Brief report
First survey on antibiotic resistance markers in Enterobacteriaceae in Cochabamba, Bolivia
Primer relevamiento de marcadores de resistencia a antibióticos en Enterobacteriaceae en Cochabamba, Bolivia
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Bars indicate standard deviation (SD).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Leticia A. Fernández, Carolina Ghilardi, Betiana Hoffmann, Carlos Busso, Liliana M. Gallez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Leticia A." "apellidos" => "Fernández" ] 1 => array:2 [ "nombre" => "Carolina" "apellidos" => "Ghilardi" ] 2 => array:2 [ "nombre" => "Betiana" "apellidos" => "Hoffmann" ] 3 => array:2 [ "nombre" => "Carlos" "apellidos" => "Busso" ] 4 => array:2 [ "nombre" => "Liliana M." "apellidos" => "Gallez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754116300864?idApp=UINPBA00004N" "url" => "/03257541/0000004900000001/v1_201704040030/S0325754116300864/v1_201704040030/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0325754116301274" "issn" => "03257541" "doi" => "10.1016/j.ram.2016.09.009" "estado" => "S300" "fechaPublicacion" => "2017-01-01" "aid" => "152" "copyright" => "Asociación Argentina de Microbiología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Argent Microbiol. 2017;49:39-49" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1018 "formatos" => array:3 [ "EPUB" => 55 "HTML" => 633 "PDF" => 330 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "The relationship of <span class="elsevierStyleItalic">Chlamydophila pneumoniae</span> with schizophrenia: The role of brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3) in this relationship" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "39" "paginaFinal" => "49" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papel del factor neurotrófico de origen cerebral y de la neurotropina-3 en la relación de <span class="elsevierStyleItalic">Chlamydophila pneumoniae</span> con la esquizofrenia" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1749 "Ancho" => 3417 "Tamanyo" => 155957 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Side-by-side box-whisker plots of BDNF and NT3 levels of patients with past (PaCP, past <span class="elsevierStyleItalic">C. pneumoniae</span>), persistent (PeCP, persistent <span class="elsevierStyleItalic">C. pneumoniae</span>) <span class="elsevierStyleItalic">C. pneumoniae</span> infection and <span class="elsevierStyleItalic">C. pneumoniae</span> seronegativity (CPS). PaCP, past <span class="elsevierStyleItalic">C. pneumoniae</span> infection; PeCP, persistent <span class="elsevierStyleItalic">C. pneumoniae</span> infection; CPS, <span class="elsevierStyleItalic">C. pneumoniae</span> seronegativity.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fatma Kalayci, Armagan Ozdemir, Suat Saribas, Pelin Yuksel, Sevgi Ergin, Ali Mert Kuskucu, Cana Aksoy Poyraz, Ibrahim Balcioglu, Nihat Alpay, Aykut Kurt, Zeynep Sezgin, Banu Tufan Kocak, Rana Sucu Icel, Gunay Can, Hrisi Bahar Tokman, Bekir Kocazeybek" "autores" => array:16 [ 0 => array:2 [ "nombre" => "Fatma" "apellidos" => "Kalayci" ] 1 => array:2 [ "nombre" => "Armagan" "apellidos" => "Ozdemir" ] 2 => array:2 [ "nombre" => "Suat" "apellidos" => "Saribas" ] 3 => array:2 [ "nombre" => "Pelin" "apellidos" => "Yuksel" ] 4 => array:2 [ "nombre" => "Sevgi" "apellidos" => "Ergin" ] 5 => array:2 [ "nombre" => "Ali Mert" "apellidos" => "Kuskucu" ] 6 => array:2 [ "nombre" => "Cana Aksoy" "apellidos" => "Poyraz" ] 7 => array:2 [ "nombre" => "Ibrahim" "apellidos" => "Balcioglu" ] 8 => array:2 [ "nombre" => "Nihat" "apellidos" => "Alpay" ] 9 => array:2 [ "nombre" => "Aykut" "apellidos" => "Kurt" ] 10 => array:2 [ "nombre" => "Zeynep" "apellidos" => "Sezgin" ] 11 => array:2 [ "nombre" => "Banu Tufan" "apellidos" => "Kocak" ] 12 => array:2 [ "nombre" => "Rana Sucu" "apellidos" => "Icel" ] 13 => array:2 [ "nombre" => "Gunay" "apellidos" => "Can" ] 14 => array:2 [ "nombre" => "Hrisi Bahar" "apellidos" => "Tokman" ] 15 => array:2 [ "nombre" => "Bekir" "apellidos" => "Kocazeybek" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754116301274?idApp=UINPBA00004N" "url" => "/03257541/0000004900000001/v1_201704040030/S0325754116301274/v1_201704040030/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "First survey on antibiotic resistance markers in <span class="elsevierStyleItalic">Enterobacteriaceae</span> in Cochabamba, Bolivia" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "50" "paginaFinal" => "54" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Paola M. Saba Villarroel, Gabriel O. Gutkind, José A. Di Conza, Marcela A. Radice" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Paola M." "apellidos" => "Saba Villarroel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Gabriel O." "apellidos" => "Gutkind" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "José A." "apellidos" => "Di Conza" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:4 [ "nombre" => "Marcela