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Shin CJ, O'Connor TJ. Novel induction of broad-spectrum antibiotics by the human pathogen Legionella. mSphere 2024; 9:e0012024. [PMID: 38888300 PMCID: PMC11288058 DOI: 10.1128/msphere.00120-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/14/2024] [Indexed: 06/20/2024] Open
Abstract
The majority of antibiotics are natural products, with microorganism-generated molecules and their derivatives being the most prevalent source of drugs to treat infections. Thus, identifying natural products remains the most valuable resource for novel therapeutics. Here, we report the discovery of a series of dormant bacteria in honey that have bactericidal activity toward Legionella, a bacterial pathogen that causes respiratory disease in humans. We show that, in response to bacterial products secreted by Legionella, the honey bacteria release diffusible antimicrobial molecules. Remarkably, the honey bacteria only produce these molecules in response to Legionella spp., when compared to a panel of 24 bacterial pathogens from different genera. However, the molecules induced by Legionella have broad activity against several clinically important pathogens, including many high-priority pathogens. Thus, Legionella spp. are potent drivers of antimicrobial molecule production by uncharacterized bacteria isolated from honey, providing access to new antimicrobial products and an unprecedented strategy for discovering novel antibiotics. IMPORTANCE Natural products generated by microorganisms remain the most viable and abundant source of new antibiotics. However, their discovery depends on the ability to isolate and culture the producing organisms and to identify conditions that promote antibiotic production. Here, we identify a series of previously undescribed bacteria isolated from raw honey and specific culture conditions that induce the production of antimicrobial molecules that are active against a wide variety of pathogenic bacteria.
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Affiliation(s)
- Carson J. Shin
- Department of Biological Chemistry, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tamara J. O'Connor
- Department of Biological Chemistry, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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McGinnis S, Free RJ, Burnell J, Basavaraju SV, Kanaskie T, Hannapel EJ, Plipat N, Warren K, Edens C. Suspected Legionella Transmission from a Single Donor to Two Lung Transplant Recipients - Pennsylvania, May 2022. Am J Transplant 2023; 23:1811-1814. [PMID: 37914432 DOI: 10.1016/j.ajt.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
In July 2022, the Pennsylvania Department of Health received two reports of laboratory-confirmed Legionnaires disease in patients who had recently received lung transplants from the same donor at a single Pennsylvania hospital. The donor's cause of death was freshwater drowning in a river, raising suspicion of potential donor-derived transmission, because Legionella bacteria naturally live in fresh water. Further investigation of patients receiving other organs from the same donor did not identify additional legionellosis cases. Health care-associated infection caused by water exposure at the hospital was also evaluated as a potential source of infection and was found to be unlikely. Hospital water quality parameter measurements collected during May-June 2022 were within expected ranges and no water disruptions were noted, although no testing for Legionella was performed during this period. Notifiable disease data did not identify any other Legionnaires disease cases with exposure to this hospital within the 6 months before or after the two cases. Although laboratory testing did not confirm the source of recipient infections, available data suggest that the most likely source was the donor lungs. This cluster highlights the need for increased clinical awareness of possible infection with Legionella in recipients of lungs from donors who drowned in fresh water before organ recovery.
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Affiliation(s)
| | - Rebecca J Free
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jacqueline Burnell
- Division of Infectious Diseases, Temple University Hospital, Philadelphia, Pennsylvania
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Trevor Kanaskie
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Elizabeth J Hannapel
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | | | | | - Chris Edens
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
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Komatsu S, Tanaka S, Nakanishi N. Prevalence and genetic distribution of Legionella spp. in public bath facilities in Kobe City, Japan. JOURNAL OF WATER AND HEALTH 2023; 21:1727-1734. [PMID: 38017602 PMCID: wh_2023_247 DOI: 10.2166/wh.2023.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Legionella is an important waterborne pathogen that causes legionellosis. Public baths are considered the primary cause of legionellosis infection in Japan. We investigated the prevalence and genetic distribution of 338 Legionella spp. isolates from 81 public bath facilities, including 35 hot springs and 46 other facilities, through annual periodic surveillance in Kobe, Japan, from 2016 to 2021. In addition, the genotypes of nine clinical strains of unknown infectious source from the same period were compared to those of bathwater isolates. We elucidated the differences in the distribution of Legionella species, serogroups, and genotypes between hot springs and other public baths. Legionella israelensis, L. londiniensis, and L. micdadei colonized hot springs along with L. pneumophila. The minimum spanning tree analysis based on multiple-locus variable number tandem repeat analysis (MLVA) also identified four major clonal complexes (CCs) in L. pneumophila SG1 and found that CC1 of the four CCs is a specific novel genotype with the lag-1 gene in hot springs. The same MLVA genotypes and sequence types as those of the clinical strains were not present among the strains isolated from bath water. Thus, our surveillance is useful for estimating the sources of legionellosis infection in Japan and developing prevention strategies.
