{ "abstract": "Background.: Antibiotics with anaerobic activity may result in adverse patient outcomes. Here, we report the development and application of an Anaerobic Activity Index (AAI) to quantify antianaerobic antibiotic exposure.\n\nMethods.: The numeric AAI was generated for 21 antibiotics using in vitro susceptibility data for 7 anaerobic bacterial groups. A binning strategy was applied to susceptibility proportions to result in the fewest antibiotic tied scores. In a cohort of patients with burns, 7-day anaerobic exposure was calculated, multiplied by days of therapy, and summed. Multivariable logistic regression models assessed the association between AAI quartiles and a 90-day composite outcome including culture positivity with bacteria of interest, healthcare-associated infection, and/or death.\n\nResults.: We included 88 papers reporting on anaerobic activity. The AAI ranged from 4 to 59. Meropenem (59), ertapenem (58), and tigecycline (57) were the highest ranked antibiotics, whereas penicillin (20), doxycycline (13), and aztreonam (4) had the lowest scores. Several antibiotics could not be included for lack of data. In a cohort of patients with burns, the highest 7-day AAI quartile was associated with increased odds of the 90-day composite outcome compared with the lowest quartile (OR: 2.90; 95% CI: 1.65–5.08), adjusting for Baux score and Charlson comorbidity index.\n\nConclusions.: We propose an Anaerobic Activity Index (AAI) assigning numeric scores to commonly used antibiotics. We anticipate that this score will require updating as additional susceptibility data become available. The AAI may be used as a research tool evaluating the impact of antianaerobic antibiotics on patient outcomes.", "abstract_shown": true, "affiliations": [ "Division of Infectious Diseases, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA", "Department of Infection Prevention and Control, Stony Brook University Hospital, Stony Brook, New York, USA", "Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA", "Biostatistics Center, George Washington University, Rockville, Maryland, USA", "Center for Gastrointestinal Biology and Diseases, Division of Gastroenterology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA", "Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA", "Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA", "Clinical Microbiology Laboratory, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA", "Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA", "North Carolina Jaycee Burn Center, University of North Carolina, Chapel Hill, North Carolina, USA", "Department of Internal Medicine/Infectious Diseases Division, University of Michigan Medical School, Ann Arbor, Michigan, USA", "Department of Microbiology & Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA", "Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA", "Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, Michigan, USA" ], "article_type": "research article", "arxiv": null, "author_total": 13, "authors": [ { "affs": [ 0, 1, 2 ], "name": "Natalie A. Mackow" }, { "affs": [ 3 ], "name": "Lauren Komarow" }, { "affs": [ 2 ], "name": "Sonia Napravnik", "orcid": "0000-0002-9032-3713" }, { "affs": [ 2, 4 ], "name": "Tessa M. Andermann", "orcid": "0000-0002-0844-7400" }, { "affs": [ 2, 5, 4 ], "name": "Luther Bartelt" }, { "affs": [ 6 ], "name": "Lauren M. DiBiase" }, { "affs": [ 7 ], "name": "Billy Williams" }, { "affs": [ 8, 9 ], "name": "Felicia N. Williams", "orcid": "0000-0002-5483-2529" }, { "affs": [ 10, 11 ], "name": "Vincent B. Young" }, { "affs": [ 12 ], "name": "David M. Aronoff", "orcid": "0000-0003-4587-6121" }, { "affs": [ 2, 6 ], "name": "David J. Weber" }, { "affs": [ 10, 13 ], "name": "Rishi Chanderraj", "orcid": "0000-0001-8081-5258" }, { "affs": [ 2, 5 ], "name": "David van Duin", "orcid": "0000-0003-4784-3227" } ], "bibtex": "https://research.draconitic.com/paper/170g9xnjk3wmd.bib", "cited_by": 0, "doi": "10.1093/cid/ciag470", "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13734308/", "id": "170g9xnjk3wmd", "issns": [ "1058-4838", "1537-6591" ], "landing_url": "https://doi.org/10.1093/cid/ciag470", "language": "en", "licence": "CC-BY-NC-ND-4.0", "licence_label": "CC BY-NC-ND 4.0", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Article" ], [ "openalex", "2725|Antibiotic Use and Resistance" ] ], "openalex": "W7172425990", "pdf_url": null, "pmcid": "PMC13734308", "pmid": "42548283", "published": "2026-08-04", "publisher": null, "ris": "https://research.draconitic.com/paper/170g9xnjk3wmd.ris", "sources": [ { "first_seen": "2026-11-08T12:23:55Z", "native_id": "PMC13734308", "source": "pmc", "url": "https://doi.org/10.1093/cid/ciag470" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2725|Antibiotic Use and Resistance", "subfield": "infectious-disease" } ], "title": "Development and Application of an Anaerobic Activity Index", "title_text": "Development and Application of an Anaerobic Activity Index", "type": "peer-reviewed", "updated_at": "2026-11-08T12:23:55Z", "url": "https://research.draconitic.com/paper/170g9xnjk3wmd", "venue": "Clinical infectious diseases : an official publication of the Infectious Diseases Society of America", "versions": [] }