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Fifty years devoted to anaerobes: historical, lessons, and highlights

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Abstract

Renew interest and enthusiasm for anaerobes stem from both technological improvements (culture media, production of an adequate anaerobic atmosphere, identification methods) and greater awareness on the part of clinicians. Anaerobic infections were historically treated empirically, targeting the species known to be involved in each type of infection. Prevotella, fusobacteria, and Gram-positive cocci (GPAC) were considered responsible for infections above the diaphragm whereas for intra-abdominal infections, Bacteroides of the fragilis group (BFG), GPAC and clostridia were predominantly implicated. The antibiotic susceptibility of anaerobes was only taken into consideration by the clinician in the event of treatment failure or when faced with infections by multidrug-resistant bacteria (MDR). The evolution of antibiotic resistance together with clinical failures due to the absence of detection of hetero-resistant clones has resulted in a greater need for accessible antibiotic susceptibility testing (AST) and disc diffusion method. Improved isolation and identification of anaerobes, along with the availability of accessible and robust methods for performing AST, will ensure that treatment, whether empirical or guided by an antibiogram, will lead to better outcomes for anaerobic infections.

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The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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    Luc J. Dubreuil

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Highlights

• Never refrigerate samples.

• The reference method for MIC determination is agar dilution.

• Disc diffusion methods (EUCAST and CA-SFM) have been revisited.

• Do not ignore squatter colonies in the zone of inhibition which often indicate hetero-resistance.

• Clostridia are not always susceptible to metronidazole, linezolid, and daptomycin.

• Avoid any confusion between B. fragilis cfiA+ and cfiA− strains.

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Dubreuil, L.J. Fifty years devoted to anaerobes: historical, lessons, and highlights. Eur J Clin Microbiol Infect Dis 43, 1–15 (2024). https://doi.org/10.1007/s10096-023-04708-4

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