Antibiogram, Prevalence of OXA Carbapenemase Encoding Genes, and RAPD-Genotyping of Multidrug-Resistant Acinetobacter baumannii Incriminated in Hidden Community-Acquired Infections

Acinetobacter spp. has gained fame from their ability to resist difficult conditions and their constant development of antimicrobial resistance. This study aimed to investigate the prevalence, susceptibility testing, OXA carbapenemase-encoding genes, and RAPD-genotyping of multidrug resistant Acinetobacter baumannii incriminated in hidden community-acquired infections in Egypt. The antimicrobial susceptibility testing was assessed phenotypically using Kirby–Bauer disk diffusion method. Also, Modified-Hodge test (MHT) was carried out to detect the carbapenemases production. Multiplex-PCR was used to detect the carbapenemase-encoding genes. Furthermore, the genetic relationship among the isolated strains was investigated using RAPD fingerprinting. The bacteriological examination revealed that, out of 200 Gram-negative non-fermentative isolates, 44 (22%) were identified phenotypically and biochemically as Acinetobacter spp. and 23 (11.5%) were molecularly confirmed as A.baumannii. The retrieved A.baumannii strains were isolated from urine (69%), sputum (22%), and cerebrospinal fluid (csf) (9%). The isolated A. baumannii strains exhibited multidrug resistance and the production rates of carbapenemases were 56.5, 60.9, and 78.3% with meropenem, imipenem, and ertapenem disks, respectively. The blaOXA-24-like genes were the most predominant among the tested strains (65.2%), followed by blaOXA-23 (30.4%) and blaOXA-58 (17.4%), in addition, the examined strains are harbored IMP, VIM, and NDM genes with prevalence of 60.9, 43.5, and 13%, respectively, while KPC and GES genes were not detected. RAPD-PCR revealed that the examined strains are clustered into 11 different genotypes at ≥90% similarity. Briefly, to the best of our knowledge, this study is the first report concerning community-associated A. baumannii infections in Egypt. The high prevalence of hidden multidrug-resistant (MDR) and extensively drug-resistant (XDR) A.baumannii strains associated with non-hospitalized patients raises an alarm for healthcare authorities to set strict standards to control the spread of such pathogens with high rates of morbidity and mortality.

Download Full-text

Antimicrobial Resistance Pattern of Extensively Drug Resistant Carbapenemase Producing Enterobacteriaceae

Bangladesh Journal of Medical Microbiology ◽

10.3329/bjmm.v13i2.51786 ◽

2019 ◽

Vol 13 (2) ◽

pp. 7-10

Author(s):

Fatima Afroz ◽

Shaheda Anwar ◽

Mashrura Quraishi ◽

GM Mohiuddin ◽

SM Ali Ahmed ◽

...

Keyword(s):

Bacterial Infections ◽

Multidrug Resistant ◽

Diffusion Method ◽

Clinical Samples ◽

Resistance Pattern ◽

Drug Resistant ◽

Disk Diffusion Method ◽

Cross Sectional ◽

Extensively Drug Resistant ◽

Broth Microdilution Method

Carbapenems, often agents of last resort for multidrug resistant bacterial infections are now threatened by widespread dissemination of carbapenem-resistant Enterobacteriaceae (CRE). Production of carbapenemases remain the most clinically important mechanism of carbapenem resistance in Enterobacteriaceae. The objective of this study was to determine the antibiogram pattern of carbapenemase producing Enterobacteriaceae. A cross sectional study was conducted at department of Microbiology and Immunology, BSMMU from September 2018 to August 2019. A total of 145 CRE isolates from different clinical samples were studied.Antimicrobial susceptibility was examinedby disk diffusion method and MIC of colistin by broth microdilution method. Resistant carbapenemase genes NDM and OXA-48 were identified by polymerase chain reaction. Out of 145 CRE isolates, 104 were NDM, 73 were OXA-48and 34 isolates were both NDM and OXA-48 co-producers. All the NDM and OXA-48 carbapenemase producing isolates were 100% resistant to meropenem, imipenem, ertapenem, ceftriaxone, ceftazidime, cefotaxime, cefuroxime, amoxicillin + clavulanic acid and piperacillin + tazobactam. Resistance rates of reserved antimicrobials to treat CRE isolates were also alarming. Thirty seven percent, 9.6% and 5.5 % of OXA-48 carbapenemase producers and 26.0%, 10.6% and 2.9% of NDM carbapenemase producers were resistant to colistin, polymyxin B and tigecycline respectively.Among the carbapenemase producing isolates, 16.6% (24) were multidrug resistant (MDR), 82.1% (119) were extensively drug resistant (XDR) and 1.3% (2) isolates were pan drug resistantwhich highlights the emerging therapeutic challenge for these superbugs. Bangladesh J Med Microbiol 2019; 13 (2): 7-10

