Tubo-ovarian abscess caused by multidrug resistant Bacteroides gracilis

Bacteroides gracilis infections are very rare and have always been reported to have a polymicrobial etiology. The majority of these infections occur in the head and neck areas, the pleuropulmonary system, and the abdominal cavity. We report a case of tubo-ovarian abscess caused by B. gracilis. A literature search revealed no previous reports. Our patient, a 29-year-old woman, experienced fever and lower abdominal pain caused by a tubo-ovarian abscess. Her treatment consisted of surgical drainage and prolonged intravenous antibiotic therapy. Initial therapy with cefotaxime and metronidazole failed and she remained febrile after the laparotomy. Her clinical condition improved slowly after initiation of imipenem therapy. Culture of a pus specimen obtained during surgery yielded B. gracilis, which was resistant to imipenem but susceptible to clindamycin. Combination therapy with imipenem and clindamycin was then administered and she recovered completely. Clindamycin was subsequently prescribed for long-term bacterial suppression. The potential difficulties in treating B. gracilis infections were a major clinical concern in the treatment of this patient.