Volumen 61 (2022): Heft 1 (March 2022)

New strategies in the development of anthrax vaccines and therapeutics have been presented. Recently, considerable progress has been made in the finding of new drugs and suitable therapy for anthrax. Very promising research considers the use of antimicrobials against selected bacteria species, including antibiotic-resistant strains. However, alternative therapeutic options should also be considered, among them vaccines. Bacillus anthracis spores are still the most dangerous weapon amongst pathogens which can be used in a bioterror attack. In this case, research for new anti-anthrax preparations is of primary importance for the protection of humans and animals. The overview of the most recent data shows the many new and promising possibilities for effective strategies in the development of vaccines and anti-anthrax preparations. The most effective of them should be available in the National Stockpile in the event of a biological crisis.

Anaerobic bacteraemia is not frequent (1.2–13.7%), but is associated with a high mortality rate of 16–27%. Anaerobic infections including bacteraemia nearly always arise from contamination by endogenous bacteria into contiguous or other sites like gastrointestinal tracts, genito-urinary tracts, abscesses etc. Factors leading to anaerobic bacteraemia are mainly surgical procedures, crush injuries, the presence of foreign bodies, tissue necrosis, tumours, diabetes. The most common infectious anaerobic agents are Gram-negative bacilli belonging to the Bacteroides/Parabacteroides, which under normal conditions constitute the natural human microflora. An important factor in the virulency of B. fragilis is the ability to form abscesses; a limited infection may progress to bacteraemia and then systemic inflammatory response syndrome and sepsis. Anaerobic bacteraemia mainly affects adults, with elderly patients over 65 years with underlying diseases. The importance of anaerobic bacteria in neonatal bacteraemia and sepsis is a relatively new phenomenon. In contrast the prevalence of anaerobes in bloodstream infections in children is extremely rare with children between 2 and 6 years of age having the least risk ranging 0–0.5% overall. The incidence of recovery of anaerobes in neonatal bacteraemia varies between 1.8% and 12.5%. The majority of cases reported in the literature were due to Bacteroides spp. (41%) other cultured anaerobes belonged to Clostridium spp. (32%), Peptostreptococcus spp. (20%).

Blood cultures remain the gold standard for detection of the etiologic both anaerobes and aerobes agent of bloodstream infection. In recent years significant progress has been made in the methods used in the diagnosis of anaerobes, which significantly reduced the time and cost of the examination. Currently, the mass spectometry MALDI-TOF MS and 16S rRNA sequencing are increasingly used for anaerobic bacteria identification. In 2022, EUCAST published standardized disk diffusion method for the drug susceptibility testing of Bacteroides spp. and other 4 clinically significant anaerobes. Determining the sensitivity of anaerobes to antibiotics is important due to the increasing drug resistance in this group. Number of B. fragilis strains resistant to clindamycin and moxifloxacin is increasing. According to the published studies sensitivity to clindamycin and moxifloxacin is significantly rare and occurs in 64% and 68% of isolates and in 50.8% and 58.2% respectively. Carbapenems and metronidazole continue to be the most effective active antibiotics to be used in the empirical therapy of anaerobic bacteraemia. There are case reports of infections caused by multidrug-resistant strains of Bacteroides spp, meaning resistant to at least three antibiotics from different groups. Rapid microbial diagnosis, targeted therapy and surgical treatment of a possible source of infection are crucial in treatment of sepsis caused by anaerobic bacteria.