Summary auto-generated
This retrospective study examined the microbiology of 17 axillary hidradenitis suppurativa (HS) specimens collected over 6 years at a military hospital. HS is a recurrent inflammatory condition of apocrine sweat glands that can lead to abscess formation and scarring. The researchers isolated 42 bacterial isolates total (2.5 per specimen), comprising 12 aerobic or facultative bacteria and 30 anaerobic or micro-aerophilic bacteria. Aerobic bacteria alone were found in 35% of cases, anaerobic bacteria alone in 41%, and mixed infections in 24%. Staphylococcus aureus was the most common aerobe (6 isolates), followed by Streptococcus pyogenes and Pseudomonas aeruginosa. Peptostreptococcus species were the most frequently isolated anaerobes, followed by Prevotella species. The organisms isolated originated from oropharyngeal, gastrointestinal, and skin flora. The polymicrobial nature of HS and predominance of anaerobic bacteria suggest that antimicrobial therapy should target both aerobic and anaerobic pathogens. Fourteen patients were followed for at least 2 months; 11 recovered while 3 had persistent infections, including those with P. aeruginosa. The study emphasizes the importance of appropriate specimen collection and culture methods for both aerobic and anaerobic bacteria to guide effective treatment.
Key findings
- Anaerobic bacteria were isolated in 65% of hidradenitis suppurativa cases, either alone (41%) or mixed with aerobes (24%), contradicting the historical view of S. aureus as the sole pathogen
- The average isolate count was 2.5 per specimen, demonstrating the polymicrobial nature of HS with Peptostreptococcus and Prevotella species predominating among anaerobes
- Anaerobic bacteria originated from normal oropharyngeal, gastrointestinal, and skin flora, suggesting secondary contamination or polymicrobial synergy in abscess formation
- Antimicrobial therapy must target both aerobic and anaerobic bacteria; agents like clindamycin, cefoxitin, and imipenem provide appropriate coverage
- Persistent infections occurred in 3 of 14 followed patients, particularly those with P. aeruginosa and B. fragilis, suggesting these organisms may be more resistant to standard therapy
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Abstract
A retrospective review of the microbiological and clinical data of 17 specimens obtained from axillary hidradenitis suppurativa (HS) over a period of 6 years was undertaken to study the aerobic and anaerobic microbiology of this condition. A total of 42 bacterial isolates (2.5 per specimen) were obtained, 12 aerobic or facultative (0.7 per specimen) and 30 anaerobic or micro-aerophilic (1.8 per specimen). Aerobic and facultative bacteria only were isolated in six (35%) cases, anaerobic bacteria only in seven (41%) and mixed aerobic and anaerobic bacteria in four (24%). The predominant aerobic bacteria were Staphylococcus aureus (six isolates), Streptococcus pyogenes (three) and Pseudomonas aeruginosa (two). The most frequently isolated anaerobes were Peptostreptococcus spp. (10), Prevotella spp. (seven), micro-aerophilic streptococci (four), Fusobacterium spp. (three) and Bacteroides spp. sensu stricto (three). This study highlights the polymicrobial nature and predominance of anaerobic bacteria in axillary HS and the need for antimicrobial thereby to reflect this.