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Kasanga M, Shempela DM, Daka V, Mwikisa MJ, Sikalima J, Chanda D, Mudenda S. Antimicrobial resistance profiles of Escherichia coli isolated from clinical and environmental samples: findings and implications. JAC Antimicrob Resist 2024; 6:dlae061. [PMID: 38680604 PMCID: PMC11055401 DOI: 10.1093/jacamr/dlae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/17/2024] [Indexed: 05/01/2024] Open
Abstract
Background The overuse and misuse of antimicrobials has worsened the problem of antimicrobial resistance (AMR) globally. This study investigated the AMR profiles of Escherichia coli isolated from clinical and environmental samples in Lusaka, Zambia. Methods This was a cross-sectional study conducted from February 2023 to June 2023 using 450 samples. VITEK® 2 Compact was used to identify E. coli and perform antimicrobial susceptibility testing. Data analysis was done using WHONET 2022 and SPSS version 25.0. Results Of the 450 samples, 66.7% (n = 300) were clinical samples, whereas 33.3% (n = 150) were environmental samples. Overall, 47.8% (n = 215) (37.8% clinical and 10% environmental) tested positive for E. coli. Of the 215 E. coli isolates, 66.5% were MDR and 42.8% were ESBL-producers. Most isolates were resistant to ampicillin (81.4%), sulfamethoxazole/trimethoprim (70.7%), ciprofloxacin (67.9%), levofloxacin (64.6%), ceftriaxone (62.3%) and cefuroxime (62%). Intriguingly, E. coli isolates were highly susceptible to amikacin (100%), imipenem (99.5%), nitrofurantoin (89.3%), ceftolozane/tazobactam (82%) and gentamicin (72.1%). Conclusions This study found a high resistance of E. coli to some antibiotics that are commonly used in humans. The isolation of MDR and ESBL-producing E. coli is a public health concern and requires urgent action. Therefore, there is a need to instigate and strengthen interventional strategies including antimicrobial stewardship programmes to combat AMR in Zambia.
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Affiliation(s)
- Maisa Kasanga
- Department of Epidemiology and Biostatistics, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Doreen Mainza Shempela
- Laboratory Department, Churches Health Association of Zambia, CHAZ COMPLEX Meanwood Drive (off Great East Road), Plot No. 2882/B/5/10, P.O. Box 34511, JC9H+VFF, Lusaka, Zambia
| | - Victor Daka
- Public Health Department, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia
| | - Mark J Mwikisa
- Department of Pathology and Microbiology, Lusaka Trust Hospital, Plot 2191, H8CC+52F, Nsumbu Rd, Woodlands, Lusaka, Zambia
| | - Jay Sikalima
- Laboratory Department, Churches Health Association of Zambia, CHAZ COMPLEX Meanwood Drive (off Great East Road), Plot No. 2882/B/5/10, P.O. Box 34511, JC9H+VFF, Lusaka, Zambia
| | - Duncan Chanda
- Adult Centre of Excellence, University Teaching Hospital, Lusaka, Zambia
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
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Oliveira A, Dias C, Oliveira R, Almeida C, Fuciños P, Sillankorva S, Oliveira H. Paving the way forward: Escherichia coli bacteriophages in a One Health approach. Crit Rev Microbiol 2024; 50:87-104. [PMID: 36608263 DOI: 10.1080/1040841x.2022.2161869] [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: 06/17/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023]
Abstract
Escherichia coli is one of the most notorious pathogens for its ability to adapt, colonize, and proliferate in different habitats through a multitude of acquired virulence factors. Its presence affects the food-processing industry and causes food poisoning, being also a major economic burden for the food, agriculture, and health sectors. Bacteriophages are emerging as an appealing strategy to mitigate bacterial pathogens, including specific E. coli pathovars, without exerting a deleterious effect on humans and animals. This review globally analyzes the applied research on E. coli phages for veterinary, food, and human use. It starts by describing the pathogenic E. coli pathotypes and their relevance in human and animal context. The idea that phages can be used as a One Health approach to control and interrupt the transmission routes of pathogenic E. coli is sustained through an exhaustive revision of the recent literature. The emerging phage formulations, genetic engineering and encapsulation technologies are also discussed as a means of improving phage-based control strategies, with a particular focus on E. coli pathogens.
