title: Inducible metronidazole resistance in nim-positive and nim-negative bacteroides fragilis group strains after several passages metronidazole containing columbia agar plates.
abstract: BACKGROUND
  Recent data show an emergence of resistance in the Bacteroides fragilis group against several antimicrobial agents and inducible resistance against metronidazole in nim-positive strains. The aim of the present study was to investigate inducible metronidazole resistance in nim-positive as well as in nim-negative B. fragilis group strains.
  
  
  METHODS
  Of 18 B. fragilis strains (including four nim-positive reference strains and one ATCC strain), two Bacteroides ovatus strains, and one Bacteroides thetaiotaomicron DSM strain minimum inhibitory concentration (MIC) values for metronidazole were determined by Etest and analyzed for nim genes (nimA to -G) by PCR. For this purpose bacterial suspensions were incubated on supplemented Columbia agar plates containing metronidazole at twice the MIC value of the specific strain and incubated under anaerobic conditions for 48 hours. After incubation, growing bacteria were harvested and thereafter incubated at four times the original MIC. This procedure was repeated with increasing antibiotic concentrations. The resulting MIC values were confirmed by Etest.
  
  
  RESULTS
  The MIC values for metronidazole of the four nim-positive reference strains ranged from 3 to 8 mg/l. The B. fragilis ATCC 25285 strain and the B. thetaiotaomicron DSM 2255 strain were nim negative with MIC values of 0.19 mg/l and 0.75 mg/l, respectively. Three clinical isolates of B. fragilis strains showed MIC values of > 256 mg/l. In all three strains, nim genes were detected by PCR. The other clinical isolates were nim negative. In these strains, MIC values ranged from 0.19 to 0.75 mg/l. After several passages on metronidazole containing agar, all B. fragilis group strains exhibited MIC values of > 256 mg/l determined by Etest.
  
  
  CONCLUSIONS
  Metronidazole resistance can be selected not only in nim-positive strains but also in nim-negative strains, suggesting that mechanisms other than nim genes are involved. These findings and the emerging resistance of the B. fragilis group against several antimicrobial agents underscore the importance of susceptibility testing of anaerobes even in routine laboratories.
authors.affiliation: Institute for Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Liebigstr. 24, 04103 Leipzig, Germany. schaur@medizin.uni-leipzig.de
authors.forename: R
authors.initials: R
authors.lastname: Schaumann
authors.forename: S
authors.initials: S
authors.lastname: Petzold
authors.forename: M
authors.initials: M
authors.lastname: Fille
authors.forename: A C
authors.initials: AC
authors.lastname: Rodloff
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D001441:Bacteroides fragilis / Q000187:drug effects*; D024881:Drug Resistance, Bacterial / Q000235:genetics; D015964:Gene Expression Regulation, Bacterial; D005798:Genes, Bacterial; D008795:Metronidazole / Q000494:pharmacology*; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole