Antibiotic susceptibility of Bacteroides fragilis group strains in Hungary

Resistance rates to different antibiotics of 495 Bacteroides fragilis group strains were followed between 1987 and 1994 in Hungary. In 1992 the strains were collected in three different laboratories, whereas during the other periods strains were isolated in one centre. Metronidazole, chloramphenicol, imipenem and amoxicillin/clavulanic acid were the most active drugs. A high level of resistance was observed in 1987 for ampicillin (88% at > 4 mg/L), erythromycin (51% at > 4 mg/L), tetracyclin (53% at > 8 mg/L) and clindamycin (27% at > 4 mg/L). The same level of resistance was seen during the further years for clindamycin and ampicillin. Resistance to cefoxitin increased from 6% to 11% between 1987 and 1993/1994. No differences in resistance rates were observed between the strains collected in the three centers. For 100 strains, the results of the E test were compared with those of the micro-broth dilution test, both being used routinely for testing the antibiotic susceptibility of Bacteroides fragilis group strains in this period.     

<Emphasis Type="Italic">In Vitro</Emphasis> susceptibility to selected antibiotics in bacteria of the <Emphasis Type="Italic">Bacteroides fragilis</Emphasis> group

Susceptibility of strains of Bacteroides fragilis group (1284 isolates from cancerous and noncancerous patients in 1994–2004) showed an increase in resistance toward some antibiotics (by 9 % toward penicillin and 8 % toward clindamycin) compared with the resistance level of 10 years ago. The increase in resistance was not detected in the case of ampicillin + sulbactam and metronidazole.     

Prevalence and Antimicrobial Susceptibility of Enterotoxigenic Bacteroides fragilis in Children with Diarrhoea in Nicaragua

Enterotoxigenic Bacteroides fragilis (ETBF) strains have been reported as a cause of diarrhoeal diseases. Diarrhoea is an important cause of morbidity and mortality in children from developing countries. This study was conducted to determine the prevalence and antimicrobial susceptibility of ETBF in children from León, Nicaragua. Faecal specimens from 106 children under ten years of age with diarrhoea and 60 asymptomatic, age-matched controls were examined for presence of ETBF using an assay based on immunomagnetic separation (IMS) in combination with PCR (IMS-PCR) and HT29/C1 cell assay. ETBF was present in nine children with diarrhoea (8.4%) and was more often identified in children ≤1 year (7/63, 11.1%) but all ETBF positive children were under 2 years of age. ETBF was isolated as the only pathogen in five of nine positive children (55.5%). The agar dilution method was used to determine the antimicrobial susceptibility pattern of the ETBF strains. All strains were resistant to ampicillin (range 8–1024 mg/L) and one strain was also resistant to clindamycin MIC 256 mg/L. All the other antimicrobial agents were active against the strains (MIC₅₀and MIC₉₀): 8 and 16 mg/L for cefoxitin, 0.004 and 0.008 mg/L for imipenem, 0.5 and 0.5 mg/L for clindamycin and for metronidazole, 2 and 4 mg/L for chloramphenicol. A majority (77%) of the ETBF strains were β-lactamase producers.     

Antibiotic resistance among anaerobic Gram-negative bacilli: lessons from a French multicentric survey

Temporal changes of antibiotic susceptibilities among anaerobes in France are followed in our laboratory since 1992. For Bacteroides strains, resistance increased from 1992 to 1998 for amoxicillin-clavulanic acid, cefotetan and clindamycin. The present study evaluates the situation in 2000 for 434 Gram-negative anaerobic clinical isolates (obtained from 9 large university hospitals) by testing amoxicillin and ticarcillin alone or combined with clavulanic acid, cefoxitin, cefotetan, imipenem, clindamycin and metronidazole (using the NCCLS-approved method for MIC determination. The main genera tested included Bacteroides (359 strains of the fragilis group), Prevotella (40 strains), Fusobacterium (23 strains) and miscellaneous species (8 strains). Resistance rates within the B. fragilis group were: amoxicillin-clavulanic acid 5.6%, ticarcillin 33%, ticarcillin-clavulanic acid 2%, cefoxitin 13%, cefotetan 44%, clindamycin 33%, imipenem 1% and metronidazole <1%, respectively. Only one strain of B. fragilis was resistant to metronidazole (MIC=64 mg/L); due to the presence of the nimA gene on the chromosome. Resistance to imipenem or metronidazole was only found among the B. fragilis species. These two former drugs excepted, B. fragilis was less resistant to antibiotics than the other species. beta-lactamase production was detected for 357/359 strains of the fragilis group, 26/40 stains of Prevotella and 3/23 strains of Fusobacterium. Dynamic changes of antibacterial resistance are occurring within the B. fragilis group: decreased resistance to amoxicillin-clavulanic acid, ticarcillin-clavulanic acid, imipenem while resistance for cefoxitin, cefotetan, clindamycin continues to increase. Regular antibiotic surveys are needed as a source of information to guide the empirical therapy of anaerobic infections.     

In vitro Activity of Gatifloxacin Against 238 Strains of Anaerobic Bacteria

The activity of gatifloxacin, a new 8-methoxy-fluoroquinolone, was tested against 208 pulmonary pathogens and against an additional 30 isolates of the Bacteroides fragilis group. Pulmonary isolates were from patients with documented anaerobic pleuropulmonary infections and were obtained by appropriate sampling methods. MICs were determined using the NCCLS-approved Wadsworth brucella laked blood agar method and compared to those of clindamycin, imipenem, metronidazole and trovafloxacin. Breakpoints used to define susceptible and [resistant] categories were (in μg/ml): Clindamycin-2, imipenem-4, metronidazole 8 and trovafloxacin. No breakpoint has been defined for gatifloxacin. Gatifloxacin inhibited 99% of all anaerobes tested at 4 μg/ml and 97% of all strains at 2 μg/ml. One strain of B. fragilis was resistant to gatifloxacin at 4 μg/ml; all strains of other B. fragilis group species were susceptible. One strain of Peptostreptococcus sp. was resistant to both gatifloxacin and trovafloxacin (MIC >4 μg/ml). All other strains were susceptible to all agents at ≤μg/ml. All of the non-sporeforming Gram-positive rods were susceptible to gatifloxacin at ≤μg/ml (three strains had an MIC of 4 μg/ml). Trovafloxacin had MICs of 4 μg/ml for two strains, and an MIC of 8 μg/ml for one strain. Five percent of B. fragilis, 21% of other B. fragilis group species and 20% of Clostridium species (other than C. difficile, C. perfringens or C. ramosum) were resistant to clindamycin. No imipenem resistant isolates were found in this study. Gatifloxacin appears to have excellentin vitro activity against pulmonary isolates of anaerobes and very good activity against strains of the B. fragilis group.     

Antimicrobial susceptibility, β-lactamase and enterotoxin production in <Emphasis Type="Italic">Bacillus cereus</Emphasis> isolates from clinical and food samples

The antimicrobial susceptibility of 30 clinical and 30 food Bacillus cereus isolates was determined. All isolates were susceptible to streptomycin, ciprofloxacin and gentamicin, 90 % of them to clindamycin and vancomycin, and 67 % to erythromycin. All isolates were resistant to amoxicillin with clavulanic acid, ampicillin, cefotaxime, ciprofloxacin, cloxacillin, cefotaxime with clavulanic acid and penicillin. The MIC values (determined by E-tests) were 48–256 mg/L for ampicillin, 0.19–1.5 mg/L for gentamicin, 0.125–1.0 mg/L for clindamycin, 0.047–4.0 mg/L for erythromycin and 1.5–16 mg/L for vancomycin. The MICs 4.6–18.75 g/L were observed for penicillin using the microdilution method. The presence of metallo-β-lactamases was detected by E-test for 100 % of strains. Nonhemolytic diarrheal enterotoxin (NHE) was produced by 98.3 % of strains, while 31.7 % of them produced hemolytic diarrheal enterotoxin (HBL). Clinical isolates produced 10 % more HBL than food isolates. The psychrotrophic strains isolated from food samples produced NHE at 6.5 °C in 73 % of cases.     

Relation between resistance to β-lactam antibiotics and cadmium in salmonellae isolated from pigs

Of 50Salmonella species isolated from pigs, 30 were resistant to cadmium and 18 of these also to azlocillin. The azlocillin-resistant isolates were resistant to cadmium at 80–500, mg/L CdSO₄. A broader spectrum of resistance to azlocillin, ampicillin and cephazollin was found in strains resistant to <200 mg/L CdSO₄. Resistance to silver, mercury, chloramphenicol and streptomycin was independent of the resistance to β-lactam antibiotics and Cd²⁺. Production and levels of β-lactamase do not correlate with the spectrum of resistance.     

Antibiotic resistance of Helicobacter pylori in Mazandaran, North of Iran

Background: The aim of this study was to investigate the prevalence of resistances in Helicobacter pylori against commonly used antibiotics including metronidazole, clarithromycin, amoxicillin, and tetracycline in Iranian patients. Methods: H. pylori isolates were collected from gastric biopsies from patients referred for upper gastrointestinal endoscopy at Tooba Medical Center, Sari, Iran, from 2007 to 2010. None of them had been using antibiotics for at least 8 months. H. pylori was identified based on morphological shape and positive biochemical tests for catalase, oxidase, and urease activity. Antibiotic resistance for metronidazole, clarithromycin, amoxicillin, and tetracycline was investigated by using epsilometer test. Resistance was defined by minimal inhibitory concentration (MIC) > 0.5 mg/L for amoxicillin (AMX), >4 mg/L for tetracycline (TET), >8 mg/L for metronidazole (MTZ), and >1 mg/L for clarithromycin (CLR). Results: Strains were collected from 132 patients, mean age 45.8 years, 52 (39%) were women. Patients had diverse diagnoses: gastritis 42 (31.8%), duodenal ulcer 45 (34%), gastric cancer 15 (11.3%), or gastric ulcer 30 (22.7%). The prevalences of resistance of H. pylori strains isolated from the patients were 73.4% for metronidazole, 30% for clarithromycin, 6.8% for amoxicillin, and 9% for tetracycline. Twenty‐eight (21.2%) were double resistant to MTZ‐CLR, 16 (12.1%) showed triple resistance to MTZ‐CLR‐AMX, and 8 (6%) were resistant to all four tested antibiotics (MTZ‐CLR‐AMX‐TET). No associations were detected between multiple resistant strains and clinical manifestations (p > .05). Conclusions: The prevalence of H. pylori antibiotic resistance to metronidazole and clarithromycin was high in Iran consistent with the reported low success rates for H. pylori treatment in this country.     

Transferable lincosamide-macrolide resistance in Bacteroides.

Inter- and intraspecies transfer of resistance to clindamycin, lincomycin, and erythromycin in the strict anaerobe, Bacteroides, is described. This lincosamide-macrolide resistance was found to be specified by a 27 × 10⁶-dalton plasmid, designated pBF4, originally identified in a clinical Bacteroides fragilis isolate. Transfer of this plasmid to a strain of Bacteroides uniformis was demonstrated to occur by a deoxyribonuclease insensitive process which required cell-to-cell contact. Chloroform sterilized donor cell supernatants or filtrates of donor cells did not mediate resistance transfer. Transfer of the antibiotic resistance and pBF4 plasmid deoxyribonucleic acid (DNA) were always coincident. Drug resistant progeny recovered from such matings were able to transfer the pBF4 plasmid and its associated resistance markers to a suitable B.fragilis recipient strain. Compared to interspecies matings, resistance transfer was 100- to 1000-fold greater between isogenic donor and recipient strains, suggesting the possibility of a host controlled restriction-modification system.     

Susceptibility of <Emphasis Type="Italic">Streptococcus thermophilus</Emphasis> to antibiotics

A total of 74 Streptococcus thermophilus isolates collected between 1948 and 2005 from different environments were investigated to assess erythromycin, clindamycin, streptomycin, gentamicin, tetracycline and ampicillin susceptibility by means of microdilution, Etest and disk diffusion methods. For this purpose a new S. thermophilus Susceptibility test Medium (SSM) was developed. This medium allowed a better identification of strains with atypical tetracycline resistance. The recipe is a mixed formulation of Iso-Sensitest medium (90% v/v) and M17 medium (10% v/v) supplemented with lactose (0.5% w/v). The overall agreement of the techniques was good with exception of tetracycline, for which Etest provided lower MICs than the microdilution method. Most strains were susceptible to all the antibiotics tested while a few erythromycin, tetracycline and streptomycin resistant strains were detected.     