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Affiliation(s)
- Shoko Komatsu
- Department of Infectious Diseases, Kobe Institute of Health, Kobe, Japan E-mail:
| | - Shinobu Tanaka
- Department of Infectious Diseases, Kobe Institute of Health, Kobe, Japan
| | - Noriko Nakanishi
- Department of Infectious Diseases, Kobe Institute of Health, Kobe, Japan
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McGinnis S, Free RJ, Burnell J, Basavaraju SV, Kanaskie T, Hannapel EJ, Plipat N, Warren K, Edens C. Suspected Legionella Transmission from a Single Donor to Two Lung Transplant Recipients - Pennsylvania, May 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:1001-1004. [PMID: 37708069 PMCID: PMC10511268 DOI: 10.15585/mmwr.mm7237a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
In July 2022, the Pennsylvania Department of Health received two reports of laboratory-confirmed Legionnaires disease in patients who had recently received lung transplants from the same donor at a single Pennsylvania hospital. The donor's cause of death was freshwater drowning in a river, raising suspicion of potential donor-derived transmission, because Legionella bacteria naturally live in fresh water. Further investigation of patients receiving other organs from the same donor did not identify additional legionellosis cases. Health care-associated infection caused by water exposure at the hospital was also evaluated as a potential source of infection and was found to be unlikely. Hospital water quality parameter measurements collected during May-June 2022 were within expected ranges and no water disruptions were noted, although no testing for Legionella was performed during this period. Notifiable disease data did not identify any other Legionnaires disease cases with exposure to this hospital within the 6 months before or after the two cases. Although laboratory testing did not confirm the source of recipient infections, available data suggest that the most likely source was the donor lungs. This cluster highlights the need for increased clinical awareness of possible infection with Legionella in recipients of lungs from donors who drowned in fresh water before organ recovery.
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Du R, Feng Y, Wang Y, Huang J, Tao Y, Mao H. Metagenomic next-generation sequencing confirms the diagnosis of Legionella pneumonia with rhabdomyolysis and acute kidney injury in a limited resource area: a case report and review. Front Public Health 2023; 11:1145733. [PMID: 37228720 PMCID: PMC10205016 DOI: 10.3389/fpubh.2023.1145733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/11/2023] [Indexed: 05/27/2023] Open
Abstract
Background Legionella pneumonia, rhabdomyolysis, and acute kidney injury are called the Legionella triad, which is rare and associated with a poor outcome and even death. Early diagnosis and timely treatment are essential for these patients. Case presentation A 63-year-old man with cough, fever, and fatigue was initially misdiagnosed with common bacterial infection and given beta-lactam monotherapy but failed to respond to it. Conventional methods, including the first Legionella antibody test, sputum smear, and culture of sputum, blood, and bronchoalveolar lavage fluid (BALF) were negative. He was ultimately diagnosed with a severe infection of Legionella pneumophila by metagenomics next-generation sequencing (mNGS). This patient, who had multisystem involvement and manifested with the rare triad of Legionella pneumonia, rhabdomyolysis, and acute kidney injury, finally improved after combined treatment with moxifloxacin, continuous renal replacement therapy, and liver protection therapy. Conclusion Our results showed the necessity of early diagnosis of pathogens in severe patients, especially in Legionnaires' disease, who manifested with the triad of Legionella pneumonia, rhabdomyolysis, and acute kidney injury. mNGS may be a useful tool for Legionnaires' disease in limited resource areas where urine antigen tests are not available.
