Activity of trospectomycin against Bacteroides fragilis and other Bacteroides species.

The in vitro activity of trospectomycin (U-63366; 6'-n-propyl spectinomycin pentahydrate sulfate) was evaluated against 189 clinical isolates of the Bacteroides fragilis group and 65 Bacteroides species isolates. At less than or equal to 8 micrograms/ml, the activity of trospectomycin compared favorably with those of clindamycin and cefoxitin against B. fragilis, Bacteroides distasonis, and Bacteroides vulgatus, and there was no cross resistance to these three drugs among the strains of the B. fragilis group. All the Bacteroides species were susceptible to trospectomycin. The results of this in vitro study indicate that trospectomycin possesses excellent activity against Bacteroides species.     

Activity of Sulfamethoxazole and Trimethoprim Against Bacteroides fragilis

Minimum inhibitory concentrations (MICs) of sulfamethoxazole (SMX) and trimethoprim (TMP), alone and in three combinations, 20:1, 1:1, and 1:20, were determined on Diagnostic Sensitivity Test (DST) and Mueller-Hinton (MH) agars containing lysed blood for various inocula of 91 strains of Bacteroides fragilis from the U.S.A. and U.K. MICs of SMX were high with large inocula and higher on MH than DST, but results for TMP were less affected by these two factors. True SMX resistance was rare: 10 U.S.A. strains previously reported as resistant appeared to be susceptible. Maximum potentiation of MICs was observed when SMX and TMP were combined in ratios close to those of the ratios of their MICs, that is, SMX/TMP 20:1 for large inocula and the reverse for small inocula for determinations on DST and usually 20:1 for all inoculum sizes on MH. These observations explain some of the discrepancies in reports, but defer the problem of potential usefulness of the drugs in the treatment of infection with anaerobes to future study.     

Bacteroides fragilis endocarditis

We recently diagnosed and treated an unusual case of primary endocarditis due to Bacteroides fragilis, for which no underlying etiology was found. Antibiotic treatment involved multiple parenteral and oral antibiotics, and sensitivity studies allowed choice of antibiotics. Despite complications, the patient was cured. Few cases of Bacteroides fragilis endocarditis have been reported, and therapy has changed with newer antibiotics.     

Activity of beta-lactamase produced by Bacteroides fragilis against newly introduced cephalosporins

The purified beta-lactamase from Bacteroides fragilis hydrolyzed newly introduced cephalosporins including cefuroxime and HR 756, and was inhibited by 7 alpha-methoxylated cephalosporins such as 6059-S and YM09330.     

Activity of newer beta-lactam agents against clinical isolates of Bacteroides fragilis and other Bacteroides species.

The in vitro activities of beta-lactam antibiotics against Bacteroides fragilis and B. fragilis group isolates are presented. Clinical isolates from 1986 were compared with strains from 1979 to 1982. Imipenem, ticarcillin-clavulanic acid, and ceftizoxime were the most active agents. Cefotetan was equivalent to cefoxitin against B. fragilis but less active against B. fragilis group isolates. Enhancement of cefotaxime by its desacetyl metabolite was minimal.     

Permeability to beta-lactams in Bacteroides fragilis

Bacteroides fragilis strains TAL2480 and TAL3636 were used to assess outer membrane permeability to various beta-lactam compounds. These strains were chosen because they possess beta-lactamases capable of hydrolysing all commonly employed beta-lactams except monobactams. The beta-lactamases are located in the periplasmic space and could be released by sonication and osmotic shock. Permeability was calculated by the method of Zimmerman & Rosselet (1977, Antimicrobial Agents and Chemotherapy 12, 368-72). The rank order of permeative ability (from fastest to slowest) was as follows: cephaloridine, imipenem, cefotaxime, cefoxitin, cefoperazone, nitrocefin, cephalothin, and latamoxef. Our results showed that ionic charge, hydrophobicity, and molecular weight influenced beta-lactam drug uptake by B. fragilis. These results are similar to findings for Escherichia coli, where increased negative charge and increased molecular weight are associated with decreased drug uptake. However, unlike E. coli, increased drug hydrophobicity, for a given charge and molecular weight of the drug, was associated with increased uptake by B. fragilis.     

Tetracycline transport in Bacteroides fragilis.

