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Manual Reading of Sensititre Broth Microdilution System Panels Improves Accuracy of Susceptibility Reporting for Polymyxin Antibiotics. J Clin Microbiol 2021; 59:e0033221. [PMID: 34165324 DOI: 10.1128/jcm.00332-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Accurate and reproducible antimicrobial susceptibility testing (AST) of polymyxin antibiotics is critical, as these drugs are last-line therapeutic options for the treatment of multidrug-resistant Gram-negative bacterial infections. However, polymyxin AST in the routine laboratory remains challenging. In this study, we evaluated the performance of an automated broth microdilution (BMD) system (Sensititre, ThermoFisher) compared to that of agar dilution (AD) for colistin and polymyxin B AST of 129 Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii complex clinical isolates. MICs derived from the Sensititre instrument based on two operator comparisons demonstrated overall categorical agreement (CA) of 86% and 89% compared to AD for colistin and 89% and 92% compared to AD for polymyxin B. However, error rates were higher than recommended by CLSI. Manual inspection of microdilution wells revealed microbial growth and skip wells which were erroneously interpreted by the Aris 2X instrument. Using manually interpreted BMD MICs read by two operators increased the overall categorical agreements to 88% and 95% compared to AD for colistin and 92% and 96% compared to AD for polymyxin B. Laboratories choosing to use the Sensititre platform for polymyxin AST should consider manual evaluation of wells as part of their algorithm.
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Aydın M, Azak E, Bilgin H, Menekse S, Asan A, Mert HTE, Yulugkural Z, Altunal LN, Hatipoğlu ÇA, Tuncer Ertem G, Altunok ES, Demirkaya MH, Çeviker SA, Akgul F, Memis Z, Konya P, Azap A, Aydin G, Korkmaz D, Karakoç ZÇ, Yapar D, Karakecili F, Gunal O, Keske S, Kapmaz M, Kader C, Demirel A, Ergönül Ö. Changes in antimicrobial resistance and outcomes of health care-associated infections. Eur J Clin Microbiol Infect Dis 2021; 40:1737-1742. [PMID: 33586014 DOI: 10.1007/s10096-020-04140-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/20/2020] [Indexed: 11/26/2022]
Abstract
To describe the change in the epidemiology of health care-associated infections (HAI), resistance and predictors of fatality we conducted a nationwide study in 24 hospitals between 2015 and 2018. The 30-day fatality rate was 22% in 2015 and increased to 25% in 2018. In BSI, a significant increasing trend was observed for Candida and Enterococcus. The highest rate of 30-day fatality was detected among the patients with pneumonia (32%). In pneumonia, Pseudomonas infections increased in 2018. Colistin resistance increased and significantly associated with 30-day fatality in Pseudomonas infections. Among S. aureus methicillin, resistance increased from 31 to 41%.
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Affiliation(s)
- Mehtap Aydın
- Department of Infectious Diseases and Clinical Microbiology, Umraniye Research and Training Hospital University of Health Science, Elmalıkent, Adem Yavuz Cd., 34764, Ümraniye/İstanbul, Turkey.
| | - Emel Azak
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, University of Kocaeli, Kocaeli, Turkey
| | - Hüseyin Bilgin
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Marmara University, Istanbul, Turkey
| | - Sirin Menekse
- Department of Infectious Diseases and Clinical Microbiology, Kartal Koşuyolu Research and Training Hospital, Istanbul, Turkey
| | - Ali Asan
- Department of Infectious Diseases and Clinical Microbiology, University of Health Science, Bursa, Turkey
| | - Habibe Tülin Elmaslar Mert
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trakya University, Edirne, Turkey
| | - Zerrin Yulugkural
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trakya University, Edirne, Turkey
| | - Lutfiye Nilsun Altunal
- Department of Infectious Diseases and Clinical Microbiology, Umraniye Research and Training Hospital University of Health Science, Elmalıkent, Adem Yavuz Cd., 34764, Ümraniye/İstanbul, Turkey
| | - Çiğdem Ataman Hatipoğlu
- Department of Infectious Diseases and Clinical Microbiology, University of Health Science Ankara Research and Training Hospital, Ankara, Turkey
| | - Gunay Tuncer Ertem
- Department of Infectious Diseases and Clinical Microbiology, University of Health Science Ankara Research and Training Hospital, Ankara, Turkey
| | - Elif Sargın Altunok
- Department of Infectious Diseases and Clinical Microbiology, Gaziosmanpaşa Research and Training Hospital, Istanbul, Turkey
| | - Melike Hamiyet Demirkaya
- Department of Infectious Diseases and Clinical Microbiology, Baskent University School of Medicine, Ankara, Turkey
| | - Sevil Alkan Çeviker
- University of Health Science Kütahya Evliya Çelebi Research and Training Hospital, Kütahya, Turkey
| | - Fethiye Akgul
- Department of Infectious Diseases and Clinical Microbiology, Batman State Hospital, Batman, Turkey
| | - Zeynep Memis
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Petek Konya
- Department of Infectious Diseases and Clinical Microbiology, Afyonkarahisar University of Health Science, Afyon, Turkey
| | - Alpay Azap
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara University, Ankara, Turkey
