title: Multidrug-resistant oral Capnocytophaga gingivalis responsible for an acute exacerbation of chronic obstructive pulmonary disease: Case report and literature review.
abstract: BACKGROUND
  Capnocytophaga genus was recently known to highly contribute to the beta-lactam (BL) and macrolide-lincosamide-streptogramin (MLS) resistance gene reservoir in the oral microbiota (BL: blaCSP-1and blaCfxA; MLS: erm(F) and erm(C)). But fluoroquinolone (FQ) resistance remains uncommon in literature, without available data on resistance mechanisms.
  
  
  METHODS
  For the first time, a case of acute exacerbation of chronic obstructive pulmonary disease (COPD) was described in a 78-year-old immunocompetent patient due to a multidrug-resistant Capnocytophaga gingivalis isolate with significant microbiological finding. C.gingivalis acquired resistance to third generation cephalosporins (blaCfxA3gene), MLS (erm(F) gene), and fluoroquinolones. Genetics of the resistance, unknown as regards fluoroquinolone, was investigated and a substitution in QRDR of GyrA was described (Gly80Asn substitution) for the first time in the Capnocytophaga genus.
  
  
  METHODS
  A comprehensive literature review of Capnocytophaga spp. extra-oral infection was conducted. Including the present report, on 43 cases, 7 isolates were BL-resistant (17%), 4 isolates were MLS-resistant (9.5%) and 4 isolates were FQ-resistant (9.5%). The studied clinical isolate of C.gingivalis was the only one to combine resistance to the three groups of antibiotics BL, MLS and FQ. Four cases of Capnocytophaga lung infection were reported, including three infections involving C. gingivalis (two FQ resistant) and one involving C. sputigena.
  
  
  CONCLUSIONS
  This multidrug-resistant C. gingivalis isolate illustrated the role of oral flora as a reservoir of antibiotic resistance and its contribution to the limitation of effective antibiotics in severe respiratory infections.
authors.affiliation: Pôle odontologie, CHU de Nice, Nice, France; Faculté d'odontologie, Université de Nice-Sophia-Antipolis, Nice, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Ehrmann
authors.affiliation: Equipe de Microbiologie EA 1254, Université de Rennes 1, France; CHU de Rennes, Rennes, France. Electronic address: anne.gougeon@univ-rennes1.fr.
authors.forename: Anne
authors.initials: A
authors.lastname: Jolivet-Gougeon
authors.affiliation: Equipe de Microbiologie EA 1254, Université de Rennes 1, France; CHU de Rennes, Rennes, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Bonnaure-Mallet
authors.affiliation: Service d'hygiène et vaccinations, Centre Hospitalier Universitaire de Nice, 06003 Nice, France; Faculté de Médecine, Université de Nice Sophia-Antipolis, Nice, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Fosse
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002206:Capnocytophaga / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification / Q000472:pathogenicity; D002511:Cephalosporins / Q000494:pharmacology; D027081:DNA Gyrase / Q000235:genetics*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D024841:Fluoroquinolones / Q000494:pharmacology; D015870:Gene Expression; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D006801:Humans; D055231:Lincosamides / Q000494:pharmacology; D018942:Macrolides / Q000494:pharmacology; D008297:Male; D009154:Mutation; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D025361:Streptogramins / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D055231:Lincosamides; D018942:Macrolides; D025361:Streptogramins; D027081:DNA Gyrase
keywords: Antibiotic resistance; Capnocytophaga gingivalis; Chronic obstructive pulmonary disease; Fluoroquinolone; Oral microbiota