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Overview of the MIC-value ranges for Atopobium vaginae and Gardnerella vaginalis for 15 antimicrobial agents.
Source publication
Previous studies have indicated that a recently described anaerobic bacterium, Atopobium vaginae is associated with bacterial vaginosis (BV). Thus far the four isolates of this fastidious micro-organism were found to be highly resistant to metronidazole and susceptible for clindamycin, two antibiotics preferred for the treatment of BV.
Nine strains...
Context in source publication
Context 1
... which is frequently used as a treatment for bacterial vaginosis, has indeed higher activity against G. vaginalis and A. vaginae than metronidazole, but L. crispa- tus is more susceptible to clindamycin than L. gasseri with as a consequence that a regimen of clindamycin can remove also the H 2 O 2 -producing lactobacilli from the vaginal microflora (Table 2). Hydrogen peroxide produc- tion is generally believed to be an important factor in the preservation of a normal vaginal microflora [1], i.e. in the build up of vaginal colonisation resistance. ...
Citations
... Fannyhessea vaginae usually has low MICs to penicillins (0.008-<0.25 µg ml −1 ) and clindamycin (<0.016 µg ml −1 ), and variable, often higher MICs to metronidazole (2->256 µg ml −1 ) [20]; Petrina et al. found a median metronidazole MIC of 64 µg ml −1 [21]. Successful treatment courses for invasive disease have included clindamycin alone, clindamycin in combination with metronidazole, amoxicillin-clavulanate and amoxicillin [3,4,15,16]. ...
Introduction. Fannyhessea vaginae (formerly Atopobium vaginae ) is an anaerobic organism commonly associated with female genital flora, with rare cases of invasive disease reported in females.
Case report. We discuss the case of an 81-year-old male who presented with an acute history of back pain and signs of urinary tract infection in the context of intermittent self-urinary catheterisation. Multiple blood cultures grew Fannyhessea vaginae with a later finding of lumbar vertebral osteomyelitis as the cause of back pain. Treatment was commenced with ampicillin, later switched to ceftriaxone, with improvement of acute signs of infection.
Conclusion. Gram-positive anaerobic organisms including Fannyhessea vaginae are possibly under-recognised causes of urinary tract particularly in older males. These bacteria may prove challenging to grow in standard protocols for urine culture; anaerobic or extended incubation could be considered particularly in complicated cases of urinary tract infection without an identifiable pathogen.
... Metronidazole is the most commonly used antimicrobial agent against anaerobic bacterial species. However, the results of susceptibility testing on metronidazole for F. vaginae are variable because some strains have high MIC values (De Backer et al., 2006). In our reported case, this F. vaginae strain was resistant to metronidazole (MIC >256 mg/mL), although the pathogen can be inhibited by low concentrations of clindamycin (MIC of 0.016 mg/mL), another commonly used antimicrobial agent for treating anaerobes. ...
Bloodstream infection caused by anaerobic microorganisms continues to be associated with a high mortality risk, necessitating a rapid diagnosis and an appropriate treatment. As an anaerobic gram-positive organism associated with vaginal infections, Fannyhessea vaginae is a rare cause of invasive infections. In this case, a 32-year-old pregnant woman with bacterial vaginosis presented with bacteremia. The microbiological analysis of the blood cultures identified F. vaginae. The patient was treated empirically with 5 days of cefoperazone/sulbactam and recovered well. Here, we provide a review of the literature on F. vaginae infections, and the reported cases demonstrate the need for awareness of the different anaerobic species found in the vaginal tract and adaptation of empirical therapies, especially in pregnant women.
... The bacterial isolate was characterized ©2023 Authors, INDIA by Gram's staining, morphological characters and genus specific biochemical tests mentioned in Bergey's Manual of Systematic Bacteriology. [1,3,7,8] The isolate was also verified using automated ® VITEK 2 Compact system. ...
... St. Muller-Hinton agar plates were inoculated by maintaining turbidity of 0.5 McFarland standard of the isolate, and antibiotic discs for gram positive bacteria obtained from HI Media Laboratories (Mumbai, India) were placed on the plates as per the guidelines recommended by the Clinical and Laboratory Standards Institute. [8] Isolation of bacteriophage: Bacteriophage can be isolated from environment and can be tested against various bacteria as they possess desirable characteristics hence can be used in treatments. [9,10] Media used was TPA, TPB and NB. ...
