Journal List > Korean J Lab Med > v.29(4) > 1011555

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

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.

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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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