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Peptostreptococcus Infection Treatment & Management

  • Author: Itzhak Brook, MD, MSc; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
 
Updated: Oct 07, 2015
 

Medical Care

A patient's recovery from anaerobic infection depends on prompt and proper treatment according to the following principles: (1) neutralizing toxins produced by anaerobes, (2) preventing local bacterial proliferation by changing the environment, and (3) limiting the spread of bacteria.

Control the environment by debriding necrotic tissue, draining pus, improving circulation, alleviating obstruction, and increasing tissue oxygenation. Certain types of adjunctive therapy, such as hyperbaric oxygen therapy, may be useful but remain unproven.

In many cases, antimicrobial therapy is the only form of therapy required, but it can also be an adjunct to a surgical approach. Because anaerobic bacteria, including peptostreptococci, are generally recovered mixed with aerobic organisms, choose antimicrobial agents that treat both types of pathogens, taking into consideration their aerobic and anaerobic antibacterial spectrum and their availability in oral or parenteral form.[25, 26]

Penicillin G is most effective for treating anaerobic gram-positive cocci and microaerophilic streptococci. Other effective agents include other penicillins, cephalosporins, chloramphenicol, clindamycin, vancomycin, telithromycin, linezolid, quinupristin/dalfopristin, and carbapenems.

The efficacy of macrolides (eg, erythromycin) and imidazoles (eg, metronidazole) is variable and unpredictable. Imidazoles are ineffective against some anaerobic gram-positive cocci and all aerotolerant strains.

The newer quinolones are effective against more than 90% of anaerobic cocci; ciprofloxacin is less effective.

Occasionally, certain strains are resistant to antimicrobials, especially after administration of these agents.

When mixed with other beta-lactamase–producing bacteria, anaerobic gram-positive cocci and microaerophilic streptococci may survive penicillin or cephalosporin therapy because of the protection provided by the free enzyme. In such instances, antimicrobials with wider spectrums of activity may be more effective.

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Surgical Care

In most cases, surgical therapy is critically important. Surgical therapy includes (1) draining abscesses, (2) debriding necrotic tissues, (3) decompressing closed-space infections, and (4) relieving obstructions.[27] If surgical drainage is not used, the infection may persist and serious complications may develop.

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Contributor Information and Disclosures
Author

Itzhak Brook, MD, MSc Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, Society for Ear, Nose and Throat Advances in Children, American Federation for Clinical Research, Surgical Infection Society, Armed Forces Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Aaron Glatt, MD Chief Administrative Officer, Executive Vice President, Mercy Medical Center, Catholic Health Services of Long Island

Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American Association for Physician Leadership, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Additional Contributors

Andrea Leigh Zaenglein, MD Professor of Dermatology and Pediatrics, Department of Dermatology, Hershey Medical Center, Pennsylvania State University College of Medicine

Andrea Leigh Zaenglein, MD is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology

Disclosure: Received consulting fee from Galderma for consulting; Received consulting fee from Valeant for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Anacor for consulting; Received grant/research funds from Stiefel for investigator; Received grant/research funds from Astellas for investigator; Received grant/research funds from Ranbaxy for other; Received consulting fee from Ranbaxy for consulting.

References
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  2. Finegold SM. Anaerobic Bacteria in Human Disease. Orlando, Fla: Academic Press; 1977.

  3. Bourgault AM, Rosenblatt JE, Fitzgerald RH. Peptococcus magnus: a significant human pathogen. Ann Intern Med. 1980 Aug. 93(2):244-8. [Medline].

  4. Bartlett JG. How important are anaerobic bacteria in aspiration pneumonia: when should they be treated and what is optimal therapy. Infect Dis Clin North Am. 2013 Mar. 27(1):149-55. [Medline].

  5. Brook I. Recovery of anaerobic bacteria from clinical specimens in 12 years at two military hospitals. J Clin Microbiol. 1988 Jun. 26(6):1181-8. [Medline].

  6. Martin WJ. Isolation and identification of anaerobic bacteria in the clinical laboratory. A 2-year experience. Mayo Clin Proc. 1974 May. 49(5):300-8. [Medline].

  7. Brook I. Peptostreptococcal infection in children. Scand J Infect Dis. 1994. 26(5):503-10. [Medline].

  8. Murdoch DA. Gram-positive anaerobic cocci. Clin Microbiol Rev. 1998 Jan. 11(1):81-120. [Medline].

  9. Jousime-Somers H, Summanen P, Citron DM, et al. Wadsworth-KTL Anaerobic Bacteriology Manual. 6th ed. Belmont, Calif: Star Publishing; 2002.

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  12. Park Y, Choi JY, Yong D, Lee K, Kim JM. Clinical features and prognostic factors of anaerobic infections: a 7-year retrospective study. Korean J Intern Med. 2009 Mar. 24(1):13-8. [Medline]. [Full Text].

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  23. Song Y, Liu C, McTeague M, Vu A, Liu JY, Finegold SM. Rapid identification of Gram-positive anaerobic coccal species originally classified in the genus Peptostreptococcus by multiplex PCR assays using genus- and species-specific primers. Microbiology. 2003 Jul. 149:1719-27. [Medline].

  24. Glupczynski Y, Berhin C, Nizet H. Antimicrobial susceptibility of anaerobic bacteria in Belgium as determined by E-test methodology. Eur J Clin Microbiol Infect Dis. 2009 Mar. 28(3):261-7. [Medline].

  25. Hecht DW. Anaerobes: antibiotic resistance, clinical significance, and the role of susceptibility testing. Anaerobe. 2006 Jun. 12(3):115-21. [Medline].

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  27. Mazuski JE, Solomkin JS. Intra-abdominal infections. Surg Clin North Am. 2009 Apr. 89(2):421-37, ix. [Medline].

  28. Goldstein EJ, Citron DM, Merriam CV. Linezolid activity compared to those of selected macrolides and other agents against aerobic and anaerobic pathogens isolated from soft tissue bite infections in humans. Antimicrob Agents Chemother. 1999 Jun. 43(6):1469-74. [Medline].

  29. Goldstein EJ, Citron DM, Warren YA, Tyrrell KL, Merriam CV, Fernandez H. In vitro activity of moxifloxacin against 923 anaerobes isolated from human intra-abdominal infections. Antimicrob Agents Chemother. 2006 Jan. 50(1):148-55. [Medline].

  30. Dahya V, Chalasani P, Ramgopal M. Peptostreptococcus endocarditis presenting as lumbar discitis in an immunocompromised patient. Am J Med Sci. 2015 Feb. 349 (2):187-8. [Medline].

 
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