Abstract
The treatment options for the therapy of anaerobic infections, the most typical anaerobic pathogens and their mechanisms of resistance to antimicrobials are given in the article. The data on the susceptibility testing of Bacteroides spp., Clostridium spp. and Fusobacterium spp. isolated form hospitalized adults from Sweden and Nicaragua who were receiving antimicrobial therapy and from Nicaraguan antimicrobial treated children and healthy children under 2 years of age. Benzylpenicillin, cephalotin and piperacillin were the antimicrobials less effective against Bacteroides species, followed by clindamycin and cefoxitin. Fusobacterium species resistant to benzylpenicillin were also found. A significant difference was observed between the Nicaraguan and Swedish patients. Most Clostridium species from both groups of patients were sensetive to the antimicrobial agents tested. Bacteroides strains were the only bacterial species resistant to ampicillin and cefoxitin isolated from children; the percentage of resistant strains increased with age. These resistant strains were isolated mainly from antimicrobial treated children. However, Bacteroides strains resistant to ampicillin were also isolated from the intestinal microflora of healthy children. No resistant strains to imipenem, metronidazole and chloramphenicol were found. The antimicrobial susceptibility pattern of anaerobic and aerobic bacteria isolated from 219 Nicaraguan patients was determined against the most common antimicrobials used in Nicaragua. B.fragilis group strains were the most common anaerobic isolates and the most resistant to ampicillin (56%), cefoxitin (28%) and clindamycin (25%). Fusobacterium strains resistant to ampicillin and cefoxitin (44% and 12% resistance, respectively) were also isolated. All the gram-positive anaerobic strains isolated were sensitive to the antimicrobials tested.
-
1.
Finegold S.M. Anaerobic infections in humans: An overview. Anaerobe 1995;1:3-9.
-
2.
Nord C.E. Treatment of intraabdominal infections. World wide clinical trials. Infect Dis Clin Pract 1995; 4:S17-25.
-
3.
Brismar B., Nord C.E. Monobactams and carbapenems for treatment of intraabdominal infections. Infection 1999;27:136-47.
-
4.
Olsen I., Solberg C.O., Finegold S.M. A primer on anaerobic bacteria and anaerobic infections for the uninitiated. Infection 1999;27:159-65.
-
5.
Nord C.E. Use of newer quinolones for the treatment of intraabdominal infections: Focus on clinafloxacin. Infection 1999;27:166-72.
-
6.
Gorbach S.L. Antibiotic treatment of anaerobic infections. Clin Infect Dis 1994;18:305-10.
-
7.
Rasmussen B.A., Bush K., Tally F.P. Antimicrobial resistance in anaerobes. J Infect Dis 1997;24:110-20.
-
8.
Hedberg M., Nord C.E. Beta-lactam resistance in anaerobic bacteria. J Chemother 1996;8:3-16.
-
9.
Garcia-Rodriguez J.A., Garcia-Sanchez J.E., Munoz-Bellido J.L. Antimicrobial resistance in anaerobic bacteria: Current situation. Anaerobe 1995;1:69-80.
-
10.
Lubbe M.M., Botha P.L., Chalkley L.Y. Comparative activity of eighteen antimicrobial agents against anaerobic bacteria isolated in South Africa. Eur J Clin Microbiol Infect Dis 1999;18:46-54.
-
11.
Wexler H.M., Molitoris E., Mollitoris D., Finegold S.M. In vitro activity of levofloxacin against a selected group of anaerobic bacteria isolated from skin and soft tissue infections. Antimicrob Agents Chemother 1998;42:984-6.
-
12.
Zwolska Z., Jezierska-Anczukow A., Filczak K., et al. A Polish multicenter survey of Antimicrobial susceptibility and prevalence of b-lactamase productions among bacterial pathogens isolated from hospitalized and ambulatory patients. Pol Merkuriusz Lek 1998;4:241-6.
-
13.
Doern G.V., Johns R.N., Pfaller M.A., Kugler K.C., Beach M.L. The SENTRY Study Group (North America). Bacterial pathogens isolated from patients with skin and soft tissue infections: Frequency of occurrence and antimicrobial susceptibility patterns from the SENTRY Antimicrobial Surveillance Program (United States and Canada, 1997). Diagn Microbiol Infect Dis 1999;34:65-72.
-
14.
Wise R. A review of the mechanisms of action and resistance of antimicrobial agents. Can resp J 1999;6:20A-2A.
-
15.
Sloan J., Murry L.M., Luras D., Levy S.B., Rood J.L. The Clostridium perfringens TetP determinant comprises two overlapping genes: tet(P), which mediates active tetracycline efflux, and tetB(P), which is related to the ribosomal protection family of tetracycline-resistance determinants. Mol Microbiol 1994;11:403-15.
-
16.
Anderson J.D., Sykes R.B. Characterization of a b-lactamase obtained from a strain of Bacteroides fragilis resistant to beta-lactam antibiotics. J Med Microbiol 1973;6:201-6.
-
17.
Olsson B., Nord C.E., Wadstrom T. Formation of b-lactamase in Bacteroides fragilis: Cell bound and extracellular activity. Antimicrob Agents Chemother 1976;9:727-35.
-
18.
Sato K., Inoue M., Mitsuhashi S. Activity of b-lactamase produced by Bacteroides fragilis against newly introduced cephalosporins. Antimicrob Agents Chemother 1980; 17:736-7.
-
19.
Brook I., Calhoun L., Yocum P. b-Lactamase-producing isolates of Bacteroides species from children. Antimicrob Agents Chemother 1980;18:164-6.
