The susceptibility trends for the species of the Bacteroides fragilis group against various antibiotics from 1997 to 2004 were determined by using data for 5,225 isolates referred by 10 medical centers. The antibiotic test panel included ertapenem, imipenem, meropenem, ampicillin-sulbactam, piperacillin-tazobactam, cefoxitin, clindamycin, moxifloxacin, tigecycline, chloramphenicol, and metronidazole. From 1997 to 2004 there were decreases in the geometric mean (GM) MICs of imipenem, meropenem, piperacillin-tazobactam, and cefoxitin for many of the species within the group. B. distasonis showed the highest rates of resistance to most of the ␤-lactams. B. fragilis, B. ovatus, and B. thetaiotaomicron showed significantly higher GM MICs and rates of resistance to clindamycin over time. The rate of resistance to moxifloxacin of B. vulgatus was very high (MIC range for the 8-year study period, 38% to 66%). B. fragilis, B. ovatus, and B. distasonis and other Bacteroides spp. exhibited significant increases in the rates of resistance to moxifloxacin over the 8 years. Resistance rates and GM MICs for tigecycline were low and stable during the 5-year period over which this agent was studied. All isolates were susceptible to chloramphenicol (MICs < 16 g/ml). In 2002, one isolate resistant to metronidazole (MIC ‫؍‬ 64 g/ml) was noted. These data indicate changes in susceptibility over time; surprisingly, some antimicrobial agents are more active now than they were 5 years ago.Pathogens of the Bacteroides fragilis group are the anaerobic pathogens that are the most frequently isolated from blood and abscesses. They are also among the most antibiotic-resistant isolates in anaerobic and mixed infections (21). Susceptibility to antibiotics varies considerably among the species of the group, yet most clinical laboratories do not routinely determine the species of the organism or test the susceptibilities of any anaerobic isolates, including those in the B. fragilis group, due to technical difficulties surrounding Bacteroides susceptibility testing (21). Consequently, the treatment of anaerobic infections is selected empirically, based on published reports on patterns of susceptibility (14,15,19,20). Therefore, the importance for reference laboratories to provide information on the patterns of susceptibility of the species within the group is important clinically. For over 20 years we have conducted a national survey on the susceptibility patterns of these important pathogens and our laboratory at Tufts New England Medical Center served as a reference center for the storage and testing of Bacteroides clinical isolates. We undertook this analysis to determine the susceptibility trends of the various species, using data from 1997 to 2004 for 5,225 isolates referred by 10 geographically diverse medical centers distributed throughout the United States. Bacterial isolates. Nonduplicate clinical isolates of the B. fragilis group were referred for susceptibility testing to the Special Studies Laboratory at New England Medical Center by ...

There is debate regarding the correlation between in vitro susceptibility testing and clinical response to therapy for Bacteroides bacteremia. We conducted a prospective multicenter observational study of 128 patients with bacteroides bacteremia. Outcome was correlated with results of in vitro susceptibility testing of Bacteroides isolates recovered from blood and/or nonblood sites, determined with use of 3 end points: mortality at 30 days, clinical response (cure vs. failure), and microbiological response (eradication vs. persistence). The mortality rate among patients who received inactive therapy (45%) was higher than among patients who received active therapy (16%; P=.04). Clinical failure (82%) and microbiological persistence (42%) were higher for patients who received inactive therapy than for patients who received active therapy (22% and 12%, respectively; P=.0002 and.06, respectively). In vitro activity of agents directed at Bacteroides species reliably predicts outcome: the specificity was 97%, and positive predictive value was 82%. Antimicrobial susceptibility testing may be indicated for patients whose blood specimens yield Bacteroides species.

In summary, resistance to antibiotics was greater among non-B. fragilis Bacteroides species than among B. fragilis and was especially greater among species with a low frequency of isolation, such as Bacteroides caccae and B. uniformis. The emergence of resistance among the non-B. fragilis Bacteroides species underscores the need for speciation of B. fragilis group isolates and for clinicians to be aware of associations between species and drug resistance.

A significant proportion of candidaemia with reduced fluconazole susceptibility may be caused by C. albicans, C. tropicalis and C. parapsilosis, species usually considered fully susceptible to fluconazole. Thus, identification of these species may not be predictive of fluconazole susceptibility. Other factors that are associated with reduced fluconazole susceptibility may help clinicians choose adequate empirical anti-Candida therapy.