... Supernatant was filtered through 0.45-micron millipore syringe filters and the filtrate is then tested for the presence of lytic activity against Atopobium. The methods used were Turbidity reduction method [8,9,10] 1mL of chloroform was added in 5mL of processed sewage sample, mixed properly and centrifuged at 3000 rpm for 20 minutes. 1mL supernatant is transferred in 5mL of broth culture of bacteria. ...
Atopobium vaginae is a facultative anaerobic, Gram-positive bacterium, firstly considered as a normal saprophyte of the healthy vaginal flora but it is now recognized as one of the causal agents of Bacterial Vaginosis (BV). BV is a complex polymicrobial infection of the vagina that perturbs & shifts the vaginal flora from Lactobacilli to opportunistic pathogens that can include Atopobium vaginae. Symptoms of which are, greyish white discharge, pH greater than 4.5, etc. The infection is associated with adverse consequences including late miscarriage, prematurity in high-risk pregnancies and vaginitis in post pubertal women, chorioamnionitis, postpartum endometritis and an increased risk of HIV acquisition. The establishment of polymicrobial biofilm of A. vaginae resists repeated antibiotics & intravaginal antiseptic treatments resulting in its presence in 80-90% of cases of relapse and showing its relevance in BV recurrence after standard treatment with antibiotics. In the present study, isolation and identification of A. vaginae was carried out initially. VITEK 2 system was applied for identification. Demonstration of resistance to Atopobium was found resistant to Augmentin, Amoxicillin, Piperacillin, Ampicillin, Ampicillin/ Sulbactam, Cefotaxime, Ceftriaxone and Furazolidone. which is a global health issue that directs the exploration and attention towards other alternative treatments, viz, plant-derived compounds and phage therapy. This study shows favourable results for the Azadirachta indica extracts, Eucalyptus leaves extracts and for phage therapy of A. vaginae infections. With its host-specific and easy-to-handle advantage, it can emerge as one of the promising therapies in the future to treat infections to overcome bacterial resistance.
... Several factors can alter the composition of the vaginal flora, including the patient's age, level of sexual activity, hormonal conditions, and health status (2). In bacterial vaginosis, the number of bacteria reaches 10 9 -10 11 cfu/ml, and its aerobic lactobacilli decrease, and anaerobic bacteria such as Bacteroides ureolyticus, Gardnerella vaginalis, Atopobium vaginae, and Mycoplasma hominis increase (3). Gardnerella vaginalis is a facultative anaerobic bacterium found in less than 1% of cases in the women's normal vaginal flora. ...
... According to another study (2002), 29% of Gardnerella vaginalis strains were resistant to metronidazole. Recent studies shown that clindamycin is more effective than metronidazole against Gardnerella vaginalis (3). In a study by Bostwick et al. (2016), it was shown that in the case of BV, the most commonly prescribed antibiotics are clindamycin and metronidazole, and resistance to these compounds is increasingly common (29). ...
Background and Objectives: Gardnerella vaginalis is one of the most important causes of prevalent genital infections that pose serious risks. This study aimed to determine the prevalence of Gardnerella vaginalis and antibiotic resistance pattern of isolates of patients referred to the gynecology clinic of Shahriar Noor Hospital by PCR and culture methods.
Materials and Methods: The study was conducted on 500 patients who had suffered from a vaginal infection. The demographic data of patients were studied. For diagnosis of Gardnerella vaginalis isolates, cultivation in anaerobic conditions, biochemical tests, PCR and Gardnerella vaginalis antibiotic susceptibility test to metronidazole and clindamycin were performed. Data analysis was performed utilizing SPSS statistical software version 19 and the Chi-square test.
Results: Among the 500 patients, 173 were diagnosed with Gardnerella vaginitis. There was a significant relationship between age group, level of education, and contraceptive method with Gardnerella vaginosis incidence. Performing antibiotic susceptibility tests showed that the resistance of Gardnerella vaginalis isolated strains to metronidazole and clindamycin was 86.12% and 17.34%, respectively.
