resistance against ceftazidime, a third generation cephalosporin. Within the aminoglycoside class of antibiotics, isolates exhibited resistance to Antimicrobial resistance in tdh/trh+ V. parahaemolyticus One V. parahaemolyticus isolate was tdh+ and one isolate was PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/19632594 trh+. Martin’s River had higher levels of bacterialindicator species. Clinical V. parahaemolyticus Clinical isolates tested displayed comparable resistance profiles to environmental isolates tested. However, environmental isolates demonstrated intermediate resistance and resistance to a greater range of antibiotics when compared to clinical isolates. Yet, based on analyses with two-sample proportion tests, the overall percentage of resistance and intermediate resistance and Vibrio parahaemolyticus isolates expressed resistance or intermediate resistance. doi:10.1371/journal.pone.0089616.g003 animal model as combination drug regimens with 2353-45-9 price doxycycline and a cephalosporin. All tested V. vulnificus isolates were susceptible to third and fourth generation cephalosporins, although two V. parahaemolyticus isolates demonstrated intermediate resistance to cefotaxime, a third-generation cephalosporin, and two isolates demonstrated a degree of resistance to cefepime, a fourth-generation cephalosporin. While the percentage of isolates expressing intermediate resistance and resistance to the newer generation cephalosporins was relatively low, these antibiotics are considered to be some of the best defenses against the severe infections that these organisms can elicit, so even a small percentage of resistant isolates could be cause for concern. Due to the contraindication of doxycycline and fluoroquinolones in children, a combination of trimethoprim-sulfamethoxazole and 
an aminoglycoside antibiotic is recommended. Given that three of the four tested aminoglycosides were associated with intermediate resistance or resistance in a subset of isolates, this may be a resistance pattern of concern. Conversely, for the aminoglycoside, gentamicin, all tested isolates were fully susceptible. Based on these data, physicians in the Bay region may consider focusing on gentamicin as the aminoglycoside of choice in multi-drug treatment regimens for Vibrio infections contracted by children recreating in the Chesapeake Bay. Comparison to other studies of V. vulnificus and V. parahaemolyticus antimicrobial susceptibility The percent resistance among PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/19632868 Vibrios, in this study was comparable to a similar study conducted on Vibrios isolated from Gulf Coast oysters in Louisiana. Han et al. also found higher levels of resistance among V. parahaemolyticus compared to V. vulnificus isolates. In addition, ampicillin was the only tested antimicrobial in the Gulf Coast study to which a large percentage of V. parahaemolyticus isolates demonstrated intermediate resistance to resistance. This trend was seen as early as the 1970s in a study that tested resistance of V. parahaemolyticus to ampicillin and b-lactamase inhibitors, where over 90% of isolates were found to be resistant to ampicillin. In contrast to the present study, Han et al. found no resistance in either Vibrio species to chloramphenicol, cefotaxime, or ceftazidime, while we observed intermediate resistance against these three antimicrobial agents among a subset of V. vulnificus and V. parahaemolyticus. Our findings are also in partial agreement with two large studies of V. vulnificus and V. parahaemolyticus isolates originating from the Georgia and South Car
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