What is the clinical significance of Prevotella bivia (formerly known as Prevotella bivia, a bacterium in the genus Prevotella)?

From the Guidelines

Prevotella bivia infections should be treated with metronidazole as the first-line antibiotic, typically prescribed at 500 mg orally twice daily for 7-14 days, due to its effectiveness against anaerobic bacteria and the bacterium's production of beta-lactamases, which makes it resistant to many penicillins and cephalosporins when used alone 1. When treating Prevotella bivia infections, it is essential to consider the severity of the infection and the potential for polymicrobial infections, where the bacterium synergizes with other bacteria.

• Alternative treatments include clindamycin (300 mg orally twice daily for 7 days) or amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days) 1.
• For severe infections, intravenous therapy may be necessary, and the choice of antibiotic should be based on the clinical condition of the patient and the individual risk for infection by resistant pathogens 1.
• Proper diagnosis through anaerobic culture is crucial, as symptoms can mimic other conditions, and complete treatment is essential to prevent recurrence and complications such as abscess formation or chronic infection.
• The recent study by Aziz et al. (2024) highlights the importance of maintaining gut health to reduce the risk of obesity, cardiovascular, and other age-related inflammatory diseases, and notes that Prevotella is one of the bacteria that can create inflammation and contribute to the development of various diseases 1.

From the Research

Prevotella bivia Characteristics

• Prevotella bivia is an obligate anaerobic gram-negative bacterium that is part of the human microbiota 2
• It can cause opportunistic infections, including specific oral infections, local or systemic infections 2
• Prevotella bivia is naturally found in the human vagina, but can also cause infections in other body locations 3

Antimicrobial Susceptibility

• Prevotella bivia strains have shown susceptibility to certain antimicrobials, including:
  • Piperacillin-tazobactam 2, 4
  • Cefoxitin 2, 5, 4
  • Meropenem 2, 4
  • Imipenem 2, 4
  • Tigecycline 2, 4
  • Metronidazole 2, 5, 4, 6
• However, resistance to certain antimicrobials has also been detected, including:
  • Ampicillin 2, 5, 6
  • Penicillin 5, 6
  • Clindamycin 2, 4, 6
  • Tetracycline 2, 5, 4
  • Moxifloxacin 2, 4

Clinical Significance

• Infections with Prevotella bivia can be severe due to the risk of osteomyelitis and the lack of good protocols for adequate therapeutic management 3
• Early microbiological diagnosis and proper therapeutic management are crucial to avoid complications and the development of bacterial resistance to antibiotics 3
• The high rates of non-susceptibility to certain antimicrobials emphasize the need for species-level identification of clinical Prevotella isolates and periodic monitoring of their susceptibility to guide empirical treatment 2, 4