Lessons Learned from the Anaerobe Survey: Historical Perspective and Review of the Most Recent Data (2005-2007)
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2010
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Background. The rationale and lessons learned through the evolution of the National Survey for the Susceptibility of Bacteroides fragilis Group from its initiation in 1981 through 2007 are reviewed here. The survey was conceived in 1980 to track emerging antimicrobial resistance in Bacteroides species. Methods. Data from the last 11 years of the survey (1997-2007), including 6574 isolates from 13 medical centers, were analyzed for in vitro antimicrobial resistance to both frequently used and newly developed anti-anaerobic agents. The minimum inhibitory concentrations of the antibiotics were determined using agar dilution in accordance with Clinical and Laboratory Standards Institute recommendations. Results. The analyses revealed that the carbapenems (imipenem, meropenem, ertapenem, and doripenem) and piperacillin-tazobactam were the most active agents against these pathogens, with resistance rates of 0.9%-2.3%. In the most recent 3 years of the survey (2005-2007), resistance to some agents was shown to depend on the species, such as ampicillin-sulbactam against Bacteroides distasonis (20.6%) and tigecycline against Bacteroides uniformis and Bacteroides eggerthii (similar to 7%). Very high resistance rates (>50%) were noted for moxifloxacin and trovafloxacin, particularly against Bacteroides vulgatus. During that period of study, non-B. fragilis Bacteroides species had >40% resistance to clindamycin. Metronidazole-resistant Bacteroides strains were also first reported during that period. Conclusions. In summary, resistance to antibiotics was greater among non-B. fragilis Bacteroides species than among B. fragilis and was especially greater among species with a low frequency of isolation, such as Bacteroides caccae and B. uniformis. The emergence of resistance among the non-B. fragilis Bacteroides species underscores the need for speciation of B. fragilis group isolates and for clinicians to be aware of associations between species and drug resistance.
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Lizzie Johnson Harrell
Lizzie Johnson Harrell, Ph.D., trailblazing clinical microbiologist, retired in November 2011 after 33 years at Duke University Medical Center. She was Associate Director of the Clinical Microbiology Laboratory, and also Research Professor of Molecular Genetics and Microbiology, and Pathology. When she joined the faculty in Microbiology (now MGM), she became the first full-time African American faculty member in any of the Basic Science departments at Duke.
Dr. Harrell, the oldest of 13 children, was born and reared in the coastal town of Shallotte, North Carolina. She graduated from Union High School (Valedictorian) in 1961 and decided to pursue a career in science. She notes that her decision to become a scientist was influenced by Russia’s launching of the world’s first satellite (Sputnik 1) in 1957. The global community was shocked because everyone had expected the United States to be the first to launch a satellite into space. Thus, students were encouraged to pursue science careers. She earned her BS degree in Biology and Chemistry (Cum Laude) from North Carolina College at Durham (now North Carolina Central University [NCCU]) in 1965. At NCCU, she was elected to membership in Alpha Kappa Mu National Scholastic Honor Society and Beta Kappa Chi National Scientific Honor Society, as well as Who’s Who in American Colleges and Universities.
Her first job was as a research technician for the DuPont Company in Newark, Delaware, where she conducted research on antiviral agents for influenza A virus. She was one of the first African American college graduates to be hired at that laboratory. After three years at DuPont, she returned to North Carolina and worked in the Pediatric Research Laboratory at the University of North Carolina at Chapel Hill (UNC) for a year. Then she entered graduate school at UNC and earned her MS degree in Bacteriology and Immunology in 1971. Her mentor was renowned Infectious Diseases physician, Dr. Janet J. Fischer, MD, who was interested in anaerobic infections.
Dr. Harrell’s master’s thesis, “Anaerobic Bacteria Isolated from Clinical Specimens,” became the guide for diagnosing anaerobic infections in the Clinical Microbiology Laboratory at UNC. After graduation, she was hired as a research assistant in the laboratory. One of the drugs that she studied was Trimethoprim-sulfamethoxazole (Bactrim, Septra) which is now a commonly used antimicrobial for treating many types of bacterial infections, including urinary tract infections. During Black Alumni Reunion weekend, in October 2011, Dr. Harrell was honored as one of the “Black Pioneers” who attended UNC between 1952 and 1972.
In 1972, she moved to Washington, DC where she helped to organize and supervise a new Infectious Diseases Research Laboratory at the Veterans Administration hospital. She worked with Infectious Diseases physician/Pharmacist, Richard H. Parker, MD, RPH and helped to train residents from Georgetown and Howard Universities during their rotation at the VA hospital. This position provided her the opportunity to develop her administrative and teaching skills, to do clinical trials on new antimicrobials, and to work with physicians who were treating infections in Vietnam War veterans.
In 1975, Dr. Harrell returned to North Carolina and enrolled in the doctoral program at North Carolina State University. Her mentor was Dr. James B. Evans, Chair of the Microbiology Department. She was able to use her laboratory skills, and knowledge of antibiotics and anaerobic microbiology to study “The Effects of Anaerobiosis on the Antimicrobial Susceptibility of Staphylococci.” In 1978, she became the first African American to earn a Ph.D. in Microbiology from NC State University.
In 1978, Dr. Harrell began her career in the Clinical Microbiology Laboratory at Duke University Medical Center where she worked with Dr. Gale Hill (Anaerobe Lab.) and Dr. Dolph Klein (Director of Clinical Microbiology Lab.). She excelled in the laboratory and advanced through the ranks to become Associate Director of the Clinical Microbiology Laboratory, and Section Head for Bacteriology, Mycobacteriology and Molecular Microbiology.
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