scholarly journals CHARACTERIZATION OF ENTEROAGGREGATIVE ESCHERICHIA COLI AMONG DIARRHEAL CHILDRENIN WESTERN BRAZILIAN AMAZON

2018 ◽  
Vol 55 (4) ◽  
pp. 390-396 ◽  
Author(s):  
Roger Lafontaine Mesquita TABORDA ◽  
Luiz Antônio da SILVA ◽  
Patricia Puccinelli ORLANDI ◽  
Flávia Serrano BATISTA ◽  
Renata Santos RODRIGUES ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Virulence Factors ◽  
Antimicrobial Susceptibility ◽  
Antibiotic Sensitivity ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
E Coli ◽  
Biofilm Production ◽  
Porto Velho

ABSTRACT BACKGROUND: Enteroaggregative Escherichia coli (EAEC) is one of the main acute and chronic diarrhea causes both in children and adults, mainly in developing countries. OBJECTIVE: The aim of the present study is to characterize EAEC strains isolated from faecal samples and to identify genes potentially contributing to virulence, biofilm production and antimicrobial resistance in children admitted to a pediatric hospital in Porto Velho, Rondônia State. METHODS: The total of 1,625 E. coli specimens were isolated from 591 children in the age group 6 years or younger who were hospitalized in Cosme and Damião Children Hospital in Porto Velho, between February 2010 and February 2012, with acute gastroenteritis. Colonies suggestive of E. coli were subjected to polymerase chain reaction testing in order to identify the virulence factors. The in vitro adhesion assays using HEp-2 adherence were tests. Biofilm detection through spectrophotometry and antimicrobial susceptibility tests were conducted in the disk diffusion method. RESULTS: The mentioned study examined 591 stool samples from children with diarrhea. Diarrheogenic E. coli was found in 27.4% (162/591) of the children. EAEC was the diarreagenic E. coli most frequently associated with diarrhea 52.4% (85/162), which was followed by enteropathogenic E. coli 43.8% (71/162), enterotoxigenic E. coli 2.4% (4/162), and enterohemorrhagic E. coli 1.2% (2/162). The aggR gene was detected in 63.5% (54/85) of EAEC isolates; moreover, statistically significant correlation was observed among typical EAEC (aggR) and aatA (P<0.0001), irp2 (P=0.0357) and shf (P=0.0328). It was recorded that 69% (59/85) of the 85 analyzed EAEC strains were biofilm producers; 73% (43/59) of the biofilm producers carried the aggR gene versus 42.3% (11/26) of non-producers (P=0.0135). In addition, there was association between the aatA gene and biofilm production; 61% (36/59) of the samples presented producer strains, versus 19.2% (5/26) of non-producers (P<0.0004). Antibiotic sensitivity test evidenced that most EAEC were ampicillin 70.6% (60/85), sulfamethoxazole 60% (51/85), tetracycline 44.7% (38/85) and cefotaxime 22.4% (19/85) resistant. CONCLUSION: As far as it is known, the present study is pioneer in Northern Brazil to investigate EAEC virulence factors and to show the antimicrobial susceptibility of EAEC strains isolated from children with diarrhea.

scholarly journals Phenotypic Antimicrobial Susceptibility of Escherichia coli from Raw Meats, Ready-to-Eat Meats, and Their Related Samples in One Health Context

2021 ◽  
Vol 9 (2) ◽  
pp. 326
Author(s):  
Frederick Adzitey ◽  
Nurul Huda ◽  
Amir Husni Mohd Shariff
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Resistance Index ◽  
Diffusion Method ◽  
Resistant Bacteria ◽  
Disk Diffusion Method ◽  
E Coli ◽  
The Usa ◽  
Raw Meats

