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  Table of Contents  
Year : 2013  |  Volume : 31  |  Issue : 4  |  Page : 392-394

Anaerobes in nosocomial and community acquired pleural infections

1 Department of Clinical Microbiology and Infectious Diseases, Dr. Suat Seren Chest Diseases and Chest Surgery Research Hospital, Yenisehir, Izmir, Turkey
2 Department of Microbiology and Clinical Microbiology, Dr. Suat Seren Chest Diseases and Chest Surgery Research Hospital, Yenisehir, Izmir, Turkey
3 Department of Chest Diseases, Dr. Suat Seren Chest Diseases and Chest Surgery Research Hospital, Yenisehir, Izmir, Turkey

Date of Submission11-Mar-2013
Date of Acceptance08-Aug-2013
Date of Web Publication25-Sep-2013

Correspondence Address:
G Senol
Department of Clinical Microbiology and Infectious Diseases, Dr. Suat Seren Chest Diseases and Chest Surgery Research Hospital, Yenisehir, Izmir
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0255-0857.118902

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 ~ Abstract 

Anaerobes are important causes of pleural space infections. The aim of the study is to evaluate the role of the anaerobic bacteria in pleural infections. The study involved 278 consecutive clinical samples sent to the Clinical Microbiology Laboratory of Tertiary Chest Hospital. Anaerobes were isolated in 39 community acquired and five nosocomial cases out of 278 anaerobic cultivations (15.8%). Total of 56 anaerobe strains were identified and 21 aerobes were accompanied to anaerobic isolates. Aerobe isolates were associated with anaerobic microorganisms in 19 cases (43.2%). Bacteroides species (21.4%) and Pseudomonas aeruginosa (33.3%) were the most common anaerobic and aerobic isolates.

Keywords: Anaerobe bacteria, community acquired infections, empyema, nosocomial infections, pleuropulmonary infections

How to cite this article:
Senol G, Coskun M, Gunduz A, Bicmen C, Tibet G. Anaerobes in nosocomial and community acquired pleural infections. Indian J Med Microbiol 2013;31:392-4

How to cite this URL:
Senol G, Coskun M, Gunduz A, Bicmen C, Tibet G. Anaerobes in nosocomial and community acquired pleural infections. Indian J Med Microbiol [serial online] 2013 [cited 2021 Jan 22];31:392-4. Available from:

 ~ Introduction Top

Pleuropulmonary infections continue to cause significant morbidity and mortality despite the improvement of antimicrobial therapy and the existence of multiple options for drainage of the infected pleural space. [1] They are generally an internal extension of infection from pneumonia, lung, oral, retropharyngeal, paravertebral, or skin abscess, mediastinal lymph nodes, or external introduction of organisms due to trauma or surgery. [2] Several studies have indicated anaerobic bacteria approximately 15% in pleuropulmonary infections. [3] However, literature shows large discrepancies between countries, as well as between different hospitals in the same country. This retrospective study was designed to investigate the variety of anaerobic bacterial isolates of pleuropulmonary infections in a tertiary medical centre.

 ~ Materials and Methods Top

Pleuropulmonary clinical samples (aspiration materials of thoracentesis, drainage of thoracic tube, transthoracic abscess aspiration and broncoscobic aspirations) were studied for anaerobic culture in clinical microbiology laboratory of tertiary chest diseases and chest surgery referral hospital between 2007 and 2009 years. Cases were classified as nosocomial and community acquired infections according to hospital infection control team records. National nosocomial infections surveillance system (Utah Higher Education Staff Association-UHESA) definitions for nosocomial infections were applied. [4]

Specimens were examined by Gram stain for microscopic evaluation and inoculated onto 5% sheep's blood, chocolate and Eosin- Methylene-Blue, blood agar containing kanamycin and vancomycin (BD Schaedler Agar, Becton Dickinson, U.S.A), and into an enriched thioglycolate broth (containing hemin and vitamin K1). The anaerobic cultures were performed by anaerobic jar using BD GasPak pouch with anaerobe indicator system (Becton Dickinson, Maryland, U.S.A). The anaerobic plates and thioglycolate broth were examined at 48 h and 96 h. The plates were observed up to 7 days for any growth. Pure isolates were identified by both classical methods (Gram stain morphology, catalase, oxidase, indol, urease, and nitrate tests) and the Crystal identification system (Becton Dickinson, U.S.A.). [5],[6] Hospital ethics committee has approved the study.

 ~ Results Top

The study involved 278 consecutive clinical samples. Anaerobes were isolated in 44 cases out of 278 anaerobic cultivations (15.8%). Ages of patients were in range of 17-74 years old (mean 45.3 years). Total of 56 anaerobe isolates were identified and 21 aerobes were accompanied to anaerobes. In 12 cases (27.3%), more than one anaerobe bacteria were isolated. Aerobe isolates were associated with anaerobic microorganisms in 19 cases (43.2%). Six anaerobe (10.7%) and five aerobe (23.8%) bacteria were identified in five nosocomial infection cases (11.4%). All nosocomial infections were polymicrobial. Bacteroides species were isolated in nine ampyema, two lung abscesses and one nosocomial postlobectomy ampyema cases. All microorganisms isolated from clinical specimens were given in [Table 1]. Details of nosocomial cases were also seen in [Table 2].
Table 1: Aerobe and anaerobe microorganisms isolated from clinical specimens in anaerobic cultivation

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Table 2: Aerobe and anaerobe microorganisms isolated from nosocomial cases

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 ~ Discussion Top

Various studies during the past 15 years have provided data concerning bacteriologic patterns, pathophysiologic mechanisms and strategies of management. Contradictory results have been reported. Possible reason of the different results among studies could be necessity of special conditions for recovery of anaerobes (rapid transport, adequate transport medium, specific media and anaerobic conditions). [7]

