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Background Clostridioides (formerly Clostridium) difficile infection (CDI) is associated with significant morbidity and mortality, including frequent hospitalizations. However, the impact of CDI after hospital discharge is poorly understood. The purpose of this study was to assess patient discharge disposition and understand CDI-related risk factors for nonhome discharge. Methods Using a nationally representative database of Veterans Health Administration (VHA) patients (2003–2014) and a validation database from hospitalized non-VHA patients in Houston, Texas, admission and discharge disposition was obtained for patients with CDI and matched controls. Incidence of and clinical/microbiologic risk factors for nonhome discharge were assessed using these databases. Results A total of 15173 VHA patients with CDI and 48599 non-CDI control patients originally admitted from the community were included. Significantly more patients with CDI were discharged to a nonhome location compared with controls (18% vs 8%; P <.0001), most commonly hospice/death (12%) or nursing home/long-term care facility (6%). Results were confirmed using a propensity-matched analysis and a validation cohort of 1941 hospitalized patients with CDI in Houston, Texas. Age, comorbidities, severe CDI, and ribotypes F027, F001, and F053-163 were associated with a nonhome discharge (P <.05 for all). Conclusions Hospitalized patients with CDI frequently required a higher level of medical care residence at discharge compared with non-CDI patients. Risk factors for discharge to a higher level of care included CDI disease severity and variables associated with recurrent CDI. [ABSTRACT FROM AUTHOR]

Background. Hidradenitis suppurativa (HS) is a frequent and severe disease of the skin, characterized by recurrent or chronic skinfold suppurative lesions with a high impact on quality of life. Although considered inflammatory, antimicrobial treatments can improve or lead to clinical remission of HS, suggesting triggering microbial factors. Indeed, mixed anaerobic microbiota are associated with a majority of HS lesions. Our aim in this study was to characterize the landscape of anaerobic infections in HS using high-throughput sequencing. Methods. We sampled and cultured 149 lesions and 175 unaffected control skinfold areas from 65 adult HS patients. The microbiome of 80 anaerobic lesions was compared to that of 88 control samples by 454 high-throughput sequencing after construction of 16S ribosomal RNA gene libraries. Results. Bacterial cultures detected anaerobes in 83% of lesions vs 53% of control samples, combined with milleri group streptococci and actinomycetes in 33% and 26% of cases, respectively. High-throughput sequencing identified 43 taxa associated with HS lesions. Two gram-negative anaerobic rod taxa, Prevotella and Porphyromonas, predominated, contrasting with a reduced abundance of aerobic commensals. These rare taxa of normal skinfold microbiota were associated with lesions independently of gender, duration and familial history of HS, body mass index, and location. Two main additional taxa, Fusobacterium and Parvimonas, correlated with the clinical severity of HS. Conclusions. In this study we reveal the high prevalence and particular landscape of mixed anaerobic infection in HS, paving the way for rationale targeted antimicrobial treatments. [ABSTRACT FROM AUTHOR]

Metronidazole has been used for the treatment of infections for >45 years and is still successfully used for the treatment of trichomoniasis, amoebiasis, and giardiasis. Anaerobic bacterial infections caused by Bacteroides species, fusobacteria, and clostridia respond favorably to metronidazole therapy. Good clinical results in the treatment of vaginosis due to Gardnerella vaginalis have also been reported. Rates of resistance to metronidazole are still generally low; however, several studies have reported decreased susceptibility among Bacteroides species, as well as different mechanisms of resistance. Metronidazole-resistant Helicobacter pylori strains have been described, but combination therapy (eg, metronidazole, amoxicillin, or clarithromycin plus omeprazole) is still recommended for eradication of this pathogen in patients with gastroduodenal ulcers. Metronidazole is considered to be a cost-effective drug because of its low cost, good activity against pathogenic anaerobic bacteria, favorable pharmacokinetic and pharmacodynamic properties, and minor adverse effects. Metronidazole is still the criterion standard for therapy of anaerobic infections, as was described by Tally and colleagues 35 years ago. [ABSTRACT FROM AUTHOR]