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Affiliation(s)
- Ana Oliveira
- CEB - Centre of Biological Engineering, University of Minho, Braga, Portugal
- LABBELS - Associate Laboratory, Braga, Guimarães, Portugal
| | - Carla Dias
- CEB - Centre of Biological Engineering, University of Minho, Braga, Portugal
- LABBELS - Associate Laboratory, Braga, Guimarães, Portugal
| | - Ricardo Oliveira
- INIAV, IP-National Institute for Agrarian and Veterinary Research, Vairão, Vila do Conde, Portugal
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, Porto, Portugal
- ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, Porto, Portugal
| | - Carina Almeida
- INIAV, IP-National Institute for Agrarian and Veterinary Research, Vairão, Vila do Conde, Portugal
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, Porto, Portugal
- ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, Porto, Portugal
| | - Pablo Fuciños
- ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, Porto, Portugal
| | - Sanna Sillankorva
- INL - International Iberian Nanotechnology Laboratory, Avenida Mestre José Veiga, Braga, Portugal
| | - Hugo Oliveira
- CEB - Centre of Biological Engineering, University of Minho, Braga, Portugal
- LABBELS - Associate Laboratory, Braga, Guimarães, Portugal
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Zhou Q, Natarajan B, Kannan P. Nanostructured biosensing platforms for the detection of food- and water-borne pathogenic Escherichia coli. Anal Bioanal Chem 2023:10.1007/s00216-023-04731-6. [PMID: 37169938 DOI: 10.1007/s00216-023-04731-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
Pathogenic bacterial infection is one of the principal causes affecting human health and ecosystems. The accurate identification of bacteria in food and water samples is of significant interests to maintain safety and health for humans. Culture-based tests are practically tedious and may produce false-positive results, while viable but non-culturable microorganisms (NCMs) cannot be retrieved. Thus, it requires fast, reliable, and low-cost detection strategies for on-field analysis and point-of-care (POC) monitoring. The standard detection methods such as nucleic acid analysis (RT-PCR) and enzyme-linked immunosorbent assays (ELISA) are still challenging in POC practice due to their time-consuming (several hours to days) and expensive laboratory operations. The optical (surface plasmon resonance (SPR), fluorescence, and surface-enhanced Raman scattering (SERS)) and electrochemical-based detection of microbes (early stage of infective diseases) have been considered as alternative routes in the emerging world of nanostructured biosensing since they can attain a faster and concurrent screening of several pathogens in real samples. Moreover, optical and electrochemical detection strategies are opening a new route for the ability of detecting pathogens through the integration of cellphones, which is well fitted for POC analysis. This review article covers the current state of sensitive mechanistic approaches for the screening and detection of Escherichia coli O157:H7 (E. coli) pathogens in food and water samples, which can be potentially applied in clinical and environmental monitoring.
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Affiliation(s)
- Qiang Zhou
- College of Biological, Chemical Sciences and Engineering, Jiaxing University, Jiaxing, Zhejiang Province, 314001, People's Republic of China
| | - Bharathi Natarajan
- College of Medicine, Jiaxing University, Jiaxing, Zhejiang Province, 314001, People's Republic of China.
| | - Palanisamy Kannan
- Department of Endocrinology, First Hospital of Jiaxing (Affiliated Hospital of Jiaxing University), 1882 Zhonghuan South Road, Jiaxing, Zhejiang Province, 314001, People's Republic of China.
