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Antimicrobial Agents and Chemotherapy, April 2005, p. 1294-1301, Vol. 49, No. 4
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.4.1294-1301.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

In Vitro Susceptibility Testing of Borrelia burgdorferi Sensu Lato Isolates Cultured from Patients with Erythema Migrans before and after Antimicrobial Chemotherapy

Klaus-Peter Hunfeld,^1,2* Eva Ruzic-Sabljic,³ Douglas E. Norris,² Peter Kraiczy,¹ and Franc Strle⁴

Institute of Medical Microbiology, University Hospital of Frankfurt, Frankfurt/Main, Germany,¹ Institute of Microbiology and Immunology, Medical Faculty, University of Ljubljana,³ Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia,⁴ The Harry W. Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland²

Received 26 July 2004/ Returned for modification 7 September 2004/ Accepted 19 December 2004

Clinical treatment failures have been reported to occur in early Lyme borreliosis (LB) for many suitable antimicrobial agents. Investigations of possible resistance mechanisms of the Borrelia burgdorferi complex must analyze clinical isolates obtained from LB patients, despite their receiving antibiotic treatment. Here, borrelial isolates obtained from five patients with erythema migrans (EM) before the start of antibiotic therapy and again after the conclusion of treatment were investigated. The 10 isolates were characterized by restriction fragment length polymorphism analysis and plasmid profile analysis and subjected to susceptibility testing against a variety of antimicrobial agents including those used for initial chemotherapy. Four out of five patients were infected by the same genospecies (Borrelia afzelii, n = 3; Borrelia garinii, n = 1) at the site of the EM lesion before and after antimicrobial therapy. In one patient the genospecies of the initial isolate (B. afzelii) differed from that of the follow-up isolate (B. garinii). No significant changes in the in vitro susceptibilities became obvious for corresponding clinical isolates before the start and after the conclusion of antimicrobial therapy. This holds true for the antimicrobial agents used for specific chemotherapy of the patients, as well as for any of the additional agents tested in vitro. Our study substantiates borrelial persistence in some EM patients at the site of the infectious lesion despite antibiotic treatment over a reasonable time period. Borrelial persistence, however, was not caused by increasing MICs or minimal borreliacidal concentrations in these isolates. Therefore, resistance mechanisms other than acquired resistance to antimicrobial agents should be considered in patients with LB resistant to treatment.

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* Corresponding author. Mailing address: Institute of Medical Microbiology, University Hospital of Frankfurt, Paul-Ehrlich Str. 40, D-60596 Frankfurt/Main, Germany. Phone: 49-69-6301-6441. Fax: 49-69-6301-5767. E-mail: K.Hunfeld{at}em.uni-frankfurt.de.

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Antimicrobial Agents and Chemotherapy, April 2005, p. 1294-1301, Vol. 49, No. 4
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.4.1294-1301.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

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