Meat is an important food source that can provide a significant amount of protein for human development. The occurrence of bacteria that are resistant to antimicrobials in meat poses a public health risk. This study evaluated the occurrence and antimicrobial resistance of E. coli (Escherichia coli) isolated from raw meats, ready-to-eat (RTE) meats and their related samples in Ghana. E. coli was isolated using the USA-FDA Bacteriological Analytical Manual and phenotypic antimicrobial susceptibility test was performed by the disk diffusion method. Of the 200 examined meats and their related samples, 38% were positive for E. coli. Notably, E. coli was highest in raw beef (80%) and lowest in RTE pork (0%). The 45 E. coli isolates were resistant ≥ 50% to amoxicillin, trimethoprim and tetracycline. They were susceptible to azithromycin (87.1%), chloramphenicol (81.3%), imipenem (74.8%), gentamicin (72.0%) and ciprofloxacin (69.5%). A relatively high intermediate resistance of 33.0% was observed for ceftriaxone. E. coli from raw meats, RTE meats, hands of meat sellers and working tools showed some differences and similarities in their phenotypic antimicrobial resistance patterns. Half (51.1%) of the E. coli isolates exhibited multidrug resistance. The E. coli isolates showed twenty-two different resistant patterns, with a multiple antibiotic resistance index of 0.0 to 0.7. The resistant pattern amoxicillin (A, n = 6 isolates) and amoxicillin-trimethoprim (A-TM, n = 6 isolates) were the most common. This study documents that raw meats, RTE meats and their related samples in Ghana are potential sources of antimicrobial-resistant E. coli and pose a risk for the transfer of resistant bacteria to the food chain, environment and humans.

scholarly journals Association between Biofilm-Production and Antibiotic Resistance in Uropathogenic Escherichia coli (UPEC): An In Vitro Study

Diseases ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 17 ◽  
Author(s):  
Payam Behzadi ◽  
Edit Urbán ◽  
Márió Gajdács
Keyword(s):  
Escherichia Coli ◽  
Biofilm Formation ◽  
In Vitro Study ◽  
Point Of View ◽  
Diffusion Method ◽  
Medical Attention ◽  
Disk Diffusion Method ◽  
Biofilm Production ◽  
Tract Infections

Urinary tract infections (UTIs) are among the most common infections requiring medical attention worldwide. The production of biofilms is an important step in UTIs, not only from a mechanistic point of view, but this may also confer additional resistance, distinct from other aspects of multidrug resistance (MDR). A total of two hundred and fifty (n = 250) Escherichia coli isolates, originating from clean-catch urine samples, were included in this study. The isolates were classified into five groups: wild-type, ciprofloxacin-resistant, fosfomycin-resistant, trimethoprim-sulfamethoxazole-resistant and extended spectrum β-lactamase (ESBL)-producing strains. The bacterial specimens were cultured using eosine methylene blue agar and the colony morphology of isolates were recorded. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion method and E-tests. Biofilm-formation of the isolates was carried out with the crystal violet tube-adherence method. n = 76 isolates (30.4%) produced large colonies (>3 mm), mucoid variant colonies were produced in n = 135 cases (54.0%), and n = 119 (47.6%) were positive for biofilm formation. The agreement (i.e., predictive value) of mucoid variant colonies in regard to biofilm production in the tube-adherence assay was 0.881 overall. Significant variation was seen in the case of the group of ESBL-producers in the ratio of biofilm-producing isolates. The relationship between biofilm-production and other resistance determinants has been extensively studied. However, no definite conclusion can be reached from the currently available data.

scholarly journals Antibiogram of Escherichia coli isolated from semi-closed system farmed Asian clam (Corbicula fluminea)

2021 ◽  
Vol 8 (1) ◽  
pp. 24-27
Author(s):  
Wanikda Eh Chuan ◽  
Akrimah Yusof ◽  
Aweng Eh Rak ◽  
Shareef Mohd Hafiz Mani ◽  
Seong Wei Lee
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Sensitivity ◽  
Plate Count ◽  
Diffusion Method ◽  
Human Consumption ◽  
Disk Diffusion Method ◽  
E Coli ◽  
Asian Clam ◽  
Antibiotic Sensitivity Test ◽  
Clam Corbicula

