Brief report
Characterization of third generation cephalosporin-resistant Escherichia coli clinical isolates from Ushuaia, Argentina
Caracterización de aislamientos clínicos de Escherichia coli resistente a cefalosporinas de tercera generación de Ushuaia, Argentina
Ivan Gramundia, Ezequiel Albornozb, Manuel Boutureiraa, Melina Rapoportb, Sonia Gomezb,c, Alejandra Corsob, Gabriel Castroa, Diego Facconeb,c,
Corresponding author
a Laboratorio de Microbiología, Hospital Regional Ushuaia, Ushuaia, Tierra del Fuego, Argentina
b Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas-ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
c Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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Assessment of risk factors and spatial analysis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:3 [ 0 => "en" 1 => "en" 2 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "49" "paginaFinal" => "59" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Seroprevalencia de leptospirosis humana en una comunidad rural del partido de Tandil (Argentina). Identificación de los factores de riesgo y del análisis espacial" ] ] "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" => 1224 "Ancho" => 1340 "Tamanyo" => 333313 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Spatial clusters detected with higher risk of infection with <span class="elsevierStyleItalic">Leptospira</span> spp., and of the presence of the main risk factors.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Julia A. Silva, Exequiel A. Scialfa, Matías Tringler, Marcelo G. Rodríguez, Adela Tisnés, Santiago Linares, Mariana A. Rivero" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Julia A." "apellidos" => "Silva" ] 1 => array:2 [ "nombre" => "Exequiel A." "apellidos" => "Scialfa" ] 2 => array:2 [ "nombre" => "Matías" "apellidos" => "Tringler" ] 3 => array:2 [ "nombre" => "Marcelo G." "apellidos" => "Rodríguez" ] 4 => array:2 [ "nombre" => "Adela" "apellidos" => "Tisnés" ] 5 => array:2 [ "nombre" => "Santiago" "apellidos" => "Linares" ] 6 => array:2 [ "nombre" => "Mariana A." "apellidos" => "Rivero" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Highlights" "clase" => "author-highlights" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0005" class="elsevierStylePara elsevierViewall">Epidemiologic and spatial analysis of leptospirosis can be applied in human population.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall">Information about leptospirosis in rural areas is scarce.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">Preventive measures can be applied for human leptospirosis from rural areas.</p></li></ul></p></span>" ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754122000335?idApp=UINPBA00004N" "url" => "/03257541/0000005500000001/v1_202303161058/S0325754122000335/v1_202303161058/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S032575412200058X" "issn" => "03257541" "doi" => "10.1016/j.ram.2022.07.001" "estado" => "S300" "fechaPublicacion" => "2023-01-01" "aid" => "509" "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. 2023;55:25-42" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Antimicrobial resistance dissemination associated with intensive animal production practices in Argentina: A systematic review and meta-analysis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:3 [ 0 => "en" 1 => "en" 2 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "25" "paginaFinal" => "42" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diseminación de la resistencia a antimicrobianos asociada a prácticas de producción animal intensiva en Argentina: Una revisión sistemática y metaanálisis" ] ] "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" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2079 "Ancho" => 2508 "Tamanyo" => 350027 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Flow diagram of selected studies included in the systematic review and meta-analyses.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Barbara Prack McCormick, María P. Quiroga, Verónica E. Álvarez, Daniela Centrón, Pablo Tittonell" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Barbara" "apellidos" => "Prack McCormick" ] 1 => array:2 [ "nombre" => "María P." "apellidos" => "Quiroga" ] 2 => array:2 [ "nombre" => "Verónica E." "apellidos" => "Álvarez" ] 3 => array:2 [ "nombre" => "Daniela" "apellidos" => "Centrón" ] 4 => array:2 [ "nombre" => "Pablo" "apellidos" => "Tittonell" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Highlights" "clase" => "author-highlights" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0005" class="elsevierStylePara elsevierViewall">AMR and multidrug resistance associated with the animal and the production system.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall">Higher prevalence of AMR in swine and chicken, and intensive production.