Bacteroides

Large group of bile-resistant, nonspore forming, slender gram-negative rods Normal inhabitants of the bowel; normal stool contains 10 11 Bacteroides fragilis/gram Other species, Bacteroides ovatus, Bacteroides distasonis, Bacteroides vulgatus, Bacteroides thetaiotaomicron often implicated in intra-addominal infections, especially after disruption of the intestinal wall after a perforation or a surgery, acute appendicitis and diverticulitis These infections are often polymicrobial Bacteroides fragilis and Bacteroides thetaiotaomicron are implicated in pelvic inflammatory disease and ovarian abcess

Bacteroides fragilis
Antigenic structure:
Capsule: polysaccharide Can cause abscess formation on its own! Lipopolysaccharide: Less toxic than that of other gram negatives. Lacks the part of the lipopolysaccharide molecule with endotoxic activity, including betahydroxymyristic acid So when signs of fever and shock appear in Bacteroides infection, they are usually due to the inflammatory immune response to the infection Proteases Neuraminidases Two cytolysins that can lyse RBCs Enterotoxin causing diarrhoea Superoxide dismutase helps it to survive in the presence of oxygen for days. When a facultative anaerobe such as Escherichia coli is present at the site of infection, it consumes all the ocygen, and produces an environment where Bacteroides and other anaerobes can thrive!

Clinical findings:
Foul smelling discharge due to short chain fatty acid products of anaerobic metabolism Infection in proximity to a mucosal surface (why? Because anaerobes are part of the normal flora) Gas in the tissues due to production of CO2 and H2 Negative aerobic cultures

Laboratory Diagnosis:
Specimen collection: Pus or other samples are collected in anaerobic transport media, or transported in gaspaks Culture: Kanamycin Vancomycin blood agar

Treatment:
Bacteroides produces beta lactamase. These beta lactamases are inhibited by beta-lactam/beta-lactam inhibittor combinations like ampicillin/sulbactam Other antibiotics, clindamycin and metonidazole Note: clindamycin resistance in Bacteroides fragilis has been on the increase. Rule of thumb: Clindamycin for lesions above the diaphragm New drugs: Tigecycline, approved by US FDA for use in skin and soft tissue infections, and intra abdominal infections . Has good activity against Bacteroides fragilis group.