title: Resistance carrying plasmid in a traumatic wound.
abstract: OBJECTIVE
  To isolate and identify antibiotic-resistant bacteria from the exudate of a complex wound and determine if antibiotic resistance genes are chromosomal or plasmid borne.
  
  
  METHODS
  Antibiotic resistant bacteria from wound exudate of a single clinical sample were selected on agar media with ampicillin. A single colony was further screened for resistance to kanamycin by antibiotic-supplemented agar and to other antibiotics by an automated Phoenix instrument. Identification of the isolate was carried out by biochemical profiling and by 16S rDNA analysis.
  
  
  RESULTS
  Approximately 51% of total bacteria in the wound exudate with identical colony morphotype were resistant to 100 microg/ml of ampicillin. A single colony from this population also demonstrated resistance to 50 microg/ml of kanamycin on kanamycin-supplemented agar. Further antimicrobial sensitivity testing by the Phoenix instrument indicated resistance to inhibitory concentrations of amoxicillin-clavulanate, ampicillin-sulbactam, cefazolin, gentamicin, nitrofurantoin, tobramycin, and trimethoprim-sulfamethoxazole. Biochemical and 16S rDNA analysis identified this bacterial isolate as a member of genus Enterobacter. A plasmid preparation from this isolate successfully transferred ampicillin and kanamycin resistance to E. coli competent cells. E. coli transformants displayed two resistance phenotypes and the plasmids from these transformants displayed two different restriction type patterns, with one correlating to ampicillin and kanamycin resistance and the other only to ampicillin resistance.
  
  
  CONCLUSIONS
  A multiple antibiotic-resistant Enterobacter spp. from the wound fluid of a clinical sample was found to carry an antibiotic-resistant plasmid in a closely related species E. coli. The presence of antibiotic resistance plasmid in Enterobacteria that are part of the normal microbial flora of the human gut and skin could lead to the spread of resistance phenotype and emergence of antibiotic resistant pathogens. This study suggests normal human microbial fl ora could be a potential reservoir for resistance genes.
authors.affiliation: Wound Biology and Translational Research Division, Armed Forces Institute of Pathology, Washington DC, USA. alavim@afip.osd.mil
authors.forename: M R
authors.initials: MR
authors.lastname: Alavi
authors.forename: A
authors.initials: A
authors.lastname: Ravizee
authors.forename: R
authors.initials: R
authors.lastname: Burgess
authors.forename: V
authors.initials: V
authors.lastname: Antonic
authors.forename: M
authors.initials: M
authors.lastname: Izadjoo
authors.forename: A
authors.initials: A
authors.lastname: Stojadinovic
mesh_terms: D015373:Bacterial Typing Techniques; D004269:DNA, Bacterial / Q000032:analysis / Q000235:genetics; D004587:Electrophoresis, Agar Gel; D004754:Enterobacter / Q000145:classification / Q000235:genetics*; D004756:Enterobacteriaceae Infections / Q000382:microbiology*; D005122:Exudates and Transudates / Q000382:microbiology*; D005240:Feasibility Studies; D006801:Humans; D007613:Kanamycin Resistance / Q000235:genetics*; D008403:Mass Screening / Q000379:methods; D008826:Microbial Sensitivity Tests; D010802:Phylogeny; D010957:Plasmids / Q000235:genetics*; D016133:Polymerase Chain Reaction; D016415:Sequence Alignment; D017422:Sequence Analysis, DNA; D014946:Wound Infection / Q000382:microbiology*; D014950:Wounds, Penetrating / Q000150:complications
chemical_list: D004269:DNA, Bacterial