In the present study, antibiogram of Escherichia coli isolated from farmed Asian clam, Corbiculafluminea was characterised. Asian clam or locally known as ‘etak’ is processed to became smokedclam and consumed as snack by Kelantanese. However, there are many diarrhoea cases afterconsuming smoked clam. Furthermore, there are also insufficient information about the E.coli levelin Asian clam farm and effective antibiotic in controlling the bacteria in the litereature. Hence, thisstudy was carried out to provide information of antibiogram of E.coli to be reference in the future.Eosin Methylene Blue agar (EMB) was used to isolate E. coli. A total of 100 isolated bacteria weresubjected to antibiotic sensitivity test using disk diffusion method. A total of 18 types of antibioticsnamely novobiocin (30µg/disk), fosfomycin (50 µg/disk), tetracycline (30µg/disk), lincomycin(15µg/disk), flumequine (30µg/disk), sulphamethoxazole (25 µg/disk), amoxycillin (25 µg/disk),chloramphenicol (30 µg/disk), oleandomycin (15 µg/disk), spiramycin (100 µg/disk), ampicillin(10 µg/disk), oxytetracycline (30 µg/disk), doxycycline (30 µg/disk), nalidixic acid (30 µg/disk),florfenicol (30 µg/disk), erythromycin (15 µg/disk), kanamycin (30 µg/disk) and oxolinic acid (2µg/disk). The findings of the present study showed total plate count of E. coli was 6.45 x 103 colonyforming unit (CFU/100g) of sampled Asian clam. Hence, the clam is needed to be under cleansingtreatment before can consider safe for human consumption. Antibiotic results showed 51 % wasrecorded as antibiotic resistance case, 44 % antibiotic sensitive case and 5 % as antibioticintermediary sensitive case. None of the tested antibiotics was successfully inhibited the growth ofthe present bacterial isolates indicating more antibiotics are needed to be screen in the future studyto find out the most effective antibiotic in controlling isolated E. coli.

scholarly journals Escherichia coli O157:H7 in Retail Lettuce (Lactuca sativa) in Addis Ababa City: Magnitude of Contamination and Antimicrobial Susceptibility Pattern

2021 ◽  
Vol 12 ◽  
Author(s):  
Aklilu Feleke Haile ◽  
Silvia Alonso ◽  
Nega Berhe ◽  
Tizeta Bekele Atoma ◽  
Prosper N. Boyaka ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Susceptibility ◽  
Addis Ababa ◽  
Foodborne Pathogen ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Susceptibility Pattern ◽  
Disk Diffusion Method ◽  
E Coli ◽  
Antimicrobial Susceptibility Pattern

Escherichia coli O157:H7 is an important foodborne pathogen but largely under investigated in Africa. The objectives of this study were to estimate the prevalence and pattern of antimicrobial resistance of E. coli O157:H7 in lettuce in Addis Ababa, Ethiopia. A total of 390 retail lettuce samples were collected across the 10 subcities of Addis Ababa. E. coli O157:H7 was isolated and identified following ISO-16654:2001 standard. The isolates were further tested for antimicrobial susceptibility to 13 antimicrobials using the Kirby–Bauer disk diffusion method. Out of the 390 lettuce samples examined, two (0.51%) carried E. coli O157:H7. The antimicrobial susceptibility pattern of strains showed resistance to ampicillin (100%) and tetracycline (50.0%). One of the two isolates was multidrug resistant to two antimicrobials tested. The results of this study demonstrate the presence of drug-resistant E. coli O157:H7 in lettuce in markets in Addis Ababa. Despite the low prevalence, its presence in a product that is eaten raw highlights potential public health risk in the area associated with this pathogen.

scholarly journals Bacterial Profile of Urinary Tract Infections: Evaluation of Biofilm Formation and Antibiotic Resistance Pattern of Uropathogenic Escherichia coli

2020 ◽  
Vol 14 (4) ◽  
pp. 2577-2584
Author(s):  
Tariq Ahmad Shah ◽  
P. Preethishree ◽  
Ashwini ◽  
Vidya Pai
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Biofilm Formation ◽  
Urine Samples ◽  
Diffusion Method ◽  
E Coli ◽  
Biofilm Production ◽  
Tract Infections