Background. During 1974-1988, the incidence of anaerobic bacteremia at the Mayo Clinic (Rochester, MN) decreased. This trend occurred nationally, prompting calls for discontinuation of routine anaerobic blood cultures. However, recently, the sites of anaerobic infection have been shown not to be as predictable as once thought, and since 1993, the incidence of anaerobic bacteremia has increased significantly in our medical center. Methods. Records from the Mayo Clinic Division of Clinical Microbiology were used to tabulate the number of cases of anaerobic bacteremia in patients at the clinic for the 12-year period from 1993 through 2004. Medical records for patients with anaerobic bacteremia were reviewed from the periods of 1993-1994 and 2004 to identify differences between these 2 patient populations with different rates of bacteremia. Results. The mean incidence of anaerobic bacteremias increased from 53 cases per year during 1993-1996 to 75 cases per year during 1997-2000 to 91 cases per year during 2001-2004 (an overall increase of 74%). The total number of cases of anaerobic bacteremia per 100,000 patient-days increased by 74% (P<.001). The number of anaerobic blood cultures per 1000 cultures performed increased by 30% (P = .002). Organisms from the Bacteroides fragilis group, other species of Bacteroides, and Clostridium species were most commonly isolated. Conclusions. Anaerobic bacteremia has reemerged as a significant clinical problem. Although there are probably multiple reasons for this change, the increasing number of patients with complex underlying diseases makes the clinical context for anaerobic infections less predictable than it once was. Anaerobic blood cultures should be routinely performed in medical centers with a patient population similar to ours. [ABSTRACT FROM AUTHOR]

The usefulness of fluoroquinolones for the treatment of mixed aerobic and anaerobic infections has been investigated since these agents started being used in clinical practice. Newer compounds have increased in vitro activity against anaerobes, but clinically relevant susceptibility breakpoints for these bacteria have not been established. Pharmacodynamic analyses and corroboration by new data from clinical trials have enhanced our knowledge concerning the use of fluoroquinolones to treat selective anaerobic pathogens. These studies suggest that newer agents could be useful in the treatment of several types of mixed aerobic and anaerobic infections, including skin and soft-tissue, intra-abdominal, and respiratory infections. The major concerns with expanding the use of fluoroquinolones to treat anaerobic infections have been reports of increasing resistance in Bacteroides group isolates and the impact of these antibiotics on the incidence of Clostridium difficile-associated disease. [ABSTRACT FROM AUTHOR]

Tetanus remains a serious problem in public health, particularly in developing countries, despite efficient prevention programs. A retrospective study was conducted at an infectious diseases intensive care unit during 1998–2003 involving patients admitted with grade III tetanus. The aim of the study was to evaluate the efficacy and safety of intrathecal baclofen for the treatment of tetanus. Lumbar puncture was performed, and a subarachnoid catheter was inserted for drug administration. An intrathecal bolus of baclofen was followed by a continuous infusion of 20 μg/h, until a maximum daily dose of 2 mg was provided. Twenty-two patients were treated overall. Control of the symptoms was achieved in all patients but one. Seven patients had colonization of the catheter, and 1 patient developed meningitis. All patients except one recovered. In our study, this means of treatment was efficacious and well tolerated. [ABSTRACT FROM AUTHOR]

Provides guidelines for the selection anti-infective agents for complicated intra-abdominal infections in the U.S. Identification of anaerobic organisms identified in community-acquired infections; Accounts on the types of infections requiring antimicrobial therapy; Consideration of the ways to decrease the likelihood of recurrence; Adequacy of visceral perfusion.

The results of a multicenter US survey using the National Committee for Clinical Laboratory Standards currently recommended methodology for measuring in vitro susceptibility of 2673 isolates of Bacteroides fragilis group species were compared from 1997 to 2000. The test panel consisted of 14 antibiotics: 3 carbapenems, 3 β-lactam-β-lactamase inhibitors, 3 cephamycins, 2 fluoroquinolones, dindamycin, chloramphenicol, and metronidazole. Declines in the geometric mean minimum inhibitory concentrations were seen with imipenem, meropenem, ampicillin-sulbactam, and the cephamycins. Increased geometric means were observed with the fluoroquinolones and were usually accompanied by an increase in resistance rates. Bacteroides distasonis shows the highest resistance rates among β-lactam antibiotics, whereas Bacteroides vulgatus shows the highest resistance levels among fluoroquinolones. B. fragilis shows the lowest resistance rates for all antibiotics. All strains were susceptible to chloramphenicol and metronidazole concentrations <8 µg/mL. The data underscore the need for species identification and continued surveillance to monitor resistance patterns. [ABSTRACT FROM AUTHOR]