Download Full-text

The Dissemination of Multidrug Resistance (MDR) and Extensively Drug Resistant (XDR) among Uropathogenic E. coli (UPEC) Isolates from Urinary Tract Infection Patients in Babylon Province, Iraq

Baghdad Science Journal ◽

10.21123/bsj.2019.16.4(suppl.).0986 ◽

2019 ◽

Vol 16 (4(Suppl.)) ◽

pp. 0986

Author(s):

Al-Hasnawy Et al.

Keyword(s):

Escherichia Coli ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Multidrug Resistant ◽

Diffusion Method ◽

Drug Resistant ◽

Disk Diffusion Method ◽

E Coli ◽

Extensively Drug Resistant

Antibiotic resistance is a problem of deep scientific concern both in hospital and community settings. Rapid detection in clinical laboratories is essential for the judicious recognition of antimicrobial resistant organisms. So, the growth of Uropathgenic Escherichia coli (UPEC) isolates with Multidrug-resistant (MDR) and Extensively Drug-resistant (XDR) profiles that thwart therapy for (UTIs) has been detected and has straight squeezed costs and extended hospital stays. This study aims to detect MDR- and XDR-UPEC isolates. Out of 42 UPEC clinical isolates were composed from UTI patients. The bacterial strains were recognized by standard laboratory protocols. Susceptibility to antibiotic was measured by the standard disk diffusion method Out of 42 Uropathogenic E. coli, 37 (88.09%) were found to be MDR while 5 isolates (11.90%) were XDR. The present study concluded high prevalence of uropathogenic Escherichia coli (UPEC) with Multidrug-resistant (MDR) isolated from urinary tract infection in Babylon province – Iraq.

Download Full-text

Overexpression of blaOXA-58 Gene Driven by ISAba3 is Associated with Imipenem Resistance in a Clinical Acinetobacter baumannii Isolate from Vietnam

10.1101/2020.06.29.178632 ◽

2020 ◽

Author(s):

Anh T. Nguyen ◽

Son C. Pham ◽

Anh K. Ly ◽

Chau V.V. Nguyen ◽

Thanh T. Vu ◽

...

Keyword(s):

Gene Expression ◽

Acinetobacter Baumannii ◽

Mrna Level ◽

Pcr Amplification ◽

Multidrug Resistant ◽

Resistant Isolate ◽

Diffusion Method ◽

Disk Diffusion Method ◽

Imipenem Resistance ◽

Very High

AbstractThe aim of this study was to investigate genetic structures and expression of blaOXA-58 gene in five Acinetobacter baumannii clinical isolates recovered from two hospitals in southern Vietnam during 2012-2014. A. baumannii isolates were identified by automated microbiology systems and confirmed by PCR. All isolates were characterized as multidrug resistant by antimicrobials testing using the disk diffusion method. Four imipenem susceptible and one non-susceptible isolates (MIC > 32 μg.ml−1) were identified by E-test. PCR amplification of blaOXA-58 gene upstream and downstream sequences revealed the presence of ISAba3 at both locations in one multidrug resistant isolate. Semi quantitation of blaOXA-51 and blaOXA-58 gene expression was performed by the 2−ΔΔCt method. The blaOXA-51 gene expression of five isolates showed little difference but the isolate bearing ISAba3-blaOXA-58-ISAba3 exhibited significant higher blaOXA-58 mRNA level. Higher β-lactamases activity in periplasmic than cytoplasmic fraction was found in most isolates. The isolate overexpressing blaOXA-58 gene possessed very high periplasmic enzyme activity. In conclusion, the A. baumannii isolate bearing ISAba3-blaOXA-58 gene exhibited high resistance to imipenem, corresponding to an overexpression of blaOXA-58 gene and very high periplasmic β-lactamases activity.

Download Full-text

Overexpression of blaOXA-58 Gene Driven by ISAba3 Is Associated with Imipenem Resistance in a Clinical Acinetobacter baumannii Isolate from Vietnam

BioMed Research International ◽

10.1155/2020/7213429 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Anh T. Nguyen ◽

Son C. Pham ◽

Anh K. Ly ◽

Chau V. V. Nguyen ◽

Thanh T. Vu ◽

...

Keyword(s):

Gene Expression ◽

Acinetobacter Baumannii ◽

Mrna Level ◽

Pcr Amplification ◽

Multidrug Resistant ◽

Resistant Isolate ◽

Diffusion Method ◽

Disk Diffusion Method ◽

Imipenem Resistance ◽

Very High

The aim of this study was to investigate genetic structures and expression of blaOXA-58 gene in five Acinetobacter baumannii clinical isolates recovered from two hospitals in southern Vietnam during 2012-2014. A. baumannii isolates were identified by automated microbiology systems and confirmed by PCR. All isolates were characterized as multidrug resistant by antimicrobial testing using the disk diffusion method. Four imipenem susceptible and one nonsusceptible isolates (MIC>32 μg·ml-1) were identified by E-test. PCR amplification of blaOXA-58 gene upstream and downstream sequences revealed the presence of ISAba3 at both locations in one multidrug-resistant isolate. Semiquantitation of blaOXA-51 and blaOXA-58 gene expression was performed by the 2-ΔΔCt method. The blaOXA-51 gene expression of five isolates showed little difference, but the isolate bearing ISAba3-blaOXA-58-ISAba3 exhibited significantly higher blaOXA-58 mRNA level. Higher β-lactamases activity in periplasmic than cytoplasmic fraction was found in most isolates. The isolate overexpressing blaOXA-58 gene possessed very high periplasmic enzyme activity. In conclusion, the A. baumannii isolate bearing ISAba3-blaOXA-58 gene exhibited high resistance to imipenem, corresponding to an overexpression of blaOXA-58 gene and very high periplasmic β-lactamase activity.

Download Full-text

Colistin and Carbapenem-Resistant Acinetobacter baumannii Aci46 in Thailand: Genome Analysis and Antibiotic Resistance Profiling

Antibiotics ◽

10.3390/antibiotics10091054 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1054

Author(s):

Nalumon Thadtapong ◽

Soraya Chaturongakul ◽

Sunhapas Soodvilai ◽

Padungsri Dubbs

Keyword(s):

Antibiotic Resistance ◽

Acinetobacter Baumannii ◽

Antibiotic Resistance Genes ◽

Carbapenem Resistance ◽

Multidrug Resistant ◽

Diffusion Method ◽

Whole Genome ◽

Disk Diffusion Method ◽

Genome Data ◽

Carbapenem Resistant

Resistance to the last-line antibiotics against invasive Gram-negative bacterial infection is a rising concern in public health. Multidrug resistant (MDR) Acinetobacter baumannii Aci46 can resist colistin and carbapenems with a minimum inhibitory concentration of 512 µg/mL as determined by microdilution method and shows no zone of inhibition by disk diffusion method. These phenotypic characteristics prompted us to further investigate the genotypic characteristics of Aci46. Next generation sequencing was applied in this study to obtain whole genome data. We determined that Aci46 belongs to Pasture ST2 and is phylogenetically clustered with international clone (IC) II as the predominant strain in Thailand. Interestingly, Aci46 is identical to Oxford ST1962 that previously has never been isolated in Thailand. Two plasmids were identified (pAci46a and pAci46b), neither of which harbors any antibiotic resistance genes but pAci46a carries a conjugational system (type 4 secretion system or T4SS). Comparative genomics with other polymyxin and carbapenem-resistant A. baumannii strains (AC30 and R14) identified shared features such as CzcCBA, encoding a cobalt/zinc/cadmium efflux RND transporter, as well as a drug transporter with a possible role in colistin and/or carbapenem resistance in A. baumannii. Single nucleotide polymorphism (SNP) analyses against MDR ACICU strain showed three novel mutations i.e., Glu229Asp, Pro200Leu, and Ala138Thr, in the polymyxin resistance component, PmrB. Overall, this study focused on Aci46 whole genome data analysis, its correlation with antibiotic resistance phenotypes, and the presence of potential virulence associated factors.