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">Lower prevalence of AMR in cattle, and in extensive production/family farming.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0020" class="elsevierStylePara elsevierViewall">There is a research gap regarding prevalence of AMR in beef-cattle from feedlot.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0025" class="elsevierStylePara elsevierViewall">Need for restriction of highest priority antimicrobials in food-producing animals.</p></li></ul></p></span>" ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S032575412200058X?idApp=UINPBA00004N" "url" => "/03257541/0000005500000001/v1_202303161058/S032575412200058X/v1_202303161058/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Characterization of third generation cephalosporin-resistant <span class="elsevierStyleItalic">Escherichia coli</span> clinical isolates from Ushuaia, Argentina" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "43" "paginaFinal" => "48" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ivan Gramundi, Ezequiel Albornoz, Manuel Boutureira, Melina Rapoport, Sonia Gomez, Alejandra Corso, Gabriel Castro, Diego Faccone" "autores" => array:8 [ 0 => array:3 [ "nombre" => "Ivan" "apellidos" => "Gramundi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Ezequiel" "apellidos" => "Albornoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Manuel" "apellidos" => "Boutureira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Melina" "apellidos" => "Rapoport" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Sonia" "apellidos" => "Gomez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Alejandra" "apellidos" => "Corso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "Gabriel" "apellidos" => "Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:4 [ "nombre" => "Diego" "apellidos" => "Faccone" "email" => array:1 [ 0 => "dfaccone@anlis.gob.ar" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Laboratorio de Microbiología, Hospital Regional Ushuaia, Ushuaia, Tierra del Fuego, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas-ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Caracterización de aislamientos clínicos de <span class="elsevierStyleItalic">Escherichia coli</span> resistente a cefalosporinas de tercera generación de Ushuaia, Argentina" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Escherichia coli</span> is one of the main human pathogens causing both hospital- and community-acquired infections. <span class="elsevierStyleItalic">E. coli</span> mostly cause uncomplicated urinary tract infections (UTIs), however some of them evolve to complicated infections such as upper UTI, sepsis or meningitis. Globally, the SMART study points to <span class="elsevierStyleItalic">E. coli</span> as the gram negative bacilli most frequently implicated in intra-abdominal infections and urinary tract infections.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a> In Latin America, the SENTRY study reports <span class="elsevierStyleItalic">E. coli</span> in cases of sepsis and soft skin infections with a prevalence of 19% and 19.7% respectively.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">E. coli</span> resistant to β-lactams, particularly to third-generation cephalosporins (TGCs), represent a major global public health concern. TGCs are used to treat <span class="elsevierStyleItalic">E. coli</span> causing UTIs, bloodstream infections and intra-abdominal infections. In many cases resistance to TGCs is accompanied by resistance to other antimicrobials used for therapy leaving few treatment options. Resistance to TGCs in <span class="elsevierStyleItalic">E. coli</span> can be mediated by different mechanisms, including chromosomally encoded AmpC β-lactamase hyperproduction, increased efflux or reduced outer membrane permeability, however the two main relevant mechanisms are plasmid-mediated extended-spectrum β-lactamases (ESBLs) or plasmid-mediated AmpCs enzymes.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a> There are currently a large number of ESBLs described among <span class="elsevierStyleItalic">E. coli</span> isolates, being CTX-M the most detected family. More than 230 CTX-M variants have been reported, nevertheless CTX-M-2, CTX-M-9, CTX-M-14 and CTX-M-15 are the most frequently described enzymes among <span class="elsevierStyleItalic">Enterobacterales</span><a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a>(<a href="https://www.ncbi.nlm.nih.gov/pathogens/refgene/">https://www.ncbi.nlm.nih.gov/pathogens/refgene/ - ctx-m</a>; last accession 04.19.22).</p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">E. coli</span> sequence type 131 (ST131) is a globally disseminated multidrug-resistant (MDR) clone responsible for different human infections including UTI and bloodstream infections.