Differences in susceptibilities of species of the Bacteroides fragilis group to several beta-lactam antibiotics: indole production as an indicator of resistance.

Clinical isolates of the members of the Bacteroides fragilis group differ markedly in their susceptibilities to a variety of beta-lactam antibiotics, including cefoperazone, moxalactam, cefotaxime, cefoxitin, cefamandole, cephalothin, cefazolin, and carbenicillin, as determined by dilution techniques. The minimum concentrations required to inhibit at least 50% of the strains tested (MIC50) for the entire B. fragilis group were lowest with moxalactam and cefoxitin, 4 and 8 micrograms/ml, respectively, whereas the MIC90S of cefoperazone, cefotaxime, moxalactam, cefoxitin, and carbenicillin were equivalent (64 micrograms/ml); the MIC90S of cefamandole, cephalothin, and cefazolin were higher. Indole-positive members of the group (B. ovatus, B. thetaiotaomicron, and B. uniformis) were significantly more resistant to every antibiotic tested than were indole-negative members (B. fragilis, B. distasonis, and B. vulgatus). In a 6-month survey of clinical laboratory data, indole-positive strains comprised 40% of the B. fragilis group isolates and 22% of all Bacteroides isolates; B. fragilis was the most common species isolated (23%). The increased use of second-generation and the introduction of third-generation cephalosporins may dictate that clinical microbiology laboratories routinely identify members of the B. fragilis group as to species or, alternatively, test for indole production in addition to performing more extensive susceptibility testing.