Download Full-text

Sequence Analyses and Phenotypic Characterization Revealed Multidrug Resistant Gene Insertions in the Genomic Region Encompassing Phase 2 Flagellin Encoding fljAB Genes in Monophasic Variant Salmonella enterica Serovar 4,5,12:i:- Isolates From Various Sources in Thailand

Frontiers in Microbiology ◽

10.3389/fmicb.2021.720604 ◽

2021 ◽

Vol 12 ◽

Author(s):

Aye Thida Win ◽

Sirirak Supa-amornkul ◽

Renato H. Orsi ◽

Jaclyn H. Carey ◽

William J. Wolfgang ◽

...

Keyword(s):

Salmonella Enterica ◽

Multidrug Resistant ◽

Genomic Region ◽

Diffusion Method ◽

Phenotypic Characterization ◽

Phase 2 ◽

Disk Diffusion Method ◽

Pcr Screening ◽

Mercury Tolerance ◽

Encoding Genes

Salmonella enterica serovar 4,5,12:i:- (S. 4,5,12:i:-), a monophasic variant of Salmonella Typhimurium (STm) lacking the phase 2 flagellin encoding genes fljAB, has become increasingly prevalent worldwide. The increasing trends in multidrug resistant (MDR) S. 4,5,12:i:- prevalence also pose an important global health threat. Though many reports have characterized phenotypic and genotypic drug resistance of this serovar, few studies have characterized antimicrobial resistance of this serovar in Thailand. In this study, 108 S. 4,5,12:i:- isolates from various sources in Thailand and four international S. 4,5,12:i:- isolates were screened using polymerase chain reaction (PCR) to detect the presence of five target regions which are associated with antimicrobial resistant (AMR) genes, in the genomic region that contained fljAB genes in STm. We determined AMR phenotypes of all isolates by Kirby-Bauer disk diffusion method. Whole genome sequencing (WGS) was performed on 53 representative isolates (based on differences in the pulsed filed gel electrophoresis profiles, the sources of isolate, and the PCR and AMR patterns) to characterize the genetic basis of AMR phenotype and to identify the location of AMR determinants. Based on PCR screening, nine PCR profiles showing distinct deletion patterns of the five target regions have been observed. Approximately 76% of isolates (or 85 of 112 isolates), all of which were Thai isolates, contained five target regions inserted between STM2759 and iroB gene. A total of 21 phenotypic AMR patterns were identified with the predominant AmpST resistant phenotype [i.e., 84% (or 94 of 112) tested positive for resistance to ampicillin, streptomycin, and tetracycline], and 89% (or 100 of 112) were found to be MDR (defined here as resistant to at least three classes of tested antimicrobials). Using WGS data, a total of 24 genotypic AMR determinants belonging to seven different antimicrobial groups were found. AMR determinants (i.e., blaTEM–1, strB-A, sul2, and tetB, conferring resistance to ampicillin, streptomycin, sulfonamides, and tetracycline, respectively) were found to be inserted in a region typically occupied by the phase 2 flagellin encoding genes in STm. These resistant genes were flanked by a number of insertion sequences (IS), and co-localized with mercury tolerance genes. Our findings identify AMR genes, possibly associated with multiple IS26 copies, in the genetic region between STM2759 and iroB genes replacing phase 2 flagellin encoding fljAB genes in Thai S. 4,5,12:i:- isolates.

Download Full-text

Antibiotic Resistance Patterns and Molecular Typing of Acinetobacter Baumannii Strains Isolated from Burn Patients in Iran

International Journal of Medical Laboratory ◽

10.18502/ijml.v5i4.153 ◽

2018 ◽

Cited By ~ 1

Author(s):

Fahimeh Nourbakhsh ◽

Elaheh Tajbakhsh ◽

Dana Daneshmand ◽

Samaneh Borooni ◽

Vajiheh Nourbakhsh

Keyword(s):