Urinary tract infection (UTI) is one of the most common complaints in the outpatient clinic and a major health problem owing to the emergence of antibiotic resistance and biofilm formation. The objective of this study was to isolate and identify the causative bacterial agent of UTI and detect in vitro biofilm formation by Escherichia coli and investigate its correlation with antibiotic resistance. Urine samples from 519 patients with suspected UTIs were collected and processed by conventional microbiological procedures. Antimicrobial susceptibility testing for E. coli isolates was performed on Mueller Hinton agar (MHA) plates using the Kirby-Bauer disk diffusion method. Biofilm production was evaluated using the tissue culture plate method. Of 519 urine samples, 115 (22.1%) showed significant bacteriuria. The most common isolate was E. coli (n=57, 49.6%), followed by Klebsiella spp. (n=23, 20%). All E. coli isolates were evaluated for their ability to form biofilms in vitro. Of 57 isolates, 50 (87.7%) were biofilm producers and 7 (12.3%) were non-biofilm producers. Antibiogram of E. coli isolates revealed the highest resistance to ampicillin (96.5%) and nitrofurantoin (91.2%), followed by amoxyclav (82.5%), ceftazidime (73.7%), cefepime (71.9%), and tetracycline (71.9%). A significant association (p<0.05) was observed between biofilm formation and resistance to amoxyclav, ceftazidime, cefepime, imipenem, and nitrofurantoin. A significant correlation was noted between biofilm production and antibiotic resistance. Hence, screening of all isolates of uropathogenic E. coli for biofilm production and studying their antibiogram would allow appropriate choice of antibiotic therapy.

scholarly journals Identification of Extended-Spectrumβ-LactamasesEscherichia coliStrains Isolated from Market Garden Products and Irrigation Water in Benin

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Wassiyath Moussé ◽  
Haziz Sina ◽  
Farid Baba-Moussa ◽  
Pacôme A. Noumavo ◽  
Nadège A. Agbodjato ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Susceptibility ◽  
Irrigation Water ◽  
Food Habits ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
E Coli ◽  
Pcr Method ◽  
Horticultural Products

The present study aimed at biochemical and molecular characterization ofEscherichia colistrains isolated from horticultural products and irrigation water of Cotonou. The samples were collected from 12 market gardeners of 4 different sites. Rapid’E. colimedium was used for identification ofE. colistrains and the antimicrobial susceptibility was performed by the agar disk diffusion method. Theβ-lactamases production was sought by the liquid acidimetric method. The genes coding forβ-lactamases and toxins were identified by PCR method. The results revealed that about 34.95% of the analyzed samples were contaminated byE. coli. Cabbages were the most contaminated byE. coli(28.26%) in dry season. All isolated strains were resistant to amoxicillin. The penicillinase producingE. colicarriedblaTEM(67.50%),blaSHV(10%), andblaCTX-M(22.50%) genes. The study revealed that the resistance genes such as SLTI (35.71%), SLTII (35.71%), ETEC (7.15%), and VTEC (21.43%) were carried. Openly to the found results and considering the importance of horticultural products in Beninese food habits, it is important to put several strategies aiming at a sanitary security by surveillance and sensitization of all the actors on the risks of some practices.

scholarly journals Prevalence and Antimicrobial Susceptibility Profiles of Pathogen Isolated from Bovine Mastitis Milk in Transylvania, Romania

2016 ◽  
Vol 73 (2) ◽  
pp. 329
Author(s):  
Cosmina Bouari ◽  
George Nadas ◽  
Flore Chirila ◽  
Sorin Rapuntean ◽  
Cornel Catoi ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Clavulanic Acid ◽  
Antimicrobial Susceptibility ◽  
Bovine Mastitis ◽  
Acid Resistance ◽  
Diffusion Method ◽  
Economic Losses ◽  
Disk Diffusion Method