A." "apellidos" => "Radice" "email" => array:2 [ 0 => "mradice@ffyb.uba.ar" 1 => "marcelaradice@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Ciudad Autónoma de Buenos Aires, CP 1113, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad Nacional del Litoral, Facultad de Bioquímica y Ciencias Biológicas, Santa Fe, CP 3000, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Primer relevamiento de marcadores de resistencia a antibióticos en <span class="elsevierStyleItalic">Enterobacteriaceae</span> en Cochabamba, Bolivia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1248 "Ancho" => 1475 "Tamanyo" => 88942 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Antimicrobial susceptibility profiles. CTX, cefotaxime; CAZ: ceftazidime, FOX: cefoxitin, FEP: cefepime, NAL: nalidixic acid, CIP: ciprofloxacin, LEV: levofloxacin, KAN: kanamycin, GEN: gentamicin, AMI: amikacin.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Antibiotic resistance is one of the most challenging problems in modern medicine worldwide. High resistance levels are observed in Latin America, probably due to the widespread, and often inappropriate, use of antibiotics in our region, resulting in ineffective treatments which enhance morbidity and mortality rates.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Third generation cephalosporins (TGC) and quinolones constitute first line antibiotics in enterobacterial infections; however increasing resistance levels are continuously reported. The production of extended spectrum β-lactamases (ESBL) is the most relevant TGC resistance mechanism, being CTX-M-type enzymes prevalent globally (more than 160 different enzymes have already been reported at <a href="http://www.lahey.org/studies/">www.lahey.org/studies/</a>). CTX-M-enzymes are clustered in different groups, CTX-M-1 group, CTX-M-2 group, CTX-M-8 group, CTX-M-9 group and CTX-M-25 group; many of these groups include different allelic variants. CTX-M-15, corresponding to the CTX-M-1 group and CTX-M-14, belonging to the CTX-M-9 group, are by far the most clinically relevant ESBL worlwide<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Spontaneous chromosomal mutations in <span class="elsevierStyleItalic">gyrA</span> and <span class="elsevierStyleItalic">parC</span>, within the quinolone resistance-determining region (QRDR), constitute the main mechanism conferring high level quinolone resistance. Plasmid-mediated quinolone resistance (PMQR) determinants, such as Qnr proteins (A, B, C, D and S), Aac(6′)-Ib-cr enzyme, QepA and OqxAB efflux pumps are increasingly reported<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a>. Even though these markers only provide low level quinolone resistance by themselves, it has been shown that they facilitate the selection of chromosomal mutations in QRDR, <span class="elsevierStyleItalic">in vitro</span><a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">No surveillance studies on resistance markers in clinical isolates have been previously conducted in Cochabamba, Bolivia. The aim of this study was to characterize β-lactam and quinolone resistance mechanisms in TGC resistant <span class="elsevierStyleItalic">Enterobacteriaceae</span>. Therefore, a prospective, observational, descriptive and transversal study was carried out.</p><p id="par0025" class="elsevierStylePara elsevierViewall">All cefotaxime and/or ceftazidime-resistant <span class="elsevierStyleItalic">Enterobacteriaceae</span> recovered from 5 health centers in Cochabamba, Bolivia, from December 2012 to March 2013 were included. Identification was performed by conventional biochemical tests. Antimicrobial susceptibility profiles were determined by disk diffusion and agar dilution methods in accordance with CLSI, 2014.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Total DNA was obtained by boiling bacterial suspensions, and plasmid DNA was extracted by alkaline lysis. Screening of ESBL coding genes, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-1</span> group, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-2</span> group, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-8</span> group, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-9</span> group, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-25</span> group, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-2</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-10</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">PER-2</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">KPC</span> and <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">GES</span>, was performed by simple PCR amplifications. Primers used and the expected amplicon sizes are shown in a supplementary table (Table S1). Plasmid encoded <span class="elsevierStyleItalic">ampC</span> genes<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a> and <span class="elsevierStyleItalic">Escherichia coli</span> phylogenetic groups<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a> were determined by multiplex PCR as previously reported.