High Incidence of Cefoxitin and Clindamycin Resistance among Anaerobes in Taiwan

Teng, Lee‐Jene; Hsueh, Po-Ren; Tsai, Jui‐Chang; Liaw, Shwu-Jen; Ho, Shen‐Wu; Luh, Kwen‐Tay

doi:10.1128/aac.46.9.2908-2913.2002

Cited by 77 publications

(60 citation statements)

References 15 publications

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“…An increase in the mean incidence of anaerobic bacteremia has recently been noted by Lassmann et al (9), with the most commonly isolated organisms being those of the B. fragilis group. Over the past 20 years, geographic variations and increasing resistance of this group to several of the traditionally used antimicrobial agents and some of the newer ␤-lactam agents have been reported (1,2,6,14,17,18). Periodic monitoring of the susceptibility patterns of these organisms is now recommended.…”

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confidence: 99%

Resistance Trends of the Bacteroides fragilis Group over a 10-Year Period, 1997 to 2006, in Madrid, Spain

Betriú

Culebras

Gómez

et al. 2008

Antimicrob Agents Chemother

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The changes in susceptibilities of Bacteroides fragilis group strains isolated in our hospital from 1997 to 2006 were studied. A total of 1,343 clinical strains were included. The study showed differences in the resistance rates in the different species of the group. Increasing resistance to clindamycin and moxifloxacin was observed. Susceptibility to imipenem, piperacillin-tazobactam, and metronidazole remained unchanged.Members of the Bacteroides fragilis group can cause infections as serious as intra-abdominal infection, postoperative wound infection, and bacteremia. An increase in the mean incidence of anaerobic bacteremia has recently been noted by Lassmann et al. (9), with the most commonly isolated organisms being those of the B. fragilis group. Over the past 20 years, geographic variations and increasing resistance of this group to several of the traditionally used antimicrobial agents and some of the newer ␤-lactam agents have been reported (1,2,6,14,17,18). Periodic monitoring of the susceptibility patterns of these organisms is now recommended. We studied the susceptibilities of B. fragilis group strains isolated in our hospital from 1997 to 2006 to determine changes and to detect resistance trends.(This study was presented at the 47th Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, IL, 17 to 20 September 2007).The study included a total of 1,343 B. fragilis group clinical strains isolated in our hospital from 1997 to 2006. Only one isolate per patient was studied to avoid duplication. The isolates were recovered from the following sources: abdomen (45.6%), skin and soft tissue (40.1%), blood (10.3%), genital tract (2.1%), respiratory tract (0.9%), and other sites (0.9%). Species were identified using the Rapid ID 32A system (bioMérieux, Marcy l'Etoile, France). Reference strains B. fragilis ATCC 25285 and B. thetaiotaomicron ATCC 29741 were used as controls. The MICs obtained by testing the quality control strains in parallel with test strains were within the acceptable range indicated by CLSI (formerly the NCCLS) for each antimicrobial agent tested.Susceptibilities were determined by the agar dilution method according to CLSI criteria (10). The following agents were studied: metronidazole, chloramphenicol, clindamycin, cefoxitin, imipenem, amoxicillin-clavulanate, piperacillin-tazobactam, moxifloxacin, and tigecycline (tested since 2000). To calculate antibiotic resistance rates, the CLSI-approved breakpoints (4) were used. The breakpoint for tigecycline resistance used was that established by the U.S. Food and Drug Administration.The most frequent species isolated within the group was B. fragilis (62%), followed by B. thetaiotaomicron (13.5%), B. uniformis (7.8%), B. vulgatus (3.5%), B. caccae (3.3%), B. distasonis (3.2%), B. ovatus (3.1%), B. eggerthii (0.6%), B. stercoris (0.5%), B. merdae (0.5%), and Bacteroides spp. (1.8%). There were no significant differences in the distribution of the various species during the study period.MIC ranges, MICs at which 50% and 90% of ...

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confidence: 99%

Resistance Trends of the Bacteroides fragilis Group over a 10-Year Period, 1997 to 2006, in Madrid, Spain

Betriú

Culebras

Gómez

et al. 2008

Antimicrob Agents Chemother

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“…However, surveillance data for anaerobic pathogens remain scarce (28). The antimicrobial resistance of anaerobic pathogens adversely affects clinical outcome, resulting in treatment failure and mortality (20).…”

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Increasing Trends in Antimicrobial Resistance among Clinically Important Anaerobes and Bacteroides fragilis Isolates Causing Nosocomial Infections: Emerging Resistance to Carbapenems

