Brook Itzhak
Georgetown University School of Medicine, Washington, DC, USA.
Semin Respir Infect. 2002 Sep;17(3):195-203. doi: 10.1053/srin.2002.34694.
Anaerobes of oral origin are common in chronic upper respiratory tract and other head and neck infections. Anaerobes are the predominant components of the normal human oropharyngeal flora, and are therefore a common cause of bacterial infections of the upper respiratory tract that are of endogenous origin. These bacteria can be isolated in chronic otitis media, sinusitis, and tonsillitis, and their complications. Anaerobes also predominate in deep oral and neck infections and abscesses. Their isolation requires appropriate methods of collection, transportation, and cultivation of specimens. In addition to their active pathogenic role in these infections, many anaerobes express an indirect effect through their ability to produce the enzyme beta-lactamase. This enables these organisms to shield non-beta-lactamase-producing bacteria (BLPB) from penicillins. Inadequate therapy against BLPB may lead to clinical failures. Treatment of anaerobic infection is complicated by their slow growth, their polymicrobial nature, and the growing resistance of anaerobic bacteria to antimicrobials. Antimicrobial therapy is often the only form of therapy needed, whereas in other instances it is an important adjunct to a surgical approach. Because anaerobes generally are isolated mixed with aerobic organisms, therapy should provide for adequate coverage of both types of pathogens.
口腔来源的厌氧菌在慢性上呼吸道及其他头颈部感染中很常见。厌氧菌是正常人类口咽菌群的主要组成部分，因此是内源性上呼吸道细菌感染的常见原因。这些细菌可在慢性中耳炎、鼻窦炎、扁桃体炎及其并发症中分离出来。厌氧菌在深部口腔和颈部感染及脓肿中也占主导地位。它们的分离需要适当的标本采集、运输和培养方法。除了在这些感染中发挥积极的致病作用外，许多厌氧菌还通过产生β-内酰胺酶的能力发挥间接作用。这使得这些微生物能够保护不产生β-内酰胺酶的细菌（BLPB）免受青霉素的影响。对BLPB治疗不足可能导致临床治疗失败。厌氧菌感染的治疗因它们生长缓慢、具有多种微生物特性以及厌氧菌对抗菌药物的耐药性不断增加而变得复杂。抗菌治疗通常是唯一需要的治疗形式，而在其他情况下，它是手术治疗的重要辅助手段。由于厌氧菌通常与需氧菌混合分离，治疗应能充分覆盖这两种类型的病原体。