In susceptible strain of Bacteroides fragilis, tetracycline uptake is biphasic. The initial phase is independent of adenosine 5'-triphosphate synthesis, which is coupled to fumarate reduction; this phase is not altered by expression of tetracycline resistance genes in a resistant strain. The second phase appears to occur by active transport, since it is largely reduced by rotenone, an inhibitor of electron transport to fumarate; moreover, this phase is under negative control of the tetracycline resistance gene.     

Chloramphenicol Acetyltransferase of Bacteroides fragilis

Chloramphenicol-resistant strains of Bacteroides fragilis (minimum inhibitory concentration, 12.5 mug/ml) were isolated from a stool specimen which contained multiply resistant Escherichia coli. The enzyme responsible for resistance, chloramphenicol acetyltransferase, was produced constitutively by these strains; the specific activity was 10-fold lower than that of the E. coli enzymes. Similar activity was not detected in susceptible B. fragilis strains, nor could it be induced by growth in the presence of chloramphenicol or by mutagenesis. The enzyme had a pH optimum of 7.8 and a molecular weight of approximately 89,000. The K(m) for chloramphenicol was 5.2 muM, and the enzyme was sensitive to inhibition by 5,5'-dithiobis-2-nitrobenzoic acid. The enzyme produced by an E. coli strain isolated from the same specimen had a similar K(m) and sensitivity to 5,5'-dithiobis-2-nitrobenzoic acid.     

Beta-lactamase-mediated imipenem resistance in Bacteroides fragilis.

Imipenem has excellent antimicrobial activity owing in part to beta-lactamase stability. We found that only 2 of over 350 Bacteroides fragilis group clinical isolates were resistant to imipenem, with an MIC of more than 16 micrograms/ml. These two isolates from the Tufts Anaerobe Laboratory (TAL) were resistant to all other beta-lactam agents tested. The organisms were able to inactivate imipenem in broth cultures and contained similar beta-lactamases that were able to hydrolyze carbapenems, cephamycins, cephalosporins, and penicillins. The molecular sizes of the beta-lactamases in TAL2480 and TAL3636 were estimated to be 44,000 daltons. The novel beta-lactamase contained Zn2+ as a cofactor. An additional factor contributing to resistance was determined. The outer membranes of these two organisms were found to limit free diffusion of the drugs into the periplasm. This novel beta-lactamase, associated with a barrier to drug permeation, resulted in high-grade beta-lactam drug resistance.     

Cefoxitin inactivation by Bacteroides fragilis.

We have surveyed the susceptibility of 1,575 clinical isolates of the Bacteroides fragilis group of organisms to cefoxitin and eight other antimicrobial agents. Eleven isolates, 0.7% of the total, were highly cefoxitin resistant and had minimum inhibitory concentrations of greater than or equal to 64 micrograms/ml. These isolates were also resistant to other beta-lactam antibiotics. Of 11 isolates, 4 were able to inactivate cefoxitin in broth cultures, as measured by microbiological and high-pressure liquid chromatography assays. Two distinct patterns of cefoxitin breakdown products were detected by high-pressure liquid chromatography analysis. The beta-lactamase inhibitors clavulanic acid and sulbactam failed to show synergism with cefoxitin. These data demonstrate that members of the B. fragilis group have acquired a novel resistance mechanism enabling them to inactivate cefoxitin.     

