultures on controls and patients who were G vaginalis positive were the same (approximately equal to 10(7) cfu/g). Quantitative studies show greater differences than qualitative cultures between normal controls and patients with vaginal infections, indicating that some symptoms and signs of such infections may be related to quantitative polymicrobial changes.     

Isolation and identification of anaerobic organisms from the male and female urogenital tracts

Since Bacteroides spp may play an important role together with Gardnerella vaginalis in the pathogenesis of non-specific vaginitis and balanoposthitis, anaerobic organisms were isolated and identified from 34 female and 20 male patients attending a department of genitourinary medicine, and the results compared with the clinical findings and the presence of other routinely isolated pathogens. Twenty-three different organisms were recovered from 13 of the 20 men; of these organisms, 20 were of the Bacteroides spp. Most isolates were of the B melaninogenicus/oralis group, which forms part of the commensal vaginal flora in women. A definite association between the presence of anaerobes and other pathogens needs to be firmly established, as this obviously causes important complications in treating these conditions.     

Isolation and identification of anaerobic organisms from the male and female urogenital tracts.

Since Bacteroides spp may play an important role together with Gardnerella vaginalis in the pathogenesis of non-specific vaginitis and balanoposthitis, anaerobic organisms were isolated and identified from 34 female and 20 male patients attending a department of genitourinary medicine, and the results compared with the clinical findings and the presence of other routinely isolated pathogens. Twenty-three different organisms were recovered from 13 of the 20 men; of these organisms, 20 were of the Bacteroides spp. Most isolates were of the B melaninogenicus/oralis group, which forms part of the commensal vaginal flora in women. A definite association between the presence of anaerobes and other pathogens needs to be firmly established, as this obviously causes important complications in treating these conditions.     

Comparison of cefotetan plus doxycycline with cefoxitin plus doxycycline in the inpatient treatment of acute salpingitis

Pelvic inflammatory disease (PID), one of the major sequelae of the current epidemic of sexually transmitted diseases, has been shown to be a polymicrobial infection. This study compares the efficacy and safety of two broad-spectrum combination drug regimens, cefotetan with doxycycline and cefoxitin with doxycycline, in the treatment of PID. A total of 108 patients with acute salpingitis were hospitalized and randomized into two treatment groups: cefotetan/doxycycline (N = 54) and cefoxitin/doxycycline (N = 54). Before antibiotic administration, Chlamydia trachomatis was identified in 17 (16%) of the patients, Neisseria gonorrhoeae from 72 (67%), and anaerobic and aerobic bacteria were identified from the endometrial cultures of 86 (80%). There were seven tubo-ovarian abscesses (TOAs) that were diagnosed in the cefotetan group, and six in the cefoxitin group. Clinical cure was achieved in 51 of 54 (94%) patients in each group. Of the six patients whose treatment failed, all had positive cultures for N. gonorrhoeae and facultative/anaerobic bacteria, whereas none had C. trachomatis. Two patients from each study arm whose treatment failed were diagnosed with TOAs and responded subsequently to clindamycin plus an aminoglycoside. Cultures that were obtained after the completion of inpatient treatment showed the eradication of C. trachomatis and N. gonorrhoeae in all patients. Also, both regimens were effective in reducing aerobic and anaerobic pathogens. Finally, both regimens were well tolerated, with few side-effects.