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a> This clone belongs to phylogroup B2 and was successfully spread worldwide. Its main characteristics include the expression of resistance determinants to multiple drugs, including the production of CTX-M-15 ESBL and resistance to fluoroquinolones by chromosomal mutations, and the acquisition of virulence genes, where the possession of the type 1 fimbriae FimH30 allele is common.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a> In addition to <span class="elsevierStyleItalic">E. coli</span> ST131, other relevant ESBL-producing <span class="elsevierStyleItalic">E. coli</span> clones, such as ST10, ST38, ST405, and ST648, were associated with human infections.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">2,13</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In Argentina, Marchisio et al. analyzed 71 <span class="elsevierStyleItalic">Enterobacterales</span> recovered from outpatient urine cultures in two health institutions from Santa Fe city during July 2010.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> Among 63 <span class="elsevierStyleItalic">E. coli</span> isolates, only one (1.6%) showed resistance to TGC mediated by CMY-2 plasmidic-AmpC. In another study carried out during October 2010 in 15 hospitals from three regions of Argentina, a total of 1120 <span class="elsevierStyleItalic">E. coli</span> clinical isolates were analyzed, detecting resistance to TGC in 64 strains (5.7%).<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> Among 13 selected <span class="elsevierStyleItalic">E. coli</span> isolates, 7 harbored <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, 3 of them <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-2</span>, and the remaining 3 encoded <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-14</span>.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> In an additional study performed between November 2012 and April 2013, a total of 3105 community urine samples from adult male patients from a health care institution were analyzed.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a> A total of 374 <span class="elsevierStyleItalic">E. coli</span> isolates were recovered and a frequency of 15.2% of ESBL-producing strains was detected, although no molecular characterization was performed to describe the genes involved.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a> Additionally, according to the WHONET-Argentina network, the national rate of resistance to TGCs among community-onset <span class="elsevierStyleItalic">E. coli</span> infections for the year 2015 was 5.3%.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The city of Ushuaia is located in the Isla Grande archipelago, a very important tourist spot. In 2015, Ushuaia had a stable population of <70<span class="elsevierStyleHsp" style=""></span>000 people and received around 400<span class="elsevierStyleHsp" style=""></span>000 national and international tourists (<a href="https://turismoushuaia.com/wp-content/uploads/2018/05/sintesis-2015.pdf">https://turismoushuaia.com/wp-content/uploads/2018/05/sintesis-2015.pdf</a>). A lack of information and studies about the epidemiology of TGC resistance in this city was observed. Therefore<span class="elsevierStyleBold">,</span> the objective of the present work was to characterize and describe TGC-resistant <span class="elsevierStyleItalic">E. coli</span> clinical isolates in the southernmost city of Argentina.</p><p id="par0055" class="elsevierStylePara elsevierViewall">A prospective, descriptive study was performed at the Microbiology Laboratory of Hospital Regional Ushuaia between January 2013 and March 2015. All <span class="elsevierStyleItalic">E. coli</span> isolates were obtained from non-repetitive cultures from inpatients and outpatients. The isolates were recovered from urine, blood, respiratory materials, skin and soft tissue, puncture fluids and prosthetic material. Screening cultures were excluded from the study. Epidemiological data, age and sex were analyzed. Species identification was performed by conventional biochemical methods in accordance to the Manual of Clinical Microbiology. Antimicrobial susceptibility was evaluated by the Kirby-Bauer agar diffusion method, according to CLSI guidelines M100-S23.