Liu¹,

Huang

Liao

et al. 2008

Antimicrob Agents Chemother

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This study reports data on the susceptibilities to five commonly used antianaerobic agents of five clinically frequently encountered anaerobes from 2000 to 2007 and to Bacteroides fragilis isolates causing nosocomial infections from 1990 to 2006. There was a trend of decreasing susceptibilities of these anaerobes to ampicillinsulbactam, cefmetazole, chloramphenicol, and clindamycin with time during the study period. The rates of susceptibility to clindamycin and cefmetazole for all clinical isolates of Bacteroides fragilis isolates were higher than those of isolates associated with nosocomial infections. The MICs of 207 anaerobic blood isolates collected in 2006 to 14 antimicrobial agents were determined by the agar dilution method. The rates of nonsusceptibility to imipenem and meropenem were 7% and 12% for B. fragilis isolates (n ‫؍‬ 60), 7% and 3% for Bacteroides thetaiotamicron isolates (n ‫؍‬ 30), 4% and 4% for Fusobacterium species (n ‫؍‬ 27), 6% and 0% for Prevotella species (n ‫؍‬ 16), 15% and 0% for Clostridium species (n ‫؍‬ 28), and 0% and 0% for Peptostreptococcus species (n ‫؍‬ 32). The rates of susceptibility to moxifloxacin were 90% for B. fragilis isolates, 87% for B. thetaiotaomicron isolates, 81% for Fusobacterium species, 75% for Prevotella species, 93% for Clostridium species, and 78% for Peptostreptococcus species. Thirty-six percent of Clostridium species and 12% of Peptostreptococcus species were not susceptible to metronidazole. Comparison of the data with the data from a previous survey from the same institute in 2002 revealed higher rates of nonsusceptibility to carbapenems, especially for B. fragilis, Fusobacterium species, and Prevotella species isolates. The high rates of nonsusceptibility to commonly used antianaerobic agents mandate our attention, and periodic monitoring of the trend of the resistance is crucial.

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“…Such infections may be easily mistreated, because susceptibility testing of anaerobic bacteria is not usually performed in everyday clinical practice, due to the belief that resistance among anaerobes is predictable. Large multicenter studies indicate that metronidazole, carbapenems and betalactam-beta-lactamase inhibitor combinations are still effective against these species (6,9,14), although reports from different parts of the world call attention to the emergence of resistance, especially to metronidazole (2,5,6,8,12,15,16). Nevertheless, infections due to multidrug-resistant Bacteroides sp.…”

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confidence: 99%

Two Cases of Infections Due to Multidrug-Resistant Bacteroides fragilis Group Strains

et al. 2006

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Bacteroides fragilis group strains are still considered susceptible to most antimicrobial agents used for the treatment of infections caused by anaerobic organisms. We describe two cases of infections due to isolates simultaneously resistant to clindamycin, tetracycline, cefoxitin, piperacillin-tazobactam, and imipenem and, in one of the two cases, to metronidazole. Such infections, although still rare, do exist and tend to complicate treatment. First case report.A 71-year-old man was admitted to the internal medicine ward of Laikon General Hospital, a university-affiliated, tertiary-care hospital in downtown Athens, Greece, with a temperature of up to 39°C and diarrhea for 8 days. The patient's medical history included Crohn's disease; stomach lymphoma, which had led to a total gastrectomy 15 years earlier; common variable immunodeficiency; and cytomegalovirus (CMV) colitis.The patient's blood cell count was within the normal range, and serum biochemistry revealed only an elevated C-reactive protein level (280 mg/liter; normal values, Ͻ50 mg/liter). Computed tomography scanning of the upper and lower abdomen was negative, while a colonoscopy revealed findings consistent with CMV colitis. Blood samples for culture were taken on admission; and after 2 days of incubation, the anaerobic bottle (BacT/ALERT 3D; bioMerieux, Marcy l'Etoile, France) yielded a gram-negative anaerobic rod that was identified as Bacteroides fragilis by the special-potency disk method; growth in the presence of 20% bile (Bacteroides-bile esculin agar plates; Bioprepare, Gerakas, Greece); and the biochemical profile (ID32ANA system; bioMerieux), including a negative reaction for indole (7). Cultures of stool samples were negative for pathogens.Upon receipt of the preliminary finding of bacteremia caused by an anaerobic gram-negative organism, antimicrobial treatment was initiated with metronidazole three times daily at 500 mg intravenously (i.v.) and cefotaxime three times daily at 2 g i.v., after which the fever subsided but the diarrhea persisted, because of his underlying disease. His condition deteriorated during the following weeks, as he developed liver cirrhosis, ascites, and CMV pulmonary infiltrations. The patient died after 3 months of hospitalization due to pulmonary edema.Susceptibility testing of the B. fragilis isolate was performed by the Etest method (AB Biodisk, Solna, Sweden), according to the manufacturer's instructions, on brucella blood agar plates supplemented with vitamin K and hemin. The resulting MICs were Ͼ256 mg/liter for benzylpenicillin, piperacillin-tazobactam, ticarcillin-clavulanic acid, cefoxitin, and clindamycin; Ͼ32 mg/liter for imipenem and ertapenem; 128 mg/liter for tetracycline; and 0.5 mg/liter for metronidazole. The strain was positive for beta-lactamase production by the nitrocefin disk method (Cefinase; BBL, Becton Dickinson and Co., Franklin Lakes, NJ). The imipenem, ertapenem, and metronidazole MICs were confirmed by the agar dilution method (11). All plates used for susceptibility testing were in...

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High Incidence of Cefoxitin and Clindamycin Resistance among Anaerobes in Taiwan

Cited by 77 publications

References 15 publications

Resistance Trends of the Bacteroides fragilis Group over a 10-Year Period, 1997 to 2006, in Madrid, Spain

Resistance Trends of the Bacteroides fragilis Group over a 10-Year Period, 1997 to 2006, in Madrid, Spain

Increasing Trends in Antimicrobial Resistance among Clinically Important Anaerobes and Bacteroides fragilis Isolates Causing Nosocomial Infections: Emerging Resistance to Carbapenems

Two Cases of Infections Due to Multidrug-Resistant Bacteroides fragilis Group Strains

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