title: Simultaneous resistance to metronidazole, co-amoxiclav, and imipenem in clinical isolate of Bacteroides fragilis.
abstract: A blood-culture isolate of Bacteroides fragilis, taken from a woman after elective laparotomy, was resistant to metronidazole and had reduced susceptibility to imipenem and co-amoxiclav. After treatment with imipenem, pus drained from the pleural cavity yielded an identical isolate that had become highly resistant to imipenem and co-amoxiclav. Emergence of full resistance to the beta-lactam antibiotics was accompanied by a tenfold rise in the specific activity of a metallo-beta-lactamase. Clinicians need to be alert to simultaneous resistance to metronidazole, co-amoxiclav, and imipenem and development of high-level resistance to imipenem in B fragilis during treatment with this agent.
authors.affiliation: Nottingham Public Health Laboratory, UK.
authors.forename: P
authors.initials: P
authors.lastname: Turner
authors.forename: R
authors.initials: R
authors.lastname: Edwards
authors.forename: V
authors.initials: V
authors.lastname: Weston
authors.forename: A
authors.initials: A
authors.lastname: Gazis
authors.forename: P
authors.initials: P
authors.lastname: Ispahani
authors.forename: D
authors.initials: D
authors.lastname: Greenwood
mesh_terms: D000328:Adult; D000658:Amoxicillin / Q000494:pharmacology; D019980:Amoxicillin-Potassium Clavulanate Combination; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D001442:Bacteroides Infections / Q000188:drug therapy / Q000382:microbiology; D001441:Bacteroides fragilis / Q000187:drug effects*; D002969:Clavulanic Acids / Q000494:pharmacology; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination / Q000494:pharmacology*; D016724:Empyema, Pleural / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D015378:Imipenem / Q000494:pharmacology*; D008795:Metronidazole / Q000494:pharmacology*
chemical_list: D002969:Clavulanic Acids; D008795:Metronidazole; D015378:Imipenem; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin