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Akrami S, Ekrami A, Jahangirimehr F, Yousefi Avarvand A. High prevalence of multidrug-resistant Pseudomonas aeruginosa carrying integron and exoA, exoS, and exoU genes isolated from burn patients in Ahvaz, southwest Iran: A retrospective study. Health Sci Rep 2024; 7:e2164. [PMID: 38903659 PMCID: PMC11187163 DOI: 10.1002/hsr2.2164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 05/05/2024] [Accepted: 05/14/2024] [Indexed: 06/22/2024] Open
Abstract
Background Pseudomonas aeruginosa as an opportunistic pathogen produces several virulence factors. This study evaluated the relative frequency of exoenzymes (exo) A, U and S genes and integron classes (I, II, and III) among multi-drug-resistant clinical P. aeruginosa isolates from burn patients in Ahvaz, southwest of Iran. Methods In this cross-sectional study P. aeruginosa isolates were recovered from 355 wound samples. The antimicrobial susceptibility test was done by disk agar diffusion method on Muller-Hinton agar according to the Clinical and Laboratory Standards Institute. MDR isolates were defined if they showed simultaneous resistance to 3 antibiotics. Extensively drug-resistant was defined as nonsusceptibility to at least one agent in all but two or fewer antimicrobial categories. The presence of class I, II, and III integrons and virulence genes was determined using a PCR assay on extracted DNA. Results Overall, 145 clinical P. aeruginosa isolates were confirmed with biochemical and PCR tests. Overall, 35% (52/145) of the isolates were taken from males and 64% (93/145) from female hospitalized burn patients. The highest resistance rates of P. aeruginosa isolates to antibiotics were related to piperacillin 59% (n = 86/145) and piperacillin-tazobactam 57% (n = 83/145). A total of 100% of isolates were resistant to at least one antibiotic. MDR and XDR P. aeruginosa had a frequency of 60% and 29%, respectively. The prevalence of integron classes I, II, and III in P. aeruginosa was 60%, 7.58%, and 3.44%, respectively. IntI was more common in MDR and XDR P. aeruginosa isolates. In addition, 70(48%) of P. aeruginosa isolates did not harbor integron genes. Besides, exoA, exoS, and exoU in P. aeruginosa had a frequency of 55%, 55%, and 56%, respectively. Conclusion It was found that P. aeruginosa as a potent pathogen with strong virulence factors and high antibiotic resistance in the health community can cause refractory diseases in burn patients.
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Affiliation(s)
- Sousan Akrami
- Department of Microbiology, School of MedicineTehran University of Medical SciencesTehranIran
- Department of Laboratory Sciences, School of Allied Medical SciencesAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Alireza Ekrami
- Department of Laboratory Sciences, School of Allied Medical SciencesAhvaz Jundishapur University of Medical SciencesAhvazIran
| | | | - Arshid Yousefi Avarvand
- Department of Laboratory Sciences, School of Allied Medical SciencesAhvaz Jundishapur University of Medical SciencesAhvazIran
- Infectious and Tropical Diseases Research Center, Health Research InstituteAhvaz Jundishapur University of Medical SciencesAhvazIran
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Ali ASBE, Ozler B, Baddal B. Characterization of Virulence Genes Associated with Type III Secretion System and Biofilm Formation in Pseudomonas aeruginosa Clinical Isolates. Curr Microbiol 2023; 80:389. [PMID: 37880467 DOI: 10.1007/s00284-023-03498-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/15/2023] [Indexed: 10/27/2023]
Abstract
Pseudomonas aeruginosa is a common pathogen with an increasing multidrug resistance (MDR) phenotype. Its virulence determinants include many factors such as antimicrobial resistance, biofilm formation, and type III secretion system (T3SS) which correlate with disease severity. There are no reports regarding the virulence features of P. aeruginosa in Cyprus. The aim of this study was to investigate the frequency and distribution of selected virulence-encoding genes and evaluate the biofilm formation potential as well as antibiotic resistance rates of isolates in the region. One hundred clinical P. aeruginosa isolates were obtained from clinical specimens and were identified using standard microbiological techniques. Antimicrobial susceptibility was assessed using the VITEK-2 system and biofilm quantification was performed by the microtiter plate assay with crystal violet staining. The presence of algD, exoU, exoT, and exoS was evaluated using polymerase chain reaction (PCR). Among all isolates, 35% were strong biofilm former, 28% were moderate biofilm former, 19% were weak biofilm former, and 18% were non-biofilm former. The rates of MDR and extensive drug resistance (XDR) were 26% and 1%. PCR analysis indicated that 93% of the isolates were algD positive. T3SS genes exoT, exoS, and exoU were detected in 91%, 63%, and 32% of the isolates, respectively. There was a high frequency of exoT + /exoS + genotype (61%), whereas exoT + /exoU + (32%) and exoS + /exoU + (2%) genotypes were relatively uncommon. This study reports the first dataset on the molecular profile of P. aeruginosa in Cyprus. Our results demonstrated that most strains have the biofilm-forming capacity with an algD-positive genotype and the majority carry exoT and exoS with a high frequency of exoT + /exoS + genotype.
