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Bacterial synergy in pelvic inflammatory disease
1Uniformed Services, University of the Health Sciences, Bethesda, Maryland.
Abstract:
Polymicrobial aerobic and anaerobic flora are responsible for pelvic inflammatory disease (PID). The most frequent pathogens appear to be Neisseria gonorrhoea and anaerobic bacteria (most commonly anaerobic cocci and Bacteroides sp.). Recent studies have demonstrated the recovery of Chlamydia trachomatis in up to a third of these infections. Although N. gonorrhoea is frequently recovered from cervical cultures, it is less commonly recovered from intra-abdominal sites. Recent studies have demonstrated the in-vivo synergistic relationship between N. gonorrhoeae and Bacteroides fragilis. The growth of each component of the mixed infection was enhanced when these were present together in an abscess. Furthermore, the emergence of encapsulated strains was enhanced in these infections. This synergy enables the organisms to cause more severe local and systemic damage to the host. Therapeutic intervention should include the use of antimicrobial agents effective against both the aerobic and anaerobic components of the mixed infection. Unless such therapy is given, the infection may persist. It is also recommended to use antimicrobials that possess synergy between them against the bacterial pathogens. Agents effective against the anaerobic pathogens are metronidazole, clindamycin and cefoxitin. Antimicrobials effective against the Gram-positive aerobic pathogens and N. gonorrhoeae are spiramycin and penicillins. Aminoglycosides or third generation cephalosporins are effective against Gram-negative enterics. The combination of metronidazole and spiramycin has shown to be synergistic against mixed infections of Bacteroides sp. and N. gonorrhoeae.
Insights
Pelvic inflammatory disease (PID) involves aerobic and anaerobic bacteria, including Neisseria gonorrhoeae and Chlamydia trachomatis. Effective PID treatment requires antimicrobials targeting both aerobic and anaerobic pathogens for synergistic action.
Area of Science:
- Microbiology
- Infectious Diseases
- Gynecology
Background:
- Pelvic inflammatory disease (PID) is a polymicrobial infection involving aerobic and anaerobic bacteria.
- Key pathogens include Neisseria gonorrhoeae, anaerobic cocci, Bacteroides sp., and Chlamydia trachomatis.
- N. gonorrhoeae is often found in cervical cultures but less frequently at intra-abdominal sites.
Purpose of the Study:
- To investigate the synergistic relationship between N. gonorrhoeae and anaerobic bacteria in PID.
- To highlight the impact of this synergy on disease severity and host damage.
- To recommend effective therapeutic strategies for polymicrobial PID.
Main Methods:
- Review of recent studies on PID pathogens and their interactions.
- Analysis of in-vivo synergistic relationships between N. gonorrhoeae and Bacteroides fragilis.
- Evaluation of antimicrobial agents effective against aerobic and anaerobic components of PID.
Main Results:
- N. gonorrhoeae and anaerobic bacteria, particularly Bacteroides sp., are primary causes of PID.
- A synergistic relationship exists between N. gonorrhoeae and Bacteroides fragilis, enhancing infection severity.
- This synergy promotes the emergence of encapsulated strains, increasing host damage.
Conclusions:
- PID treatment must target both aerobic and anaerobic pathogens with synergistic antimicrobial agents.
- Metronidazole, clindamycin, and cefoxitin are effective against anaerobic pathogens.
- Spiramycin and penicillins target Gram-positive aerobes and N. gonorrhoeae; aminoglycosides or third-generation cephalosporins target Gram-negative enterics.
- A combination of metronidazole and spiramycin demonstrates synergy against mixed Bacteroides sp. and N. gonorrhoeae infections.