The bacteriology of aspiration pneumonia

A prospective study of 54 cases of pulmonary infection following aspiration was performed. Specimens utilized for bacteriologic study were either transtracheal aspirates, empyema fluid or blood. Appropriate anaerobic bacteriologie methods were employed. Anaerobic bacteria were recovered in 50 patients (93 per cent) and were the only pathogens in 25 (46 per cent). The predominant species were Bacteroides melanino-genicus, Fusobacterium nucleatum and anaerobic or microaerophilic gram-positive cocci. Bacteroides fragilis, which is resistant to many commonly used antibiotics, was recovered in nine patients (17 per cent). Aerobic and facultative bacteria were present in 29 patients (54 per cent), but anaerobes were present concurrently in all but 4. Enteric gram-negative bacilli and pseudomonads were particularly common in patients whose disease developed in the hospital. Eleven patients with mixed aerobic and anaerobic infections were treated successfully with antibiotics which were active only against the anaerobic isolates, thereby further implicating the pathogenic role of these microorganisms. The results indicate that anaerobes play a key role in most cases of infection following aspiration.     

Sepsis associated with decubitus ulcers

Among 21 patients with sepsis attributed solely to decubitus ulcers, bacteremia was documented in 16 (76 per cent). Bacteremia involved obligate anaerobes in eight patients (50 per cent) and was polymicrobial in eight patients (50 per cent). Twelve of 17 patients who received appropriate antibiotics had persistent bacteremia; in five patients, bacteremia was terminated only after surgical debridement. Ten of these 21 patients died, eight despite appropriate antibiotics. Among 14 patients who underwent surgical debridement, only four patients died. Surgical debridement and antibiotics effective against aerobic as well as anaerobic bacteria are both important in the treatment of this serious complication.     

Spontaneous bacterial peritonitis and bacterascites prevalence in asymptomatic cirrhotic outpatients undergoing large-volume paracentesis

Background and Aim: Spontaneous bacterial peritonitis and bacterascites prevalence in asymptomatic cirrhotic patients on large‐volume paracentesis is unknown. The aim of this study was to investigate spontaneous bacterial peritonitis and bacterascites prevalence in a prospective cohort of cirrhotic outpatients following large‐volume paracentesis with low risk of infection. Methods: We prospectively studied all large‐volume paracenteses performed in cirrhotic outpatients for 1 year. Patients with fever, abdominal pain, peritonism or hepatic encephalopathy were excluded from the study. The ascitic fluid was analyzed by means of a reagent strip with a colorimetric scale from 0 to 4. A strip test of 0 or 1 was considered negative. In those cases with a reagent strip ≥2, conventional polymorphonuclear count was performed. Ascitic fluid culture was done into blood culture bottles in all cases. Results: We performed 204 paracenteses in 40 patients. Nine cases were excluded. Culture‐negative neutrocytic ascites was diagnosed in one case (0.5%), while bacterascites was diagnosed in six out of 195 cases (3%), mainly by gram‐positive cocci. Conclusion: The spontaneous bacterial peritonitis prevalence in outpatient cirrhotics with low risk of infection undergoing large‐volume paracentesis is very low. Moreover, the prevalence of bacterascites is low and without clinical consequences. The routine analysis of ascitic fluid may be unnecessary in this clinical setting. Nevertheless, the use of reagent strips is a reasonable alternative due to its accessibility and low cost.     

Spontaneous bacterial peritonitis: a comparative study of 2 methods of ascitic fluid culture

The sensitivity in the diagnosis of spontaneous bacterial peritonitis of ascitic fluid inoculation in blood culture bottles has been compared with the conventional method. We have analyzed 74 positive ascitic fluid cultures from 64 patients, the samples being processed by both techniques simultaneously. While all the ascitic fluid cultures performed by inoculation in blood culture bottles were positive, in only 42 from the 74 conventional cultures (56, 75%) bacterial growth was detected (p less than 0.001). Nineteen bacterascites were diagnosed by inoculation in blood culture bottles and 10 by the conventional method (p = NS). Gram stain was only positive in 3 spontaneous bacterial peritonitis (6%). We conclude that ascitic fluid inoculation in blood culture bottles improves significantly the sensitivity of the microbiological diagnosis of spontaneous bacterial peritonitis, without increasing the diagnosis of bacterascites.     

