Case Report

Multidrug-Resistant Bacteroides fragilis Bacteremia in a US Resident: An Emerging Challenge

Table 1

Previous case reports of B.  fragilis resistance and treatment regimens.

Case reportsSource of infectionResistance mechanismsDefinitive treatment regimenOutcome

United States case reports

Sherwood et al. [1]Bacteremia + woundnimEMoxifloxacin 400 mg IV q24 h + linezolid 600 mg IV q12 h
Duration: 8 weeks
Survived

Kapalpila et al. [2]Bacteremia + intra-abdominal fluidNo molecular investigation; resistant to MTZ1, imipenem, PTZ1, clindamycin, cefotetan, amp/sul1, moxifloxacinErtapenem 1 g IV q24 hr + Linezolid 600 mg IV q12 hr
Duration: 4 weeks
Survived

Non-United States case  reports

Ank et al. [3]BacteremiacfiA, nimE, ermF, tetQMoxifloxacin 400 mg IV q24 h + piperacillin-tazobactam 4.5 g IV q8 hr
Duration: 7 days
Survived

Urbán et al. [4]Abdominal fluidcfiA, nimA, erm, cepA, tetQLocally applied antibiotic therapy/wound careSurvived

Hartmeyer et al. [5]Bacteremia + intra-abdominal fluidcfiA, nimD, ermF, tetQ, tetXMeropenem + metronidazole
Duration: 6 days, discontinuation due to death
Died

Katsandri et al. (2 case  reports) [6]Case  1: bacteremia from a colitis
Case  2: esophagojejunal anastomotic leak
cfiACase  1: metronidazole 500 mg IV q8 h + cefotaxime 2 g IV q8 h
Case  2: imipenem 500 mg IV q8 h
Case  1: died
Case  2: died

Wareham et al. [7]Bacteremia from pancreatitis cfiA, ermF, tetQ, efflux pump bmeB9/B15Linezolid 600 mg IV q12 hDied

Rotimi et al. (3 case  reports) [8]Case  1: paracolic abscess
Case  2: surgical wound
Case  3: groin and scrotal abscess
No molecular investigation; resistant to MTZCase  1: imipenem 500 mg IV q8 h
Case  2: amoxicillin-clavulanate acid 600 mg PO q8 h
Case  3: meropenem 500 mg IV q8 h + cefepime + amikacin 500 mg IV q12 h
Case  1: survived
Case  2: survived
Case  3: died

Turner et al. [9]Bacteremia from peritonitis and empyemaNo molecular investigation; resistant to MTZ, imipenem, amoxicillin-clavulanate acidGentamicin and clindamycinSurvived

MTZ: metronidazole; PTZ: piperacillin-tazobactam.