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> The antimicrobials tested were defined by the WHONET Argentina Network protocol. Isolates were classified as suspicious of ESBL-production, displaying inhibition halos ≤27<span class="elsevierStyleHsp" style=""></span>mm to cefotaxime and/or ≤22<span class="elsevierStyleHsp" style=""></span>mm to ceftazidime, and were selected for further characterization. Phenotypic ESBL production was confirmed when there was a positive synergistic effect between discs of amoxicillin-clavulanic acid (10/20<span class="elsevierStyleHsp" style=""></span>μg) and cefotaxime (30<span class="elsevierStyleHsp" style=""></span>μg), or ceftazidime (30<span class="elsevierStyleHsp" style=""></span>μg). PCR was performed to detect the following genes: <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">PER-2</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV</span> and <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CMY</span>.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M</span> genes were classified using PCR to differentiate among the following CTX-M groups: <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-2</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-1/15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-8/25</span>, and <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-9/14</span>.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM</span> gene was amplified and sequenced using the Sanger sequencing method. The presence of clinically relevant <span class="elsevierStyleItalic">E. coli</span> clones from humans was evaluated by multiplex PCR to detect ST69, ST73, ST95, and ST131 clones.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a> Whole-genome sequencing of selected strains was performed, using DNA extracted with QIAcube, using the QIAamp1 DNA Mini Kit (Qiagen) and sequenced on an Illumina-MiSeq sequencer. Paired-end reads were trimmed with Trim Galore (V.0.6.3) and analyzed for quality with FASTQC (V.0.11.5). Kraken2 (V.2.0.7-beta) was used to confirm the species. Reads were de novo assembled with Spades ensambler running under Unicycler (v0.4.8-beta) and its quality was evaluated with QUAST (V.5.0.2). The annotation of the genomes was done with Prokka (V.1.14.0). ARIBA was run to determine resistance genes (ResFinder, V.2.14.4). Sequence types (Achtman scheme) for each genome was determined by running ARIBA sequence type (MLST, V.2.14.6) and clonal complexes (CC) were obtained by submitting trimmed reads to Enterobase. The <span class="elsevierStyleItalic">fimH</span> gene, encoding the type 1 fimbriae adhesin, was characterized using fimTyper from the Center of Genomic Epidemiology (<a href="http://www.genomicepidemiology.org/">http://www.genomicepidemiology.org/</a>). The phylogroup assignment was performed in silico according to the Clermont PCR method using the command line tool.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">During the period from January 2013 to March 2015 a total of 1632 <span class="elsevierStyleItalic">E. coli</span> isolates were recovered at the Hospital Regional de Ushuaia, Tierra del Fuego province. Nearly two percent (32/1632; 1.96%) of the isolates were resistant to TGC and suspected to be ESBL producers. Most suspected isolates were recovered from urine (31/32: 97%), and one from the peritoneal cavity. The age of the patients ranged from 5 and 84 years, and 87% of them were women. Twenty-seven (84%) isolates were from outpatients while five patients had over 48<span class="elsevierStyleHsp" style=""></span>h of hospitalization at the time of sampling.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Among the 32 <span class="elsevierStyleItalic">E. coli</span> isolates, 91% showed resistance to cefotaxime and 28% to ceftazidime. Twenty-seven (84%) <span class="elsevierStyleItalic">E. coli</span> were phenotypically confirmed as ESBL-producers, therefore the rate of ESBL-producing <span class="elsevierStyleItalic">E. coli</span> from Ushuaia reached 1.65%. The five ESBL-negative <span class="elsevierStyleItalic">E. coli</span> isolates were positive for the plasmid-borne <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CMY</span> gene. Among the 27 ESBL-producer isolates, 26 were positive for <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M</span> gene and one was only positive for <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM</span> gene. <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M</span> genes were grouped according to their nucleotide sequence similarity as follows: CTX-M-1/15 (n: 13; 54%); CTX-M-9/14 (n: 6; 25%); CTX-M-2 (n: 4; 17%); and CTX-M-1/15 plus CTX-M-9/14 (n: 1; 4%), while two isolates were not viable for further studies. The dissociated TGC phenotype, displaying resistance to cefotaxime and susceptibility to ceftazidime, is related to the strong cefotaximase activity of CTX-M family ESBLs, as previously described.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> The TEM-producer <span class="elsevierStyleItalic">E. coli</span> isolate showed a low-level ESBL activity profile and was confirmed by sequencing as ESBL TEM-19. Additional resistance to ampicillin-sulbactam (78%), ciprofloxacin (75%), trimethoprim-sulfomethoxazole (65%), cefoxitin (22%), and nitrofurantoin (19%) were also observed. No resistance to carbapenems was observed.