Obligate anaerobes

Microbiology

• Colonizes skin and mucosal surfaces
• Difficult to grow

Organisms

• Gram-negative
  • Bacilli
    • Bacteroides species
      • B. fragilis group: B. fragilis, B. thetaiotaomicron, B. distasonis, B. vulgatus, B. ovatus, B. uniformis
      • Other Bacteroides spp.: B. gracilis, B. ureolyticus, Bilophila wadsworthia, Sutterella spp
    • Prevotella species
      • Pigmented: P. melaninogenica, P. intermedia, P. denticola, P. loescheii, P. corporis, P. nigrescens
      • Non-pigmented: P. oris, P. buccae, P. oralis group (P. oralis, P. buccalis, P. veroralis), P. bivia, P. disiens
    • Porphyromonas species: P. asaccharolytica, P. gingivalis, P. endodontalis
    • Fusobacterium species: F. nucleatum, F. necrophorum, F. gonidiaformans, F. naviforme, F. mortiferum, F. verium
    • Bilophila species
    • Sutterella species
  • Cocci
    • Veillonella species
• Gram-positive
  • Cocci
    • Peptostreptococcus spp.: P. magnus, P. asaccharolyticus, P. prevotii, P. intermedius, P. anaerobius, P. micros
  • Bacilli (spore-forming)
    • Clostridium species: C. perfringens, C. ramosum, C. septicum, C. novyi, C. histolytica, C. sporogenes, C. difficile, C. bifermentans, C. butyricum, C. innocuum, C. sordellii, C. botulinum, C. tetani
  • Bacilli (non-spore-forming)
    • Propionibacterium species: P. acnes, P. propionicum, P. granulosum
    • Eubacterium tentum
    • Bifidobacterium species: B. eriksonii, B. dentium
    • Actinomyces species: A. israelii, A. naestundii, A. viscosus, A. odontolyticus, A. meyerii

Management

• Ampicillin or penicillin (for Gram-positive anaerobes)
• β-lactam/β-lactamase inhibitor combinations,
• Cephamycins (e.g. cefoxitin)
• carbapenems
• clindamycin (though increasing resistance)
• metronidazole
• moxifloxacin
• tetracycline

Further Reading

• Brook I. Spectrum and treatment of anaerobic infections. J Infect Chemother (2015). doi: 10.1016/j.jiac.2015.10.010