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1Institute of Clinical Microbiology, University of Szeged, Szeged, Hungary 2Department of Medicine, Microbiology and Immunology, Loyola University Chicago, Maywood, and Department of Medicine, VA Hospital, Hines, USA 3Division of Microbiology, University Hospital, Queen's Medical Centre, Nottingham, UK 4Department of Microbiology, Faculty of Medicine, University of Kuwait, Kuwait 5`Vitality’ Laboratory, Biological Research Center of Hungarian Academy of Sciences, Szeged, Hungary
Correspondence József Sóki soki{at}mlab.szote.u-szeged.hu
Received September 4, 2003
Accepted January 23, 2004
Fifteen Bacteroides fragilis isolates from the USA, Hungary and Kuwait were examined for carbapenem resistance, for carbapenemase activity and, with the use of various PCR-based methods and nucleotide sequencing, for cfiA genes and activating insertion sequence (IS) elements. All the B. fragilis isolates were cfiA-positive, 10 of the cfiA genes being upregulated by IS elements that are already known. Of these 10, one was of a novel type (designated IS943) and two further ones (IS614B and IS614C) were suspected hybrids of IS612, IS614 and IS942. There were five cfiA-positive imipenem-resistant B. fragilis isolates with elevated imipenem MICs (minimal inhibitory concentration) that harboured no IS insertion upstream of the cfiA gene, but produced carbapenemase; these isolates might possess a novel activation mechanism. On the basis of the available phenotypic and genotypic evidence, the present data suggest that there are at least two cfiA activation mechanisms among B. fragilis isolates.
The GenBank accession numbers for the sequences of conserved regions upstream of cfiA in B. fragilis 21216, 388/1, 388/2, 19841 and 16997 are AY373492, AY373493, AY373494, AY373495 and AY374121, respectively. The GenBank accession number for the nucleotide sequence of insertion sequence element IS943 is AF519175.
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