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Among the 30 available isolates, 12 (40%) were identified as ST131 and one as ST69. Nine out of twelve (75%) <span class="elsevierStyleItalic">E. coli</span> ST131 isolates were positive for the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-1/15</span> group, one for <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-2</span>, one for <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-9/14</span>, and one for ESBL <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-19</span>. The ST69 isolate was positive for the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-2</span> group.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Considering that the CTX-M-1/15-group was the most prevalent ESBL, seven <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-1/15</span>-positive <span class="elsevierStyleItalic">E. coli</span> isolates (ECO1 to ECO7) were selected for the whole-genome sequencing analysis (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Four of these strains were confirmed as ST131 (ECO3, ECO4, ECO6 and ECO7), two isolates (ECO1 and ECO2) were typed as ST617 (clonal complex 10) and one (ECO5) as ST405 (CC405). The <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> allele was confirmed by sequencing in all seven isolates. The four ST131-CTX-M-15 producing <span class="elsevierStyleItalic">E. coli</span> isolates harbored additional resistance genes: <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">mph(A)</span>, <span class="elsevierStyleItalic">aac(6</span>′)<span class="elsevierStyleItalic">-Ib-cr</span>, <span class="elsevierStyleItalic">tetA</span>, <span class="elsevierStyleItalic">catB3</span>, <span class="elsevierStyleItalic">sul1</span> and <span class="elsevierStyleItalic">qacE</span> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Further resistance genes were found in some of the four ST131 isolates (n): <span class="elsevierStyleItalic">aadA5</span> (3), <span class="elsevierStyleItalic">dfrA17</span> (3), <span class="elsevierStyleItalic">aac(3)-IIa</span> (3), <span class="elsevierStyleItalic">aadA1</span> (1), <span class="elsevierStyleItalic">ant(2</span>″<span class="elsevierStyleItalic">)-Ia</span> (1), <span class="elsevierStyleItalic">cmlA1</span> (1) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). All these four ST131-CTX-M-15 producing isolates exhibited the same mutations at the quinolone-resistance determining regions (QRDRs): Ser83Leu and Asp87Asn of <span class="elsevierStyleItalic">gyrA</span> gene, plus Ser80Ile and Glu84Val of <span class="elsevierStyleItalic">parC</span> gene, and Ile529Leu of <span class="elsevierStyleItalic">parE</span> gene. Additionally, these four ST131 isolates were <span class="elsevierStyleItalic">in silico</span> serotyped as O25:H4 and three of them were typed as fimH30, while the remaining one was 98.65% related to fimH1516 <a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a>(<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The two <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>-producing ST617 <span class="elsevierStyleItalic">E. coli</span> isolates harbored the following acquired resistance genes, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">mph(A)</span>, <span class="elsevierStyleItalic">aac(6</span>′<span class="elsevierStyleItalic">)-Ib-cr</span>, <span class="elsevierStyleItalic">aadA5</span>, <span class="elsevierStyleItalic">tetB</span>, <span class="elsevierStyleItalic">catB3</span>, <span class="elsevierStyleItalic">dfrA17</span>, <span class="elsevierStyleItalic">sul1</span> and <span class="elsevierStyleItalic">qacE</span> genes, while ECO2 isolate additionally harbored <span class="elsevierStyleItalic">tetA</span>, <span class="elsevierStyleItalic">aac(3)-IIa</span>, <span class="elsevierStyleItalic">aph(3</span>″<span class="elsevierStyleItalic">)-Ib</span>, <span class="elsevierStyleItalic">aph(6)-Id</span> and <span class="elsevierStyleItalic">sul2</span> genes (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). These isolates showed the following QRDR mutations: Ser83Leu and Asp87Asn of <span class="elsevierStyleItalic">gyrA</span> gene, Ser80Ile of <span class="elsevierStyleItalic">parC</span> gene, and Ser458Ala of <span class="elsevierStyleItalic">parE</span> gene. These two strains, ECO1 and ECO2, were serotyped as O101:H10 but with an untyped <span class="elsevierStyleItalic">fim</span> gene. The ECO5 (ST405) isolate harbored <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">mph(A)</span>, <span class="elsevierStyleItalic">tetB</span>, <span class="elsevierStyleItalic">aadA5</span>, <span class="elsevierStyleItalic">aac(3)-IIa</span>, <span class="elsevierStyleItalic">dfrA17</span>, <span class="elsevierStyleItalic">sul1</span> and <span class="elsevierStyleItalic">qacE</span> genes, and showed the same mutations in the QRDR as ST617 strains (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). This strain was serotyped asO102: H6 and showed the fimH27 allele. Additionally, according to the phylogroup analysis, all four <span class="elsevierStyleItalic">E. coli</span> ST131 (CC131) isolates belonged to phylogroup B2, while both ST617 (CC10) belonged to phylogroup A, and <span class="elsevierStyleItalic">E. coli</span> ST405 (CC405) to phylogroup D.