{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T11:03:52Z","timestamp":1784891032396,"version":"3.55.0"},"reference-count":58,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Med. Sci.","Medical Sciences"],"abstract":"<jats:p>Objectives: This study aimed to provide an updated overview of metronidazole susceptibility among human clinical isolates of Bacteroides, Phocaeicola, and Parabacteroides in Europe based on EUCAST breakpoint interpretation. Methods: A systematic review and meta-analysis were undertaken following searches of Web of Science, MEDLINE\/PubMed, and Embase for studies published between 2011 and 2025. Eligible studies reported metronidazole susceptibility data, including minimum inhibitory concentrations and\/or susceptible\/resistant proportions, for clinical isolates from European countries. Risk of bias was assessed using criteria adapted from the Joanna Briggs Institute critical appraisal tool. Random-effects meta-analysis of proportions was used to estimate pooled susceptibility, with heterogeneity quantified by I2 and \u03c42; 95% prediction intervals and country subgroup analyses were also performed. Small-study effects were evaluated by funnel plot inspection, Egger\u2019s and Begg\u2019s tests. Results: Thirty-eight studies, comprising 72 country-specific datasets and 8501 isolates, were included. The pooled susceptibility proportion was 99.81% (95% CI 99.44\u201399.99%), with substantial heterogeneity (I2 = 68.2%; \u03c42 = 0.0038). The 95% prediction interval ranged from 95.75% to 100%. Although between-country differences were statistically significant, susceptibility remained consistently high overall. Lower values in Portugal and Switzerland came from single small datasets. Conclusions: These findings support the sustained in vitro activity of metronidazole across Europe, while highlighting the need for continued surveillance, particularly in underrepresented settings.<\/jats:p>","DOI":"10.3390\/medsci14040424","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T10:38:41Z","timestamp":1784889521000},"page":"424","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metronidazole Susceptibility Patterns in European Bacteroides, Phocaeicola, and Parabacteroides Clinical Isolates\u2014A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2117-0100","authenticated-orcid":false,"given":"Kinga","family":"Markowska-Michalak","sequence":"first","affiliation":[{"name":"Chair and Department of Medical Microbiology, Medical University of Warsaw, Chalubinskiego 5 Street., 02-004 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9036-7452","authenticated-orcid":false,"given":"Anna","family":"Majewska","sequence":"additional","affiliation":[{"name":"Chair and Department of Medical Microbiology, Medical University of Warsaw, Chalubinskiego 5 Street., 02-004 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2348-4402","authenticated-orcid":false,"given":"Hanna","family":"Pituch","sequence":"additional","affiliation":[{"name":"Chair and Department of Medical Microbiology, Medical University of Warsaw, Chalubinskiego 5 Street., 02-004 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e00346-25","DOI":"10.1128\/jb.00346-25","article-title":"Lessons from the model gut Bacteroidales Bacteroides fragilis and Bacteroides thetaiotaomicron and future opportunities","volume":"207","author":"Comstock","year":"2025","journal-title":"J. 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