Antibiotic Resistance ◽

Acinetobacter Baumannii ◽

Molecular Typing ◽

Multidrug Resistant ◽

Diffusion Method ◽

Resistance Pattern ◽

Burn Patients ◽

Disk Diffusion Method ◽

Burn Center ◽

Antibiotic Resistance Pattern

Background and Aims: Acinetobacter baumannii is an important multidrug-resistant opportunistic pathogen frequently causing various nosocomial infections and is a serious threat to burn patients. These infections are usually caused by the outbreak strains. The aim of this study was to show antibiotic resistance pattern and molecular typing of A.baumannii genes isolates collected from burn patients and also distribution of different types of burn patients. Materials and Methods: In this study, 307 different strains were detected. Totally 100 A.baumannii strain was selected in burn center of Isfahan hospital. Antibiotic resistance pattern was determined by disk diffusion method (Kirby Bauer). The presence of genes coding in antibiotic resistance were analyzed by using M-PCR method. The standard strains of Escherichia coli ATCC 25922 and A. baumannii ATCC 19606 were used as negative and positive controls. Results: The antibiotic resistance pattern for A.baumannii showed high resistance for ciprofloxacin, ceftazidime, and tetracycline with frequency of 82.5%, 75.3%, 72%, respectively. Moreover, the most sensitive antibiotics were chloramphenicol, and nitrofurantoin with the resistance frequency of 3.9% and 2.8%. CITM (91.1%) was the highest detected gene. Conclusions: High prevalence of antibiotic resistance pattern among A.baumannii isolated from burn center hospitals indicates the important role of multidrug resistant isolates.

Download Full-text

Antibiotic resistance assessment of Acinetobacter baumannii isolates from Tehran hospitals due to the presence of efflux pumps encoding genes (adeA and adeS genes) by molecular method

BMC Research Notes ◽

10.1186/s13104-020-05387-6 ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Batool Basatian-Tashkan ◽

Mohammad Niakan ◽

Mansoor Khaledi ◽

Hamed Afkhami ◽

Fatemeh Sameni ◽

...

Keyword(s):

Acinetobacter Baumannii ◽

High Frequency ◽

Efflux Pumps ◽

Diffusion Method ◽

Toxic Substances ◽

Mechanisms Of Resistance ◽

Molecular Method ◽

Disk Diffusion Method ◽

Pcr Method ◽

Encoding Genes

Abstract Objective Acinetobacter baumannii (A. baumannii) has caused many problems in nosocomial infections. Efflux pumps are considered as one of the most important mechanisms of resistance in this bacterium and have the ability to excrete toxic substances such as antibiotics out of the cell. Results In this study, 60 isolates of A. baumannii were collected from patients in several hospitals in Tehran, Iran. After diagnosis using standard biochemical methods, the pattern of antibiotic susceptibility was determined using the disk diffusion method according to CLSI guidelines. The adeA and adeS genes were identified by PCR method. The highest resistance to Piperacillin and the lowest resistance to Gentamicin were observed (100% compared to 48.4%). 6.6% of the isolates had only adeA gene and adeS gene was observed in 8.4% of isolates and both genes were detected in 73.4% of the samples. Despite the high resistance of t A. baumannii o antibiotics and due to the high frequency of genes of adeA and adeS efflux pumps in A. baumannii isolates, it can be concluded that these efflux pumps may play an important role in resistance of this bacterium. By determining the pattern of antibiotic the resistance before treatment, the resistance of this pathogen can be prevented in societies.

Download Full-text

Molecular Detection of Genes Involved in Biofilm Formation in Staphylococcus aureus Strains Isolates: Evidence From Shahid Motahari Hospital in Tehran

Jundishapur Journal of Microbiology ◽

10.5812/jjm.102058 ◽

2020 ◽

Vol 13 (7) ◽

Author(s):

Anis Mohammadi ◽

Mehdi Goudarzi ◽

Masoud Dadashi ◽

Malihe Soltani ◽

Hossein Goudarzi ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Diffusion Method ◽