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Resistance to TGCs and carbapenems in <span class="elsevierStyleItalic">E. coli</span> is a global public health concern, therefore the prompt detection and characterization of mechanisms involved and the clones associated with the dissemination is essential. Global, regional and local studies are necessary to increase the information about this pathogen. During the period January 2013 to March 2015, 1.96% of <span class="elsevierStyleItalic">E. coli</span> clinical isolates, mainly recovered from urine samples of outpatients in Ushuaia, showed resistance to TGCs. This rate was quite lower than that of other contemporary reports <a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10,16,17</span></a>and the results of the National surveillance (WHONET-Argentina network) for the year 2015, where the percentage of resistance to TGCs among community-onset <span class="elsevierStyleItalic">E. coli</span> infections was 5.3%.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The main mechanism of resistance to TGC was mediated by ESBL production, particularly CTX-M. The CTX-M-1/15 group was the most commonly detected followed by the CTX-M-9/14 and CTX-M-2 groups. The proportion among the CTX-M-groups was similar to a previous report from Argentina, where CTX-M-1/15 enzymes represented >50% of ESBL-producing <span class="elsevierStyleItalic">E. coli</span> isolates.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> In Ushuaia, urinary tract infections by ESBL-producer organisms are treated with piperacillin-tazobactam or carbapenems.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Plasmid-borne <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CMY</span> gene, which was detected in five ESBL-negative TGC-resistant <span class="elsevierStyleItalic">E. coli</span> isolates, is the second mechanism involved in resistance to TGC. TEM-19 variant, which was also previously described in our country,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a> was detected in only one isolate showing marginal ESBL activity. The above information highlights the usefulness of phenotypic assays to confirm even weak ESBL-producers and defines an optimal antimicrobial therapy in infected patients.</p><p id="par0100" class="elsevierStylePara elsevierViewall">There is scarce information from our country about the circulation of the MDR ST131 <span class="elsevierStyleItalic">E. coli</span> clone. The present work analyzes TGC-R <span class="elsevierStyleItalic">E. coli</span> clinical isolates mainly recovered from urine samples and a high proportion (40%) of them were classified as ST131 <span class="elsevierStyleItalic">E. coli</span> clone. A deep analysis by whole-genome sequencing of some of these strains confirmed the main characteristics of this international high-risk clone, such as the MDR phenotype, including resistance to fluoroquinolones and TGC, serotype O25:H4, fimbriae FimH30, and grouping into the phylogroup B2. This information confirms the circulation of this international clone in Ushuaia and contributes to a better understanding of its spread throughout our country. Similarly, the finding of the other two ESBL-producing international high-risk clones, ST617 (CC10) and ST405, highlights a concerning scenario.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6,13</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The present study was conducted in Ushuaia, the southernmost city of Argentina located in the Isla Grande archipelago and could forecast a different behavior of antimicrobial resistance dissemination compared to continental cities. The following were some limitations of our work: (i) it was not possible to analyze if patients were residents or visitors to Ushuaia city, which could have an important effect on the incidence of antimicrobial resistance; ii) the number of fully sequenced isolates was limited; and iii) a complete characterization of <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M</span>-carrying plasmids was not performed.