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4
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Guangzhang C, Fangfang F, Siqian D, Xinyi X, Xiaochuan B, Yihan R, Li W. Outer membrane vesicles from Escherichia coli are efficiently internalized by macrophage cells and alter their inflammatory response. Microb Pathog 2023; 175:105965. [PMID: 36592640 DOI: 10.1016/j.micpath.2022.105965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/26/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022]
Abstract
The release of extracellular vesicles (EV) by pathogenic microbes is considered an alternative cell-to-cell transport of macromolecules transport mechanism. In Gram-negative bacteria, EVs may be formed by outer membrane budding, so-called outer membrane vesicles (OMVs). Previous studies have revealed E. coli constitutively release nano-sized OMVs, which can be potent activators of cellular functions without live bacteria. But the immunomodulatory activity of E. coli OMVs is still relatively poorly understood. Here we investigated the morphological characterization and composition of E.Coli OMVs, kinetics of internalization by Raw 264.7 macrophage cells, and their immunomodulatory activity on cells. By transmission electron microscopy and dynamic light scattering, E.Coli OMVs were identified as typical cup-shaped, bilayered membranous structures, mainly distributed between 72.5 and 212.5 nm. We also demonstrated by confocal fluorescence microscopy that exposure of Raw 264.7 cells to E.Coli OMVs resulted in internalization of these nanoparticles and decreased mitochondrial membrane potential. In addition, E. Coli OMVs treatment induced the production of ROS, iNOS, IL-1β, IL-6, IL-10 and up-regulation of CD86 and CD206. Taken together, our results indicated that E.Coli OMVs are immunobiologically active, can directly interact with macrophage and participate in immune responses.
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Affiliation(s)
- Chen Guangzhang
- School of Basic Medicine, Bengbu Medical College, Bengbu, 233030, China
| | - Fan Fangfang
- School of Basic Medicine, Bengbu Medical College, Bengbu, 233030, China
| | - Deng Siqian
- School of Basic Medicine, Bengbu Medical College, Bengbu, 233030, China
| | - Xia Xinyi
- School of Clinical Medicine, Bengbu Medical College, Bengbu, 233030, China
| | - Bian Xiaochuan
- School of Clinical Medicine, Bengbu Medical College, Bengbu, 233030, China
| | - Ren Yihan
- School of Clinical Medicine, Bengbu Medical College, Bengbu, 233030, China
| | - Wei Li
- School of Basic Medicine, Bengbu Medical College, Bengbu, 233030, China; Anhui Key Laboratory of Infection and Immunity at Bengbu Medical College, Bengbu, 233030, China.
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Zamora-Mendoza L, Guamba E, Miño K, Romero MP, Levoyer A, Alvarez-Barreto JF, Machado A, Alexis F. Antimicrobial Properties of Plant Fibers. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27227999. [PMID: 36432099 PMCID: PMC9699224 DOI: 10.3390/molecules27227999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 11/19/2022]
Abstract
Healthcare-associated infections (HAI), or nosocomial infections, are a global health and economic problem in developed and developing countries, particularly for immunocompromised patients in their intensive care units (ICUs) and surgical site hospital areas. Recurrent pathogens in HAIs prevail over antibiotic-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. For this reason, natural antibacterial mechanisms are a viable alternative for HAI treatment. Natural fibers can inhibit bacterial growth, which can be considered a great advantage in these applications. Moreover, these fibers have been reported to be biocompatible and biodegradable, essential features for biomedical materials to avoid complications due to infections and significant immune responses. Consequently, tissue engineering, medical textiles, orthopedics, and dental implants, as well as cosmetics, are fields currently expanding the use of plant fibers. In this review, we will discuss the source of natural fibers with antimicrobial properties, antimicrobial mechanisms, and their biomedical applications.
