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Updated: Apr 20 2020

Bacteroides fragilis

  • Snapshot
    • A 25-year-old man presents to the emergency room for pain in his right lower quadrant. He was found to have perforated appendicitis and was immediately taken to the operating room for emergent laparoscopic appendectomy. Due to the complexity of the case, the operation was converted to an open appendectomy. Post-operatively, he was put on a 7-day course of clindamycin and returned home. Two days later, he returned to the emergency room for diffuse abdominal pain. A computed tomography (CT) of his abdomen shows a fluid collection at the site of the appendix.
  • Introduction
    • Classification
      • Bacteroides fragilis
        • an anaerobic, gram-negative bacillus
        • part of the bacterial flora of the mucous membranes including gastrointestinal tract, mouth, and genitals
        • can cause abscesses at any endogenous site, including central nervous system (CNS), head and neck, abdomen, and pelvis
    • Epidemiology
      • incidence
        • more common in chronic infections
      • risk factors
        • immunocompromised state
        • bad dental hygiene
        • animal bite
        • trauma
        • surgery
    • Pathogenesis
      • susceptible to oxidative damage
      • capsule is antiphagocytic
      • penicillin resistance due to beta-lactamase production
  • Presentation
    • CNS infections
      • brain abscess
    • Head and neck infections
      • dental infection
      • retropharyngeal abscess
      • peritonsillar abscess
    • Aspiration pneumonia
    • Empyema
    • Intra-abdominal infections
      • peritonitis
      • abscess
    • Wound infections
  • Imaging
    • Computed tomography (CT)
      • site
        • involved area (i.e., abdomen)
      • indication
        • evaluate for abscess
  • Studies
    • Labs
      • anaerobic culture
    • Making the diagnosis
      • most cases are diagnosed based on clinical findings, imaging, and laboratory studies
  • Differential
    • Necrotizing fasciitis
      • distinguishing factors
        • often also caused by anaerobic bacteria producing gas
        • infection of fascia and presents with pain out of proportion to exam
  • Treatment
    • Management approach
      • the ultimate choice of antibiotic therapy depends on cultured bacteria and its sensitivity profile
      • antibiotics shown below are commonly used against anaerobes
    • Medical
      • metronidazole
        • indication
          • good activity against anaerobes
          • limited activity against aerobic bacteria
      • clindamycin
        • indication
          • B. fragilis is becoming increasingly resistant
          • activity against aerobic, gram-positive cocci as well
    • Operative
      • surgical incision and drainage of abscesses
        • indication
          • abscess
  • Complications
    • Death
    • Contiguous spread of infection
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