</p><p id="par0035" class="elsevierStylePara elsevierViewall">PMQR genes (<span class="elsevierStyleItalic">qepA, oqxAB, aac(6’)-Ib-cr, qnr</span> (A, B, C, D, S)) were investigated by PCR amplification using specific primers<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a>. Amplicons identity was assessed by digestion and/or sequencing. Nucleotide sequences were compared with NCBI-BLAST databases. Statistical analysis was performed using the Fisher's exact test (SPSS version 22).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Clonal relatedness was analyzed by REP/ERIC-PCR and dendrograms were constructed using the Treecon 1.3b program. Isolates displaying more than 90% identity were considered to be clonally related.</p><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 101 TGC-resistant enterobacteria, corresponding to <span class="elsevierStyleItalic">E. coli</span> (87), <span class="elsevierStyleItalic">K. pneumoniae</span> (11), <span class="elsevierStyleItalic">C. freundii</span> (1), <span class="elsevierStyleItalic">M. morganii</span> (1) and <span class="elsevierStyleItalic">E. cloacae</span> (1), were recovered. A high proportion of the samples (71.3%) were recovered from women aged between 50 to 80 years old. Eighty five enterobacteria (84.0%) were isolated from urine, 7 from wound secretions, 4 from blood, 4 from tracheal secretions and the remaining from ear secretions. A similar distribution was observed between outpatients and inpatients (49.0% and 51.0%, respectively).</p><p id="par0050" class="elsevierStylePara elsevierViewall">High resistance rates to nalidixic acid, ciprofloxacin, levofloxacin and gentamicin were observed. Eighty five percent of the isolates were not susceptible to ceftazidime and 90% to cefepime. Resistance to cefoxitin, kanamycin and amikacin was less frequent (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">MIC<span class="elsevierStyleInf">50</span> and MIC<span class="elsevierStyleInf">90</span> values were as follows: cefotaxime 128<span class="elsevierStyleHsp" style=""></span>μg/ml and >128<span class="elsevierStyleHsp" style=""></span>μg/ml, ceftazidime 16<span class="elsevierStyleHsp" style=""></span>μg/ml and 128<span class="elsevierStyleHsp" style=""></span>μg/ml, cefepime 8<span class="elsevierStyleHsp" style=""></span>μg/ml and 32<span class="elsevierStyleHsp" style=""></span>μg/ml, nalidixic acid >64<span class="elsevierStyleHsp" style=""></span>μg/ml and ciprofloxacin >32<span class="elsevierStyleHsp" style=""></span>μg/ml.</p><p id="par0060" class="elsevierStylePara elsevierViewall">All isolates were CTX-M producers, 89/101 (88.1%) harbored <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-1</span> group markers corresponding to: <span class="elsevierStyleItalic">E. coli</span> (78), <span class="elsevierStyleItalic">K. pneumoniae</span> (9), <span class="elsevierStyleItalic">E. cloacae</span> (1) and <span class="elsevierStyleItalic">M. morganii</span> (1). Ten isolates carried <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-9</span> group markers belonging to: <span class="elsevierStyleItalic">E. coli</span> (9) and <span class="elsevierStyleItalic">K. pneumoniae</span> (1). The only <span class="elsevierStyleItalic">C. freundii</span> displayed a <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-2</span> group gene, showing a very low prevalence of this marker. Finally, one <span class="elsevierStyleItalic">K. pneumoniae</span> isolate was positive for both <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-1</span> and <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-9</span> group markers. In good agreement with the South American scene, a radical change of the CTX-M-2 group to CTX-M-1 and CTX-M-9 groups was noted<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">3,13,16</span></a>.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Ten randomly selected PCR products were sequenced, those positive for the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-1</span> group were identified as <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, while those positive for the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-9</span> group corresponded to <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-14.</span> Neither the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-8</span> group nor the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-25</span> group were detected. In accordance with CLSI breakpoints, from 89 <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-1</span> group-harboring isolates, 62 (69.7%) were resistant to ceftazidime, 24 (27.0%) were categorized as intermediate and only 3 (3.3%) were categorized as susceptible. Among the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-9</span> group positive isolates, 8/10 were categorized as susceptible to ceftazidime, 1 was categorized as intermediate and the remaining as resistant. <span class="elsevierStyleItalic">C. freundii</span> harboring the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-2</span> group was categorized as intermediate to this agent.