Accumulation of norfloxacin by Bacteroides fragilis

The accumulation of norfloxacin by Bacteroides fragilis NCTC 9343 was determined by the modified fluorescence method. The time required to achieve a steady-state concentration (SSC) after allowing B. fragilis to accumulate norfloxacin in an aerobic or an anaerobic environment was approximately 2 min; the SSC achieved in air was 90.28 +/- 9.32 ng of norfloxacin/mg (dry weight) of cells, and that achieved anaerobically was 98.45 +/- 3.7 ng of norfloxacin/mg (dry weight) of cells. Initial rates of accumulation were determined with a range of external concentrations, as up to 8 microg/ml the concentration of norfloxacin accumulated increased proportionally to the external concentration, 12.13 ng/mg (dry weight) of cells per microg of exogenous norfloxacin per ml. At concentrations above 10 microg/ml no increase in the rate of norfloxacin accumulation was observed. From the kinetic data, a Lineweaver-Burk plot calculated a K(m) of 5.03 microg/ml and a V(max) of 25.1 ng of norfloxacin/s. With an increase in temperature of between 0 and 30 degrees C, the concentration of norfloxacin accumulated also increased proportionally at 4.722 ng of norfloxacin/mg (dry weight) of cells/ degrees C. At low concentrations of glucose (<0.2%; 11 mM), the concentration of norfloxacin accumulated was decreased. With the addition of 100 microM carbonyl cyanide m-chlorophenylhydrazone (CCCP) the mean SSC of norfloxacin was increased to 116 +/- 7.01 ng of norfloxacin/mg (dry weight) of cells; glucose had no significant effect in the presence of CCCP. Magnesium chloride (20 mM) decreased the SSC of norfloxacin to 40.5 +/- 3.76 ng of norfloxacin per mg (dry weight) of cells. These data suggest that the mechanism of accumulation of norfloxacin by B. fragilis is similar to that of aerobic bacteria and that the fluoresence procedure is suitable for use with an anaerobic bacterium.     

Prevalence of enterotoxigenic Bacteroides fragilis in hospital-acquired diarrhea

Stool specimens from 152 hospitalized patients with diarrhea were analyzed for the presence of enterotoxigenic Bacteroides fragilis (ETBF) by a nested polymerase chain reaction (PCR) assay. ETBF gene sequences were directly detected in 14/152 (9.21%) stools of patients. The prevalence of ETBF in hospital-acquired diarrhea was statistically significant when compared to a prevalence of 2.3% in control subjects (P = 0.04). B. fragilis was cultured from 19.7% (30/152) patients with diarrhea; 4 of these isolates were enterotoxigenic. To determine whether colonization with B. fragilis is heterogeneous in nature, multiple colonies from 17 individual patients were analyzed for enterotoxin gene sequences and genotyped by arbitrarily primed PCR. Of these 17 patients, 13 harbored multiple strain types suggesting heterogeneity of colonization with both enterotoxigenic and non-enterotoxigenic strains. Identification of ETBF in the stools of 10 patients in the absence of a positive culture is likely due to the noted heterogeneity and suggests that detection of enterotoxin by PCR should be performed directly in the stool. These preliminary data indicate that ETBF may play a role in hospital-acquired diarrhea of unknown origin and suggest the need for further studies.     

Survey of Bacteroides fragilis susceptibility patterns in France

The in-vitro activities of 19 antimicrobial agents were determined by an agar dilution technique against 300 isolates of the Bacteroides fragilis group, collected from several French hospitals during 1987 and 1988. Results were compared with data determined for strains isolated in 1977. Amongst beta-lactam antibiotics, amoxycillin + clavulanic and imipenem displayed the best activity, although two strains resistant to both amoxycillin clavulanate and imipenem were obtained in the 1987-1988 survey. Chloramphenicol was invariably active against isolates from both periods. Much more resistance to clindamycin was seen in isolates from the more recent survey. Resistance to 5-nitroimidazoles was not observed in isolates from the 1977 survey but was present in a few isolates from the more recent study.     

Bacteroides fragilis resistance to clindamycin in vitro.

Clindamycin resistance in Bacteroides fragilis was examined in 507 strains isolated from 1973 to 1981. Three groups were recognized: highly susceptible (minimum inhibitory concentration [MIC] less than or equal to 0.125 microgram/ml), intermediately susceptible (MIC = 0.25 to 4 micrograms/ml), and highly resistant to (MIC greater than or equal to 8 microgram/ml). The incidence of high-level resistance (1.8%) had not changed during this period. Only 8 of 17 isolates reputed to be highly clindamycin resistant that were referred to our laboratory proved to be highly resistant (MICs greater than or equal to 32 microgram/ml), whereas the other 9 were intermediately susceptible. Analysis of 2- and 10-microgram clindamycin disks for determining the susceptibility of B. fragilis revealed a high false-resistance rate with the 2-microgram disk, most errors occurring with the intermediate group. There was no false resistance with the 10-microgram disk. When disk diffusion susceptibility of B. fragilis is employed, we recommend the 10-microgram disk to predict accurately the susceptibility of B. fragilis to clindamycin.     

Fluoroquinolone Resistance in Bacteroides fragilis following Sparfloxacin Exposure

In vitro pharmacodynamic studies investigating the antimicrobial properties of five fluoroquinolones, (trovafloxacin, sparfloxacin, clinafloxacin, levofloxacin, and ciprofloxacin) against Bacteroides fragilis ATCC 23745 were conducted. The times required to reduce the viable counts by 3 log units were as follows: clinafloxacin, 2.9 h; levofloxacin, 4.6 h; trovafloxacin, 6 h; and sparfloxacin, 10 h. Exposure to ciprofloxacin did not achieve a 3-log decrease in viable counts. The susceptibility of B. fragilis was determined both prior to exposure and following 24 h of exposure to each of the five fluoroquinolones tested. The MICs of clinafloxacin, levofloxacin, trovafloxacin, sparfloxacin, ciprofloxacin, metronidazole, cefoxitin, chloramphenicol, and clindamycin were determined by the broth microdilution method. The MICs for B. fragilis preexposure were as follows: clinafloxacin, 0.25 microg/ml; trovafloxacin, 0.5 microg/ml; sparfloxacin, 2 microg /ml; levofloxacin, 2 microg/ml; and ciprofloxacin, 8 microg/ml. Similar pre- and postexposure MICs were obtained for cultures exposed to trovafloxacin, clinafloxacin, levofloxacin, and ciprofloxacin. However, following 24 h of exposure to sparfloxacin, a fluoroquinolone-resistant strain emerged. The MICs for this strain were as follows: clinafloxacin, 1 microg/ml; trovafloxacin, 4 microg/ml; sparfloxacin, 16 microg/ml; levofloxacin, 16 microg/ml; and ciprofloxacin, 32 microg/ml. No changes in the susceptibility of B. fragilis pre- and postexposure to sparfloxacin were noted for metronidazole (MIC, 1 microg/ml), cefoxitin (MIC, 4 microg /ml), chloramphenicol (MIC, 4 microg/ml), and clindamycin (MIC, 0.06 microg/ml). Resistance remained stable as the organism was passaged on antibiotic-free agar for 10 consecutive days. Mutant B. fragilis strains with decreased susceptibility to clinafloxacin, trovafloxacin, sparfloxacin, levofloxacin, and ciprofloxacin were selected on brucella blood agar containing 8x the MIC of levofloxacin at a frequencies of 6.4 x 10(-9), 4x the MICs of trovafloxacin and sparfloxacin at frequencies of 2.2 x 10(-9) and 3. 3 x 10(-10), respectively, and 2x the MIC of clinafloxacin at a frequency of 5.5 x 10(-11); no mutants were selected with ciprofloxacin. The susceptibilities of strains to trovafloxacin, levofloxacin, clinafloxacin, sparfloxacin, and ciprofloxacin before and after exposure to sparfloxacin were modestly affected by the presence of reserpine (20 microg/ml), an inhibitor of antibiotic efflux. The mechanism of fluoroquinolone resistance is being explored, but it is unlikely to be efflux due to a lack of cross-resistance to unrelated antimicrobial agents and to the fact that the MICs for strains before and after exposure to sparfloxacin are minimally affected by reserpine.     

Rifampin and bacteriocin resistance in Bacteroides fragilis.

A low-molecular-weight bacteriocin produced by a Bacteroides fragilis strain inhibited ribonucleic acid polymerase activity in crude extracts of a susceptible B. fragilis indicator strain. A total of 10 rifampin-resistant mutants of the indicator strain were isolated. Nine of the rifampin-resistant mutants were resistant to the bacteriocin, and the other mutant was hypersusceptible. The rifampin- and bacteriocin-resistant mutants all adsorbed approximately the same amount of the bacteriocin as the indicator strain. Two of these rifampin- and bacteriocin-resistant mutants were investigated further, and the polymerase activity in crude extracts of the two mutants was not affected by either rifampin or the bacteriocin. The in vitro ribonucleic acid polymerase activity of the hypersusceptible strain was more susceptible to the bacteriocin than the parent indicator strain was. The bacteriocin-producing strain was susceptible to rifampin but was resistant to its own bacteriocin in vivo. The in vitro ribonucleic acid polymerase activity of the producer strain was only slightly affected by 64 arbitrary units of the bacteriocin. Increasing concentrations of the bacteriocin inhibited ribonucleic acid polymerase extracts of the producer strain.