Clinical sites associated with anaerobic infections^[1-5]

Site of infection	Anaerobe detection rate in local infections (frequency)	Anaerobic or microaerophilic organisms at each site that may cause infection
Ears, eyes, oral cavity, throat
Conjunctiva	Ocular infections (Occasionally)	Cutibacterium acnes, GPAC*
Ear and mastoid	Otitis media (Frequently) Mastoiditis (Frequently)	GPAC, Prevotella* spp, Porphyromonas spp, Bacteroides spp, Fusobacterium spp
Sinuses	Chronic sinusitis (Very frequently) Acute sinusitis (Rarely)	GPAC, Prevotella* spp, Porphyromonas spp, Bacteroides spp, Fusobacterium spp
Oral cavity	Postoperative infections of the oral mucosa (Very frequently)	GPAC, Prevotella* spp, Porphyromonas spp, Bacteroides spp, Fusobacterium spp, Actinomyces spp, Veillonella spp, Capnocytophaga spp, Tannerella forsythia, Treponema spp
Teeth	Odontogenic infections (Very frequently) Necrotizing periodontal disease or ulcerative gingivitis, also called Vincent angina ("trench mouth", an erosive polymicrobial infection) (Always) Noma (cancrum oris) (Always)	GPAC, microaerophilic streptococci Vincent angina: Fusobacterium* spp, anaerobic spirochetes
Tonsils/pharynx	Peritonsillar and retropharyngeal abscess (Very frequently)	Fusobacterium spp (eg, F. nucleatum, F. necrophorum), Prevotella spp, Porphyromonas spp, GPAC*
Salivary glands	Parotitis (Very frequently)	Bacteroides spp, Fusobacterium spp, GPAC*
Neck
Thyroid, cervical lymph nodes	Cervical lymphadenitis (Occasionally) Suppurative thyroiditis (Rarely) ^[3-5]	GPAC, Prevotella* spp, Porphyromonas spp
Neck structures	Deep neck abscess (Very frequently)	Bacteroides spp, Fusobacterium spp, GPAC*
Neck structures	Jugular vein suppurative thrombophlebitis (Lemierre syndrome) (Very frequently)	F. necrophorum
Pleuropulmonary
Lung	Lung abscess (Very frequently) Aspiration and/or necrotizing pneumonia (Very frequently) Pleural empyema (Very frequently) Bronchiectasis (Occasionally) Nosocomial pneumonia (Occasionally)	Prevotella spp, Fusobacterium spp, GPAC, Bacteroides* spp, non-spore forming gram-positive rods (Actinomyces, Eubacterium, and Lactobacillus spp)
Intra-abdominal and female genital tract
Abdomen	Intra-abdominal abscess (Very frequently) Appendicular abscess (Very frequently) Appendicitis/peritonitis (Very frequently) Post-surgical intra-abdominal infections (Very frequently) Liver abscess (Frequently) Biliary tract infections (Occasionally)	Bacteroides fragilis and other Bacteroides spp (more than 50 species such as B. vulgatus, B. thetaiotaomicron), Prevotella spp, Porphyromonas spp, Fusobacterium spp, Veillonella spp, Bilophila wadsworthia, GPAC, Clostridium* spp, Eubacterium spp, Eggerthella spp, Bifidobacterium spp
Female genital tract	Pelvic inflammatory disease (Very frequently) Pelvic abscess (Very frequently) Endometritis (Very frequently) Vaginal cuff abscess (Very frequently) Bacterial vaginosis (Very frequently) Urinary tract infections (Very rarely)	Lactobacillus spp, GPAC, Bacteroides* spp, Fusobacterium spp, Prevotella spp, Veillonella spp, Porphyromonas spp, Sneathia spp, Actinomyces and Eubacterium spp (in intrauterine contraceptive device-associated infections) Less than half of pelvic inflammatory disease is associated with sexually transmitted infections (eg, Neisseria gonorroheae, Chlamydia trachomatis)
Skin and soft tissue (including bone/joint)
Skin, soft tissue and bone/joint infections	Impetigo (Occasionally) Infected/gas gangrene (Very frequently; especially in setting of diabetes) Breast abscess (Very frequently) Perianal, perirectal, pilonidal abscess (Very frequently) Necrotizing cellulitis (Very frequently) Infections after trauma (Very frequently) Acne vulgaris (Very frequently) Wound infections (Frequently) Other abscesses (Frequently) Cellulitis and necrotizing fasciitis (Frequently) Bite wounds (Frequently) Diabetic foot infections (Frequently) Infected decubitus ulcers (Frequently) Orthopedic device infections (Frequently) Native joint septic arthritis or osteomyelitis (Occasionally) Prosthetic joint infections (Rarely)	GPAC, Prevotella* spp, Fusobacterium spp, Bacteroides fragilis, other Bacteroides spp, Clostridium spp, (including C. perfringens), Cutibacterium spp
Central nervous system
CNS (NOTE: there are no anaerobic colonizing bacteria at CNS sites in healthy individuals)	Brain abscess and subdural empyemas (Very frequently) CNS shunt infections (Rarely) Meningitis (Very rarely)	Brain abscesses yield polymicrobial bacteria; CNS shunt infections may culture a variety of bacteria with low virulence (including Cutibacterium spp)
Bacteremia/sepsis
Blood (NOTE: there are no anaerobic colonizing bacteria in the bloodstream in healthy individuals)	Intra-abdominal sepsis (Very frequently) Septic abortion (Very frequently) Bacteremia after oral surgery or tooth extraction (Occasionally) Bacteremia due to endocarditis (Rarely)	Bacteroides fragilis group, Clostridium spp, GPAC, Veillonella* spp, Eggethelia spp