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Affiliation(s)
- Afnan S B E Ali
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, 99138, Nicosia, Cyprus
| | - Batur Ozler
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, 99138, Nicosia, Cyprus
| | - Buket Baddal
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, 99138, Nicosia, Cyprus.
- Microbial Pathogenesis Research Group, DESAM Research Institute, Near East University, 99138, Nicosia, Cyprus.
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Wei L, Wu Q, Zhang J, Guo W, Gu Q, Wu H, Wang J, Lei T, Xue L, Zhang Y, Wei X, Zeng X. Prevalence, Virulence, Antimicrobial Resistance, and Molecular Characterization of Pseudomonas aeruginosa Isolates From Drinking Water in China. Front Microbiol 2020; 11:544653. [PMID: 33343513 PMCID: PMC7744469 DOI: 10.3389/fmicb.2020.544653] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 11/02/2020] [Indexed: 01/26/2023] Open
Abstract
Pseudomonas aeruginosa is an important opportunistic pathogen and remains a major threat to the microbial safety of drinking water. There is a lack of comprehensive data on P. aeruginosa contamination in drinking water in China. Therefore, this study aimed to determine the prevalence, genetic diversity, virulence genes, and antimicrobial resistance of P. aeruginosa isolated from mineral water and spring water in China. From January 2013 to January 2014, 314 drinking water samples were collected from 23 cities in China. Of the collected samples, 77 (24.5%) were contaminated with P. aeruginosa, and these comprised 34 raw water (30.4%), 39 activated carbon-filtered water (30.6%), and four final water product (3.9%). A total of 132 P. aeruginosa isolates were obtained, and all of them showed the presence of virulence genes, with the detection rates of ExoU, ExoS, phzM, toxA, and lasB genes being 7.6, 86.3, 95.5, 89.4, and 100%, respectively. All isolates were sensitive to the 14 antibiotics (ciprofloxacin, levofloxacin, ofloxacin, norfloxacin, gentamicin, tobramycin, amikacin, polymyxin B, imipenem, meropenem, aztreonam, ceftazidime, cefepime, and piperacillin/tazobactam) tested. The 132 isolates were categorized into 42 sequence types according to multilocus sequence typing, and ST235 accounted for 8.3% (11) of the total isolates. Thus, this study provides comprehensive data on the prevalence and characteristics of P. aeruginosa in drinking water in China and can aid in developing preventive measures against contamination during the drinking water treatment process.
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Affiliation(s)
- Lei Wei
- Guangdong Provincial Key Laboratory of Microbiology Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, China.,School of Bioscience and Bioengineering, South China University of Technology, Guangzhou, China
| | - Qingping Wu
- Guangdong Provincial Key Laboratory of Microbiology Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, China
| | - Jumei Zhang
- Guangdong Provincial Key Laboratory of Microbiology Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, China
| | - Weipeng Guo
- Guangdong Provincial Key Laboratory of Microbiology Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, China
| | - Qihui Gu
- Guangdong Provincial Key Laboratory of Microbiology Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, China
| | - Huiqing Wu
- Guangdong Provincial Key Laboratory of Microbiology Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, China
| | - Juan Wang
- College of Food Science, South China Agricultural University, Guangzhou, China
| | - Tao Lei
- Guangdong Provincial Key Laboratory of Microbiology Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, China
| | - Liang Xue
- Guangdong Provincial Key Laboratory of Microbiology Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, China
| | - Youxiong Zhang
- Guangdong Provincial Key Laboratory of Microbiology Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, China
| | - Xianhu Wei
- Guangdong Provincial Key Laboratory of Microbiology Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, China
| | - Xiaocong Zeng
- Biological Testing and Analysis Department, Guangdong Provincial Institute of Food Inspection, Guangzhou, China
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Hasannejad-Bibalan M, Jafari A, Sabati H, Goswami R, Jafaryparvar Z, Sedaghat F, Sedigh Ebrahim-Saraie H. Risk of type III secretion systems in burn patients with Pseudomonas aeruginosa wound infection: A systematic review and meta-analysis. Burns 2020; 47:538-544. [PMID: 32532479 DOI: 10.1016/j.burns.2020.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 03/17/2020] [Accepted: 04/23/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The pathogenesis of Pseudomonas aeruginosa is multifactorial and attributed to the production of several cell-associated and extracellular virulence factors including those implicated in adherence, iron uptake, exoenzymes (Exo) and exotoxins. The present study aimed to determine the prevalence of type III secretion systems (T3SS) effectors in Iranian burn patients with P. aeruginosa wound infection. METHODS A systematic search was conducted to identify papers published by Iranian authors in the Web of Science, PubMed, Scopus, Embase, and Google Scholar electronic databases during the period of January, 2000 to December, 2018. Publications which met our inclusion criteria were selected for data extraction and analysis by Comprehensive Meta-Analysis Software. The inclusion criteria were articles that include burn patients with a wound infection caused by P. aeruginosa, and reported the prevalence of aimed exoenzymes. RESULTS Ten publications were selected out of 15 full-text reviewed articles with the inclusion criteria. Of ten studies, the pooled prevalence of ExoS producing isolates was estimated at 57.1% (95% CI: 40.3-72.5%). Five studies reported the prevalence of ExoU and ExoT, from which, the pooled prevalence of ExoU and ExoT producing isolates was estimated at 51.4% (95% CI: 31.4-70.9%) and 86.4% (95% CI: 48.1-97.8%), respectively. Four studies reported the prevalence of ExoY, from which, the pooled prevalence of ExoY producing isolates was estimated at 79.0% (95% CI: 48.6-93.8%). CONCLUSION Our results showed a remarkable prevalence of T3SS-positive genotype in patients with burn injuries. These findings provided attractive targets for new therapeutic strategies for burn patients who were infected with cytotoxin-producing P. aeruginosa.
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Affiliation(s)
| | - Alireza Jafari
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hoda Sabati
- Biotechnology and Biological Science Research Center, Faculty of Science, Shahid Chamran University of Ahvaz, Iran
| | - Rajendra Goswami
- Institute for Tuberculosis Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Zakiyeh Jafaryparvar
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Farzaneh Sedaghat
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hadi Sedigh Ebrahim-Saraie
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
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Javanmardi F, Emami A, Pirbonyeh N, Keshavarzi A, Rajaee M. A systematic review and meta-analysis on Exo-toxins prevalence in hospital acquired Pseudomonas aeruginosa isolates. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2019; 75:104037. [PMID: 31518698 DOI: 10.1016/j.meegid.2019.104037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/26/2019] [Accepted: 09/10/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Pseudomonas aeruginosa (PA) is an opportunistic pathogen that produces widespread and often overwhelming infections. Among different virulence factors, toxins are important bacterial agent which increases PA pathogenesis especially in immunocompromised patients. The aim of this meta-analysis was to determine the prevalence of exotoxin production in PA isolates in the world. Also according to the importance of drug resistance in isolates with more pathogenicity this estimation was conducted in resistant isolates. METHODS A systematic search was conducted in international database like PubMed, Scopus, Web of Science and Embase up to December 2018. Joanna Briggs Institute Checklist was used to evaluate the quality assessment of studies. Random effect model was applied to pool the prevalence data. Stata 13 software was used to analyze the data. RESULTS Total of 58 eligible studies that fulfilled the inclusion criteria of the study were selected for qualitative synthesis. Among exotoxins; the highest prevalence was related to exoT (0.83 (CI95%: 0.64-0.96)). Lowest prevalence rate was seen in exoU with estimated prevalence 0.32 (CI95%: 0.24-0.41). In Carbapenem resistance isolates exoA and exoT had the highest prevalence (1.00 (CI95%: 0.98-1.00)). CONCLUSION This first meta-analysis on PA isolates with toxin potency indicated high prevalence of exotoxin production in clinical isolates of PA which is an alarming point as a clinical aspect. It was found that the ExoT has the most prevalence rate among toxins. The results of simultaneous evaluation of exotoxins and antimicrobial resistance can develop treatment policies against PA infections in hospitals and hospitalized patients.
