Ann Lab Med.  2015 Sep;35(5):479-486. 10.3343/alm.2015.35.5.479.

Multicenter Study of Antimicrobial Susceptibility of Anaerobic Bacteria in Korea in 2012

• Lee Y
• Park YJ
• Kim MN
• Uh Y
• Kim MS
• Lee K

• KMID: 2369762
• DOI: http://doi.org/10.3343/alm.2015.35.5.479

Abstract

BACKGROUND
Periodic monitoring of regional or institutional resistance trends of clinically important anaerobic bacteria is recommended, because the resistance of anaerobic pathogens to antimicrobial drugs and inappropriate therapy are associated with poor clinical outcomes. There has been no multicenter study of clinical anaerobic isolates in Korea. We aimed to determine the antimicrobial resistance patterns of clinically important anaerobes at multiple centers in Korea.
METHODS
A total of 268 non-duplicated clinical isolates of anaerobic bacteria were collected from four large medical centers in Korea in 2012. Antimicrobial susceptibility was tested by the agar dilution method according to the CLSI guidelines. The following antimicrobials were tested: piperacillin, piperacillin-tazobactam, cefoxitin, cefotetan, imipenem, meropenem, clindamycin, moxifloxacin, chloramphenicol, metronidazole, and tigecycline.
RESULTS
Organisms of the Bacteroides fragilis group were highly susceptible to piperacillin-tazobactam, imipenem, and meropenem, as their resistance rates to these three antimicrobials were lower than 6%. For B. fragilis group isolates and anaerobic gram-positive cocci, the resistance rates to moxifloxacin were 12-25% and 11-13%, respectively. Among B. fragilis group organisms, the resistance rates to tigecycline were 16-17%. Two isolates of Finegoldia magna were non-susceptible to chloramphenicol (minimum inhibitory concentrations of 16-32 mg/L). Resistance patterns were different among the different hospitals.
CONCLUSIONS
Piperacillin-tazobactam, cefoxitin, and carbapemems are highly active beta-lactam agents against most of the anaerobes. The resistance rates to moxifloxacin and tigecycline are slightly higher than those in the previous study.

Keyword

Anaerobe; Multicenter; Imipenem; Moxifloxacin; Tigecycline

MeSH Terms

Agar
Bacteria, Anaerobic*
Bacteroides fragilis
Cefotetan
Cefoxitin
Chloramphenicol
Clindamycin
Gram-Positive Cocci
Imipenem
Korea
Metronidazole
Piperacillin
Agar
Cefotetan
Cefoxitin
Chloramphenicol
Clindamycin
Imipenem
Metronidazole
Piperacillin

Reference

1. Clinical and Laboratory Standards Institute. M11-A8. Methods for antimicrobial susceptibility testing of anaerobic bacteria; Approved standard. 8th ed. Wayne, PA: Clinical and Laboratory Standards Institute;2012.

2. Brook I, Wexler HM, Goldstein EJ. Antianaerobic antimicrobials: spectrum and susceptibility testing. Clin Microbiol Rev. 2013; 26:526–546. PMID: 23824372.

3. Pumbwe L, Chang A, Smith RL, Wexler HM. Clinical significance of overexpression of multiple RND-family efflux pumps in Bacteroides fragilis isolates. J Antimicrob Chemother. 2006; 58:543–548. PMID: 16840432.

4. Goldstein EJ, Solomkin JS, Citron DM, Alder JD. Clinical efficacy and correlation of clinical outcomes with in vitro susceptibility for anaerobic bacteria in patients with complicated intra-abdominal infections treated with moxifloxacin. Clin Infect Dis. 2011; 53:1074–1080. PMID: 21998288.

5. Lassmann B, Gustafson DR, Wood CM, Rosenblatt JE. Reemergence of anaerobic bacteremia. Clin Infect Dis. 2007; 44:895–900. PMID: 17342637.

6. Lee K, Shin HB, Chong Y. Antimicrobial resistance patterns of Bacteroides fragilis group organisms in Korea. Yonsei Med J. 1998; 39:578–586. PMID: 10097686.

7. Yim J, Lee Y, Kim M, Seo YH, Kim WH, Yong D, et al. Antimicrobial susceptibility of clinical isolates of Bacteroides fragilis group organisms recovered from 2009 to 2012 in a Korean hospital. Ann Lab Med. 2015; 35:94–98. PMID: 25553287.

