Abstract

PIP: Anaerobic organisms are the predominant etiologic agents in female genital tract infections. This article describes the conditions necessary for anaerobic growth, cites the diseases in which these organisms play a role, and outlines therapy for anaerobic genital infections. As interest in anaerobic bacteria has increased and culture techniques have improved, the number and variety of species of organisms has grown. Infections generally consist of several anaerobic species with 1 or more aerobic species. It is unclear whether additional organisms such as mycoplasma species or chlamydia impact on the establishment of genital tract infections, and whether multiple anaerobic organisms are needed to establish and maintain infection. For clinical infection to develop, an alteration in either host resistance or numbers of bacteria present must occur. Infections are usually associated with a compromised host whose defense mechanisms have been altered by natural causes or medical interventions such as trauma, surgery, irradiation, steroid treatment, immunosuppressive agents, cytotoxic agents, and certain antibiotics. Infections are classified as either hospital-acquired or community-acquired. The latter category includes pelvic inflammatory disease, pelvic thrombophlebitis, septic abortion, and premature rupture of the membranes. Hospital-acquired infections include postcesarean section endometritis, postoperative pelvic infections, wound infections, hospital-terminated pregnancy, septic thrombophlebitis, and pelvic abscess. Most diseases caused by anaerobic bacteria are characterized by tissue necrosis and abscess formation and an indolent or chronic course. Therapy options include supportive therapy with fluids and blood, administration of antibiotics, and surgical drainage. Initial therapy with full supportive endeavors and full-dose antimicrobial therapy is preferable to planned sequential antibiotic management. In vitro activity against anaerobes and aerobic organisms, tissue penetration, and toxicity should be considered in selecting antimicrobial agents. High-dose single agent chemotherapy is effective in early infections, whereas late infections require double or triple therapy.