Cross-Infection Due to Imipenem-Resistant
            <i>Bacteroides fragilis</i>
            Associated with a Totally Implantable Venous Port

Arpin, Corinne; Dubois, Véronique; Rogues, Anne-Marie; Menard, Fanny; A, Gavinet; Maire, Jean-Pierre; Gachie, J.P.; Bezian, M.C.; Quentin, Claudine

doi:10.1128/jcm.40.8.3032-3034.2002

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…The fact that ®ve samples were taken from one patient might imply that the same strain has been isolated several times. Similar ®ndings indicating a spread of imipenem-resistant B. fragilis strains between hospitalized patients were recently reported by Arpin et al [26]. It seems that low-level resistance to imipenem is becoming more prevalent and resistance is even seen in species other than B. fragilis.…”

Section: Discussionsupporting

confidence: 87%

Antimicrobial susceptibility of Bacteroides fragilis group isolates in Europe

Hedberg

Nord

2003

Clinical Microbiology and Infection

114

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Section: Discussionsupporting

confidence: 87%

Antimicrobial susceptibility of Bacteroides fragilis group isolates in Europe

Hedberg

Nord

2003

Clinical Microbiology and Infection

114

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“…However, we were only able to detect metallo-â-lactamase activity for strains 119 and AK-2. Expression of the group 3a, class B metallo-â-lactamase encoded by the silent cfiA chromosomal gene required the location of an IS immediately upstream (Arpin et al, 2002). Edwards (1997) reported that various strains of B. fragilis that produced â-lactamases were resistant to the action of benzylpenicillin and cefoxitin and displayed moderate resistance to imipenem.…”

Section: Resultsmentioning

confidence: 99%

Relationship between penicillin-binding protein patterns and β-lactamases in clinical isolates of Bacteroides fragilis with different susceptibility to β-lactam antibiotics

Píriz

Vadillo

Quesada

et al. 2004

Journal of Medical Microbiology

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This study examines the role of the penicillin-binding proteins (PBPs) of Bacteroides fragilis in the mechanism of resistance to different â-lactam antibiotics. Six of the eight strains used were â-lactamase-positive by the nitrocefin assay. These strains displayed reduced susceptibility to imipenem (MIC, 2-16 mg l À1 ) and some of them were resistant to the actions of ampicillin, cefuroxime, cephalexin, cefoxitin and piperacillin. When studying specific enzymic activity, the capacity to degrade cefuroxime was only detected in strains AK-4, R212 and 0423 and the capacity to degrade cephalexin was only detected in strains R212 and 2013E; no specific activity was detected on imipenem. Metallo-â-lactamase activity was only detected in strains AK-2 and 119, despite the fact that the cfiA gene was identified in four strains (AK-2, 2013E, 119 and 7160). The cepA gene was detected in six of the eight strains studied. Three high-molecular-mass PBPs were detected in all strains; however, in some cases, PBP2Bfr and/or PBP3Bfr appeared as a faint band. PBP4Bfr and PBP5Bfr were detected in six strains. PBP6Bfr only was detected in B. fragilis strains AK-2, 0423, 119 and 7160. By analysis of the sequence of B. fragilis chromosomal DNA and comparison with genes that are known to encode PBPs in Escherichia coli, six genes that encode PBP-like proteins were detected in the former organism. The gene that encodes the PBP2 orthologue of E. coli (pbpABfr, PBP3Bfr) was sequenced in six of the eight strains and its implications for resistance were examined. Differences in the PBP3Bfr amino acid sequences of strains AK-2 and 119 and their production of â-lactamases indicate that these differences are not involved in the mechanism of resistance to imipenem and/or cephalexin.

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“…Nevertheless, at least one study, which used molecular genotypic methods, has reported patient-to-patient dissemination of resistant Bacteroides sp. isolates (1). In contrast, the first hypothesis may be more accurate, as at least the first case patient, due to his underlying conditions, should have had multiple hospital admissions, coupled with antibiotic treatment.…”

Section: First Case Reportmentioning

confidence: 87%

Two Cases of Infections Due to Multidrug-Resistant Bacteroides fragilis Group Strains

et al. 2006

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Bacteroides fragilis group strains are still considered susceptible to most antimicrobial agents used for the treatment of infections caused by anaerobic organisms. We describe two cases of infections due to isolates simultaneously resistant to clindamycin, tetracycline, cefoxitin, piperacillin-tazobactam, and imipenem and, in one of the two cases, to metronidazole. Such infections, although still rare, do exist and tend to complicate treatment. First case report.A 71-year-old man was admitted to the internal medicine ward of Laikon General Hospital, a university-affiliated, tertiary-care hospital in downtown Athens, Greece, with a temperature of up to 39°C and diarrhea for 8 days. The patient's medical history included Crohn's disease; stomach lymphoma, which had led to a total gastrectomy 15 years earlier; common variable immunodeficiency; and cytomegalovirus (CMV) colitis.The patient's blood cell count was within the normal range, and serum biochemistry revealed only an elevated C-reactive protein level (280 mg/liter; normal values, Ͻ50 mg/liter). Computed tomography scanning of the upper and lower abdomen was negative, while a colonoscopy revealed findings consistent with CMV colitis. Blood samples for culture were taken on admission; and after 2 days of incubation, the anaerobic bottle (BacT/ALERT 3D; bioMerieux, Marcy l'Etoile, France) yielded a gram-negative anaerobic rod that was identified as Bacteroides fragilis by the special-potency disk method; growth in the presence of 20% bile (Bacteroides-bile esculin agar plates; Bioprepare, Gerakas, Greece); and the biochemical profile (ID32ANA system; bioMerieux), including a negative reaction for indole (7). Cultures of stool samples were negative for pathogens.Upon receipt of the preliminary finding of bacteremia caused by an anaerobic gram-negative organism, antimicrobial treatment was initiated with metronidazole three times daily at 500 mg intravenously (i.v.) and cefotaxime three times daily at 2 g i.v., after which the fever subsided but the diarrhea persisted, because of his underlying disease. His condition deteriorated during the following weeks, as he developed liver cirrhosis, ascites, and CMV pulmonary infiltrations. The patient died after 3 months of hospitalization due to pulmonary edema.Susceptibility testing of the B. fragilis isolate was performed by the Etest method (AB Biodisk, Solna, Sweden), according to the manufacturer's instructions, on brucella blood agar plates supplemented with vitamin K and hemin. The resulting MICs were Ͼ256 mg/liter for benzylpenicillin, piperacillin-tazobactam, ticarcillin-clavulanic acid, cefoxitin, and clindamycin; Ͼ32 mg/liter for imipenem and ertapenem; 128 mg/liter for tetracycline; and 0.5 mg/liter for metronidazole. The strain was positive for beta-lactamase production by the nitrocefin disk method (Cefinase; BBL, Becton Dickinson and Co., Franklin Lakes, NJ). The imipenem, ertapenem, and metronidazole MICs were confirmed by the agar dilution method (11). All plates used for susceptibility testing were in...

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Cross-Infection Due to Imipenem-Resistant Bacteroides fragilis Associated with a Totally Implantable Venous Port

Cited by 8 publications

References 27 publications

Antimicrobial susceptibility of Bacteroides fragilis group isolates in Europe

Antimicrobial susceptibility of Bacteroides fragilis group isolates in Europe

Relationship between penicillin-binding protein patterns and β-lactamases in clinical isolates of Bacteroides fragilis with different susceptibility to β-lactam antibiotics

Two Cases of Infections Due to Multidrug-Resistant Bacteroides fragilis Group Strains

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