Molecular Characteristics ◽

Burn Patients ◽

Disk Diffusion Method ◽

High Prevalence ◽

Burn Units ◽

Resistance Patterns ◽

Encoding Genes

Background: Infections caused by Staphylococcus aureus strains are a major public health challenge worldwide, especially in specialized burn hospitals. Infections caused by S. aureus account for more than 50% of burn-related deaths. Objectives: Since data on characteristics of these isolates are not sufficient, the current study aimed to assess the prevalence of resistance to antibacterial agents and to analyze the distribution of biofilm, and adhesion encoding genes among S. aureus strains isolated from burn patients in Motahari Hospital, Tehran, Iran. Methods: A total of 83 S. aureus strains were collected from burn wounds of patients admitted to a referral burn center in Tehran for 10 months. In vitro antibacterial susceptibility of isolates was evaluated using the Kirby-Bauer disk diffusion method. Strains were subjected to polymerase chain reaction (PCR) to determine the presence of nucA, mecA, ebps, cna, bbp, fnbA, fnbB, clfA, and clfB genes. Results: The highest frequency of resistance was found to cephalexin and cefoxitin (87.9%), followed by clindamycin (75.9%), erythromycin (72.3%), and ciprofloxacin (60.2%). Five resistance patterns were identified in which cephalexin, cefoxitin, clindamycin, erythromycin, and ciprofloxacin had the most predominant resistance profile (36.1%). Biofilm gene detection indicated a markedly high prevalence of cna (74.7%), clfB (54.2%), clfA (50.6%), fnbA (42.1%), ebp (13.2%), and fnbB (12%). Six different biofilm genetic patterns were identified, wherein clfA, clfB, fnbA, ebp, and cna (30.1%), clfA, clfB, fnbA, fnbB, ebp, and cna (12%), and clfA, clfB, and cna (8.4%) were the top three most frequently identified patterns. Conclusions: The prevalence of biofilm encoding genes, which are associated with multidrug resistance in S. aureus strains isolated from burn patients, is high. Therefore, identification of epidemiology, molecular characteristics, and biofilm management of S. aureus infection in burn units would be helpful.

Download Full-text

Molecular Characterization of Tigecycline Non-Susceptibility among Extensively Drug-Resistant Acinetobacter baumannii Isolates of Clinical Origin

Chemotherapy ◽

10.1159/000515100 ◽

2021 ◽

pp. 1-7

Author(s):

Mehri Haeili ◽

Ali Abdollahi ◽

Amin Ahmadi ◽

Amin Khoshbayan

Keyword(s):

Acinetobacter Baumannii ◽

Molecular Mechanisms ◽

Efflux Pump ◽

Genetic Alterations ◽

Disk Diffusion ◽

Diffusion Method ◽

Transcriptional Level ◽

Drug Resistant ◽

Disk Diffusion Method ◽

Extensively Drug Resistant

Introduction: Tigecycline (TGC) is one of the last-resort therapeutic agents for treating infections caused by extensively drug resistant Acinetobacter baumannii isolates. Although resistance to TGC is not common, non-susceptible A. baumannii (NSAB) isolates have been described. In the current study, we aimed to assess the molecular mechanisms mediating TGC non-susceptibility in 5 clinical isolates of A. baumannii with reduced susceptibility to TGC. Methods: Susceptibility of isolates to TGC as well as various classes of antibiotics was evaluated by broth dilution and disk diffusion methods, respectively. The presence of tetX and tetX1 genes was investigated by PCR. The nucleotide sequences of adeR and adeS genes were assessed by PCR amplicon sequencing. To evaluate the association between reduced susceptibility to TGC and upregulation of AdeABC efflux pump, transcriptional level of adeB gene was quantified by RT-qPCR analysis. Results: All 5 TGC-NSAB isolates had a TGC MIC of ≥4 mg/L and were resistant to all antimicrobials tested by disk diffusion method except for minocycline and doxycycline for which a susceptibility rate of 40% and 20% was observed, respectively. The tetX/X1 genes were not detected in any isolates. All TGC non-susceptible isolates harbored genetic alterations in the adeRS operon, including AdeS G186V, N268H, and D60N and AdeR A136V and V120I substitutions among, which G186V and D60N were predicted by PROVEAN tool analysis as inactivating alterations. Reduced TGC susceptibility was associated with upregulation of AdeABC efflux pump in all TGC non-susceptible isolates. Conclusion: It can be concluded from our results that reduced susceptibility to TGC in the studied isolates was mainly mediated by genetic alterations in the AdeRS system, which resulted in overexpression of AdeABC efflux pump. Emergence of TGC non-susceptibility among isolates that had not been previously exposed to TGC is an issue of great concern.

Download Full-text