 Mastitis in cows, one of the most common and economically important infectious diseases of dairy cattle, all over the world, with significant impact due to economic losses, occurs when the udder becomes inflamed because the leukocytes are released into the mammary gland usually in response to bacteria invasion of the teat canal.The main objective of this study was to evaluate the in vitro antimicrobial susceptibility of bacteria isolated from milk in order to design specific control programs for bovine mastitis in this area.A total of 204 milk samples aseptically collected both from farms and private owners were processed during May 2014 and March 2016 within the Microbiology Laboratory of the Faculty of Veterinary Cluj-Napoca, Romania. The microbiological examination was carried out by inoculation on blood agar and MacConkey medium. After the overnight incubation in aerobic conditions, the identification of the isolates was performed using microscopic, cultural and biochemical methods. Biochemical identification was based on API 20 Biomerieux system. Susceptibility to antibiotics was evaluated using Kirby Bauer disk diffusion method on Mueller-Hinton agar; the antibiotics were represented by Amoxicillin and Clavulanic Acid, Ceftiofur, Florfenicol, Mastidiscs, Enrofloxacin, Penicillin and Tetracycline.Staphylococcus spp. was the most common isolated pathogen, in 54.9% of the specimens, followed by Streptococcus spp. in 20.1%, Escherichia coli in 10.78%, Klebsiella spp. in 8.34%, Bacillus spp. in 5.88%. The most frequent associations were represented by staphylococci-streptococci in 62.7% of the samples, followed by streptococci-bacillus in 19.8% of the samples. The most important etiological agents identified were Staphylococcus aureus, S uberis, Streptococcus agalactiae, and Escherichia coli. Antimicrobial susceptibility test for the total isolates revealed good sensitivity to Enrofloxacin, Mastidiscs and Amoxicillin and Clavulanic Acid. Resistance was observed for Penicillin and Tetracycline.The major mastitis pathogens identified was Staphylococcus aureus, while recurrent mastitis treatment was based on systemic and local administration of Enrofloxacin and Mastidiscs respectively.

scholarly journals Isolation, identification and antibiogram profiles of enterovirulent Escherichia coli from diarrhoeic goat in some selected areas of Rangpur district of Bangladesh

2018 ◽  
Vol 4 (1) ◽  
pp. 36-43 ◽  
Author(s):  
Md Rashed Kamal ◽  
Md Fakhruzzaman ◽  
Mir Rowshan Akter ◽  
Md Atiqul Haque
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Sensitivity ◽  
Biochemical Properties ◽  
Diffusion Method ◽  
Gram Stain ◽  
Disk Diffusion Method ◽  
E Coli ◽  
First Choice ◽  
Antibiotic Sensitivity Test ◽  
Metallic Sheen

Enterovirulent Escherichia coli remain as an important etiological agent of goat diarrhoea in Bangladesh. The present study was designed with a view to isolate and identifies E. coli from field cases. For this purpose, a total of 135 faecal samples (85 from diarrhoeic and 50 from apparently healthy goat) were collected during the period from January 2012 to July 2012 from different areas in Rangpur District. It was found that the prevalence of E. coli was higher (18.82 %) in diarrhoeic goats while it was lower (14.00 %) in non diarrhoeic goats. Age wise distribution of E. coli isolates were 26.42% in day old to 1 year, 10.53% in 1-2 years and 11.36% in above 2 years age of goat respectively. All the isolates of E. coli revealed greenish black colony with metallic sheen in Eosine methylene blue agar, bright pink color smooth transparent colony in MacConkey agar and slight pinkish smooth colony in Salmonella-Shigella agar. Gram stain and hanging drop techniques were performed with the cultured bacteria. Biochemical properties of the isolates were studied, and antibiotic sensitivity test was done by agar disk diffusion method. In Gram stain, the organisms revealed Gram negative, small rod shaped, occurs singly or paired. Biochemically, all of the isolates showed fermentation of dextrose, sucrose and maltose with the production of acid and gas, negative result to Voges-Proskauer test, positive result to Methylred test and differential result to Indol test. All the isolates of E. coli were highly sensitive to ciprofloxacin and gentamicin while moderately sensitive to colistin, livofloxacin and azithromycin and less sensitive to ceftraexon and tetracyclin and resistant to amoxycillin, ampicillin, erythromycin, and neomycin. Therefore, ciprofloxacin and gentamicin may be the antibiotics of first choice, and colistin, livofloxacin and azithromycin may be the second choice among the test antibiotics for the treatment of illness caused by these bacteria.Asian J. Med. Biol. Res. March 2018, 4(1): 36-43

scholarly journals Evolution of In Vitro Antimicrobial Susceptibility of Equine Clinical Isolates in France between 2016 and 2019