</p><p id="par0070" class="elsevierStylePara elsevierViewall">A <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>like marker was detected in 70/101 (69.3%) ESBL-producing isolates, mainly in those carrying <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-1</span> group markers (68/89, 76.4%). Sequenced amplicons corresponded 100% to <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1.</span> None of the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-9</span> group positive isolates rendered positive amplification for <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1.</span> The association of <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-1</span> group markers with <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span> was confirmed in this study (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). Neither the presence of plasmidic AmpC coding genes nor <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-2</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-10</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">PER-2</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">KPC</span> and <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">GES</span> were detected.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Fifty eight from 87 <span class="elsevierStyleItalic">E. coli</span> isolates (67.0%) belonged to phylogenetic group B2, 17.0% to group A and 16.0% to group D. The CTX-M-1 group producers were mostly associated with the phylogenetic group B2 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01), followed by A and D. CTX-M-9 group producers were mainly associated with phylogenetic group D, followed by A and B2.</p><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> describes the different PMQR detected in this study. The <span class="elsevierStyleItalic">aac(6′)-Ib-cr</span> gene was present in 83.0% of the isolates, being the most prevalent PMQR determinant among the studied enterobacteria. Other less common markers were also identified. The CTX-M-9 group producers did not harbor any of the analyzed PMQR.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Among Qnr proteins, only <span class="elsevierStyleItalic">qnrB</span> determinants were detected, corresponding to <span class="elsevierStyleItalic">qnrB1</span> (5) and <span class="elsevierStyleItalic">qnrB19</span> (1). Plasmid-mediated efflux pumps were identified in 7 <span class="elsevierStyleItalic">E. coli</span> isolates corresponding to phylogenetic group B2. A single isolate carried <span class="elsevierStyleItalic">oqxAB</span> while the other 6 harbored <span class="elsevierStyleItalic">qepA1.</span> The latter isolates also harbored <span class="elsevierStyleItalic">aac(6′)-Ib-cr</span> and <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, however they clustered in three different groups in accordance with REP-PCR profiles (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Each cluster contains isolates collected from different health centers.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">All enterobacteria included in this study were ESBL producers, corresponding to different CTX-M groups. In this work, CTX-M-1 group enzymes were prevalent in good agreement with different studies conducted by Bartoloni et al. in the Bolivian Chaco (in healthy children and urinary tract infection samples), and also with other recent studies carried in other South American countries<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">2,3,13,16</span></a>.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Although all isolates were cefotaximase producers, 10.9% and 9.9% were categorized as susceptible to ceftazidime in accordance with the current breakpoints of the CLSI and EUCAST, respectively. Ceftazidime susceptible isolates were strongly associated with the production of CTX-M-9 group ESBLs (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p><p id="par0100" class="elsevierStylePara elsevierViewall">Most CTX-M-15-producing <span class="elsevierStyleItalic">E. coli</span> belong to phylogenetic group B2. These strains display a high virulence potential and have been mainly associated with ST 131 constituting a major public health problem worldwide<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">2,4,13,16</span></a>. Accordingly, in this study, CTX-M-1 group enzymes were strongly associated with phylogroup B2 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). However, in Venezuela it was reported that phylogenetic group A was prevalent among CTX-M-15-producing uropathogenic <span class="elsevierStyleItalic">E. coli</span> isolates<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a>.