-
20.
Heimdahl A., Von Konow L., Nord C.E. b-Lactamase producing Bacteroides species in the oral cavity in relation to penicillin therapy. J Antimicrob Chemother 1981;8:225-9.
-
21.
Ednie L.M., Jacobs M.R., Appelbaum P.C. Activities of gatifloxacin compared to those of seven other agents against anaerobic organisms. Antimicrob Agents Chemother 1998;42:2459-62.
-
22.
Hoellman D.B., Spangler S.K., Jacobs M.R., Appelbaum P.C. In vitro activities of cefminox against anaerobic bacteria compared with those of nine other compounds. Antimicrob Agents Chemother 1998;42:495-501.
-
23.
Nyfors S., Kononen E., Takala A., Jousimies-Somer H. b-Lactamse production by oral anaerobic Gram-negative species in infants in relation to previous antimicrobial therapy. Antimicrob Agents Chemother 1999;43:1591-4.
-
24.
Nord C.E. Mechanisms of beta-lactame resistance in anaerobic bacteria. Rev Infect Dis 1986;8:543-7.
-
25.
Kesado T., Lindqvist L., Hedberg M., Tuner K., Nord C.E. Purification and characterization of a new b-lactamase from Clostridium butyricum. Antimicrob Agents Chemother 1989;33:1302-7.
-
26.
Hedberg M., Lindqvist L., Tuner K., Nord C.E. Effect of clavulanic acid, sulbactam and tazobactam on three different b-lactamase from Bacteroides uniformis, Clostridium butyricum and Fusobacterium nucleatum. J Antimicrob Chemother 1992;30:17-25.
-
27.
Nord C.E., Hedberg M. Resistance to beta-lactam antibiotics in anaerobic bacteria. Rev Infect Dis 1990;12:231-3.
-
28.
Sato K., Matsuura Y., Inoue M., Mitsuhashi S. Properties of a new penicillinase type produced by Bacteroides fragilis. Antimicrob Agents Chemother 1982;22:579-84.
-
29.
Lacroix J.M., Lamothe F., Malaquin F. Role of Bacteroides bivius b-lactamase in beta-lactam susceptibility. Antimicrob Agents Chemother 1984;26:694-8.
-
30.
Hedberg M., Edlund C., Lindqvist L., Rylander M., Nord C.E. Purification and characterization of a new imipenem hydrolising metallo- b-lacatamase from Bacteroides fragilis. J Antimicrob Chemother 1992;29:105-13.
-
31.
Tuner K., Lindqvist L., Nord C.E. Purification and properties of a novel b-lactamase from Fusobacterium nucleatum. Antimicrob Agents Chemother 1985;27:943-7.
-
32.
Sato K., Matsuura Y., Miyata M., Inoue M., Mitsuhashi S. Characterization of cephalosporinases from Bacteroides fragilis, Bacteroides thetaiotaomicron and Bacteroides vulgatus. J Antibiot 1983;36:76-85.
-
33.
Brook I. Anaerobic infections. Med Microbiol 1999; 10:137-53.
-
34.
Stratton C.W. Mechanisms of action for antimicrobial agents: General principles and mechanisms for selected classes of antibiotics. In: Lorian V., ed. Antibiotics in laboratory medicine, 4th ed. Williams & Wilkins; 1996. p. 579-603.
-
35.
Freeman C.D., Klutman N.E., Lamp K.C. Metronidazole: A therapeutic review and update. Drugs 1997;54:679-780.
-
36.
Caceres M., Hedberg M., Lindqvist L., Nord C.E. Purification and characterization of a beta-lactamase from Bacteroides distasonis. J Chemother 1991;3 (Suppl): 131-4.
-
37.
Caceres M., Carera E., Palmgren A.-C., Nord C.E. Antimicrobial susceptibility of anaerobic bacteria from the intestinal microflora of healthy children and antimicrobial-treated children in Nicaragua. Span J Chemother 1998;3:221-8.
-
38.
Caceres M., Carera E., Palma A., Berrios G., Weintraub A., Nord C.E. Antimicrobial susceptibility of anaerobic and aerobic bacteria isolated from mixed infections in Nicaragua. Span J Chemother 1999;12:332-9.
-
39.
Caceres M., Zhang G., Weintraub A., Nord C.E. Prevalence and antimicrobial susceptibility of enterotoxigenic Bacteroides fragilis in children with diarrhea in Nicaragua. Anaerobe 2000;6:143-8.
-
40.
Edlund C., Nord C.E. Ecological impact of antimicrobial agents on human intestinal microflora. Alpe Adria Microbiol J 1993;3:137-64.
-
41.
Okeke I.N., Lamikanra A., Edelman R. Socioeconomic and behavioral factors seeding to acquired bacterial resistance to antibiotics in developing countries. Emerg Infect Dis 1999;5:18-27.
-
42.
Stark C., Edlund C., Nord C.E. Ecological balance and disturbance in the oropharyngeal and gastrointestinal microflora. Span J Chemother 1996;4:250-9.
-
43.
Durmaz B., Durmas R., Tastekin N. Evaluation of culture results of specimens from patients with suspected anaerobic infection. Microbiologica 1999;22:155-9.
-
44.
Bush K. Characterization of b-lactamases. Antimicrob Agents Chemother 1989;33:259-63.
-
45.
Medeiros A.A. Evolution and dissemination of b-lactamases accelerated by generations of b-lactam antibiotics. Clin Infect Dis 1997;24:S10-45.