Unilateral complicated pleural empyema in a patient with bronchial asthma due to clindamycin-resistant Prevotella buccae

Sakshi Patel, Hamza Hanfe, Alkesh Kumar Khurana, Arati Bhadade, Shashwati Nema


Prevotella buccae (P. buccae) is a gram-negative obligate anaerobe mainly associated with infections of odontogenic origin. Non-oral monomicrobial infection by these obligate anaerobic bacteria is rare. Only a few cases of monomicrobial non-oral infections by P. buccae have been reported in the literature. We are reporting a case of unilateral complicated pleural empyema in a patient with bronchial asthma infected by P. buccae. Pleural fluid aerobic culture and blood culture reports were sterile. No acid-fast bacilli were detected by Acid Fast Bacilli (AFB) staining, and cartridge-based nucleic acid assay test (CBNAAT) reports were negative for Mycobacterium tuberculosis. The isolate, P. buccae was found susceptible to Metronidazole (MIC = 3 µg/ml) and resistant to Clindamycin (MIC = 256 µg/ml). In view of rising trends of antimicrobial resistance among anaerobes, it is recommended to perform anaerobic culture and sensitivity testing in clinically suspected cases of pleuropulmonary infection for appropriate diagnosis and optimal patient management. Clindamycin should be used with caution for empiric treatment.


clindamycin resistance; pleural empyema; Prevotella buccae

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Könönen E, Gursoy UK. Oral Prevotella Species and Their Connection to Events of Clinical Relevance in Gastrointestinal and Respiratory Tracts. Front Microbiol. 2022;12:798763. doi: 10.3389/fmicb.2021.798763. PMID: 35069501; PMCID: PMC8770924.

Cobo F, Rodríguez-Granger J, Sampedro A, Navarro-Marí JM. Infected breast cyst due to Prevotella buccae resistant to metronidazole. Anaerobe. 2017;48:177-178. doi: 10.1016/j.anaerobe.2017.08.015. PMID: 28866113.

Duployez C, Loiez C, Hund R, et al. A case of bacteriemic mediastinitis due to Prevotella buccae after cardiac surgery. Anaerobe. 2020;61:102097. doi: 10.1016/j.anaerobe.2019.102097. PMID: 31494261.

Ased S, Payne AN, Yang C. Idiopathic hemodynamically unstable polymicrobial purulent pericarditis: a rare case presentation. J Am Coll Emerg Physicians Open. 2020;1(5):744-746. doi: 10.1002/emp2.12202. PMID: 33145514; PMCID: PMC7593473.

Jousimies Somer H, Summanen P, Citron DM, Baron EJ, Wexler HM, Finegold SM. Wadsworth KTL Anaerobic Bacteriology Manual. 6th ed. California: Star Publishing Company; 2002.

CLSI. Performance Standards for Antimicrobial Susceptibility Testing: 33rd ed. CLSI Supplement M100.Clinical and Laboratory Standard Institute; 2023.

Corcoran JP, Wrightson JM, Belcher E, et al. Pleural infection: past, present, and future directions. Lancet Respir Med. 2015;3(7):563-577. doi: 10.1016/S2213-2600(15)00185-X. PMID: 26170076.

Dyrhovden R, Nygaard RM, Patel R, Ulvestad E, Kommedal Ø. The bacterial aetiology of pleural empyema. A descriptive and comparative metagenomic study. Clin Microbiol Infect. 2019;25(8):981-986. doi: 10.1016/j.cmi.2018.11.030. PMID: 30580031.

Schuetz AN. Antimicrobial resistance and susceptibility testing of anaerobic bacteria. Clin Infect Dis. 2014;59(5):698-705. doi: 10.1093/cid/ciu395. PMID: 24867792.

Ulger Toprak N, Veloo ACM, Urban E, et al. A multicenter survey of antimicrobial susceptibility of Prevotella species as determined by Etest methodology. Anaerobe. 2018;52:9-15. doi: 10.1016/j.anaerobe.2018.05.005. PMID: 29860038.

DOI: http://dx.doi.org/10.22551/2023.41.1004.10263

Copyright (c) 2023 Sakshi Patel, Hamza Hanfe, Alkesh Kumar Khurana, Arati Bhadade, Shashwati Nema

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