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Different PMQR markers were identified, with <span class="elsevierStyleItalic">aac(6′)-Ib-cr</span> by large as the most predominant. This variant has been reported in previous studies performed in different Latin American countries such as Argentina, Brazil, Chile, Mexico, Peru and Uruguay<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">5,9,14,16</span></a>. A higher <span class="elsevierStyleItalic">aac(6′)-Ib-cr</span> rate was observed in this study with respect to previous reports in Bolivia; nevertheless comparisons between these studies should be performed carefully due to the different bacterial selection criteria used<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Among the <span class="elsevierStyleItalic">qnrB</span> genes detected, <span class="elsevierStyleItalic">qnrB1</span> was dominant, in agreement with studies conducted in Mexico and Brazil<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">14,15</span></a>. Moreover, in previous studies conducted in Bolivia and Argentina <span class="elsevierStyleItalic">qnrB19</span>, <span class="elsevierStyleItalic">qnrB10</span> and <span class="elsevierStyleItalic">qnrB2</span> genes<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">7,9</span></a> were reported. To the best of our knowledge, this constitutes the first report of <span class="elsevierStyleItalic">qnrB1</span> in Bolivia, and even the description of its association with <span class="elsevierStyleItalic">aac(6′)-Ib-cr</span> and <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-1</span> group resistance determinants in <span class="elsevierStyleItalic">E. coli</span> isolated from clinical samples.</p><p id="par0115" class="elsevierStylePara elsevierViewall">There are few reports of plasmid-mediated fluoroquinolone efflux pumps in Latin America. In good agreement with studies performed in Bolivia and Mexico, <span class="elsevierStyleItalic">qepA1</span> was detected in CTX-M-15-producing <span class="elsevierStyleItalic">E. coli</span> isolates<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">2,14</span></a>. The <span class="elsevierStyleItalic">qepA</span> gene was also described in CTX-M-14 producing <span class="elsevierStyleItalic">E. coli</span> clinical isolates in Peru, and in CTX-M-2 producing <span class="elsevierStyleItalic">E. coli</span> in Colombia (Rincón Cruz G., PhD. Thesis, 2015); however, in Argentina <span class="elsevierStyleItalic">qepA</span>1 was found in non-ESBL producing <span class="elsevierStyleItalic">E. coli</span><a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a>.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Finally, regarding efflux pump OqxAB, which is uncommon in enterobacteria other than <span class="elsevierStyleItalic">K. pneumoniae</span>, 1 isolate of <span class="elsevierStyleItalic">E. coli</span> carrying <span class="elsevierStyleItalic">oqxAB</span> was identified, being the first report in Bolivia and one of the first descriptions in Latin America. Recently 3<span class="elsevierStyleItalic">oqxAB-</span> positive <span class="elsevierStyleItalic">E. coli</span> were detected in Peru and 1 in Argentina<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,11</span></a>.</p><p id="par0125" class="elsevierStylePara elsevierViewall">This study constitutes the first molecular survey on β-lactam and quinolone resistance markers in clinical isolates of <span class="elsevierStyleItalic">Enterobactericeae</span>, in Cochabamba, Bolivia. These results contribute to the regional knowledge of the epidemiological situation regarding the resistance to frequently used antibiotics. The molecular epidemiology of CTX-M-enzymes and its association with PMQR, mainly <span class="elsevierStyleItalic">aac(6′)-Ib-cr</span>; observed herein resembles the scene reported recently in South America.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Ethical responsibilities</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Protection of human and animal subjects</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Confidentiality of data</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Right to privacy and informed consent</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors claim that they have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres824207" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec820700" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres824206" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec820699" "titulo" => "Palabras clave" ] 4 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 5 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 6 => array:2 [ "identificador" => "xack276422" "titulo" => "Acknowledgements" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-04-04" "fechaAceptado" => "2016-10-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec820700" "palabras" => array:5 [ 0 => "CTX-M" 1 => "QnrB" 2 => "QepA" 3 => "OqxAB" 4 => "Bolivia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec820699" "palabras" => array:5 [ 0 => "CTX-M" 1 => "QnrB" 2 => "QepA" 3 => "OqxAB" 4 => "Bolivia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A molecular survey was conducted in Cochabamba, Bolivia, to characterize the mechanism involved in the resistance to clinically relevant antibiotics. Extended Spectrum β-lactamase encoding genes and plasmid-mediated quinolone resistance (PMQR) markers were investigated in a total of 101 oxyimino-cephalosporin-resistant enterobacteria recovered from different health centers during four months (2012–2013). CTX-M enzymes were detected in all isolates, being the CTX-M-1 group the most prevalent (88.1%). The presence of <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span> was detected in 76.4% of these isolates. A high quinolone resistance rate was observed among the included isolates. The <span class="elsevierStyleItalic">aac(6′)-Ib-cr</span> gene was the most frequent PMQR identified (83.0%). Furthermore, 6 isolates harbored the <span class="elsevierStyleItalic">qnrB</span> gene. Interestingly, <span class="elsevierStyleItalic">qepA1</span> (6) and <span class="elsevierStyleItalic">oqxAB</span> (1), were detected in 7 <span class="elsevierStyleItalic">Escherichia coli</span>, being the latter the first to be reported in Bolivia. This study constitutes the first molecular survey on resistance markers in clinical enterobacterial isolates in Cochabamba, Bolivia, contributing to the regional knowledge of the epidemiological situation. The molecular epidemiology observed herein resembles the scene reported in South America.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Se llevó a cabo un relevamiento molecular de la resistencia a antibióticos de importancia clínica en aislamientos recuperados en Cochabamba, Bolivia. Se estudiaron los genes codificantes de β-lactamasas de espectro extendido y de resistencia a quinolonas de localización plasmídica (PMQR) en un total de 101 aislamientos de enterobacterias resistentes a oximinocefalosporinas recuperados en distintos centros de salud, durante 4 meses (2012-2013). En todos ellos se detectó la presencia de cefotaximasas, las CTX-M grupo 1 fueron las más prevalentes (88,1%). La presencia de <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">OXA-1</span></span> se detectó en el 76,4% de estos aislamientos. Se observó una elevada proporción de aislamientos resistentes a quinolonas. El gen <span class="elsevierStyleItalic">aac(6′)-Ib-cr</span> fue el determinante PMQR más frecuentemente identificado (83%). Además, 6 aislamientos resultaron ser portadores de <span class="elsevierStyleItalic">qnrB</span>. Por otro lado, cabe remarcar que 7 <span class="elsevierStyleItalic">Escherichia coli</span> presentaron <span class="elsevierStyleItalic">qepA1</span> (6) y <span class="elsevierStyleItalic">oqxAB</span> (1); se documenta así por primera vez la presencia de <span class="elsevierStyleItalic">oqxAB</span> en Bolivia. Este estudio constituye el primer relevamiento de marcadores de resistencia en aislamientos clínicos de enterobacterias en Cochabamba, Bolivia; de este modo se contribuye al conocimiento regional de la situación epidemiológica, la cual presenta un escenario similar al observado en el resto de Latinoamérica.</p></span>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0170" class="elsevierStylePara elsevierViewall">The following is the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0040" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1248 "Ancho" => 1475 "Tamanyo" => 88942 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Antimicrobial susceptibility profiles. CTX, cefotaxime; CAZ: ceftazidime, FOX: cefoxitin, FEP: cefepime, NAL: nalidixic acid, CIP: ciprofloxacin, LEV: levofloxacin, KAN: kanamycin, GEN: gentamicin, AMI: amikacin.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 504 "Ancho" => 1480 "Tamanyo" => 30095 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Dendrogram of REP-PCR profiles of <span class="elsevierStyleItalic">qepA</span>-positive isolates. Sample origin<span class="elsevierStyleHsp" style=""></span>—<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSup">q1</span>: inpatient, health center A, urine sample; <span class="elsevierStyleSup">q2</span>: outpatient, health center A, urine sample; <span class="elsevierStyleSup">q3</span>: outpatient, health center B, urine sample; <span class="elsevierStyleSup">q4</span>: outpatient, health center B, urine sample; <span class="elsevierStyleSup">q5</span>: inpatient, health center B, secretion; <span class="elsevierStyleSup">q6</span>: inpatient, health center C, urine sample.