The in vitro activity of daptomycin against 224 current gram-positive clinical isolates including vancomycinresistant Enterococcus faecium (VREF), methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus spp. (MRSS), and penicillin-resistant Streptococcus pneumoniae (PRSP) was evaluated. The MICs at which 90% of isolates are inhibited for daptomycin and vancomycin, respectively, were as follows: MRSA, 1 and 2 g/ml; MRSS, 1 and 4 g/ml; PRSP, 1 and 0.5 g/ml; and VREF, 2 and >64 g/ml. Daptomycin was bactericidal against 82% of 17 VREF isolates. The antibacterial activity of daptomycin was strongly dependent on the calcium concentration of the medium. Daptomycin was active against all gram-positive cocci tested. (1,3,8,9,13,14,16). The characteristics of daptomycin that distinguish it from vancomycin and teicoplanin are its concentration-dependent bactericidal activity against enterococci and staphylococci, its novel mechanism of action, and its requirement for free calcium at physiologic concentrations (4-7). Hence, careful control of the concentration of free ionized Ca 2ϩ in the test medium is needed in order for daptomycin to exert its antibacterial activity (P. Fuchs, A. Barry, and S. Brown, Abstr. 39th Intersci. Conf. Antimicrob. Agents Chemother., abstr. 350, p. 199, 1999). The object of this study was to compare the antibacterial activity of daptomycin to that of vancomycin against recently isolated resistant gram-positive cocci and to demonstrate its bactericidal effect against VRE and MRSA.All bacterial isolates were unique, recently isolated, grampositive cocci that included 54 MRSA isolates, 27 methicillin- The MICs of the antibiotics for the staphylococci were determined by agar dilution. The MICs for S. pneumoniae, S. pyogenes, and enterococci were determined by broth microdilution with the NCCLS-recommended medium and 0.05-ml inocula. The minimum bactericidal concentrations (MBCs) were determined from microtiter plates (after the MICs were recorded) by plating 0.01 ml from all wells that showed no growth onto blood agar plates (BAPs). All methodologies followed the guidelines of the National Committee for Clinical Laboratory Standards (NCCLS) (10-12).Daptomycin was provided by Cubist Pharmaceuticals Inc., Cambridge, Mass.; vancomycin was purchased from Sigma Chemical Co., St. Louis, Mo.S. aureus ATCC 29213, S. aureus ATCC 43300 (MRSA), E. faecalis ATCC 29212, and S. pneumoniae ATCC 49619 were used as controls.The effect of the calcium concentration on the antibacterial activity was measured by time-kill studies in media with increasing concentrations of calcium. In addition, the MICs of daptomycin against 23 VREF isolates were determined by microdilution in the following media: base Mueller-Hinton (MH) broth (assumed no calcium supplementation); base MH broth supplemented with 25 mg (broth A), 50 mg (broth B), or 75 mg Ca 2ϩ (broth C) of Ca 2ϩ per liter, or MH II (labeled ϳ20 to 25 mg of Ca 2ϩ per liter; (BBL, Cockeysville, Md.) (11). To determine the exact concentrati...

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The results of a multicenter US survey using the National Committee for Clinical Laboratory Standards currently recommended methodology for measuring in vitro susceptibility of 2673 isolates of Bacteroides fragilis group species were compared from 1997 to 2000. The test panel consisted of 14 antibiotics: 3 carbapenems, 3 beta-lactam-beta-lactamase inhibitors, 3 cephamycins, 2 fluoroquinolones, clindamycin, chloramphenicol, and metronidazole. Declines in the geometric mean minimum inhibitory concentrations were seen with imipenem, meropenem, ampicillin-sulbactam, and the cephamycins. Increased geometric means were observed with the fluoroquinolones and were usually accompanied by an increase in resistance rates. Bacteroides distasonis shows the highest resistance rates among beta-lactam antibiotics, whereas Bacteroides vulgatus shows the highest resistance levels among fluoroquinolones. B. fragilis shows the lowest resistance rates for all antibiotics. All strains were susceptible to chloramphenicol and metronidazole concentrations <8 microgram/mL. The data underscore the need for species identification and continued surveillance to monitor resistance patterns.