Aerobic and anaerobic microbiology of paronychia

Pus specimens from 28 patients with paronychia of the finger yielded bacterial growth by techniques for cultivation of aerobic and anaerobic bacteria. Anaerobic and aerobic organisms only were isolated in pure culture in five (18%) and eight patients (29%), respectively; mixed aerobic and anaerobic flora were present in 15 patients (54%). Seventy-two isolates were recovered, or 2.6 isolates per specimen. The predominant anaerobic organisms were Gram-positive anaerobic cocci, Bacteroides species, and Fusobacterium species. The predominant aerobic organisms were Staphylococcus aureus, gamma-hemolytic streptococci, Eikenella corrodens, group A beta-hemolytic streptococci, alpha-hemolytic streptococci, and Klebsiella pneumoniae. Candida albicans was recovered in four cases. This study demonstrates the mixed aerobic and anaerobic bacteriology of paronychia.     

Analysis of 98 cases of thoracic empyema]

Ninety-eight cases of empyema thoracis admitted to Juntendo University Hospital between 1979 and 1990 were reviewed. Males accounted for 78 cases and females 20 cases. Thirteen pediatric patients ranged in age from 17 days to 4 years, while the 85 adult cases ranged from 16 to 89 years (mean: 58.4 years). The mortality rate increased with age. Fifty-three cases of community-acquired empyema thoracis consisted of 24 with no underlying disease (including 13 pediatric cases), and 29 with diabetes mellitus, alcoholic liver damage or chronic obstructive bronchopulmonary disease. Forty-five nosocomial empyema cases occurred after chest operation or thoracocentesis, or due to a subdiaphragmatic pathogenic condition or congestive heart failure complicated with aspiration pneumonia. In this series, 63 patients (64.3%) had para- or post-pneumonic empyema. Compared with the community-acquired infection cases, the mortality rate of the nosocomial infection cases was very high. Seventy-eight cases were culture-positive, including 3 positive for Mycobacterium tuberculosis. The remaining 20 cases were culture-negative. In 75 cases of culture-positive pleural fluid, aerobic bacteria were isolated from 31 cases (mortality rate: 22.6%), anaerobes mixed with aerobes from 21 cases (mortality rate: 52.4%), and anaerobes only from 23 cases (mortality rate: 21.7%). Thus, the mortality rate of mixed infected cases was highest. Anaerobes were frequently isolated from the community-acquired empyema cases, and were often found in para- or postpneumonic lesions, including aspiration pneumonia. The most commonly encountered aerobe was Staphylococcus aureus. Among the anaerobes, Bacteroides spp., microaerophilic streptococcus, Peptostreptococcus and Fusobacterium spp. were most common. A single organism was isolated in pure culture from 39 cases. Single organisms isolated from fluids were more frequently aerobes (25) than anaerobes (14). The cases harboring Bacteroides spp. showed the worst outcome, with 11 deaths in 25 such cases.     

Bacterial colonization, tracheobronchitis, and pneumonia following tracheostomy and long-term intubation in pediatric patients.

