Multidrug resistance in anaerobes
Lyudmila Boyanova1, Rumyana Markovska1, Ivan Mitov1
1Department of Medical Microbiology, Medical University of Sofia, Sofia 1431, Bulgaria.
Abstract:
Multidrug resistance (MDR) in anaerobes is not a well-known topic. Bacteroides fragilis group isolates have numerous resistance determinants such as multidrug efflux pumps, cfiA and nimB genes and activating insertion sequences, and some isolates exhibited extensive drug-resistant patterns. MDR rates in B. fragilis group were from 1.5 to >18% and up to >71% in cfiA and nimB positive isolates carrying insertion sequences. MDR was present in >1/2 of Clostridioides difficile isolates, most often in epidemic/hypervirulent strains and unusually high metronidazole or vancomycin resistance has been reported in single studies. MDR was found in Prevotella spp. (in ≤10% of isolates), Finegoldia magna, Veillonella spp. and Cutibacterium acnes. Resistance in the anaerobes tends to be less predictable and anaerobic microbiology is required in more laboratories. New hopes may be new antibiotics such as eravacycline, cadazolid, surotomycin, ridinilazol or C. difficile toxoid vaccines; however, more efforts are needed to track the MDR in anaerobes.
Insights
Multidrug resistance (MDR) is a growing concern in anaerobic bacteria, particularly in species like Bacteroides fragilis and Clostridioides difficile. Understanding and tracking this resistance is crucial for effective treatment strategies.
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Multidrug resistance (MDR) in anaerobic bacteria is an under-recognized but significant clinical challenge.
- Anaerobes possess various resistance mechanisms, including efflux pumps and specific genes like cfiA and nimB, contributing to MDR patterns.
Purpose of the Study:
- To review the current knowledge on multidrug resistance in clinically relevant anaerobic bacteria.
- To highlight the prevalence and specific resistance determinants in key anaerobic pathogens.
Main Methods:
- Literature review of studies reporting antimicrobial resistance in anaerobic bacteria.
- Analysis of reported MDR rates and resistance mechanisms in species such as Bacteroides, Clostridioides, Prevotella, and others.
Main Results:
- MDR rates vary significantly, with Bacteroides fragilis group isolates showing 1.5% to over 18% resistance, and up to 71% in specific resistant strains.
- Over half of Clostridioides difficile isolates exhibit MDR, often associated with epidemic strains, and some studies report high metronidazole or vancomycin resistance.
- MDR is also observed in Prevotella spp., Finegoldia magna, Veillonella spp., and Cutibacterium acnes, with resistance patterns being less predictable.
Conclusions:
- Anaerobic resistance is complex and requires specialized laboratory diagnostics.
- Emerging antibiotics and vaccines offer potential solutions, but continued surveillance of MDR in anaerobes is essential.
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