Mechanisms of resistance in anaerobes and new developments in testing

Anaerobic bacteria currently demonstrate increased resistance to antimicrobial agents, primarily by the production of beta-lactamase. A number of species of Bacteroides, most notably those in the Bacteroides fragilis group, produce these enzymes. A few species of Fusobacterium and Clostridium produce beta-lactamase as well. Fortunately, this mechanism of resistance is readily overcome by administering beta-lactamase inhibitors coupled with a beta-lactam antibiotic that would otherwise be inactivated. Other types of resistance encountered in anaerobic bacteria include inactivating enzymes such as chloramphenicol acetyltransferase, plasmid-mediated transferable multiple-drug resistance, changes in porin molecules in the outer membrane of the bacterial cell, decreased uptake of drug by other mechanisms, changes in the target organs such as penicillin-binding proteins, and decreased reduction of the antibiotic to an active intermediate product. In many institutions, certain drugs such as cefoxitin, clindamycin, and piperacillin, which were previously active against almost all strains of B. fragilis, are now effective against only 70 to 85% of this group of anaerobes. Drugs with essentially 100% activity against most anaerobic bacteria include chloramphenicol, imipenem, metronidazole, and the combinations of a beta-lactam antibiotic plus a beta-lactamase inhibitor such as ampicillin plus sulbactam and amoxicillin or ticarcillin combined with sodium clavulanate. This paper also discusses the indications for antimicrobial susceptibility testing of anaerobes as well as problems encountered with testing techniques that are currently being used.