Serial tracheal cultures for aerobic and anaerobic bacteria were obtained from 27 pediatric patients during one year of follow-up. The patients had required tracheostomy and prolonged intubation for periods ranging from 3 to 12 months (average, 7 1/2 months). Cultures of tracheal aspirates yielded 1,508 isolates of pathogenic aerobic (969 isolates) and anaerobic (539 isolates) bacteria. The most frequent aerobic isolates were Streptococcus pneumoniae and Staphylococcus aureus. The predominant anaerobes were anaerobic gram-positive cocci, Fusobacterium nucleatum, and Bacteroides fragilis. Replacement of one pathogen by another occurred frequently. Tracheobronchitis occurred in 24 patients, all of whom had episodes of pneumonia. The data suggest that anaerobic bacteria are a part of the bacterial flora in colonization, tracheobronchitis, and pneumonia in patients with tracheostomy and prolonged intubation.     

Spontaneous bacterial peritonitis. A review of 28 cases with emphasis on improved survival and factors influencing prognosis

During a five year period, 28 episodes of spontaneous bacterial peritonitis were documented. The number of cases recognized annually increased during the study period. Clinical and laboratory features of spontaneous bacterial peritonitis were similar to those previously reported; however, mortality was considerably lower (57 per cent). Factors associated with adverse prognosis were increasing hepatic encephalopathy, more than 85 per cent granulocytes in peripheral blood or ascitic fluid, total bilirubin greater than 8 mg/dl and serum albumin less than 2.5 g/dl. Temperature greater than 38 degrees C was associated with increased survival. Infection by enteric organisms was associated with higher mortality than infection by nonenteric organisms. Unexpectedly, patients with bacteremia fared no worse than those whose blood remained sterile. The data suggest that in patients with leukocyte counts greater than 1,000 cells/mm3 and more than 85 per cent granulocytes in their ascitic fluid, the likelihood of spontaneous bacterial peritonitis is high. Such patients deserve empiric antibiotic therapy pending the results of appropriate cultures.     

Bacteriology and beta-lactamase activity in acute exacerbation of chronic bronchitis.

OBJECTIVES: To assess the bacteriology of beta-lactamase (BL) enzyme activity in sputum of 40 patients with acute exacerbation of chronic bronchitis (AECB). METHODS: The microbiology, BL production by the different isolates, and BL contents in the sputum were determined. RESULTS: Eighty-four isolates were recovered (2.1 isolates per specimen), 44 aerobic and facultative (1.1 isolates per specimen), and 40 anaerobic (1.0 isolate per specimen). Aerobic bacteria were recovered in only 9 (22.5%) specimens, anaerobic bacteria in 9 (22.5%), and mixed aerobic and anaerobic bacteria were found in 22 (55%). The predominant aerobic isolates were Streptococcus pneumoniae (15 isolates), Haemophilus influenzae (11), Moraxella catarrhalis and Klebsiella pneumoniae (4 each). The predominant anaerobes were Peptostreptococcus sp. (19), Prevotella sp. (11), and Fusobacterium sp.(6). Mixed flora were present in 25 (62.5%) specimens, and the number of isolates varied from 2 to 5 per specimen. Thirty-nine beta-lactamase-producing bacteria (BLPB) were isolated in 33 (82.5%) of the 40 cases. The predominant aerobic BLPB were H. influenzae, M. catarrhalis, K. pneumoniae, Staphylococcus aureus, and Escherichia coli. The predominant anaerobic BLPB were Prevotella sp. and Fusobacterium sp. Beta-lactamase activity was detected in 26 (79%) of 33 of specimens in which BLPB were isolated, and in none of the seven specimens that did not harbor BLPB. CONCLUSIONS: The rapid detection of BL activity in sputum specimens may have implications for the antimicrobial management with AECB.     

Polymicrobial bacterascites. A unique entity in the spectrum of infected ascitic fluid

A retrospective analysis of 1578 abdominal paracenteses revealed ten cases of polymicrobial bacterascites, ie, growth of multiple organisms in ascitic fluid with a neutrophil count less than 250 cells/cu mm. Six of the ten paracenteses that documented this condition were traumatic (bloody or producing feculent material). Clinical peritonitis developed in only one patient. No one died as a result of the infection. Polymicrobial bacterascites is rare (0.6% of paracenteses). It is frequently due to a traumatic paracentesis (bowel entry by the paracentesis needle), and is associated with low morbidity.     

