Specyfika zakażeń bakteriami beztlenowymi na oddziałach chirurgicznych i ortopedycznych
[Specificity of the anaerobic bacterial infections in the surgical and orthopedic wards]

Streszczenie

Bakterie beztlenowe są istotnym składnikiem prawidłowej mikroflory skó­ry oraz błon śluzowych. Uczestniczą także w etiologii zakażeń, najczęściej o charakterze endogennym. Zakażenia wywołane bakteriami beztlenowymi są problemem klinicznym i terapeutycznym u pacjentów z infekcją w obrębie narządu ruchu oraz hospitalizowanych w oddziałach chirurgicznych. Specy­fika zakażeń w obrębie opisanych oddziałów jest odmienna i jej znajomość stanowi algorytm postępowania przeciwbakteryjnego.

Abstract

Introduction . The aim of this study was to estimate the contribution strictly anaerobic bacteria in the etiology of infections in patients on surgery and orthopedic wards. Methods. We examined 159 samples taken from patients hospitalized in surgical wards and 179 clinical specimens taken from orthopedic patients. Clinical strains of obligate anaerobes were identified by API 20A biochemical tests (ATB Expression, bioMerieux® S.A., Fran­ce). Susceptibility of the clinical strains was examined by ATB ANA (bioMerieux® S.A., France) system. The MIC values were determined by the gradient diffusion method, Etest (AB BIODISK, Sweden i bioMerieux® S.A., France). Results. Gram-negative bacteria predominant in the samples taken from surgical patients, Most frequently we isolated rods of the genus Bacteroides (26%): B. fragilis, B.ovatus/B.thetaiotaomicron, and B. distasonis. In 44 samples (28%) we identified only anaerobic bacteria. Multibacterial isolations, with the participation of anaerobic and aerobic flora, dominated among patients in the study. Overall 238 strictly anaerobic bacteria were cultured from patients hospitalized in orthopedic wards. Gram-positive bacteria accounted for 78%. The most frequently were isolated Peptostreptococcus (56%), Propionibacterium (10%) species. In this study all Bacteroides strains were resistant to penicillin G. Some species were resistant to clindamycin, as well. Overall 40% of Bacteroides strains taken from surgical and 50% isolated from orthopedic wards showed no sensitivity to this antibiotic. A similar phenomenon was observed among bacteria of the genus Prevotella. Conclusions. In samples taken from orthopedic patients we observed the predominance of Gram-positive anaerobic bacteria. Some of them were part of the normal flora but they should not be excluded as an etiology agents of infection. The specimens taken from patients treated in surgical wards showed the presence of a mixed microflora, which included aerobic and anaerobic bacteria, primarily Gram-negative rods. Rational empirical therapy of infections with anaerobes should be mainly based on the resistance pattern in each ward and hospital. In view of the increasing in the number of resistant strains is necessary to monitor drug resistance of anaerobic bacteria.