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Affiliation(s)
- Rao Du
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yinhe Feng
- Department of Respiratory and Critical Care Medicine, Deyang People's Hospital, Affiliated Hospital of Chengdu College of Medicine, Deyang, China
| | - Yubin Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jifeng Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yuhan Tao
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Mao
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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Cruz C, Rodrigues L, Fernandes F, Santos R, Paixão P, Chasqueira MJ. Antibiotic susceptibility pattern of Portuguese environmental Legionella isolates. Front Cell Infect Microbiol 2023; 13:1141115. [PMID: 37153155 PMCID: PMC10160366 DOI: 10.3389/fcimb.2023.1141115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/24/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Legionnaires' Disease is a pneumonia caused by Legionella spp., currently treated empirically with fluoroquinolones and macrolides. In this study, we aim to describe the antibiotic susceptibility pattern of environmental Legionella recovered in the south of Portugal. Methods Minimal inhibitory concentration (MIC) determination of 57 Legionella isolates (10 Lp sg 1, 32, Lp sg 2-14 15 L. spp) was achieved by broth microdilution, as described by EUCAST, for azithromycin, clarithromycin, ciprofloxacin, levofloxacin, and doxycycline. Results Fluoroquinolones were the most active antibiotic, displaying the lowest MIC values in contrast to doxycycline which had the highest. MIC90 and epidemiological cut-off (ECOFF) values were, respectively, 0.5/1 mg/L for azithromycin, 0.125/0.25 mg/L for clarithromycin, 0.064/0.125 mg/L for ciprofloxacin, 0.125/0.125 mg/L for levofloxacin and 16/32 mg/L for doxycycline. Discussion MIC distributions were higher than reported by EUCAST for all antibiotics. Interestingly, two phenotypically resistant isolates with high-level quinolone resistance were identified. This is the first time that MIC distributions, lpeAB and tet56 genes have been investigated in Portuguese environmental isolates of Legionella.
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Affiliation(s)
- Carolina Cruz
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Lúcia Rodrigues
- Comprehensive Health Research Center, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Filipa Fernandes
- Laboratório de Análises de Água, Técnico Lisboa, Universidade de Lisboa, Lisboa, Portugal
| | - Ricardo Santos
- Laboratório de Análises de Água, Técnico Lisboa, Universidade de Lisboa, Lisboa, Portugal
| | - Paulo Paixão
- Comprehensive Health Research Center, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Maria Jesus Chasqueira
- Comprehensive Health Research Center, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal
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De Giglio O, D’Ambrosio M, Spagnuolo V, Diella G, Fasano F, Leone CM, Lopuzzo M, Trallo V, Calia C, Oliva M, Pazzani C, Iacumin L, Barigelli S, Petricciuolo M, Federici E, Lisena FP, Minicucci AM, Montagna MT. Legionella anisa or Legionella bozemanii? Traditional and molecular techniques as support in the environmental surveillance of a hospital water network. ENVIRONMENTAL MONITORING AND ASSESSMENT 2023; 195:496. [PMID: 36947259 PMCID: PMC10033568 DOI: 10.1007/s10661-023-11078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
Understanding the actual distribution of different Legionella species in water networks would help prevent outbreaks. Culture investigations followed by serological agglutination tests, with poly/monovalent antisera, still represent the gold standard for isolation and identification of Legionella strains. However, also MALDI-TOF and mip-gene sequencing are currently used. This study was conducted to genetically correlate strains of Legionella non pneumophila (L-np) isolated during environmental surveillance comparing different molecular techniques. Overall, 346 water samples were collected from the water system of four pavilions located in a hospital of the Apulia Region of Italy. Strains isolated from the samples were then identified by serological tests, MALDI-TOF, and mip-gene sequencing. Overall, 24.9% of water samples were positive for Legionella, among which the majority were Legionella pneumophila (Lpn) 1 (52.3%), followed by Lpn2-15 (20.9%), L-np (17.4%), Lpn1 + Lpn2-15 (7.1%), and L-np + Lpn1 (2.3%). Initially, L-np strains were identified as L. bozemanii by monovalent antiserum, while MALDI-TOF and mip-gene sequencing assigned them to L. anisa. More cold water than hot water samples were contaminated by L. anisa (p < 0.001). PFGE, RAPD, Rep-PCR, and SAU-PCR were performed to correlate L. anisa strains. Eleven out of 14 strains identified in all four pavilions showed 100% of similarity upon PFGE analysis. RAPD, Rep-PCR, and SAU-PCR showed greater discriminative power than PFGE.
