Modern approach to the diagnosis of anaerobic surgical sepsis

Oxygen-sensitive anaerobic bacteria comprise the largest group of organisms among the human endogenous microflora. The oral cavity, the vagina, and the colon are the areas of the human body where the obligate anaerobes are predominant and can be isolated in very high numbers. Sepsis following surgery of any of these organs is frequently due to the escape of these endogenous bacteria during the course of the operative procedure. To enable the isolation and successful identification of most of these anaerobic microorganisms from clinical exudate, special collection and bacteriologic techniques are necessary. The acceptable anaerobic collection techniques have been reviewed in this paper. All of these techniques minimize the exposure of the clinical specimen to atmospheric oxygen during collection and transfer. The modern equipment used in sophisticated anaerobic bacteriologic workup has been discussed. Clinical clues that indicate anaerobic sepsis include a putrid odor of the exudate and evidence of abscess, necrosis, or associated gas formation. The importance and value of the gram-stain in the early identification of surgical sepsis has been stressed.