Intra‐Abdominal Anaerobic Infections: Bacteriology and Therapeutic Potential of Newer Antimicrobial Carbapenem, Fluoroquinolone, and Desfluoroquinolone Therapeutic Agents

Goldstein, Ellie J. C.

doi:10.1086/341930

Cited by 49 publications

(36 citation statements)

References 48 publications

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“…However, the extended-spectrum and broad-spectrum quinolones do not exhibit potent antianaerobic activity and as such must be used in combination with other therapeutic (antianaerobic) agents. The present study suggests that moxifloxacin exhibits potent activity against both aerobes and anaerobes and may be an effective agent for the treatment of both community-or hospital-acquired intra-abdominal infection and diabetic foot infection, both of which involve a complexed polymicrobial flora (12,17,22).…”

mentioning

confidence: 79%

In Vitro Activities of Moxifloxacin against 900 Aerobic and Anaerobic Surgical Isolates from Patients with Intra-Abdominal and Diabetic Foot Infections

Edmiston¹,

Krepel²,

Seabrook³

et al. 2004

Antimicrob Agents Chemother

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The in vitro activities of moxifloxacin, ciprofloxacin, levofloxacin, gatifloxacin, imipenem, piperacillintazobactam, clindamycin, and metronidazole against 900 surgical isolates were determined using NCCLS testing methods. Moxifloxacin exhibited good to excellent antimicrobial activity against most aerobic (90.8%) and anaerobic (97.1%) microorganisms, suggesting that it may be effective for the treatment of polymicrobial surgical infections.Infections of the abdominal-pelvic vaults and diabetic limbs involve a mixed microbial flora, often characterized by a high level of antimicrobial resistance (5-7). In addition to appropriate antimicrobial spectrum, the ideal antimicrobial agent must also have extensive tissue distribution, as many surgical infections occur in sites where there is significant disruption of tissue plains and vascular supply (7,17,22). Since the introduction of ciprofloxacin in the late 1980s, the fluoroquinolones have been viewed as potent antimicrobials for the treatment of serious gram-negative infections. Newer quinolones have improved in vitro activity against anaerobes, with trovafloxacin, moxifloxacin, and gatifloxacin having more potent activities than levofloxacin and ciprofloxacin (1, 3). Unfortunately, safety and toxicity concerns have limited the potential therapeutic usefulness of many of these agents (11,14,15,21). The present study was undertaken to investigate the in vitro activity of moxifloxacin against aerobic and anaerobic clinical isolates recently obtained from surgical patients with diabetic foot and intra-abdominal infections.Nine hundred sequential, nonduplicated clinical isolates (350 aerobic and 550 anaerobic strains) were collected over a 3-year period (1999 to 2002) from patients with intra-abdominal and diabetic foot infections in a tertiary care medical center in Milwaukee, Wis. (three surgical services: vascular surgery, trauma and critical care, and pancreatobiliary surgery). NCCLS-recommended reference broth and agar dilution methods were used for aerobic and anaerobic susceptibility testing, respectively (18,19). Microbroth and agar dilution plates were prepared on the day of testing and incubated at 35°C for 24 h (aerobes) and 48 h (anaerobes), respectively. Gram-positive and gram-negative aerobic-facultative isolates were tested in Mueller-Hinton broth. Anaerobic strains were tested within an anaerobic chamber on brucella blood agar plates supplemented with 5 g of hemin, 1 g of vitamin K 1 per ml, and 5% lysed sheep blood. The agar dilution plates were inoculated (10 5 CFU/spot) using a 32- The susceptibilities of the aerobic isolates, listed by species, are shown in Table 1. The results are expressed as the MICs at which 50 and 90% of strains were inhibited (MIC 50 and MIC 90 , respectively) and the ranges for all strains. While moxifloxacin, gatifloxacin, and imipenem demonstrated good activity against methicillin-susceptible S. aureus, E. faecalis, and Streptococcus spp., all agents tested failed to provide reliable in vitro activity (based on MIC 90 s) ...

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confidence: 79%

In Vitro Activities of Moxifloxacin against 900 Aerobic and Anaerobic Surgical Isolates from Patients with Intra-Abdominal and Diabetic Foot Infections

Edmiston¹,

Krepel²,

Seabrook³

et al. 2004

Antimicrob Agents Chemother

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“…Among the B. fragilis group, B. fragilis accounts for 40% to 54% of the Bacteroides isolates recovered from intra-abdominal as well as other infections (4,(84)(85)(86). Another important pathogen that belongs to the B. fragilis group is B. thetaiotaomicron, which accounts for 13% to 23% of the isolates.…”

Section: ␤-Lactam Antibioticsmentioning

confidence: 99%

Antianaerobic Antimicrobials: Spectrum and Susceptibility Testing

2013

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SUMMARY Susceptibility testing of anaerobic bacteria recovered from selected cases can influence the choice of antimicrobial therapy. The Clinical and Laboratory Standards Institute (CLSI) has standardized many laboratory procedures, including anaerobic susceptibility testing (AST), and has published documents for AST. The standardization of testing methods by the CLSI allows comparisons of resistance trends among various laboratories. Susceptibility testing should be performed on organisms recovered from sterile body sites, those that are isolated in pure culture, or those that are clinically important and have variable or unique susceptibility patterns. Organisms that should be considered for individual isolate testing include highly virulent pathogens for which susceptibility cannot be predicted, such as Bacteroides , Prevotella , Fusobacterium , and Clostridium spp.; Bilophila wadsworthia ; and Sutterella wadsworthensis . This review describes the current methods for AST in research and reference laboratories. These methods include the use of agar dilution, broth microdilution, Etest, and the spiral gradient endpoint system. The antimicrobials potentially effective against anaerobic bacteria include beta-lactams, combinations of beta-lactams and beta-lactamase inhibitors, metronidazole, chloramphenicol, clindamycin, macrolides, tetracyclines, and fluoroquinolones. The spectrum of efficacy, antimicrobial resistance mechanisms, and resistance patterns against these agents are described.

