C Steininger1, Birgit Willinger2. 1. Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. 2. Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Währinger Gürtel 18-20/5P, 1090, Vienna, Austria birgit.willinger@meduniwien.ac.at.
Abstract
OBJECTIVES: Actinomyces spp. are commensals that may occasionally invade deep tissue structures, causing difficult-to-treat and disfiguring lesions. Information on antimicrobial resistance patterns is limited to observations from two previous studies. Therefore, we examined antimicrobial resistance patterns in clinical isolates of Actinomyces spp. METHODS: In this retrospective assessment of antimicrobial resistance patterns, we identified 392 Actinomyces spp. at a tertiary care centre from January 2008 to December 2014. MICs of various antimicrobial agents, including ampicillin/sulbactam, meropenem, clindamycin, metronidazole and vancomycin for anaerobic actinomycetes, were obtained by Etest. For aerobic actinomycetes, imipenem, cefotaxime, amikacin, linezolid, moxifloxacin, trimethoprim/sulfamethoxazole and clarithromycin were tested. MIC results were interpreted based on guidelines published by the CLSI (formerly NCCLS). RESULTS: Actinomyces meyeri was predominantly isolated and accounted for 34% of all Actinomyces spp. identified, followed by Actinomyces turicensis with 23%. Actinomyces neuii is considered to be a rare Actinomyces sp., but accounted for 8% of isolates. Antimicrobial susceptibility testing of isolates showed that the Actinomyces spp. were almost uniformly susceptible to β-lactam antimicrobials (with and without β-lactamase inhibitors), carbapenems, tetracyclines and vancomycin. In contrast, Actinomyces spp. isolates were almost uniformly resistant to metronidazole. CONCLUSIONS: β-Lactam antimicrobial agents remain the first choice, whereas metronidazole should be avoided, in the treatment of actinomycosis. Reasonable alternatives for treatment are tetracyclines and carbapenems.
OBJECTIVES: Actinomyces spp. are commensals that may occasionally invade deep tissue structures, causing difficult-to-treat and disfiguring lesions. Information on antimicrobial resistance patterns is limited to observations from two previous studies. Therefore, we examined antimicrobial resistance patterns in clinical isolates of Actinomyces spp. METHODS: In this retrospective assessment of antimicrobial resistance patterns, we identified 392 Actinomyces spp. at a tertiary care centre from January 2008 to December 2014. MICs of various antimicrobial agents, including ampicillin/sulbactam, meropenem, clindamycin, metronidazole and vancomycin for anaerobic actinomycetes, were obtained by Etest. For aerobic actinomycetes, imipenem, cefotaxime, amikacin, linezolid, moxifloxacin, trimethoprim/sulfamethoxazole and clarithromycin were tested. MIC results were interpreted based on guidelines published by the CLSI (formerly NCCLS). RESULTS:Actinomyces meyeri was predominantly isolated and accounted for 34% of all Actinomyces spp. identified, followed by Actinomyces turicensis with 23%. Actinomyces neuii is considered to be a rare Actinomyces sp., but accounted for 8% of isolates. Antimicrobial susceptibility testing of isolates showed that the Actinomyces spp. were almost uniformly susceptible to β-lactam antimicrobials (with and without β-lactamase inhibitors), carbapenems, tetracyclines and vancomycin. In contrast, Actinomyces spp. isolates were almost uniformly resistant to metronidazole. CONCLUSIONS: β-Lactam antimicrobial agents remain the first choice, whereas metronidazole should be avoided, in the treatment of actinomycosis. Reasonable alternatives for treatment are tetracyclines and carbapenems.
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