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Affiliation(s)
- Osvalda De Giglio
- Interdisciplinary Department of Medicine, Section of Hygiene, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Marilena D’Ambrosio
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, Medical School, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Valentina Spagnuolo
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, Medical School, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giusy Diella
- Interdisciplinary Department of Medicine, Section of Hygiene, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Fabrizio Fasano
- Interdisciplinary Department of Medicine, Section of Hygiene, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Carla Maria Leone
- Present Address: Section Hygiene - AOU Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Marco Lopuzzo
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, Medical School, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Valeria Trallo
- Present Address: Section Hygiene - AOU Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Carla Calia
- Department of Biology, University of Bari Aldo Moro, Via Orabona 4, 70126 Bari, Italy
| | - Marta Oliva
- Department of Biology, University of Bari Aldo Moro, Via Orabona 4, 70126 Bari, Italy
| | - Carlo Pazzani
- Department of Biology, University of Bari Aldo Moro, Via Orabona 4, 70126 Bari, Italy
| | - Lucilla Iacumin
- Department of Agricultural, Food, Environmental and Animal Science, University of Udine, Via Sondrio 2/a, 33100 Udine, Italy
| | - Sofia Barigelli
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Via del Giochetto, 06122 Perugia, Italy
| | - Maya Petricciuolo
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Via del Giochetto, 06122 Perugia, Italy
| | - Ermanno Federici
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Via del Giochetto, 06122 Perugia, Italy
| | | | - Anna Maria Minicucci
- Health Management, A.O.U. Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Maria Teresa Montagna
- Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Interdisciplinary Department of Medicine, Section of Hygiene, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
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Yang JL, Li D, Zhan XY. Concept about the Virulence Factor of Legionella. Microorganisms 2022; 11:microorganisms11010074. [PMID: 36677366 PMCID: PMC9867486 DOI: 10.3390/microorganisms11010074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Pathogenic species of Legionella can infect human alveolar macrophages through Legionella-containing aerosols to cause a disease called Legionellosis, which has two forms: a flu-like Pontiac fever and severe pneumonia named Legionnaires' disease (LD). Legionella is an opportunistic pathogen that frequently presents in aquatic environments as a biofilm or protozoa parasite. Long-term interaction and extensive co-evolution with various genera of amoebae render Legionellae pathogenic to infect humans and also generate virulence differentiation and heterogeneity. Conventionally, the proteins involved in initiating replication processes and human macrophage infections have been regarded as virulence factors and linked to pathogenicity. However, because some of the virulence factors are associated with the infection of protozoa and macrophages, it would be more accurate to classify them as survival factors rather than virulence factors. Given that the molecular basis of virulence variations among non-pathogenic, pathogenic, and highly pathogenic Legionella has not yet been elaborated from the perspective of virulence factors, a comprehensive explanation of how Legionella infects its natural hosts, protozoans, and accidental hosts, humans is essential to show a novel concept regarding the virulence factor of Legionella. In this review, we overviewed the pathogenic development of Legionella from protozoa, the function of conventional virulence factors in the infections of protozoa and macrophages, the host's innate immune system, and factors involved in regulating the host immune response, before discussing a probably new definition for the virulence factors of Legionella.
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Yang JL, Sun H, Zhou X, Yang M, Zhan XY. Antimicrobial susceptibility profiles and tentative epidemiological cutoff values of Legionella pneumophila from environmental water and soil sources in China. Front Microbiol 2022; 13:924709. [PMID: 36312931 PMCID: PMC9597688 DOI: 10.3389/fmicb.2022.924709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022] Open
Abstract
Legionnaires’ disease (LD), caused by Legionella, including the most prevalent Legionella pneumophila, has been treated primarily with antibiotics. Environmental water and soil are the reservoirs for L. pneumophila. Studying antimicrobial susceptibility using a large number of isolates from various environmental sources and regions could provide an unbiased result. In the present study, antimicrobial susceptibility of 1464 environmental L. pneumophila isolates that were derived from various environmental water and soil sources of 12 cities in China to rifampin (RIF), erythromycin (ERY), clarithromycin (CLA), azithromycin (AZI), ciprofloxacin (CIP), moxifloxacin (MOX), levofloxacin (LEV), and doxycycline (DOX) was investigated, and minimum inhibitory concentration (MIC) data were obtained. We show that regarding macrolides, ERY was least active (MIC90 = 0.5 mg/L), while CLA was most active (MIC90 = 0.063 mg/L). A total of three fluoroquinolones have similar MICs on L. pneumophila. Among these antimicrobials, RIF was the most active agent, while DOX was the most inactive one. We observed different susceptibility profiles between serogroup 1 (sg1) and sg2-15 or between water and soil isolates from different regions. The ECOFFs were ERY and AZI (0.5 mg/L), RIF (0.002 mg/L), CIP, CLA and MOX (0.125 mg/L), LEV (0.063 mg/), and DOX (32 mg/L). Overall, two fluoroquinolone-resistant environmental isolates (0.14%) were first documented based on the wild-type MIC distribution. Not all azithromycin-resistant isolates (44/46, 95.65%) harbored the lpeAB efflux pump. The MICs of the ERY and CLA on the lpeAB + isolates were not elevated. These results suggested that the lpeAB efflux pump might be only responsible for AZI resistance, and undiscovered AZI-specific resistant mechanisms exist in L. pneumophila. Based on the big MIC data obtained in the present study, the same defense strategies, particularly against both CLA and RIF, may exist in L. pneumophila. The results determined in our study will guide further research on antimicrobial resistance mechanisms of L. pneumophila and could be used as a reference for setting clinical breakpoints and discovering antimicrobial-resistant isolates in the clinic, contributing to the antibiotic choice in the treatment of LD.
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