Conclusion: The high prevalence of Gardnerella vaginalis infections confirms the critical role of the bacterium in the occurrence of bacterial vaginosis. Therefore, it is necessary to check the prevalence of bacterial infections to recommend the correct medical treatment in different societies.
... While it is effective in the short term, a relapse occurs in 20% of patients with BV within one month [196] and up to 58% within one year [197]. Additionally, resistance to the drug can develop, with a range detection of 75-100% in women with recurrent BV after a therapeutic administration [198], which can be attributed to variable susceptibility or intrinsic feature [199]. Probiotics [200] and synthetic compounds like amoxicillin/clavulanic acid or clindamycin have been reviewed as alternatives, but there are concerns regarding dose and duration [201]. ...
Background:
The reproductive tract microbiota that evolved as an integrative component has been studied intensively in the last decade. As a result, novel research, clinical opportunities, and perspectives have been derived following the close investigation of this microecological environment. This has paved the way for an update to and improvement of the management strategies and therapeutic approaches. However, obscurities, contradictions, and controversies arise regarding the ascension route from the vagina to the endometrium via the cervix, with finality in adverse obstetric outcomes.
Methods:
Starting from these considerations, we aimed to gather all existing data and information from four major academic databases (PubMed, ISI Web of Knowledge, Scopus, and ScienceDirect) published in the last 13 years (2010-2023) using a controlled vocabulary and dedicated terminology to enhance the coverage, identification, and sorting of potentially eligible studies.
Results:
Despite the high number of returned entries (n = 804), only a slight percentage (2.73%) of all manuscripts were deemed eligible following two rounds of evaluation. Cumulatively, a low level of Lactobacillus spp. and of other core microbiota members is mandatory, with a possible eubiosis-to-dysbiosis transition leading to an impairment of metabolic and endocrine network homeostasis. This transposes into a change in the pro-inflammatory landscape and activation of signaling pathways due to activity exerted by the bacterial lipopolysaccharides (LPSs)/endotoxins that further reflect a high risk of miscarriage in various stages. While the presence of some pathogenic entities may be suggestive of an adverse obstetric predisposition, there are still pros and cons of the role of specific strains, as only the vagina and cervix have been targeted as opposed to the endometrium, which recently started to be viewed as the key player in the vagina-cervix-endometrium route. Consequently, based on an individual's profile, diet, and regime, antibiotics and probiotics might be practical or not.
Conclusions:
Resident bacteria have a dual facet and are beneficial for women's health, but, at the same time, relaying on the abundance, richness, and evenness that are definitory indexes standing as intermediaries of a miscarriage.
... With the same efficacy, both metronidazole and clindamycin can be applied to the vagina or taken orally. It is more effective against Gardnerella vaginalis and Atopobium vaginale than clindamycin or metronidazole, but not all A. vaginae isolates are metronidazole-resistant [111]. ...
Globally, the increase of pathogenic bacteria with antibiotic-resistant characteristics has become a critical challenge in medical treatment. The misuse of conventional antibiotics to treat an infectious disease often results in increased resistance and a scarcity of effective antimicrobials to be used in the future against the organisms. Here, we discuss the rise of antimicrobial resistance (AMR) and the need to combat it through the discovery of new synthetic or naturally occurring antibacterial compounds, as well as insights into the application of various drug delivery approaches delivered via various routes compared to conventional delivery systems. AMR-related infectious diseases are also discussed, as is the efficiency of various delivery systems. Future considerations in developing highly effective antimicrobial delivery devices to address antibiotic resistance are also presented here, especially on the smart delivery system of antibiotics.
... A low dosage of clindamycin of about <0.016 μg/ml has more efficacy than metronidazole (2-256 μg/ml) against the bacteria. Moreover, the susceptibility to resistance was found to be varying to metronidazole [192]. The spreading of antibiotic resistance among these microbes is mainly due to the transmission of horizontal gene transfer via mobile elements (transposons, integrons, and plasmids) [193]. ...
