[Anaerobic infections in operative medicine]

Compared with other medical disciplines, anaerobic infections play an especially important role in operative medicine. In odontogenic soft tissue infections of the orofacial area, in intraabdominal suppurative processes and in post partum, post abortum or postoperative gynecological infections, anaerobic pathogens are almost inevitably encountered. Furthermore, even in times of peace exogenous or endogenous toxic clostridial infections do not occur so rarely that they should be excluded from considerations concerning differential diagnosis. Because of the substantial malignancy of some of these infections, because of considerable variation in the species composition of anaerobic infections at different body sites and because of the peculiar antibiotic sensitivity pattern of certain anaerobes, diseases caused by anaerobic pathogens deserve special diagnostic and therapeutic attention. The reliable recognition of the anaerobic etiology of inflammatory lesions is usually only possible when microscopic or cultural bacteriological examinations are performed. As complete bacteriological analyses may be comparatively time-consuming, the clinician's requirements for planning the appropriate treatment are met best when he is informed of the tentative diagnosis of an anaerobic infection as soon as possible. This may often be achieved by microscopic or gaschromatographic techniques within less than two hours. The treatment of "surgical anaerobic infections" usually consists of operative measures combined with antibacterial chemotherapy. Only in selected cases, incision and drainage will suffice to cure a localized anaerobic suppuration. As a rule, additional application of antibacterial drugs is necessary or at least advisable in order to reliably prevent relapses or systemic spread. Appropriate chemotherapeutics are selected according to the pathogens that are individually present or may be expected with some probability. Diseases due to Gram-positive, non-spore-forming anaerobes, fusobacteria and Bacteroides species of the melaninogenicus group are comparatively easy to treat as these organisms are usually susceptible to penicillins including benzylpenicillin in sufficiently high doses. Against beta-lactamase-producing intestinal Bacteroides species such as B. fragilis and B. thetaiotaomicron, lincomycins and nitroimidazoles have proved to be highly effective. Infections caused by these Bacteroidaceae may also respond to treatment with mezlocillin, cefoxitin, lamoxactam and possibly aminopenicillins combined with clavulanic acid.(ABSTRACT TRUNCATED AT 400 WORDS)