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“…These infections are commonly caused by a mixture of aerobic and anaerobic bacteria, which creates an especially problematic situation. Not only do anaerobes act synergistically with facultative bacteria, but facultative organisms also facilitate the infectious process by promoting the growth of anaerobes (4).…”

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confidence: 99%

“…B. fragilis is known to be the most important anaerobic pathogen but accounts for only 0.5% of the normal colonic flora (4). A capsular polysaccharide, adherence potential, piliation, and toxin production all contribute to the virulence of B. fragilis (4).…”

mentioning

confidence: 99%

Levofloxacin plus Metronidazole Administered Once Daily versus Moxifloxacin Monotherapy against a Mixed Infection of Escherichia coli and Bacteroides fragilis in an In Vitro Pharmacodynamic Model

Hermsen

Hovde

Sprandel

et al. 2005

Antimicrob Agents Chemother

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Moxifloxacin has been suggested as an option for monotherapy of intra-abdominal infections. Recent data support the use of a once-daily metronidazole regimen. The purpose of this study was to investigate the activity of levofloxacin (750 mg every 24 h [q24h]) plus metronidazole (1,500 mg q24h) compared with that of moxifloxacin (400 mg q24h) monotherapy in a mixed-infection model. By using an in vitro pharmacodynamic model in duplicate, Escherichia coli and Bacteroides fragilis were exposed to peak concentrations of 8.5 mg of levofloxacin/liter q24h, 32 mg of metronidazole/liter q24h, and 2 mg for moxifloxacin/liter q24h for 24 h. The activities of levofloxacin, metronidazole, moxifloxacin, and levofloxacin plus metronidazole were evaluated against E. coli, B. fragilis, and E. coli plus B. fragilis. The targeted half-lives of levofloxacin, metronidazole, and moxifloxacin were 8, 8, and 12 h, respectively. Time-kill curves were analyzed for time to 3-log killing, slope, and regrowth. Pre-and postexposure MICs were determined. The preexposure levofloxacin, metronidazole, and moxifloxacin MICs for E. coli and B. fragilis were 0.5 and 1, >64 and 0.5, and 1 and 0.25 mg/liter, respectively. Levofloxacin and moxifloxacin achieved a 3-log killing against E. coli and B. fragilis in all experiments, as did metronidazole against B. fragilis. Metronidazole did not decrease the starting inoculum of E. coli. The area under the concentration-time curve/MIC ratios for E. coli and B. fragilis were 171.7 and 85.9, respectively, for levofloxacin and 26 and 103.9, respectively, for moxifloxacin. Levofloxacin plus metronidazole exhibited the fastest rates of killing. The levofloxacin and moxifloxacin MICs for B. fragilis increased 8-to 16-fold after the organism was exposed to moxifloxacin. No other changes in the postexposure MICs were found. Levofloxacin plus metronidazole administered once daily exhibited activity similar to that of moxifloxacin against the mixed E. coli and B. fragilis infection. A once-daily regimen of levofloxacin plus metronidazole looks promising for the treatment of intra-abdominal infections.Intra-abdominal infections include peritonitis, appendicitis, and abscesses, among a wide variety of other infections. These infections are commonly caused by a mixture of aerobic and anaerobic bacteria, which creates an especially problematic situation. Not only do anaerobes act synergistically with facultative bacteria, but facultative organisms also facilitate the infectious process by promoting the growth of anaerobes (4).Escherichia coli and Bacteroides fragilis are the organisms most commonly isolated from intra-abdominal abscesses (12). B. fragilis is known to be the most important anaerobic pathogen but accounts for only 0.5% of the normal colonic flora (4). A capsular polysaccharide, adherence potential, piliation, and toxin production all contribute to the virulence of B. fragilis (4).The polymicrobial nature of intra-abdominal infections requires the use of either dual therapy or broad-spectrum monotherapy. ...

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Intra‐Abdominal Anaerobic Infections: Bacteriology and Therapeutic Potential of Newer Antimicrobial Carbapenem, Fluoroquinolone, and Desfluoroquinolone Therapeutic Agents

Cited by 49 publications

References 48 publications

In Vitro Activities of Moxifloxacin against 900 Aerobic and Anaerobic Surgical Isolates from Patients with Intra-Abdominal and Diabetic Foot Infections

In Vitro Activities of Moxifloxacin against 900 Aerobic and Anaerobic Surgical Isolates from Patients with Intra-Abdominal and Diabetic Foot Infections

Antianaerobic Antimicrobials: Spectrum and Susceptibility Testing

Levofloxacin plus Metronidazole Administered Once Daily versus Moxifloxacin Monotherapy against a Mixed Infection of Escherichia coli and Bacteroides fragilis in an In Vitro Pharmacodynamic Model

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