Diagnostic value of two reagent strips (Multistix 8 SG and Combur 2 LN) in cirrhotic patients with spontaneous bacterial peritonitis and symptomatic bacterascites

OBJECTIVE: Spontaneous bacterial peritonitis is a life-threatening complication in patients with liver cirrhosis requiring a rapid diagnosis. We have tested two reagent strips, Multistix 8 SG and Combur 2 LN for bedside diagnosis of spontaneous bacterial peritonitis and symptomatic bacterascites, a variant of spontaneous bacterial peritonitis. METHODS: Responses of the two strips in colorimetric scale were compared with results given by cyto-bacteriological analysis of ascitic fluid. Results with positivity in grades 1 and 2 of colorimetric scale were analyzed. RESULTS: Four hundred and forty three paracentesis were performed in 116 patients including 46 samples of ascitic fluid with spontaneous bacterial peritonitis occurring in 25 patients and 20 samples of ascitic fluid with symptomatic bacterascites occurring in 17 patients. Forty two percent of spontaneous bacterial peritonitis were culture-negative neutrocytic ascites, gram-positive pathogens and enterobacteriaceae were responsible for 36% and 21% episodes of spontaneous bacterial peritonitis and 71% and 29% episodes of symptomatic bacterascites respectively. Fifty seven percent of spontaneous bacterial peritonitis had polymorphonuclear cell count<1000/mm3. For spontaneous bacterial peritonitis diagnosis, grade 1 positive Multistix and Combur tests had a sensitivity of 69.6% and 80.4% respectively, and a negative predictive value of 96% and 97.3%. Grade 2 positivity increased specificity to 98% and 99.2% and positive predictive value to 75% and 91% for the two strips respectively. Grade 1 positive tests had a sensitivity of 100% and 90% and a negative predictive value of 100% and 99.4% respectively for diagnosis of spontaneous bacterial peritonitis with polymorphonuclear count > 1000/mm3. For symptomatic bacterascites diagnosis, grade 1 positive tests had a sensitivity of 22.4% and 44.4% respectively and a negative predictive value of 96% and 97%. CONCLUSION: Although Combur had a higher sensitivity than Multistix for the diagnosis of spontaneous bacterial peritonitis, sensitivity of the two strips remains low with polymorphonuclear cell count<1000/mm3. Grade 2 positive Combur test had an acceptable positive predictive value. Sensitivity of both strips is insufficient for diagnosis of symptomatic bacterascites. Rapid cyto-bacteriological analysis of ascitic fluid remains necessary for diagnosis of these complications.     

Characteristics of brain abscess with isolation of anaerobic bacteria

In view of its localization, brain abscess (BA) usually requires medical and surgical care. A broad spectrum of bacteria is involved. Recent reports stress the increasing frequency of anaerobes, but their impact has not been well evaluated. A retrospective review was conducted of all episodes of documented BA admitted in a tertiary-care hospital over a 10 y period. BA due to anaerobic bacteria (group A) were compared with other cases (group B) to determine the frequency and eventual characteristics of BA with isolated anaerobic bacteria. Between 1991 and 2000, BA were diagnosed in 42 patients (28M, 14F, mean age 54.6 y). No differences in clinical features and laboratory findings were found between patients with BA caused by anaerobic (n = 22) and only aerobic (n = 20) bacteria. Using appropriate microbiological techniques, 41 anaerobic bacteria strains were isolated in 22 of 42 patients (52.4%) with BA. Anaerobic bacteria were associated with aerobic strains in 5 patients (12%), whereas in 17 patients (40.5%) only anaerobic strains were isolated in cerebral puncture cultures. The most frequently isolated species were Fusobacterium nucleatum (n = 14), Prevotella sp. (n = 8), Actinomyces sp. (n = 6) and Bacteroides sp. (n = 4). Compared with group B, group A had more cases of a single abscess (p = 0.03) and ear, nose and throat (ENT) as a source of infection (p = 0.04), and seemed to have a better outcome (p = 0.07). These results emphasize the important role that anaerobic bacteria play in BA. The presence of such pathogens must be evoked when faced with a single abscess, an ENT infection, or both. Therapy should take into account this high frequency.     

