A clinical isolate of Bacteroides vulgatus was resistant to tetracycline, clindamycin, ampicillin, cephaloridine, cefoxitin, and other 13-lactam antibiotics except imipenem. 13-Lactam resistance was mediated by a membraneassociated, clavulanate-sensitive cephalosporinase capable of degrading cephalosporins and penicillins. Cefoxitin also was degraded but at a slow rate. The cefoxitin resistance (Fxr) ,-Lactamase production is the most important mechanism of resistance to P-lactam antibiotics in gram-negative bacteria, and the Bacteroides fragilis group possesses a wide array of these enzymes. In general, the organisms are moderately or highly resistant to many cephalosporins and penicillins, but a-methoxyl cephamycins such as cefoxitin and the carbapenems have been highly active against Bacteroides species. In the United States, for example, imipenem resistance rates are presently low, at about 0.2%, and cefoxitin resistance (Fxr) rates have ranged up to 16% during the past decade (37, 38). High rates of Fxr are cause for concern since Fxr strains usually encountered are crossresistant to most other P-lactams (38). In the case of strains that possess metallo-p-lactamases, the cross-resistance includes the carbapenems (8, 39).Resistance of Bacteroides species to cefoxitin may involve a number of mechanisms including altered drug permeability, alterations of penicillin binding proteins, 1-lactamase production, or a combination of mechanisms (8,10,41). Excluding the relatively rare imipenem-hydrolyzing metalloenzymes, several P-lactamases capable of cefoxitin degradation have been described. These are generally cephalosporinases with a slow rate of cefoxitin hydrolysis, and they are sensitive to inhibition by clavulanate (9, 13). Recently, Aldridge et al. (1) have found that >93% of Fxr strains were still sensitive to 3-lactam-clavulanate combinations. Thus, based on these criteria, it is possible that the slow cefoxitinhydrolyzing cephalosporinases are one of the most widely disseminated mechanisms of Fxr in the Bacteroides species. In this regard, it has been suggested that these P-lactamases are not novel enzymes but rather that the strains are Fxr * Corresponding author.because of the production of much greater than normal levels of the conventional Bacteroides enzyme (36).The occurrence of high regional Fxr rates indicates the potential for clonal dissemination and/or horizontal transfer of the resistance phenotype. The transfer of Fxr by a conjugation-like mechanism has been demonstrated; however, plasmids were not involved in the transfer (10). The Fxr phenotype was mediated by the acquisition of a new P-lactamase. The present study was initiated to define the genetic basis for transmissible Fxr in Bacteroides species.The results revealed a novel genetic locus designated cfx4, which encodes an Ambler molecular class A 13-lactamase that appears to have diverged significantly from all other class A enzymes.
MATERIALS AND METHODSBacterial strains and growth. Bacteroides cells were cultured anaerobically in su...