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PMQR (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Enterobacteriaceae</span> (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CTX-M \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">E. coli</span> phylogenetic group (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="center" valign="middle"><span class="elsevierStyleItalic">aac(6</span>′)<span class="elsevierStyleItalic">-Ib-cr</span> (73)</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">E. coli (64)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CTX-M-1 group \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B2 (48), A (9), D (7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">K. pneumoniae (7)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CTX-M-1 group \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">M. morganii (1)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CTX-M-1 group \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">C. freundii (1)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CTX-M-2 group \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">aac(6</span>′)<span class="elsevierStyleItalic">-Ib-cr</span><span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">qepA1</span> (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">E. coli</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CTX-M-1 group \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B2 (6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">aac(6</span>′)<span class="elsevierStyleItalic">-Ib-cr</span><span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">qnrB1</span> (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">E. coli</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CTX-M-1 group \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B2 (2), A (1), D (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">aac(6</span>′)<span class="elsevierStyleItalic">-Ib-cr</span><span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">qnrB19</span> (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">K. pneumoniae</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CTX-M-1 group \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">oqxAB (1)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">E. coli</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CTX-M-1 group \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B2 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">qnrB1 (1)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">E. cloacae</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CTX-M-1 group \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1385770.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Main features of the PMQR producing enterobacterial isolates.</p>" ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 86736 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "First report of <span class="elsevierStyleItalic">oqxAB</span> in clinical <span class="elsevierStyleItalic">Escherichia coli</span> from Argentina" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. 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GG, MR and JDC are members of CONICET.</p> <p id="par0160" class="elsevierStylePara elsevierViewall">We would like to thank Mirtha Villarroel García, Virginia Aguilar, Tatiana Pimentel, Leovegildo Álvarez, Norah Balderrama for their help in collecting the samples and Giovanna Rincón for her technical assistance and collaboration.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/03257541/0000004900000001/v1_201704040030/S0325754116300955/v1_201704040030/en/main.assets" "Apartado" => array:4 [ "identificador" => "44540" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Agentes antimicrobianos" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03257541/0000004900000001/v1_201704040030/S0325754116300955/v1_201704040030/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754116300955?idApp=UINPBA00004N" ]
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| 2020 March | 14 | 3 | 17 |
| 2020 February | 27 | 14 | 41 |
| 2020 January | 12 | 13 | 25 |
| 2019 December | 14 | 6 | 20 |
| 2019 November | 9 | 13 | 22 |
| 2019 October | 18 | 1 | 19 |
| 2019 September | 17 | 6 | 23 |
| 2019 August | 10 | 44 | 54 |
| 2019 July | 23 | 53 | 76 |
| 2019 June | 46 | 30 | 76 |
| 2019 May | 105 | 41 | 146 |
| 2019 April | 47 | 30 | 77 |
| 2019 March | 9 | 3 | 12 |
| 2019 February | 16 | 4 | 20 |
| 2019 January | 8 | 3 | 11 |
| 2018 December | 8 | 6 | 14 |
| 2018 November | 9 | 3 | 12 |
| 2018 October | 15 | 19 | 34 |
| 2018 September | 27 | 5 | 32 |
| 2018 August | 7 | 2 | 9 |
| 2018 July | 11 | 12 | 23 |
| 2018 June | 6 | 2 | 8 |
| 2018 May | 7 | 9 | 16 |
| 2018 April | 24 | 2 | 26 |
| 2018 March | 49 | 4 | 53 |
| 2018 February | 7 | 2 | 9 |
| 2018 January | 5 | 4 | 9 |
| 2017 December | 12 | 7 | 19 |
| 2017 November | 7 | 2 | 9 |
| 2017 October | 15 | 5 | 20 |
| 2017 September | 9 | 8 | 17 |
| 2017 August | 5 | 9 | 14 |
| 2017 July | 6 | 5 | 11 |
| 2017 June | 10 | 10 | 20 |
| 2017 May | 21 | 16 | 37 |
| 2017 April | 18 | 10 | 28 |
| 2017 March | 3 | 31 | 34 |
| 2017 February | 8 | 7 | 15 |
| 2017 January | 6 | 11 | 17 |
| 2016 December | 1 | 6 | 7 |
Show all