8. Jousimies-Somer HR, Summanen P, editors. Wadsworth-KTL anaerobic bacteriology manual. 6th ed. Belmont, CA: Star Publishing Co.;2002. p. 55–70.

9. The US Food and Drug Administration. FDA Approved Drug Products Label for Tygacil, NDA no. 021821. approved on May 23, 2013. http://www.accessdata.fda.gov/drugsatfda_docs/nda/2005/21-821_Tygacil.cfm.

10. Roh KH, Kim S, Kim CK, Yum JH, Kim MS, Yong D, et al. New cfiA variant and novel insertion sequence elements in carbapenem-resistant Bacteroides fragilis isolates from Korea. Diagn Microbiol Infect Dis. 2010; 66:343–348. PMID: 20226324.

11. Citron DM, Hecht DW. Susceptibility test methods: anaerobic bacteria. In : Versalovic J, Carroll KC, Funke G, editors. Manual of clinical microbiology. 10th ed. Washington, DC: ASM Press;2011. p. 1204–1214.

12. Koeth LM, Good CE, Appelbaum PC, Goldstein EJ, Rodloff AC, Claros M, et al. Surveillance of susceptibility patterns in 1297 European and US anaerobic and capnophilic isolates to co-amoxiclav and five other antimicrobial agents. J Antimicrob Chemother. 2004; 53:1039–1044. PMID: 15128729.

13. Snydman DR, Jacobus NV, McDermott LA, Ruthazer R, Golan Y, Goldstein EJ, et al. National survey on the susceptibility of Bacteroides fragilis group: report and analysis of trends in the United States from 1997 to 2004. Antimicrob Agents Chemother. 2007; 51:1649–1655. PMID: 17283189.

14. Lee Y, Park Y, Kim MS, Yong D, Jeong SH, Lee K, et al. Antimicrobial susceptibility patterns for recent clinical isolates of anaerobic bacteria in South Korea. Antimicrob Agents Chemother. 2010; 54:3993–3997. PMID: 20585132.

15. Snydman DR, Jacobus NV, McDermott LA, Golan Y, Hecht DW, Goldstein EJ, et al. Lessons learned from the anaerobe survey: historical perspective and review of the most recent data (2005-2007). Clin Infect Dis. 2010; 50(Suppl 1):S26–S33. PMID: 20067390.

16. Karlowsky JA, Walkty AJ, Adam HJ, Baxter MR, Hoban DJ, Zhanel GG. Prevalence of antimicrobial resistance among clinical isolates of Bacteroides fragilis group in Canada in 2010-2011: CANWARD surveillance study. Antimicrob Agents Chemother. 2012; 56:1247–1252. PMID: 22203594.

17. Katsandri A, Avlamis A, Pantazatou A, Petrikkos GL, Legakis NJ, Papaparaskevas J, et al. In vitro activities of tigecycline against recently isolated Gram-negative anaerobic bacteria in Greece, including metronidazole-resistant strains. Diagn Microbiol Infect Dis. 2006; 55:231–236. PMID: 16626904.

18. Wybo I, Piérard D, Verschraegen I, Reynders M, Vandoorslaer K, Claeys G, et al. Third Belgian multicentre survey of antibiotic susceptibility of anaerobic bacteria. J Antimicrob Chemother. 2007; 59:132–139. PMID: 17095529.

19. Jacobus NV, McDermott LA, Ruthazer R, Snydman DR. In vitro activities of tigecycline against the Bacteroides fragilis group. Antimicrob Agents Chemother. 2004; 48:1034–1036. PMID: 14982803.

20. Citron DM, Goldstein EJ, Merriam CV, Lipsky BA, Abramson MA. Bacteriology of moderate-to-severe diabetic foot infections and in vitro activity of antimicrobial agents. J Clin Microbiol. 2007; 45:2819–2828. PMID: 17609322.

21. Papaparaskevas J, Pantazatou A, Katsandri A, Houhoula DP, Legakis NJ, Tsakris A, et al. Moxifloxacin resistance is prevalent among Bacteroides and Prevotella species in Greece. J Antimicrob Chemother. 2008; 62:137–141. PMID: 18385145.

22. Sóki J, Edwards R, Hedberg M, Fang H, Nagy E, Nord CE, et al. Examination of cfiA-mediated carbapenem resistance in Bacteroides fragilis strains from a European antibiotic susceptibility survey. Int J Antimicrob Agents. 2006; 28:497–502. PMID: 17097857.