Comparison of translocation rates of various indigenous bacteria from the gastrointestinal tract to the mesenteric lymph node

Bacterial translocation is defined as the passage of indigenous bacteria from the gastrointestinal (GI) tract through the lamina propria to the mesenteric lymph nodes (MLN) and other organs. We compared the relative abilities of various aerobic, facultatively anaerobic, and obligately anaerobic bacteria to translocate from the GI tract to the MLN in gnotobiotic mice colonized with single strains of bacteria. Indigenous gram-negative enteric bacilli translocated in large numbers to the MLN, whereas gram-positive bacteria translocated at intermediate levels and obligately anaerobic bacteria at only very low levels. Our results suggest that enteric bacilli such as Escherichia coli, Proteus, and Enterobacter are associated with a higher incidence of bacteremia in debilitated patients, because these bacteria translocate more efficiently from the GI tract than do other bacteria, especially obligate anaerobes.     

Viridans group streptococci: an underestimated cause of spontaneous bacterial peritonitis in cirrhotic patients with ascites

OBJECTIVES: The objective of the study was to examine the characteristics of spontaneous bacterial peritonitis (SBP) caused by streptococci, in particular viridans group streptococci (VGS), and to investigate a potential association between the long-term administration of norfloxacin and high-level resistance to fluoroquinolones in these organisms. METHODS: We reviewed 84 episodes of SBP and bacterascites caused by streptococci that occurred in 75 patients over a 6-year period. Isolates were tested for antibiotic susceptibility by the determination of minimum inhibitory concentrations. RESULTS: Of the 84 isolates, 46 (54.8%) were associated with SBP, 12 (14.3%) were associated with symptomatic bacterascites, and 26 (31%) were associated with asymptomatic bacterascites. VGS were responsible for 39 of the 58 episodes of SBP and symptomatic bacterascites, largely preceding group B streptococci (n=7), Streptococcus pneumoniae (n=6) and Streptococcus bovis (n=5). Most of the episodes were community acquired. An extraperitoneal site of infection was found in three patients only. Positive blood cultures were less frequent in patients with VGS infection than in those with SBP caused by other streptococci (12.8 versus 52.6%, P<0.001). The rates of susceptibility to penicillin, amoxicillin and cefotaxime were 84.5, 87.9 and 91.4%, respectively. All isolates, including those from patients receiving norfloxacin, were susceptible to levofloxacin and moxifloxacin. CONCLUSIONS: VGS are an underestimated cause of SBP in patients with cirrhosis. Most isolates are susceptible to beta-lactam agents and new fluoroquinolones.     

Microbiologic profile of intra-abdominal infections at Belo Horizonte,Brazil

Intra-abdominal infections (IAIs) represent one of the most common clinical problems in hospital practice, especially in surgical areas and centers of intensive care. The treatment of IAIs generally involves the draining of abscesses and empirical antimicrobial therapy. In this study, among 150 patients suffering from IAI, 106 (70.7%) yielded samples that presented microbial growth. Polyinfection was detected in 51.9% of the cases and varied from 2 to 9 distinct microbes per specimen. The overall mean number of micro-organisms isolated per patient was 2.17. Aerobic bacteria (as strict aerobes and facultative anaerobes), strict anaerobic bacteria, and fungi of the genus Candida represented 93.4%, 30.2%, and 13.2% of the cases positive for micro-organisms, respectively. The most common aerobic bacteria were those of the genera Staphylococcus, Escherichia, Proteus, and Streptococcus. Despite the frequent prior use (52%) with antimicrobials of recognized action against strict anaerobes, these micro-organisms constituted 30.9% of the total isolates, and the most frequently found were of the Bacteroides fragilis group and Prevotella species. The high prevalence of anaerobes in the specimens obtained from IAI demonstrates the need to give greater importance to these micro-organisms by making available material and human resources to carry out culture of the anaerobes as part of routine hospital procedures.     