| | - Gule Aydin
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara University, Ankara, Turkey
| | - Derya Korkmaz
- Department of Infectious Diseases and Clinical Microbiology, Afyonkarahisar State Hospital, Afyon, Turkey
| | - Zehra Çagla Karakoç
- Department of Infectious Diseases and Clinical Microbiology, Istinye University, Istanbul, Turkey
| | - Derya Yapar
- Department of Infectious Diseases and Clinical Microbiology School of Medicine, Hitit University, Corum, Turkey
| | - Faruk Karakecili
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Ozgur Gunal
- University of Health Science Samsun Research and Training Hospital, Samsun, Turkey
| | - Siran Keske
- School of Medicine Department of Infectious Diseases and Clinical Microbiology, Koc University, Istanbul, Turkey
| | - Mahir Kapmaz
- School of Medicine Department of Infectious Diseases and Clinical Microbiology, Koc University, Istanbul, Turkey
| | - Cigdem Kader
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bozok University, Yozgat, Turkey
| | - Aslıhan Demirel
- Department of Infectious Diseases and Clinical Microbiology, Florans Nightingale Hospital, Istanbul, Turkey
| | - Önder Ergönül
- School of Medicine Department of Infectious Diseases and Clinical Microbiology, Koc University, Istanbul, Turkey
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Chen X, Xu J, Zhu Q, Ren Y, Zhao L. Polymyxin B resistance rates in carbapenem-resistant Pseudomonas aeruginosa isolates and a comparison between Etest ® and broth microdilution methods of antimicrobial susceptibility testing. Exp Ther Med 2020; 20:762-769. [PMID: 32742322 DOI: 10.3892/etm.2020.8777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/15/2019] [Indexed: 12/11/2022] Open
Abstract
Polymyxin B has been considered to be the last line of defense for life-threatening infections caused by multiple drug resistant gram-negative pathogens, including carbapenem-resistant Pseudomonas aeruginosa (CRPA). The present study analyzed CRPA resistance to polymyxin B in the Suzhou district of China. Additionally, polymyxin B resistance rates were compared in different parts of the world to determine global trends. The present study also assessed the reliability and effectiveness of the Etest® in a clinical setting, as laboratories lack a reliable and efficient susceptibility test for polymyxin B. The susceptibility rate of polymyxin B reached 96.0%, which is in accordance with results obtained from the United States of America, Europe, Africa and the majority of Asian countries. However, the rate of polymyxin B non-susceptibility (resistant or intermediate) in Singapore is 0.53 (95% confidence interval, 0.12-0.93). In addition, the susceptibility rate of polymyxin B determined via Etest® was not significantly increased compared with that determined via broth microdilution (98.0 vs. 96.0%; P=0.558). Essential and categorical agreement rates reached 98.0%. In conclusion, the polymyxin B resistance rate of CRPA isolates is relatively low in the majority of countries, with the exception of Singapore. Furthermore, Etest® may be a reliable clinical method for the measurement of polymyxin B resistance in CRPA isolates.
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Affiliation(s)
- Xu Chen
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
| | - Jie Xu
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
| | - Qiongfang Zhu
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
| | - Yalu Ren
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
| | - Lina Zhao
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
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Uwizeyimana JD, Kim D, Lee H, Byun JH, Yong D. Determination of Colistin Resistance by Simple Disk Diffusion Test Using Modified Mueller-Hinton Agar. Ann Lab Med 2020; 40:306-311. [PMID: 32067429 PMCID: PMC7054692 DOI: 10.3343/alm.2020.40.4.306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/08/2019] [Accepted: 02/07/2020] [Indexed: 11/26/2022] Open
Abstract
Background Colistin has become a last-resort antibiotic for the management of multidrug-resistant gram-negative bacteria. The disk diffusion test is cheap and easy to perform but may be unreliable for colistin susceptibility testing due to poor diffusion of the large colistin molecule. An improved agar diffusion test would increase the reliability of colistin susceptibility testing. This study aimed to modify Muller-Hinton agar (MHA) to improve colistin diffusion in agar. Methods MHA was modified by reducing the agar concentration from 100% to 30% and supplementing with protamine. We tested 60 gram-negative clinical isolates of Pseudomonas aeruginosa (N=27) and Acinetobacter calcoaceticus-baumannii complex (N=33). Disk diffusion test results were interpreted based on minimum inhibitory concentrations determined by broth microdilution. Results The modified MHA yielded the best performance metrics, including 94.7% sensitivity, 100% specificity, and an area under the curve of 0.995 (95% confidence interval, 0.982–1.000), P<0.001, at a cut-off point of 13 mm. Conclusions A reduction of the agar concentration from 100% to 30% and the addition of protamine improved colistin diffusion in agar and allowed routine colistin susceptibility testing in a clinical microbiology laboratory, but should be handled with caution.