Update on resistance of Bacteroides fragilis group and related species with special attention to carbapenems 2006-2009

The susceptibility trends for the species of the Bacteroides fragilis group against various antibiotics were determined using data from 4 years [2006-2009] on 1957 isolates referred by 8 medical centers participating in a National Survey for the Susceptibility of B. fragilis. The antibiotic test panel included doripenem, ertapenem, imipenem, meropenem, ampicillin:sulbactam, piperacillin:tazobactam, cefoxitin, clindamycin, moxifloxacin, tigecycline, chloramphenicol and metronidazole. MICs were determined using agar dilution methods following CLSI recommendations. Genetic analysis of isolates from 2008 with elevated MICs (>2 μg/mL) to one or more of the carbapenems to detect presence of the cfiA gene was performed using PCR methodology. The results showed an increase in the resistance rates to the β-lactam antibiotics. High resistance rates were seen for clindamycin and moxifloxacin (as high as 60% for clindamycin and >80% for moxifloxacin), with relatively stable low resistance (5.4%) for tigecycline. For carbapenems, resistance in B. fragilis was 1.1%-2.5% in 2008-9. One isolate resistant to metronidazole (MIC 32 μg/mL) was observed as well as isolates with elevated MICs to chloramphenicol (16 μg/mL). Genetic analysis indicated that the cfiA gene was present in some but not all of the isolates with high MICs to the carbapenems. These data indicate that there continue to be changes in susceptibility over time, and that resistance can be seen among the carbapenems. High antibiotic resistance rates tend to be associated with specific species.     

Description of Complex Forms of a Porin in Bacteroides fragilis and Possible Implication of this Protein in Antibiotic Resistance

Periodic surveys of antibiotic susceptibility patterns among anaerobes have emphasized that new mechanisms of resistance have emerged, especially in the Bacteroides fragilis group. Resistance to the combination of amoxicillin and clavulanic acid among some imipenem-susceptible Bacteroides fragilis strains has been associated with modifications in outer membrane protein electrophoretic patterns with the loss of some porin-like proteins. Porins are outer membrane proteins that play a major part in membrane permeability; if they are under-expressed, they can be responsible for antibiotic resistance. In a previous work, we isolated one outer membrane protein of 45 kDa from Bacteroides fragilis and showed its porin activity. In the present study, we aim to isolate the different complex forms of this protein and to underline their possible role in antibiotic resistance. We therefore compared the electrophoretic patterns of the outer membrane proteins of several strains of Bacteroides fragilis. Although these patterns are similar to each other, some proteins, especially those of high molecular weight, are less visible in the samples heated before electrophoresis. We targeted these high molecular weight proteins (which appeared sensitive to heat) and isolated them by electro-elution. We thus identified two high molecular weight proteins (210 and 130/135 kDa) which seemed to be components of a complex including the 45 kDa outer membrane protein formerly identified by us as a porin protein. Their porin activities were tested by the swelling assay of proteoliposomes which showed that the 210 kDa protein behaved like the 45 kDa protein whereas the 130/135 kDa protein had less porin activity. Furthermore, swelling assays with antibiotic solutions made it possible to compute the role of this protein complex in antibiotic resistance.     

Surveillance and trends of antimicrobial resistance among clinical isolates of anaerobes in Kuwait hospitals from 2002 to 2007

The susceptibility trends for all anaerobes processed by the Anaerobe Reference Laboratory against various antibiotics were determined by using data for 2557 isolates referred by all government hospitals in Kuwait from 2002 to 2007. MIC were determined for the following anti-anaerobic antibiotics: amoxicillin–clavulanic acid, clindamycin, imipenem, meropenem, metronidazole, penicillin, piperacillin, piperacillin–tazobactam and vancomycin (for Gram-positive anaerobes only), using E-test method. The commonest isolates were Bacteroides fragilis (36.8%), followed by Peptostreptococcus spp. (21.9%), Bacteroides ovatus (15.5%) and Prevotella bivia (12.1%). In addition, Prevotella oralis and other Bacteroides spp. represented 8.5% and 8.1% of total number of isolates, respectively. Resistance rate varied among the antimicrobial agents and the species tested. The β-lactams, with the exception of penicillin, were the most active drugs. Piperacillin–tazobactam was the only antimicrobial agent to which all the isolates were uniformly susceptible. Imipenem and metronidazole were highly active with resistance rate of only <5% recorded against most isolates. However, 42.8, 55.8 and 9.3% of Clostridium difficile isolates were resistant to imipenem, clindamycin and meropenem, respectively. It is noteworthy that from 2002 to 2007, there was a gradual increase in resistance rates to clindamycin, amoxicillin–clavulanic acid and piperacillin among B. fragilis. Periodic surveillance of antibiotic resistance among the anaerobic bacteria is recommended as a guide to empiric antibiotic use and formulation of guideline for appropriate choice of antimicrobial therapy in anaerobic infections.     