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Affiliation(s)
- Fatemeh Javanmardi
- Burn and Wound Healing Research Center, Microbiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Emami
- Burn and Wound Healing Research Center, Microbiology Department, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Neda Pirbonyeh
- Burn and Wound Healing Research Center, Microbiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolkhalegh Keshavarzi
- Burn and Wound Healing Research Center, Surgical Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahrokh Rajaee
- Burn and Wound Healing Research Center, Microbiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Wu Q, Ye Y, Li F, Zhang J, Guo W. Prevalence and genetic characterization of Pseudomonas aeruginosa in drinking water in Guangdong Province of China. Lebensm Wiss Technol 2016. [DOI: 10.1016/j.lwt.2016.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shi H, Chen Z, Kan J. Development of loop-mediated isothermal amplification assays for genotyping of Type III Secretion System in Pseudomonas aeruginosa. Lett Appl Microbiol 2016. [PMID: 26219625 DOI: 10.1111/lam.12469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
UNLABELLED Pseudomonas aeruginosa is a well-known environmental bacterium capable of causing a variety of life-threatening human infections, with a Type III Secretion System (T3SS) as the most significant virulence determinant. P. aeruginosa strains exhibit unique T3SS virulence genotypes defined by the presence of either exoS or exoU. In this study, loop-mediated isothermal amplification (LAMP) assays for rapid detection of exoS and exoU in P. aeruginosa have been developed and evaluated. Set of four primers were designed for LAMP-based amplification of exoS and exoU respectively. The LAMP reactions were performed at 63°C for 40 min, with detection limits of 100 fg purified DNA. In 107 river water isolates, exoS and exoU were detected in 10 (9%) and 89 (83%) isolates, respectively, and in 38 soil isolates, they were detected in 7 (18%) and 31 (82%) cases respectively. In conclusion, the LAMP assays are rapid, simple and cost-effective tools for detection of the exoU- and exoS-types of P. aeruginosa strains. SIGNIFICANCE AND IMPACT OF THE STUDY This method can be used for the rapid, sensitive and low-cost detection of genes (exoS and exoU) encoding proteins that are part of Type III Secretion System of Pseudomonas aeruginosa. It can serve as an efficient method in outbreak situations or in routine surveillance studies to judge virulence potential and to investigate pathogenesis of P. aeruginosa.