Usefulness of routine analysis of ascitic fluid at the time of therapeutic paracentesis in asymptomatic outpatients. Results of a multicenter prospective study

AIM: The guidelines of the American Association for the Study of Liver Diseases recommend performing exploratory paracentesis on each patient with cirrhosis and chronic ascites. The aim of the study was to evaluate the prevalence of spontaneous bacterial peritonitis and culture-negative neutrocytic ascites in a large population of consecutive asymptomatic cirrhotic ascitic ambulatory patients. METHODS: Patients with cirrhosis and tense ascites hospitalized from January to September 2000 in 5 hepatogastroenterology units prospectively underwent an exploratory paracentesis with cytobacteriological, biochemical and bedside inoculation into aerobic and anaerobic blood culture bottles. Patients studied were not receiving antibiotics except for norfloxacin and had no obvious sign of infection such as fever or hypothermia, chills, unusual abdominal tenderness, de novo or worsening hepatic encephalopathy, recent gastrointestinal bleeding, acute renal failure or marked arterial hypotension. Clinical and biological findings and ascitic fluid cytological and bacteriological results were evaluated at each exploratory paracentesis. The results are given in mean +/- standards deviations with range. RESULTS: Sixty-seven cirrhotic patients (48M/19F, mean age 59 +/- 9 years) had 270 therapeutic paracenteses, preceded by an exploratory aspiration. Fifty-nine patients (88%) had alcoholic cirrhosis. Twenty-five patients (37.3%) received norfloxacin. At first paracentesis 41 (61.2%) and 26 (38.8%) patients were class B and C respectively according to the Child-Pugh classification; the mean Child-Pugh score was 9 +/- 1.5. None had suspicion of infection. The mean number of paracenteses was 5 +/- 4.3 per patient; 59.6% of the paracenteses (161) were compensated with human albumin. Ascitic protein concentration was 17.5 +/- 8.6 g/l, ascitic fluid cell count and number of neutrophils were 127 +/- 155/mm3 and 5.9 +/- 14/mm3 (0-60), respectively. No patient had spontaneous bacterial peritonitis nor culture-negative neutrocytic ascites; 10 cases of monomicrobial bacterascites were observed, all with commensal germs. CONCLUSIONS: In the absence of obvious signs of infection, the prevalence of spontaneous bacterial peritonitis and culture-negative neutrocytic ascites in asymptomatic cirrhotic outpatients with ascites is near 0%. Moreover, for 100 large volume paracenteses, not performing exploratory paracentesis corresponds to a savings of 5,500 euros, without risk for these patients.     