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Affiliation(s)
- Lizbeth Zamora-Mendoza
- School of Biological Sciences & Engineering, Yachay Tech University, Urcuquí 100119, Ecuador
| | - Esteban Guamba
- School of Biological Sciences & Engineering, Yachay Tech University, Urcuquí 100119, Ecuador
| | - Karla Miño
- School of Biological Sciences & Engineering, Yachay Tech University, Urcuquí 100119, Ecuador
| | - Maria Paula Romero
- School of Biological Sciences & Engineering, Yachay Tech University, Urcuquí 100119, Ecuador
| | - Anghy Levoyer
- Colegio de Ciencias e Ingenierías, Universidad San Francisco de Quito (USFQ), Departamento de Ingeniería Química, Quito 170901, Ecuador
| | - José F. Alvarez-Barreto
- Colegio de Ciencias e Ingenierías, Universidad San Francisco de Quito (USFQ), Departamento de Ingeniería Química, Quito 170901, Ecuador
| | - António Machado
- Colegio de Ciencias Biológicas y Ambientales COCIBA, Instituto de Microbiología, Universidad San Francisco de Quito (USFQ), Laboratorio de Bacteriología, Quito 170901, Ecuador
| | - Frank Alexis
- Colegio de Ciencias e Ingenierías, Universidad San Francisco de Quito (USFQ), Departamento de Ingeniería Química, Quito 170901, Ecuador
- Correspondence:
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Photocatalytic Disinfection of E. coli Using Silver-Doped TiO2 Coated on Cylindrical Cordierite Honeycomb Monolith Photoreactor Under Artificial Sunlight Irradiation. Top Catal 2022. [DOI: 10.1007/s11244-022-01700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Adegoke AA, Ikott WE, Okoh AI. Carbapenem Resistance Associated with Coliuria among Outpatient and Hospitalized Urology Patients. New Microbes New Infect 2022; 48:101019. [PMID: 36176538 PMCID: PMC9513764 DOI: 10.1016/j.nmni.2022.101019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 11/27/2022] Open
Abstract
The World Health Organization in 2017 listed carbapenem resistant Enterobacteriaceae (CRE) with critical priority for research. A research to assess carbapenem resistant Escherichia coli (CREc) in coliuria among the outpatients and inpatients of a tertiary health institution was carried out using conventional methods, polymerase chain reaction, Sanger sequencing, and bioinformatics. There were 39 positive coliuria cases from the urine samples collected from a total of 126 patients with various genitourinary diseases. The E. coli enumeration (log10 CFU/mL) revealed that 82.1% (n = 32) of the samples showed significant coliuria, 12.8% (n = 5) showed non-significant coliuria while 5.1% (n = 2) showed indeterminate coliuria even when repeated. Significantly higher numbers (p > 0.05) of the sampled inpatients yielded positive coliuria (57.9%) than the outpatients. Though there were significantly more (P > 0.05) urology female patients (n = 77) than male (n = 49), coliuria was more prevalent in sampled male patients (34.9%) than female (28.6%). Highest prevalence of coliuria was observed among the age range (18–30) years. Selected CREc that was sequenced and the sequences submitted to GenBank of National Center for Biotechnological Information (NCBI) were Escherichia coli AYO-WINI111 and Escherichia coli AYO-WINI112 with accession number MT735391 and MT735392, respectively. High resistance was observed against ertapenem (53%), imipenem (62%), meropenem (48%), and doripenem (47%), while 7%–22% of the isolates showed phenotypic intermediate carbapenem resistance. Critically dangerous CREc are harboured by large number urology patients in the study area, depicting the need for more attention in the management of the condition, as CREc are close to achieving totally antibiotic resistance.
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8
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Seely KD, Morgan AD, Hagenstein LD, Florey GM, Small JM. Bacterial Involvement in Progression and Metastasis of Colorectal Neoplasia. Cancers (Basel) 2022; 14:1019. [PMID: 35205767 PMCID: PMC8870662 DOI: 10.3390/cancers14041019] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 02/06/2023] Open
Abstract
While the gut microbiome is composed of numerous bacteria, specific bacteria within the gut may play a significant role in carcinogenesis, progression, and metastasis of colorectal carcinoma (CRC). Certain microbial species are known to be associated with specific cancers; however, the interrelationship between bacteria and metastasis is still enigmatic. Mounting evidence suggests that bacteria participate in cancer organotropism during solid tumor metastasis. A critical review of the literature was conducted to better characterize what is known about bacteria populating a distant site and whether a tumor depends upon the same microenvironment during or after metastasis. The processes of carcinogenesis, tumor growth and metastatic spread in the setting of bacterial infection were examined in detail. The literature was scrutinized to discover the role of the lymphatic and venous systems in tumor metastasis and how microbes affect these processes. Some bacteria have a potent ability to enhance epithelial-mesenchymal transition, a critical step in the metastatic cascade. Bacteria also can modify the microenvironment and the local immune profile at a metastatic site. Early targeted antibiotic therapy should be further investigated as a measure to prevent metastatic spread in the setting of bacterial infection.
