Eleven patients with bacteroides empyemas were seen at the Detroit General Hospital between July 1963 and December 1965. Three of these cases occurred in young women with acute bacteroides infections of the pelvis. Severe illnesses, with lower lobe bronchopneumonias and moderate effusions, necessitated early hospitalization. The other cases occurred in older men with significant chronic pulmonary disease. They entered with subacute, protracted, but progressive complaints. Massive, putrid, and rapidly reaccumulating effusions dominated these prolonged hospitalizations.
Diagnosis is dependent upon an awareness by physicians that these strictly anaerobic organisms are normal inhabitants of human mucous membranes and intestines, that they are potentially virulent pathogens, and that they will not be recovered unless specimens are cultured under a strictly anaerobic environment. Visualization of gram-negative bacilli in sputum and empyema fluids with negative aerobic cultures should allow earlier recognition of bacteroides pneumonias with empyema. Therapy requires combined surgical drainage and vigorous intelligent antimicrobial usage.