Multiple studies provided insight into the etiology of infected tumor mass indirectly through the administration of antimicrobial agents effective against these organisms (2-7). Therapy directed against anaerobes improved or prevented infections in many of these studies. However, the microbiology of infected tumors was not established in these reports.

Several case reports described the microbiology of infected solid tumors (8-11). Lenkey et al. (8) recovered Bacteroides orchraceus and Prevotella melaninogenica from a necrotic perinephric adenocarcinoma. Braverman et al. (9) reported a patient with Clostridum welchii gas gangrene of the uterus that was associated with endometrial adenocarcinoma.

Graham et al. (10) described a case of a large gas-filled clostridial abscess in a previously unrecognized renal cell carcinoma. Trump et al. (11) presented a patient in whom the first recurrence of a carcinoma of the rectum was an intrahepatic metastasis associated with a hepatic abscess caused by Peptostreptococcus prevotii. They also reviewed three other reported cases of infection associated with hepatic tumor nodules in which anaerobic bacteria were the primary or only infecting organisms.

Three studies investigated the microbiology of infected tumors (12-14). Rotimi and Durosinmi-Etti (12) studied 70 patients with infected ulcers; 30 of the underlying lesions in these patients were carcinoma of the breast, and 19 were a variety of skin cancers. Most infections were mixed, yielding both anaerobes and aerobes. Anaerobes were the predominant organisms isolated from individual ulcers. There were 282 bacteria isolates, and anaerobic bacteria accounted for 179 (63%). Of the 179 anaerobes isolated, 37 were Porpyromonas asaccharolytica, 31 each were P. melaninogenica and anaerobic streptococci, 29 Bacteroides fragilis, and 17 Bacteroides ureolyticus. Among the facultative organisms, Escherichia coli was the commonest and was isolated mainly from patients with carcinoma of the breast. Most infections were mixed yielding both anaerobic and aerobic bacteria and this made interpretation of the role of individual pathogens difficult to assess.

Brusis and Luckhaupt (13) reported the microbiology of 15 patients with tumors of the oral cavity, the oropharynx and with recurrent tumors of the hypopharynx and larynx that were infected with anaerobic bacteria. P. melaninogenica, Prevotella oralis Prevotella bivia, Peptostreptococcus spp., and Fusobacterium spp. were most frequently represented. Five cases showed mixed aerobic-anaerobic infections. Foul odor was present in most of the tumors and disappeared after a short time by therapy effective against anaerobic bacteria with clindamycin or metronidazole.

Brook (14) reviewed his experience in culturing necrotic tumors for aerobic and anaerobic bacteria over a period of 10 years. Specimens were obtained from 91 patients, 20 of them younger than 18 years. Bacterial growth was present in 63 (69%) specimens. Of these tumors, 14 were abdominal, 5 pelvic, 23 head and neck, 4 lung, 4 mediastinum, 2 lymphatic, 3 breast, and 8 miscellaneous. Aerobic or facultative anaerobic bacteria only were present in 12 (19%) specimens, anaerobes only in 10 (16%), and mixed aerobic and anaerobic bacteria in 41 (65%). The average number of isolates was 2.1/infected tumor. A total of 84 anaerobic and 46 aerobic and facultative anaerobic bacteria were recovered. The predominant anaerobic bacteria were Bacteroides spp., anaerobic cocci, and Propionibacterium acnes. The most frequently isolated aerobic and facultative bacteria were Staphylococcus aureus, alpha-hemolytic streptococci, E. coli, Staphylococcus epidermidis, Klebsiella pneumoniae, and Pseudomonas aeruginosa (Table 1).

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