Antimicrobial susceptibility of anaerobic bacteria in Bulgaria

ObjectivesThe antimicrobial susceptibility of anaerobic bacteria isolated from clinical specimens in the referent for Bulgaria anaerobic laboratory was studied in a period of 25 years/1983–2007/.MethodsNCCLS – recommended agar dilution methods were used. β-lactamase activity was determined with nitrocefin discs.ResultsThe 29 antimicrobial agents included in the study were divided according to their in vitro activity against the anaerobic isolates into 4 main groups for guiding empirical treatment: 1st group of metronidazole, chloramphenicol, meropenem, imipenem and combinations of β-lactam antibiotics with sulbactam – with high activity and drugs of choice for treatment; 2nd group – clindamycin, cefoxitin, carbenicillin/and azlocillin, piperacillin/ – with a good activity and low percent of resistant strains; 3rd group – of tetracycline and erythromycin with higher percent of resistant strains including the new macrolides as josamycin, clarithromycin, roxithromycin and azithromycin; 4th group – penicillins/ampicillin, amoxicillin, penicillin/and cephalosporins/cefamandole, cefazolin, cefotaxime and cefoperazone/ – not suitable for treatment of infections including Bacteroides fragilis group strains, with a very high percent of resistant strains, probably due to β-lactamase activity in most of the strains.ConclusionA continued updating and a follow-up in the changes of antibiotic susceptibility are necessary in every country as resistance patterns vary not only between geographical regions but also even among medical centers and hospitals which may be connected with differences in antibiotic usage in man and animals.     

Sequence Analysis of the Plasmid pRRI2 from the Rumen Bacterium Prevotella ruminicola 223/M2/7 and the Use of pRRI2 in Prevotella/Bacteroides Shuttle Vectors

pRRI2 is a small cryptic plasmid from the rumen bacterium Prevotella ruminicola 223/M2/7 which has been used for the construction of shuttle vectors (pRH3 and pRRI207) that replicate in many Bacteroides/Prevotella strains as well as in Escherichia coli. Sequence analysis of pRRI2 reveals that it is a 3240-bp plasmid carrying two clear open reading frames. Rep, encoded by ORF1, shows 48 and 47% amino acid sequence identity with RepA proteins from Bacteroides vulgatus and Bacteroides fragilis, respectively. ORF2, named Pre, shares 34% amino acid sequence identity with a putative plasmid recombination protein from the Flavobacterium spp. plasmid pFL1 and 30% amino acid sequence identity with BmpH from B. fragilis Tn5520. Disruption of ORF1 with HindIII prevents replication and maintenance in Bacteroides spp. hosts, but shuttle vectors carrying pRRI2 interrupted within ORF2, by EcoRI*, are able to replicate. pRRI2 shows no significant similarity with the only other P. ruminicola plasmid to have been studied previously, pRAM4.     

Mercury Resistance in Bacterial Strains Isolated from Tailing Ponds in a Gold Mining Area Near El Callao (Bolívar State,Venezuela)

Bacterial resistance to mercury (Hg) was investigated in strains isolated from Hg-contaminated tailing ponds located in the gold mining area of El Callao (Bolívar State, Venezuela). High frequencies of resistance were detected to both inorganic-Hg and organomercurials among these strains. A broad range of resistance levels was observed when determining minimal inhibitory concentrations of Hg²⁺. Some strains were able to grow in liquid medium containing 25 μM Hg²⁺, whereas others grew at 300 μM Hg²⁺. Of 190 Hg-resistant strains tested, 58.2% were additionally shown to be resistant to ampicillin (40 mg/L), 33.3% to chloramphenicol (30 mg/L), 24.9% to streptomycin (30 mg/L), 23.3% to tetracycline (30 mg/L), and 1.6% to kanamycin (30 mg/L). Furthermore, we found that 20% of the Hg-resistant strains were simultaneously resistant to as many as four of these antibiotics, at the concentrations tested. The presence of large plasmids in 62.9% of 53 Hg-resistant strains screened prompted us to investigate the horizontal transfer of resistance determinants. Mating experiments were performed using Escherichia coli and Pseudomonas aeruginosa as recipient strains. The results obtained confirmed that indigenous Hg-resistant bacteria colonizing the tailing ponds can effectively transfer the phenotype to potentially pathogenic species.     