Fibronectin in the ascitic fluid: its diagnostic significance

We studied fibronectin concentration in the ascitic fluid of 102 patients, 71 with cirrhosis, 13 with hepatocellular carcinoma, 12 with malignant peritonitis, and six with miscellaneous disease. Fibronectin concentrations in the first three groups were 45 +/- 45 mg/l, 54 +/- 84 mg/l, and 144 +/- 123 mg/l, respectively. The difference between patients with cirrhosis and malignant peritonitis was significant (p less than 0.01). However, fibronectin concentration greater than 100 mg/l had a sensitivity of 58 per cent and a specificity of 86 per cent for the diagnosis of malignant peritonitis. Ascitic fluid protein content over 30 g/l had the same sensitivity and specificity was 90 per cent. Among cirrhotic patients, high fibronectin concentrations were demonstrated in those with long-standing ascites (m = 134 +/- 58 mg/l) whereas the lowest concentrations were found in patients with severe hepatocellular failure (m = 12 +/- 9 mg/l). Concentrations were significantly different, according to whether or not spontaneous bacterial peritonitis occurred later (20 +/- 13 mg/l versus 52 +/- 49 mg/l); 83 per cent of patients with spontaneous bacterial peritonitis during their clinical course had initial fibronectin concentrations above 30 mg/l in their ascites. We conclude that: 1) measurement of fibronectin concentration in ascitic fluid is of poor diagnostic value for discrimination between malignant and non malignant ascitic, 2) low concentrations of fibronectin are associated with the occurrence of spontaneous bacterial peritonitis in cirrhotic patients. Hypothetically, the quantitative defect of fibronectin could be responsible for bacterial opsonization impairment in these patients.     

Anaerobic bacteremia: decreasing rate over a 15-year period

At the Mayo Clinic, the number of cases of anaerobic bacteremia decreased 45% between 1974 and 1988. In addition, the percentage of blood cultures positive for anaerobes decreased significantly even though the total number of blood cultures performed increased. The number of anaerobic bacteremias per 100,000 patient-days also declined over the 15-year period. Organisms of the Bacteroides fragilis group ranked third in frequency with respect to other organisms that caused aerobic and anaerobic bacteremia in 1974 but ranked only seventh in 1988 and caused slightly less than one-half of the anaerobic bacteremias. The mechanisms responsible for these changes are unclear but might relate to earlier recognition and treatment of localized anaerobic infection, widespread preoperative use of agents prior to bowel surgery, and use of broad-spectrum antimicrobial regimens that include agents with activity against anaerobes.     

Evaluation of liquid transport media for the isolation of anaerobic bacteria: Relevance to genital tract specimens

A mixture of six known anaerobic bacteria in small numbers was used to develop a simple anaerobic liquid transport system in which fastidious bacteria and oxygen-sensitive anaerobes could remain viable even after 24 hours under anaerobic conditions. The organisms, coated on alginate-wool swabs, were dispersed in pre-reduced tryptone-yeast-glucose medium which acted both as a transport medium and as a diluent for quantitative estimations. The prolonged survival of the bacteria was attributable to the incorporation of laked horse blood or bovine serum in the medium and to the pre-moistening of swabs with these blood products. At concentrations not greater than three to five per cent they acted as protective agents, enabling complete or almost complete recovery of all the bacteria to be made, even the extremely oxygen-sensitive anaerobic Clostridium novyi B. However, the largest number of obligate anaerobic bacterial species was isolated from the urethra of patients with non-gonococcal urethritis when the redox potential of the medium was further reduced with titanium trichloride.     

Retrospective analysis of Fusobacterium associated infections; experience at Aomori Prefectural Hospital with 108 cases from 1995 to 1999

We experienced 108 cases of Fusobacterium associated infections, including otolaryngeal, oral, pleuropulmonary, intraabdominal, skin and soft tissue infections, at Aomori Prefectural Hospital during The 5 year-period from 1995 to 1999. A total of 433 organisms, included 113 Fusobacterium spp. (80 Fusobacterium nucleatum, 18 Fusobaterium necrophorum, 5 Fusobacterium varium, 4 Fusobacterium mortiferum, 6 Fusobacterium spp.), were recovered with an average of 4.0 organisms per case of the 108 cases, 68% were mixed aerobic and anaerobic and yielded 185 anaerobic bacteria (2.5 per case) and 137 aerobic bacteria (1.9 per case) with an average of 4.4 per case. The remaining 32% were purely anaerobic and yielded 111 organisms with an average of 3.2 per case, Prevotella spp., Bacteroides fragilis group, Streptococcus milleri group, Enterobacteriaceae, Peptostreptococcus spp. Staphylococcus spp. were most frequently coisolated with Fusobacterium spp.