Anaerobic infections occur in surgical patients in part because of structural or functional defects in the host that (1) cause a breech in the normal mucosal barriers, (2) create localized vascular insufficiencies, or (3) produce an obstruction. Any or all of these events may compromise the oxidation-reduction potential within the tissues, encouraging rapid anaerobic growth. Although diverse anaerobic populations are spread throughout the gastrointestinal tract, a relatively limited number of organisms are responsible for clinical infection in the surgical patient. Many of these offending organisms express overt virulence factors that enhance microbial adherence, tissue destruction, and, in the case of Bacteroides fragilis, facilitate abscess formation. The selection of an appropriate perioperative or therapeutic agent requires a fundamental knowledge of the microbial ecology of this microbial population. The failure to consider the anaerobic flora as a component in the etiology of mixed surgical infections is associated with a high rate of perioperative and therapeutic failures. [ABSTRACT FROM AUTHOR]

Intra-abdominal infections are biphasic, synergistic processes with early peritonitis and bacteremia due to aerobes and a later abscess component due to anaerobes. Although Bacteroides fragilis is the most commonly recognized pathogen, other anaerobes, including other members of the B. fragilis-group species, are major components of infection. Anaerobic bacteremia is often associated with an intra-abdominal source. New antimicrobial agents with anaerobic activity are in various stages of development for the therapy of intraabdominal infections. The in vitro activity and the currently available sparse clinical data are reviewed for a new carbapenem (ertapenem), several fluoroquinolones (trovafloxacin, moxifloxacin, and gemifloxacin), and a desfluoroquinolone (BMS-284756). [ABSTRACT FROM AUTHOR]

Presents a study which determined the microbiological characteristics, epidemiology and outcome of anaerobic bloodstream infections and to identify risk factors for infection. Patients and methods; Results; Discussion.

The author discusses diagnosis of complications of Clostridium difficile infection (CDI). Topics discussed include dissemination of closely related fluoroquinolone-resistant strains of C. difficile by various typing methods pulse field gel electrophoresis type 1, restriction endonuclease assay type BI, or polymerase chain reaction ribotype 027 strains, need of new, preventive and therapeutic strategies for diagnosis of CDI, new treatments include oral agents such as vancomycin and fidaxomicin.

The article reflects on various medical studies about routine anaerobic blood cultures. It states that anaerobes have an increasing frequency in medical centers where patients with complex underlying disease are treated. It questions on the use of clinical presentation to predict the likelihood of anaerobic infection and perform cultures for only at-risk patients.

Reports the case of a 71-year-old male with Bacteroides fragilis bactermia and infected aortic aneurysm that went undiagnosed due to the failure to obtain routine anaerobic blood cultures. Declining cases of bacteremia caused by anaerobes blood cultures; Recommendation for hospitals to discontinue routine anaerobic blood cultures; Potential impact of deleting anaerobic blood cultures from routine protocols.

A letter to the editor is presented in response to the article describing the increase in the incidence of anaerobic infections that could have been due to increasing number of patients with complex underlying disease by Lassmann and colleagues in the previous issue.

Contains corrected reprints of articles published in past issues of the journal 'Clinical Infectious Diseases.' Possible regimens for patients allergic to penicillins; Anaerobic infections in the surgical patient; Phenotypes of macrolide-resistant isolates.

Presents recorrected reprints of articles published in several issues of the journal 'Clinical Infectious Diseases'. Anaerobic infections in surgical patients; Prolonged candidemia in patients with cancer; Macrolide-resistant isolates in the U.S.

The article reports on the U.S. FDA's approval for the Boostrix vaccine developed by GlaxoSmithKline. The Boostrix vaccine combines a pertussis vaccine with the routine tetanus and diphtheria booster given to adolescents. Health officials are concerned because pertussis cases and related infant mortality are on the rise in the United States. Boostrix was approved for use as a single- shot booster for young people ages 10-18 years old.