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This review describes the microbiology, diagnosis and management of bacteremia caused by …

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- Clinical review: Bacteremia caused by anaerobic bacteria in children

Because of the high mortality rate (15–35%) associated with anaerobic bacteremia, it is imperative to establish early effective therapy. Prolonged therapy with antimicrobial agents apparently is adequate for most patients. However, any source of infection, such as an abscess, should be surgically drained. The average duration of therapy in the patients who recovered in one study [17] was 20 days (range, 7–72 days), and the duration of therapy was related to the presence and severity of other infectious sites and complications. Therapy was longest in the treatment of bacteraemia associated with meningitis, wound abscess, sinusitis and empyema. When anaerobes resistant to penicillin, such as the B. fragilis group, are suspected or isolated, antimicrobial drugs, such as clin-damycin, chloramphenicol, metronidazole, cefoxitin, a car-bapenem, or the combination of a beta-lactamase inhibitor and a penicillin (i.e. ticarcillin-clavulante, piperacillin-tazobactam), should be administered. Local surveillance of antimicrobial susceptibility patterns can provide guidelines as to the choice of the best antimicrobial agent. The development of resistance to all known agents by anaerobes, makes the selection of reliable empirical therapy difficult. Many anaerobic species besides the B. fragilis group have acquired the ability to produce beta-lactamase. Rarely, resistance to imipenem, induced by metalloenzymes, and to metronidazole has been reported [48,49,50]. Consequently, one is not able to predict the susceptibility of some anaerobic isolates. Performing susceptibility testing is of great importance in treating bacteremia caused by anaerobes.

Organisms identical to those causing anaerobic bacteremia can often be recovered from other infected sites (as in 16 patients, 57%, in the study by Brook et al. [17]). No doubt these extravascular sites may have served as a source of persistent bacteremia in some cases; however, the majority of patients will recover completely if prompt treatment with appropriate antimicrobial agents is instituted before any complications develop. The early recognition of anaerobic bacteremia and administration of appropriate antimicrobial and surgical therapy play a significant role in preventing mortality and morbidity in pediatric patients.

Preventing bacteremia associated with dental or oral surgery can be accomplished by prophylactic administration of penicillin [51]. It was demonstrated that, although penicillin pro-phylaxis reduced the total number of facultative anaerobes and strict anaerobes recovered from the blood, metronidazole was more effective in decreasing the recovery of Gram-negative anaerobes [52]. Therefore, a combination of the two may be more effective than either agent alone in eliminating bacteremias after dental procedures.

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