The major isolates in anaerobic bacterial infections of the lung were reported Peptostreptococci, B. melaninogenicus (Prevotella sp. as recent nomenclature) and Fusobacterium nucleatum. [8] Maskel et al., had reported 9% single anaerobic and 12% polymicrobial infections in 434 pleural cases. [7] Anaerobic bacteria in 25 (13%), and mixed aerobic and anaerobic bacteria in 45 (23%) were detected in 197 cultures by Brook and Fraizer in their retrospective review. [2] In patients with thoracic empyema, Chen et al., had reported 14 pure anaerobe, 19 mixed aerobe and anaerobe bacteria in 139 pleuropulmonary infection cases. They found Fusobacterium species (8.6%) and Peptostreptococcus species (7.9%) as predominant anaerobes. [9] Bayonova et al., had found anaerobic bacteria in 74.2% of the empyema patients (n = 198 patient) and included 247 strains within 21 genera. The predominant anaerobes were Gram-positive anaerobic cocci (n = 52), Fusobacterium sp. (n = 1), microaerophilic streptococci (n = 2 4) and Prevotella sp. (n = 19). [10] Maskell et al., had reported most common isolates Fusobacterium sp. (n = 20), Bacteroides sp. (n = 17) and Prevotella sp. (n = 14) in 396 clinical isolates, respectively. [7]

Role of anaerobic bacteria in nosocomial pleuropulmonary infections is not clear. Chuang and colleagues had reported 3.2% anaerobic strains in all nosocomial pathogens in their long-term surveillance study in Taiwan. [11] Robert et al., had found 15 anaerobe and 21 aerobe colonisation out of 26 patients, but just in one case identified anaerobic etiology in five ventilator associated pneumonia (VAP). [12] In contrary, Marik et al., had diagnosed just one anaerobe (Veilonella paravula-nonpathogenic strain) in 17 aspiration pneumonia and none in 74 VAP cases. [13] Maskell et al., had reported 67 community acquired and five nosocomial anaerobic strains in 434 pleural infections. They identified Fusobacterium sp, Bacteroides sp and Peptostreptococci as the most common community acquired and Fusobacterium sp, Bacteroides sp, Prevotella sp and two unclassified mix anaerobe strains as nosocomial agents. [7]

B. fragilis is not member of normal oropharyngeal flora. However, B. fragilis can cause pleural space infections by transdiaphragmatic spread or haematogenous dissemination from distant sites. [14] We detected 12 (21.4%) Bacteriodes species as aetiological agent in our study.

 ~ Conclusion Top

In treatment of pleuropulmonary infections, choice of antibiotic should cover for both aerobic and anaerobic organisms. This study emphasized wide diversity of the anaerobic microbiology in pleuropulmonary infections and indicated polymicrobial aetiology in especially nosocomial cases.

 ~ References Top

1.LeMense GP, Strange C, Sahn SA. Empyema thoracis. Therapeutic management and outcome. Chest 1995;107:1532-7.  Back to cited text no. 1
2.Brook I, Frazier EH. Aerobic and anaerobic microbiology of empyema. A retrospective review in two military hospitals. Chest 1993;103:1502-7.  Back to cited text no. 2
3.Wehr CJ, Adkins RB Jr. Empyema thoracis: A ten-year experience. South Med J 1986;79:171-6.  Back to cited text no. 3
4.National Hospital Infections Surveillance and Control Department. Available from: http://www. [Last accessed on 2012 Dec 22].  Back to cited text no. 4
5.Cavallaro JJ, Wiggs LS, Miller JM. Evaluation of the BBL Crystal anaerobe identification System. J Clin Microb 1997;35:3186-91.  Back to cited text no. 5
6.Brazier JS, Hall V. A simple evaluation of the AnaeroGen system for the growth of clinically significant anaerobic bacteria. Lett Appl Microbiol 1994;18:56-8.  Back to cited text no. 6
7.Maskell NA, Batt S, Hedley EL, Davies CW, Gillespie SH, Davies RJ. The bacteriology of pleural infection by genetic and standard methods and its mortality significance. Am J Respir Crit Care Med 2006;174:817-23.  Back to cited text no. 7
8.Nagy E. Anaerobic bacteria and the lung. Grace Workshop, 22-24 October, Prague, Czech Republic 2007:317-9.  Back to cited text no. 8
9.Chen W, Lin YC, Liang, SJ, Tu CY, Chen HJ, Hang LW, et al. Hospital-acquired thoracic empyema in adults: A 5-year study. South Med J 2009;102:909-14.  Back to cited text no. 9
10.Boyanova L, Vladimir Djambazov, Gergova G, Dragomir Iotov, Petrov D, Osmanliev D, et al. Anaerobic microbiology in 198 cases of pleural empyema: A Bulgarian study. Anaerobe 2004;10:261-7.  Back to cited text no. 10
11.Chuang YC, Chen YC, Chang SC, Sun CC, Chang YY, Chen ML, et al. Secular trends of healthcare-associated infections at a teaching hospital in Taiwan, 1981-2007. J Hosp Infect 2010;76:143-9.  Back to cited text no. 11
12.Robert R, Grollier G, Frat JP, Godet C, Adoun M, Fauchère JL, et al. Colonization of lower respiratory tract with anaerobic bacteria in mechanically ventilated patients. Intensive Care Med 2003;29:1062-8.  Back to cited text no. 12
13.Marik PE, Careau P. The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: A prospective study. Chest 1999;115:178-83.  Back to cited text no. 13
14.De A, Varaiya A, Mathur M. Anaerobes in pleuropulmonary infections. Indian J Med Microbiol 2002;20:150-2.  Back to cited text no. 14
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