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Snapshot
  • A 24-year-old male was admitted to the emergency department for an emergency laparatomy following a perforated appendicitis.  Post-operatively, the patient was recovering well and completed a seven-day course of oral cephalexin. Four days after completing antibiotics, he presents again with diffuse pain over the site of the appendectomy. A CT scan of the abdomen revealed a 3-cm ring enhancing fluid collection in the right lower quadrant.
Introduction
  • Classification
    • obligate anaerobic, gram-negative, enteric rods
      • Bacteroides fragilis
  • 99% of the flora in the intestinal tract is from Bacteroides
    • also found in mouth and vagina
  • Pathogenesis
    • transmission
      • endogenous from bowel injury or surgery
    • reservoir
      • human colon
    • molecular biology
      • modified LPS has reduced endotoxin activity
      • capsule is antiphagocytic
      • antibiotic resistance is common
Presentation
  • Septicemia
  • Peritonitis
  • Abdominal abscesses 
  • Wound infections
    • increasingly common
  • Aspiration pneumonia (rarely, when present in mouth)
    • can lead to lung abscess
    • more common in alcoholics
  • Infection often results from
    • abdominal trauma
    • emergency abdominal surgery
Evaluation
  • Anaerobic cultures
Differential
  • Infections caused by other anaerobic gram-negative bacteria
    •  e.g., Prevotella and Fusobacterium
Treatment
  • Metronidazole, clindamycin, and cefoxitin
  • Abscesses should be surgically drained
Prognosis, Prevention, and Complications
  • Prognosis
    • worse in immunocompromised and elderly
    • also if there is no access to surgical intervention
  • Prevention
    • antibiotic prophylaxis prior to dental and GI surgery
 

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