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Roh, Kim, Kim, Yum, Kim, Yong, Lee, Kim, and Chong: Resistance Trends of Bacteroides fragilis Group Over an 8-Year Period, 1997-2004, in Korea
Original Article

Korean J Leg Med 2009;29(4):293-298.

Published online: 14 January 2009

DOI: https://doi.org/10.3343/kjlm.2009.29.4.293

Resistance Trends of Bacteroides fragilis Group Over an 8-Year Period, 1997-2004, in Korea

Kyoung Ho Roh, M.D.1, Sinyoung Kim, M.D.2, 3, Chang-Ki Kim, M.D.4, Jong Hwa Yum, Ph.D.5, Myung Sook Kim, M.T.2, Dongeun Yong, M.D.2, 3, Kyungwon Lee, M.D.2, 3, June Myung Kim, M.D.6, Yunsop Chong, Ph.D.2

1Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea

2Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Korea

3Brain Korea 21 for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea

4Korean Institute of Tuberculosis, Seoul, Korea

5Department of Clinical Laboratory Science, Dongeui University, Busan, Korea

6Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

Corresponding author: Dongeun Yong, M.D. Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea Tel: +82-2-2228-2442 Fax: +82-2-313-0956 E-mail: deyong@yuhs.ac

∗ This work was supported by the Brain Korea 21 Project in 2005.

      Revised 20 February 20098 May 2009       Accepted 21 May 2009

Copyright © 2009 Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

Bacteroides fragilis group organisms are the most frequently isolated anaerobes in human infections. Increasing resistance to various antimicrobial agents is a significant problem in choosing appropriate antimicrobial agents to treat anaerobic infections. Periodic monitoring of the regional resistance trends of B. fragilis group isolates is needed.

Methods:

A total of 466 nonduplicate clinical isolates of B. fragilis group organisms (276 B. fragilis, 106 Bacteroides thetaiotaomicron, and 84 other B. fragilis group organisms) were collected during the 8-yr period from 1997 to 2004 in a Korean university hospital. Minimum inhibitory concentrations to various antimicrobial agents were determined by the CLSI agar dilution method.

Results:

Eight isolates were resistant to imipenem. Additionally, the resistance rates to cefotetan were decreased in B. thetaiotaomicron, while those for clindamycin were significantly increased compared to the rates found in previous studies. Depending on species, resistance rates were 1-4% for imipenem, 1-6% for piperacillin-tazobactam, 4-11% for cefoxitin, 33-49% for piperacillin, 14-60% for cefotetan, and 51-76% for clindamycin. No isolates were resistant to chloramphenicol or metronidazole.

Conclusions:

Piperacillin-tazobactam, cefoxitin, imipenem, chloramphenicol, and metronidazole are still active against B. fragilis group isolates, while clindamycin no longer has a value as an empirical therapeutic agent in Korea. Furthermore, this study identified the first imipenem-resistant B. fragilis group isolates in Korea.

Keywords: Bacteroides fragilis group, Antimicrobial susceptibility, Trend, Korea

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Fig. 1.
Change in percent resistance of Bacteroides fragilis group organisms isolated from 1997 to 2004. (A) B. fragilis, (B) B. thetaiotaomicron, (C) Other Bacteroides spp.
Abbreviations: PIP, piperacillin; FOX, cefoxitin; CTT, cefotetan; CLI, clindamycin.
kjlm-29-293f1.tif
Table 1.
Distribution of the species within the Bacteroides fragilis group organisms isolated from 1997 to 2004
  N (%) isolates tested
Bacteroides species 1997 1998 1999 2000 2001 2002 2003 2004 Total
B. fragilis 34 30 30 40 34 30 36 42 276 (59.2)
B. thetaiotaomicron 9 11 10 12 15 22 16 11 106 (22.7)
B. vulgatus 5 4 7 1 4 4 3 2 30 (6.4)
B. ovatus 6 4 7 4 2 1 1 2 27 (5.8)
B. distasonis 3 3 6 3 4 3 2 1 25 (5.4)
B. uniformis 0 0 0 0 1 0 0 0 1 (0.2)
B. caccae 0 0 0 0 0 0 1 0 1 (0.2)
Total 57 52 60 60 60 60 59 58 466 (100.0)
Table 2.
Antimicrobial susceptibility of Bacteroides fragilis group organisms isolated from 1997 to 2004
Organism (N isolates) and antimicrobial agents MIC range MIC50 (μg/mL) MIC90 (μg/mL) % Resistant
Bacteroides fragilis (276)        
Piperacillin 2->256 16 >256 33
Piperacillin-tazobactam 0.03->128 0.5 4 1
Cefoxitin 4->128 8 32 4
Cefotetan 2->128 8 128 14
Imipenem 0.06-128 0.25 0.5 1
Clindamycin <0.06->128 8 >128 51
Chloramphenicol 2-8 4 8 0
Metronidazole 0.5-8 4 8 0
Bacteroides thetaiotaomicron (106)        
Piperacillin 4->256 64 >256 42
Piperacillin-tazobactam 0.12->256 8 16 4
Cefoxitin 4->128 16 32 6
Cefotetan 8->128 64 >128 60
Imipenem 0.03-32 0.5 2 2
Clindamycin 1->128 >128 >128 76
Chloramphenicol 2-8 8 8 0
Metronidazole 1-8 2 4 0
Other Bacteroides spp. (84)        
Piperacillin 4->256 64 >256 49
Piperacillin-tazobactam 0.03->256 4 16 6
Cefoxitin 2->128 16 64 11
Cefotetan 2->128 64 >128 54
Imipenem 0.03-32 0.5 1 4
Clindamycin 0.06->128 >128 >128 74
Chloramphenicol 2-8 4 8 0
Metronidazole 0.5-8 2 4 0
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