Animals ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 812 ◽  
Author(s):  
Albertine Léon ◽  
Sophie Castagnet ◽  
Karine Maillard ◽  
Romain Paillot ◽  
Jean-Christophe Giard
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Klebsiella Pneumoniae ◽  
Antimicrobial Susceptibility ◽  
Diffusion Method ◽  
Veterinary Antibiotics ◽  
Disk Diffusion Method ◽  
Animal Exposure

The present study described the evolution of antimicrobial resistance in equine pathogens isolated from 2016 to 2019. A collection of 7806 bacterial isolates were analysed for their in vitro antimicrobial susceptibility using the disk diffusion method. The most frequently isolated pathogens were group C Streptococci (27.0%), Escherichia coli (18.0%), Staphylococcus aureus (6.2%), Pseudomonas aeruginosa (3.4%), Klebsiella pneumoniae (2.3%) and Enterobacter spp. (2.1%). The majority of these pathogens were isolated from the genital tract (45.1%, n = 3522). With the implementation of two French national plans (named ECOANTIBIO 1 and 2) in 2012–2016 and 2017–2021, respectively, and a reduction in animal exposure to veterinary antibiotics, our study showed decreases in the resistance of group C Streptococci, Klebsiella pneumoniae and Escherichia coli against five classes, four classes and one class of antimicrobials tested, respectively. However, Staphylococcus aureus, Escherichia coli and Enterobacter spp. presented an increased resistance against all the tested classes, excepted for two fifths of E. coli. Moreover, the percentages of multi-drug resistant strains of Staphylococcus aureus and Enterobacter spp. also increased from 24.5% to 37.4% and from 26.3% to 51.7%, respectively. The data reported here are relevant to equine practitioners and will help to improve knowledge related to antimicrobial resistance in common equine pathogens.

scholarly journals Antibiotic Resistance and Plasmid Profiling of Escherichia coli Isolated from Human Sewage Samples

2021 ◽  
Vol 14 ◽  
pp. 117863612110168
Author(s):  
Sanjida Akter ◽  
A. M. Masudul Azad Chowdhury ◽  
Sohana Akter Mina
Keyword(s):  
Escherichia Coli ◽  
Developing Countries ◽  
Antibiotic Resistance ◽  
Antibiotic Sensitivity ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
E Coli ◽  
Antibiotic Sensitivity Test ◽  
Plasmid Profiling ◽  
As Relationship

In developing countries, the occurrence of antibiotic resistance is increasing day by day and antibiotic resistant microorganisms are being found in almost every environmental setting. Plasmids are considered as the main vector in the procurement and propagation of antibiotic resistance in many microorganisms such as Escherichia coli ( E. coli). The goal of this study was to examine the antibiotic resistance and screening of plasmid in E. coli strains which were previously identified from human sewage samples. During this study antibiotic susceptibility of E. coli isolates were determined by Kirby-Bauer disk diffusion method against 5 antibiotics (ampicilin, ceftriaxone, amoxicillin, ciprofloxacin, azithromycin). Furthermore, plasmid extraction of each isolate was done according to the protocol of FavorPrepTMPlasmid Mini Kit and plasmid profiling was done by agarose gel electrophoresis. In antibiotic sensitivity test, all E. coli strains showed resistance to ampicilin, amoxicillin, and ceftriaxone. In the plasmid profiling, it was revealed that all the isolates of E. coli harbored plasmids. The plasmid sizes ranged from approximately 1.5 to 15 kb. The findings of this study prove the consequences of antibiotic resistance as well as relationship of plasmid with antibiotic resistance which necessitates proper surveillance on antibiotic usage in the developing countries.

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