The role of anaerobic bacteria in mediastinitis

The management of mediastinitis involves directing appropriate antibacterial therapy against the potential bacterial pathogens. The increased recovery of anaerobic bacteria from mediastinal infections has led to a greater appreciation of their role in this condition and to re-evaluation of the proper treatment of this condition. Mediastinitis caused by anaerobic bacteria generally emerges following perforation of the oesophagus, extension of retropharyngeal abscess, suppurative parotitis, cervical cellulitis or abscess of dental origin. The bacteria recovered from these infections are often of oral origin and involve mixed aerobic-anaerobic oral flora. The predominant anaerobic isolates include Bacteroides spp., Peptostreptococcus spp., pigmented Prevotella and Porphyromonas spp. and Fusobacterium spp. Treatment includes surgical intervention, antibacterial therapy and supportive measures. Appropriate management of mediastinal infections due to aerobic and anaerobic infections requires the administration of antibacterials that are effective against both the aerobic and anaerobic components of the infection. Selection of antibacterials for the treatment of mediastinitis is determined by bacteriological studies.