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Affiliation(s)
- Jean Damascene Uwizeyimana
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.,Department of Global Health Security, Yonsei University Graduate School of Public Health, Seoul, Korea.,Department of Emergency Care, Ruli Hospital, Gakenye, Rwanda
| | - Daewon Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunsook Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 plus Program for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Byun
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.,Department of Laboratory Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea.
| | - Dongeun Yong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 plus Program for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
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Shedko ED, Timoshina O, Azyzov IS. Molecular epidemiology of mcr gene group. CLINICAL MICROBIOLOGY AND ANTIMICROBIAL CHEMOTHERAPY 2020. [DOI: 10.36488/cmac.2020.4.287-300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Colistin and polymyxin B are the “last reserve” antimicrobials for the treatment of extensively drug-resistant Gram-negative bacterial infections. The rapidly increasing prevalence of polymyxin resistance mediated by the mcr gene localized on plasmid DNA currently poses a high epidemiological threat. In order to control a distribution of mcr genes, it is necessary to develop highly accurate, highly sensitive and easy-to-use diagnostic tools. This paper provides a review of the most relevant studies on the molecular epidemiology as well as current approaches to microbiological and molecular detection of mcr group genes.
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Valencia-Martín R, Gonzalez-Galan V, Alvarez-Marín R, Cazalla-Foncueva AM, Aldabó T, Gil-Navarro MV, Alonso-Araujo I, Martin C, Gordon R, García-Nuñez EJ, Perez R, Peñalva G, Aznar J, Conde M, Cisneros JM. A multimodal intervention program to control a long-term Acinetobacter baumannii endemic in a tertiary care hospital. Antimicrob Resist Infect Control 2019; 8:199. [PMID: 31827780 PMCID: PMC6894224 DOI: 10.1186/s13756-019-0658-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 11/25/2019] [Indexed: 11/29/2022] Open
Abstract
Background Acinetobacter baumannii causes frequently nosocomial infections worldwide. Its ability to survive on dry surfaces facilitates its spread and the persistence of endemic situations, especially in the intensive care units (ICUs). The objective of this paper is to describe a multicomponent intervention program designed to control a hyperendemic persistence of multidrug-resistant A. baumannii (MDR-Ab) and to characterize its impact. Methods Design: Quasi-experimental intervention study based on open cohorts. Setting: Public tertiary referral centre. Period: January 2009–August 2017. Intervention: multifaceted program based on environmental decontamination, hand hygiene, antimicrobial stewardship, contact precautions, active surveillance, weekly reports and regular meetings. Analysis: joinpoint regression and interrupted time-series analysis. Results The intervention was successfully implemented. Through the study period, the compliance with contact precautions changed from 0 to 100% and with hand hygiene, from 41.8 to 82.3%. Between 2012 and 2016, the antibiotic consumption decreased from 165.35 in to 150.44 daily-defined doses/1000 patients-days in the ICU. The incidence density of MDR-Ab in the ICU was 10.9 cases/1000 patients-days at the beginning of the intervention. After this moment, the evolution of the incidence density of MDR-Ab was: between months 0 and 6°, it remained stable; between months 7° and 10°: there was an intense decrease, with an average monthly percentage change (AMPC) = − 30.05%; from 11° month until the end, the decrease was lighter but continuous (AMPC:-2.77%), achieving an incidence density of 0 cases/1000 patients-days on the 18° month, without any new case for 12 months. From the 30° month until the end of the study period, several little outbreaks of MDR-Ab were detected, all of them rapidly controlled. The strains of MDR-Ab isolated during these outbreaks were not clonally related with the previously endemic one, which supports its eradication from the environmental reservoirs. Conclusion The multicomponent intervention performed by a multidisciplinary team was effective to eradicate the endemic MDR-Ab.