广州南沙湿地公园候鸟源肠杆菌科耐药性及产超广谱β-内酰胺酶基因监测调查

[背景]耐药基因可通过水平转移在环境、动物和人体间发生转移,而远距离传播则主要通过候鸟的迁徙.耐药基因可通过水平转移和候鸟迁徙跨地区传播至禽畜和人类,引起公共卫生问题.[目的]分离广州南沙湿地公园候鸟粪便中肠杆菌科细菌,并鉴定菌种类别,研究其对常见抗生素的耐药性及携带的主要超广谱β-内酰胺酶(extended-spec...     

Trimethoprim resistance in hospitals.

During November 1980 to April 1981, 1561 urinary tract pathogens were collected from Turku City Hospital, Turku University Central Hospital, and Kuopio University Central Hospital. Resistance of the strains was tested by agar-plate dilution against trimethoprim, sulphamethoxazole-trimethoprim, sulphamethoxazole, ampicillin, and nitrofurantoin. Resistance to trimethoprim (greater than 8 mg/l) occurred in 8.6-12.2% of strains from the university hospitals (Pseudomonas excluded) and 38.3% of strains from Turku City Hospital. Resistance of Escherichia coli occurred in 4.1-6.2% of strains from the university hospitals and 21% of strains from Turku City Hospital. Proteus mirabilis was the most resistant of the clinically important bacterial species with resistance to trimethoprim in 29-78%. Attention is called for in defining the type of hospital used for a particular study: bacterial resistance in different hospitals cannot be compared direct and one hospital is not necessarily representative for a whole country. After seven years'' use of plain trimethoprim the prevalence of resistance in the two university hospitals in Finland was similar to that in a London hospital just before plain trimethoprim was registered for use in Britain.     

Cryptic plasmid pBf1 fromButyrivibrio fibrisolvens AR10: Its use as a replicon for recombinant plasmids

A cryptic 2.85 kb plasmid (pBf1) was isolated from the rumen bacteriumButyrivibrio fibrisolvens strain AR10, ampped with restriction endonucleases, and cleavage sites suitable for attachment toEscherichia coli plasmids were identified. AR10 was not able to be cured of pBf1 by growth at 42°C or in 0.25 g ampicillin/ml, but growth in 50 g acridine orange/ml for three culture passages produced cured colonies at a frequency of <1%. Chimeric plasmids were constructed by combining pBf1 with theE. coli plasmid pUC18, in addition to the clindamycin resistance gene fromBacteroides fragilis plasmid pDP1 (pCW2 and pCW3), or the CAT gene fromE. coli plasmid pKK232-8 (pCK1). For plasmid construction, pBf1 was cleaved at two alternative restriction sites to increase the likelihood that replication control sequences would remain functional in at least one of the plasmids. Electroporation of AR10 yielded transformant populations that clearly maintained the plasmids and that appeared to express the ampicillinase gene of pUC18, although transformants were not readily selectable with any of the three antibiotics. The suitability of pBf1 as a replicon on which to base the construction of shuttle vectors was demonstrated clearly, by persistence of plasmid pCW3 in the absence of selective pressure, and the addition of appropriate selection factors is expected to yield practical transformation vectors.     

Antibiotic Resistance Among Anaerobes: What Does it Mean?

Antibiotic resistance among anaerobes is increasing, with significant resistance to clindamycin, cephalosporins, cephamycins, and penicillins noted at community hospitals and major medical centers. A total of 615 anaerobes isolated from various Chicago area hospitals in 1996 were tested against 13 antibiotics, and the resistance patterns compared with similar data from 1991. For the Bacteroides fragilis group anaerobes, the most effective antibiotics were the β-lactam/β-lactamase inhibitor combination agents, carbapenems, trovafloxacin and metronidazole. High levels of resistance to clindamycin, piperacillin, cefoxitin and ceftizoxime were seen 1996. For non- B. fragilis group anaerobes, resistance was mush lower, and was notable only in Clostridium spp. (clindamycin and cephamycins) and Prevotella spp. (clindamycin and piperacillin). Despite the prevalence of antibiotic resistance among anaerobes, the frequency of antimicrobial susceptibility testing of anaerobes is declining. There are a number of factors that account for this decline, including a general reduction in funding of hospital clinical laboratories, a concomitant loss of expertise at these institutions, a lack of automated testing for anaerobes, and a failure to consider resistance as important to clinicians. The case for increased susceptibility testing is built upon the changing patterns of resistance such as those reported in this paper, the identification and transfer of genetic determinants corresponding to antibiotic resistance, as well as the correlation of resistance and clinical outcome.