Bacterial vaginosis (BV) is a polymicrobial vaginal dysbiosis alongside lactobacillus depletion that primarily affects women of reproductive age. The fishy odor vaginal discharge is the major cause of anaerobic pathogenic bacteria colonization. Symptomatic women face specific catastrophic physiological and immunopathological consequences in addition to an elevated risk of sexually transmitted infections. Further, rash antibiotic therapy has witnessed antimicrobial-resistance amplifying vaginal infections. The emergence of biofilm-associated antimicrobial-resistance has made the issue worsened. This article has gone on to explore novel regimens, advanced diagnosis, and various cutting-edge strategies that are found to be effective in addressing these problems and restoring vaginal health.
... Gabonese women can use vaginal ovules without medical recommendations and this could lead to BV relapses. Additionally, the high rates of BV observed in this study may be indicative of therapeutic failures, potentially resulting from a lack of patient adherence to treatment or the presence of bacteria that are naturally resistant to metronidazole (e.g., Atopobium vaginae) and capable of producing biofilms (e.g., Gardnerella vaginalis and Atopobium vaginae) [19], [20]. While VVC and AV had reasonably high prevalence rates (respectively 35% and 54%), similar results were found in previous results conducted in Senegal, Gabon and Bosnia [21][22] [23]. ...
... Antimicrobial susceptibility testing (AST) using EUCAST clinical breakpoints [22] for anaerobic bacteria indicated susceptibility to amoxicillin, clindamycin, and rifampicin. Our observations are in line with the findings of Ferris et al. and De Backer et al. that F. vaginae is usually sensitive to beta-lactam antibiotics and clindamycin but only moderately susceptible to quinolones [20,23]. Comparing the antimicrobial susceptibility mentioned in other F. vaginae bacteremia cases affirms this statement (Table 1). ...
... Both EUCAST and CLSI recommend an incubation time of 48 h for AST of anaerobic bacteria by agar dilution, but no specific guidelines were found regarding the incubation time of gradient E-tests for slow growing anaerobic bacteria. Only two reported cases stated the incubation time as being 48 h and 72 h [12,23]. Content courtesy of Springer Nature, terms of use apply. ...
This case describes a 77-year-old woman with dysregulated type II diabetes, presenting with a prosthetic joint infection and bacteremia. Computed tomography (CT) of the pelvis and sacrum revealed manifest periprosthetic collections, suggestive of a septic arthritis with loosening of the hip prosthesis. Synovial fluid grew Fannyhessea vaginae, identified by matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS). To our knowledge, this is the first report of a prosthetic joint infection due to this organism.
... As shown in Table 1, most strains were resistant to metronidazole and susceptible to clindamycin, confirming previous observations. [30][31][32] Since biofilms are known to be more tolerant than planktonic cultures, 33,34 we normalized the biofilm challenges to 4 × PSC of each antibiotic. 16,17 We then determined the effect of each antibiotic on the total biomass of the single-species biofilms. ...
Background
Bacterial vaginosis (BV), the most common cause of vaginal discharge, is characterized by the presence of a polymicrobial biofilm on the vaginal epithelium, formed primarily by Gardnerella spp., but also other anaerobic species. Interactions between bacteria in multi-species biofilms are likely to contribute to increased virulence and to enhanced antimicrobial tolerance observed in vivo. However, functional studies addressing this question are lacking.
Objectives
To gain insights into the role that interactions between BV-associated species in multi-species BV biofilms might have on antimicrobial tolerance, single- and triple-species biofilms formed by Gardnerella vaginalis, Fannyhessea (Atopobium) vaginae and Peptostreptococcus anaerobius were characterized, before and after metronidazole or clindamycin treatment.
Methods
Total biofilm biomass, total cells and cfu counts prior to and after antibiotic treatment were first determined. In addition, bacterial populations in the triple-species biofilms were also quantified by quantitative PCR (qPCR) and peptide nucleic acid (PNA) fluorescence in situ hybridization (FISH).
Results
Despite the effect observed in single-species biofilms, neither metronidazole nor clindamycin was effective in reducing triple-species biofilm biomass. Similar results were obtained when evaluating the number of total or culturable cells. Interestingly, despite differences between strain susceptibilities to antibiotics, the composition of the triple-species biofilms was not strongly affected by antibiotics.
Conclusions
Taken together, these results strengthen the idea that, when co-incubated, bacteria can interact synergistically, leading to increased tolerance to antimicrobial therapy, which helps explain the observed clinically high BV recurrence rates.