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Affiliation(s)
- R Valencia-Martín
- 1Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - V Gonzalez-Galan
- 1Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - R Alvarez-Marín
- 1Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - A M Cazalla-Foncueva
- 1Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - T Aldabó
- 2Department of Intensive Care, University Hospital Virgen del Rocío, Seville, Spain
| | - M V Gil-Navarro
- 3Department of Pharmacy, University Hospital Virgen del Rocío, Seville, Spain
| | - I Alonso-Araujo
- 2Department of Intensive Care, University Hospital Virgen del Rocío, Seville, Spain
| | - C Martin
- 2Department of Intensive Care, University Hospital Virgen del Rocío, Seville, Spain
| | - R Gordon
- 4Cleaning Service, University Hospital Virgen del Rocío, Seville, Spain
| | | | - R Perez
- 5University Hospital Virgen del Rocío, Seville, Spain
| | - G Peñalva
- 1Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - J Aznar
- 1Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - M Conde
- 1Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - J M Cisneros
- 1Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Avenida Manuel Siurot s/n, 41013 Seville, Spain
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Bardet L, Rolain JM. Development of New Tools to Detect Colistin-Resistance among Enterobacteriaceae Strains. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2018; 2018:3095249. [PMID: 30631384 PMCID: PMC6305056 DOI: 10.1155/2018/3095249] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/11/2018] [Indexed: 12/27/2022]
Abstract
The recent discovery of the plasmid-mediated mcr-1 gene conferring resistance to colistin is of clinical concern. The worldwide screening of this resistance mechanism among samples of different origins has highlighted the urgent need to improve the detection of colistin-resistant isolates in clinical microbiology laboratories. Currently, phenotypic methods used to detect colistin resistance are not necessarily suitable as the main characteristic of the mcr genes is the low level of resistance that they confer, close to the clinical breakpoint recommended jointly by the CLSI and EUCAST expert systems (S ≤ 2 mg/L and R > 2 mg/L). In this context, susceptibility testing recommendations for polymyxins have evolved and are becoming difficult to implement in routine laboratory work. The large number of mechanisms and genes involved in colistin resistance limits the access to rapid detection by molecular biology. It is therefore necessary to implement well-defined protocols using specific tools to detect all colistin-resistant bacteria. This review aims to summarize the current clinical microbiology diagnosis techniques and their ability to detect all colistin resistance mechanisms and describe new tools specifically developed to assess plasmid-mediated colistin resistance. Phenotyping, susceptibility testing, and genotyping methods are presented, including an update on recent studies related to the development of specific techniques.
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Affiliation(s)
- Lucie Bardet
- Aix-Marseille Université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Jean-Marc Rolain
- Aix-Marseille Université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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Lv J, Mohsin M, Lei S, Srinivas S, Wiqar RT, Lin J, Feng Y. Discovery of a mcr-1-bearing plasmid in commensal colistin-resistant Escherichia coli from healthy broilers in Faisalabad, Pakistan. Virulence 2018; 9:994-999. [PMID: 29667494 PMCID: PMC6037438 DOI: 10.1080/21505594.2018.1462060] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Jiali Lv
- a School of Food and Biological Engineering, Shaanxi University of Science and Technology , Xi'an , Shaanxi , China
| | - Mashkoor Mohsin
- b Institute of Microbiology, University of Agriculture , Faisalabad , Pakistan
| | - Sheng Lei
- a School of Food and Biological Engineering, Shaanxi University of Science and Technology , Xi'an , Shaanxi , China.,c Department of Medical Microbiology and Parasitology , Zhejiang University School of Medicine , Hangzhou , Zhejiang , China
| | | | - Raja Talish Wiqar
- b Institute of Microbiology, University of Agriculture , Faisalabad , Pakistan
| | - Jingxia Lin
- c Department of Medical Microbiology and Parasitology , Zhejiang University School of Medicine , Hangzhou , Zhejiang , China
| | - Youjun Feng
- a School of Food and Biological Engineering, Shaanxi University of Science and Technology , Xi'an , Shaanxi , China.,c Department of Medical Microbiology and Parasitology , Zhejiang University School of Medicine , Hangzhou , Zhejiang , China.,e College of Animal Sciences, Zhejiang University , Hangzhou , Zhejiang , China
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Presence of an mcr-3 Variant in Aeromonas caviae, Proteus mirabilis, and Escherichia coli from One Domestic Duck. Antimicrob Agents Chemother 2018; 62:AAC.02106-17. [PMID: 29203482 DOI: 10.1128/aac.02106-17] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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