Antibiotics in pelvic infections

Ocular infections due to anaerobic bacteria in children

The recent increased recovery of anaerobic bacteria from children has led to greater appreciation of the role these organisms play in pediatric infections at all body sites, including the eye. In studies that employed adequate methods for recovery of anaerobes, they were isolated from approximately one-third of the children with conjunctivitis, half of the time in pure culture. The predominant recovered anaerobes were Clostridium spp., gram-negative anaerobic bacilli, and Peptostreptococcus spp. Anaerobic bacteria were also recovered from patients who wore contact lenses and developed conjunctivitis, and were reported in cases of keratitis. The most frequently recovered anaerobes were Propionibacterium spp., Peptostreptococcus spp., Clostridium spp., Prevotella spp., and Fusobacterium spp. The most frequently recovered anaerobes from dacryocystitis were Peptostreptococcus spp., Propionibacterium spp., Prevotella spp., and Fusobacterium spp. This review describes the microbiology, diagnosis, and management of ocular infections due to anaerobic bacteria in children.

The bacteriology of acute pelvic inflammatory disease

The bacteriology of acute pelvic inflammatory disease (PID) was studied in 20 patients by simultaneous cul-de-sac, cervical, and blood cultures with aerobic and fastidious anaerobic techniques. Cul-de-sac cultures were positive in 18 of 20 patients, while all 8 normal control subjects yielded negative results (p less than 0.0005, chi-square analysis). Anaerobic bacteria (predominatly Peptococcus and Peptostreptococcus) were present in 10 patients (59 per cent), and they were the exclusive isolates in 3 patients. N. gonorrhoeae was isolated only once from the cul-de-sac despite its presence in cervical specimens. There was poor correlation between cul-de-sac and cervical cultures. Cervical cultures yielded a variety of aerobic and anaerobic bacteria with an average of 3.8 organisms per specimen. N. gonorrhoeae was isolated in 13 patients (65 per cent). Only 19 per cent of cervical isolates were recovered by culdocentesis; similarly, only 31 per cent of cul-de-sac isolates were simultaneously isolated from the cervix. Blood cultures were uniformly negative. These data suggest that: (1) culdocentesis is a reliable technique for the bacteriologic diagnosis of acute PID, and (2) whereas the gonococcus may be important in initiating acute PID, its primary role appears to be paving the way for secondary invaders from the normal vaginal flora to gain access to the upper genital tract.

Acute pelvic inflammatory disease and clinical response to parenteral doxycycline

The bacteriology of acute pelvic inflammatory disease (PID) and clinical response to parenteral doxycycline were evaluated in 30 patients. Only 3 of 21 cul-de-sac cultures from PID patients were sterile, whereas all 8 normal control subjects yielded negative results (P< 0.005). Poor correlation was observed between cervical and cul-de-sac cultures. Neisseria gonorrhoeae, isolated from the cervix in 17 patients (57%), was recovered from the cul-de-sac only once. Streptococcus, Peptococcus, Peptostreptococcus, coliforms, and other organisms normally present in the vagina were the predominant isolates recovered from the cul-de-sac. Parenteral doxycycline resulted in rapid resolution of signs and symptoms (within 48 h) in 20 of 27 evaluable patients (74%). In five others, signs and symptoms of infection abated within 4 days. The remaining two patients failed to respond; in both cases, adnexal masses developed during doxycycline therapy. Gonococci were eradicated from the cervix in all but one patient who, nevertheless, had a rapid defervescence of symptoms. There was no clear-cut correlation between the clinical response and in vitro susceptibility of cul-de-sac isolates to doxycycline. These data confirm the usefulness of broad-spectrum antibiotics in acute PID. Culdocentesis is a reliable means of obtaining material for the bacteriological diagnosis of acute PID; however, the pathogenetic role and relative importance of gonococci and various other bacteria in acute PID need to be clarified further.

Bacteremia on an obstetric-gynecologic service

In a one-year evaluation of the Obstetric-Gynecologic Services of the Los Angeles County University of Southern California Medical Center, bacteremia was confirmed on 144 occasions in 139 patients. This represented an over-all incidence of 7/1,000 admissions with gram-negative bacteremia observed in 3.1/1,000 admissions. There were four deaths in this series. The most frequently recovered aerobes were Escherichia coli, enterococci, and beta hemolytic streptococci, not Group A or D, while the most commonly isolated anaerobes were peptostreptococci, peptococci, and Bacteroides. These patterns of bacterial isolation should be acknowledged in antibiotic strategies for septic patients. There is a positive correlation between the incidence of intrapartum maternal and fetal monitoring and postpartum maternal bacteremia. The oncology patients were the most seriously ill women with bacteremia.