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Affiliation(s)
- H Shi
- College of Food Science, Southwest University, Chongqing, China
| | - Z Chen
- College of Food Science, Southwest University, Chongqing, China
| | - J Kan
- College of Food Science, Southwest University, Chongqing, China
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Jabalameli F, Mirsalehian A, Khoramian B, Aligholi M, Khoramrooz SS, Asadollahi P, Taherikalani M, Emaneini M. Evaluation of biofilm production and characterization of genes encoding type III secretion system among Pseudomonas aeruginosa isolated from burn patients. Burns 2012; 38:1192-7. [PMID: 22995427 DOI: 10.1016/j.burns.2012.07.030] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 07/17/2012] [Accepted: 07/18/2012] [Indexed: 01/08/2023]
Abstract
Pseudomonas aeruginosa is one of the common pathogenic causes of serious infections in burn patients throughout the world. Type III secretion toxins are thought to promote the dissemination of P. aeruginosa from the site of infection, the bacterial evasion of the host immune response and inhibition of DNA synthesis leading to host cell death. A total of 96 isolates of P. aeruginosa were collected from wound infections of burn patients, from April to July 2010. Antimicrobial susceptibility of the isolates were determined by disk agar diffusion method. Polymerase chain reaction (PCR)-based method was used for targeting the genes encoding the type III secretion toxins. The quantitative determination of biofilm-forming capacity was determined by a colorimetric microtiter plate assay. All the isolates were resistant to cefixime and ceftriaxone. More than 90% of the isolates were resistant to amikacin, carbenicillin, cefepime, cefotaxime, cefpodoxime, gatifloxacin, gentamicin, piperacillin/tazobactam, ticarcillin and tobramycin. All the isolates carried the exoT gene, 95% carried exoY, 64.5% carried exoU and 29% carried the exoS gene. Most of the isolates (58%) carried both exoY and exoU genes while 24% showed the concomitant presence of exoS and exoY and 1% carried both exoS and exoU. Coexistence of exoS, exoY and exoU was seen in 4% of the isolates. Biofilm formation was seen in more than 96% of the isolates among which 47% were strong biofilm producers, 26% were moderate and 22.9% were weak biofilm formers. In conclusion, the findings of this study show that the genes, particularly the exoU gene, encoding the type III secretion toxins, are commonly disseminated among the P. aeruginosa strains isolated from burn patients.
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Affiliation(s)
- Fereshteh Jabalameli
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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A universal primer multiplex PCR method for typing of toxinogenic Pseudomonas aeruginosa. Appl Microbiol Biotechnol 2012; 95:1579-87. [PMID: 22923133 DOI: 10.1007/s00253-012-4277-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 06/08/2012] [Accepted: 06/30/2012] [Indexed: 10/28/2022]
Abstract
Pseudomonas aeruginosa is a well-known opportunistic pathogen that can cause acute nosocomial necrotizing pneumonia and genetic disorder cystic fibrosis of lung patients. Pathogenic interactions between P. aeruginosa and hosts are often guided by the secreted virulence determinants that interact with specific host targets. Exotoxin A, pyocyanin, elastase, and type III secretion system are the most significant virulence determinants and cause great concern. However, P. aeruginosa in various environments has high genotypic diversity, leading to deficiency of exotoxin genes for some P. aeruginosa strains. In current study, a universal primer-multiplex PCR method (UP-MPCR) was employed for the detection of five significant enterotoxin genes (toxA, phzM, lasB, ExoU, and ExoS) and one internal control gene ecfX in P. aeruginosa. Owing to the application of universal primer (UP), different targeted products have identical amplified efficiency and the sensitivity of multiplex PCR is improved. In addition, the complexity of multiplex PCR system is reduced and the compatibility of primers in a reaction is greatly increased. This UP-MPCR method can detect the presence of five P. aeruginosa enterotoxin genes in a single assay more rapidly and sensitively than conventional methods. In 214 drinking water and environmental isolates, the ExoU, ExoS, phzM, toxA, and lasB genes were detected in 20 (9 %), 180 (84 %), 179 (84 %), 196 (92 %), and 171 (80 %) isolates, respectively.
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Ralstonia pickettii sepsis in a hemodialysis patient from Bulgaria. Braz J Infect Dis 2012; 16:400-1. [DOI: 10.1016/j.bjid.2012.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 11/27/2011] [Indexed: 11/20/2022] Open
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Strateva T, Markova B, Marteva-Proevska Y, Ivanova D, Mitov I. Widespread dissemination of multidrug-resistant Acinetobacter baumannii producing OXA-23 carbapenemase and ArmA 16S ribosomal RNA methylase in a Bulgarian university hospital. Braz J Infect Dis 2012. [DOI: 10.1016/s1413-8670(12)70333-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Contribution of an arsenal of virulence factors to pathogenesis of Pseudomonas aeruginosa infections. ANN MICROBIOL 2011. [DOI: 10.1007/s13213-011-0273-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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