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Affiliation(s)
- Kevin D. Seely
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA; (A.D.M.); (L.D.H.)
| | - Amanda D. Morgan
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA; (A.D.M.); (L.D.H.)
| | - Lauren D. Hagenstein
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA; (A.D.M.); (L.D.H.)
| | - Garrett M. Florey
- College of Osteopathic Medicine, Rocky Vista University, Parker, CO 80134, USA;
| | - James M. Small
- Department of Biomedical Sciences, Rocky Vista University, Parker, CO 80134, USA;
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Gatya Al-Mayahie SM, Al-Guranie DRT, Hussein AA, Bachai ZA. Prevalence of common carbapenemase genes and multidrug resistance among uropathogenic Escherichia coli phylogroup B2 isolates from outpatients in Wasit Province/ Iraq. PLoS One 2022; 17:e0262984. [PMID: 35077517 PMCID: PMC8789106 DOI: 10.1371/journal.pone.0262984] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/10/2022] [Indexed: 01/04/2023] Open
Abstract
Carbapenems are the last resort antimicrobials for the treatment of extended spectrum β-lactamases (ESBLs) producing Enterobacteriaceae. Emergence of carbapenems resistant group B2 uropathogenic E. coli (UPEC) is a major concern because of their high virulence. Prevalence of these enzymes and multidrug resistance (MDR) among B2 UPEC isolates from Iraqi outpatients with acute urinary tract infection (UTI) was evaluated in this research. Urine cultures were performed and the isolates were identified biochemically. Escherichia coli isolates were tested for phylogroup reference by quadraplex PCR, then B2 isolates were detected for antimicrobial resistance by disc diffusion test and carbapenemase genes by PCR. Escherichia coli was the most prevalent among Gram-negative isolates (66.6%) and B2 was the most detected phylogroup among E. coli isolates (33.9%). Most of B2 isolates showed high resistance rates to tested antimicrobials, especially β-lactams with MDR revealed in 100% of them. Whereas, low resistance rates were noted against carbapenems, aminoglycosides and nitrofurantoin. Carbapenemase genes were detected in 76.3% of B2 isolates. Of which, blaOXA-48 was the most frequent (57.8%), followed by blaPER (47.3%), blaKPC (15.7%), blaVEB and blaVIM (10.5%, for each). Whereas, blaGES and blaIMP genes were not found. Coproduction of these genes occurred among 17 isolates. The combination of blaOXA-48 and blaPER was the most frequent (41.1%). All carbapenemase producing isolates were MDR. These results revealed high prevalence of carbapenemase genes and MDR among B2 UPEC recovered in this study. In the study area. it is strongly advised to use aminoglycosides and nitrofurantoin for empirical treatment of UPEC.
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Affiliation(s)
| | | | - Aya Aziz Hussein
- Department of Biology, College of Science, Wasit University, Al-Kut City, Wasit Province, Iraq
| | - Zaineb Ali Bachai
- Department of Biology, College of Science, Wasit University, Al-Kut City, Wasit Province, Iraq
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Pakbin B, Brück WM, Rossen JWA. Virulence Factors of Enteric Pathogenic Escherichia coli: A Review. Int J Mol Sci 2021; 22:9922. [PMID: 34576083 PMCID: PMC8468683 DOI: 10.3390/ijms22189922] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 12/18/2022] Open
Abstract
Escherichia coli are remarkably versatile microorganisms and important members of the normal intestinal microbiota of humans and animals. This harmless commensal organism can acquire a mixture of comprehensive mobile genetic elements that contain genes encoding virulence factors, becoming an emerging human pathogen capable of causing a broad spectrum of intestinal and extraintestinal diseases. Nine definite enteric E. coli pathotypes have been well characterized, causing diseases ranging from various gastrointestinal disorders to urinary tract infections. These pathotypes employ many virulence factors and effectors subverting the functions of host cells to mediate their virulence and pathogenesis. This review summarizes new developments in our understanding of diverse virulence factors associated with encoding genes used by different pathotypes of enteric pathogenic E. coli to cause intestinal and extraintestinal diseases in humans.
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Affiliation(s)
- Babak Pakbin
- Institute for Life Technologies, University of Applied Sciences Western Switzerland Valais-Wallis, 1950 Sion 2, Switzerland;
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin 15315-3419, Iran
| | - Wolfram M. Brück
- Institute for Life Technologies, University of Applied Sciences Western Switzerland Valais-Wallis, 1950 Sion 2, Switzerland;
| | - John W. A. Rossen
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
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