Most anaerobic infections are polymicrobial and involve the local colonizing bacterial community that becomes unbalanced such that infection rather than homeostasis results. The putative driver of these polymicrobial infections is often unclear and difficult to specifically diagnose using available clinical microbiologic diagnostics. For treatment purposes, the clinician should empirically consider these infections as polymicrobial until culture results are available to help direct therapy. Gram-positive anaerobic cocci, Gram-negative anaerobic cocci, microaerophilic cocci, gram-positive anaerobic rods and/or gram-negative anaerobic rods may contribute to these infections: in general, very rarely is <1%; rarely is 1-10%; occasionally is 11-40%; frequently is 41-70%; very frequently is >70%; and always is 100%. The table lists potential anaerobic bacteria colonizing and/or causing infection at differing anatomic sites but is not an exhaustive list of the anaerobic bacteria present at each location. Refer to UpToDate text on anaerobic bacterial infections for additional information.

GPAC: Gram-positive anaerobic cocci; CNS: central nervous system.

* A common and important group of species within GPAC are the peptostreptococci.

References:

Nagy E, Boyanova L, Justesen US, et al. How to isolate, identify and determine antimicrobial susceptibility of anaerobic bacteria in routine laboratories. Clin Microbiol Infect 2018; 24:1139.
Brook I. Spectrum and treatment of anaerobic infections. J Infect Chemother 2016; 22:1.
Jeng LB, Lin JD, Chen MF. Acute suppurative thyroiditis: A ten-year review in a Taiwanese hospital. Scand J Infect Dis 1994; 26:297.
Yu EH, Ko WC, Chuang YC, Wu TJ. Suppurative Acinetobacter baumanii thyroiditis with bacteremic pneumonia: Case report and review. Clin Infect Dis 1998; 27:1286.
Lafontaine N, Learoyd D, Farrel S, Wong R. Suppurative thyroiditis: Systematic review and clinical guidance. Clin Endocrinol (Oxf) 2021; 95:253.

Graphic 141905 Version 1.0

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Clinical sites associated with anaerobic infections[1-5]

Clinical sites associated with anaerobic infections^[1-5]