| Abstract: | A case of Bacteroides fragilis endocarditis which developed after appendicitis is discussed. Combined therapy with tetracycline and erythromycin for over 18 months, and therapy with several other agents given over a period of more than two years in all, failed to eradicate the infection. The organism in this case was markedly resistant to penicillin, intermediate in susceptibility to vancomycin, and sensitive to tetracycline, erythromycin, lincomycin, 7-chlorolincomycin, chloramphenicol, rifampin and metronidazole. Only metronidazole (Flagyl®), however, demonstrated bactericidal activity. Unfortunately, this drug was not available at the time of this patient's illness for therapeutic evaluation.A review of the 37 published cases of endocarditis due to gram-negative anaerobic bacilli revealed that these organisms appear to be more invasive and destructive than “viridans” streptococci. Major embolie phenomena were prominent complications. The over-all mortality was 46 per cent. If the penicillin-susceptible organisms alone are considered, the mortality is probably less than 20 per cent. However, because of the lack of an agent with bactericidal activity against B. fragilis (which is usually resistant to penicillin), the mortality caused by this organism is considerably greater. |
