Affiliations: Department of Pediatrics, Georgetown University School
of Medicine, Washington DC 20016, USA
Note: [] Corresponding author: Itzhak Brook, MD, MSc, 4431 Albemarle st
NW, Washington DC 20016, USA. Tel.: +1 202 363 4253; Fax: +1 202 244 6809;
E-mail: ib6@georgetown.edu
Abstract: The awareness of the role of anaerobic bacteria in neonatal
bacteremia and sepsis has increased in recent years. The incidence of recovery
of anaerobes in neonatal bacteremia varies between 1.8% and 12.5%. Of the
179 cases reported in the literature, 73 were due to Bacteroides spp.
(69 were the Bacteroides fragilis group), 57 Clostridium spp.
(mostly Clostridium perfringens), 35 Peptostreptococus spp., 5
Propionibacterium acnes, 3 Veillonella spp., 3 Fusobacterium spp,
and 2 Eubacterium spp. Predisposing factors were perinatal maternal
complications (especially premature rupture of membranes and chorioamnionitis),
scalp abscess, prematurity, and necrotizing enterocolitis. Organisms similar to
those isolated in blood were concomitantly recovered in lung aspirates and
cerebrospinal and peritoneal fluids. The overall mortality noted is 26% and
is highest with B. fragilis group (34%). Inappropriate choice of
antimicrobial therapy was often a contributory factor to mortality. Correction
of underlying pathology, surgical drainage, and the use of proper
antimicrobials are critical to successful resolution of the infection.
Penicillin G is the drug of choice for anaerobic infection other than one due
to beta-lactamase-producing anaerobic Gram negative bacilli. Antimicrobials
useful for therapy these organisms include clindamycin, metronidazole,
chloramphenicol, a carbapenem, and the combination of a penicillin plus a
beta-lactamase inhibitor.