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Nevertheless, the information presented in this manuscript contributes to a better understanding of the dissemination of antimicrobial resistance among <span class="elsevierStyleItalic">E. coli</span> in our country, and alerts about the spread of <span class="elsevierStyleItalic">E. coli</span> ST131, ST617 and ST405 pandemic clones even in remote cities.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflict of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres1862379" "titulo" => "Highlights" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:3 [ "identificador" => "xres1862377" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 2 => array:2 [ "identificador" => "xpalclavsec1618571" "titulo" => "Keywords" ] 3 => array:3 [ "identificador" => "xres1862378" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0015" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec1618570" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-02-11" "fechaAceptado" => "2022-06-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1618571" "palabras" => array:4 [ 0 => "Extended-spectrum beta-lactamase" 1 => "<span class="elsevierStyleItalic">Escherichia coli</span>" 2 => "Third-generation cephalosporin" 3 => "ST131" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1618570" "palabras" => array:4 [ 0 => "Betalactamasa de espectro extendido" 1 => "<span class="elsevierStyleItalic">Escherichia coli</span>" 2 => "Cefalosporina de tercera generación" 3 => "ST131" ] ] ] ] "tieneResumen" => true "highlights" => array:2 [ "titulo" => "Highlights" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0005" class="elsevierStylePara elsevierViewall">Characterization of third generation cephalosporin-resistant <span class="elsevierStyleItalic">Escherichia coli</span> clinical isolates from Ushuaia, Argentina.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall">32 third generation cephalosporin-resistant <span class="elsevierStyleItalic">E. coli</span> from Ushuaia, Argentina were studied.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">International high-risk clones ST131, ST617 and ST405 were detected.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0020" class="elsevierStylePara elsevierViewall">CTX-M ESBL was the main mechanism of resistance to third generation cephalosporins.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0025" class="elsevierStylePara elsevierViewall">Whole genome sequence analysis of 7 MDR <span class="elsevierStyleItalic">E. coli</span> allowed full characterization of these isolates.</p></li></ul></p></span>" ] "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Escherichia coli</span> is one of the main human pathogens causing different hospital- and community-acquired infections. During the period from January 2013 to March 2015, 1.96% (32/1632) of <span class="elsevierStyleItalic">E. coli</span> isolates recovered at the Hospital Regional de Ushuaia, Tierra del Fuego province, were resistant to third-generation cephalosporins (TGCs). These isolates were resistant to cefotaxime (91%) and/or ceftazidime (28%). No resistance to carbapenems was detected. Twenty-six isolates were positive for <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M</span> gene, grouped as CTX-M-1/15 (54%); CTX-M-9/14 (25%); CTX-M-2 (17%); and CTX-M-1/15 plus CTX-M-9/14 (4%). Five TGC-resistant strains were positive for <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CMY</span> gene, while one strain harbored TEM-19 ESBL. Twelve isolates were identified as ST131 <span class="elsevierStyleItalic">E. coli</span> hyperepidemic clone, and one as ST69. Genome sequence analysis of seven <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span><span class="elsevierStyleItalic">E. coli</span> selected isolates confirm the circulation of ST131, ST617 and ST405 international high-risk clones in the city of Ushuaia.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Escherichia coli</span> es uno de los principales patógenos humanos causantes de diferentes infecciones de inicio hospitalario y comunitario. Se determinó que el 1,96% (32/1.632) de los aislamientos de <span class="elsevierStyleItalic">E. coli</span> recuperados entre enero de 2013 y marzo de 2015 en el Hospital Regional de Ushuaia, provincia de Tierra del Fuego, fueron resistentes a cefalosporinas de tercera generación (CTG). Estos aislamientos fueron resistentes a cefotaxima (91%) y/o a ceftazidima (28%). No se detectó resistencia a los carbapenemes. Veintiséis aislamientos fueron positivos para el gen <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M</span>, agrupados como CTX-M-1/15 (54%), CTX-M-9/14 (25%), CTX-M-2 (17%) y CTX-M-1/15 más CTX-M-9/14 (4%). Cinco cepas resistentes a CTG dieron positivo para el gen <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CMY</span>, mientras que un aislamiento presentó la BLEE TEM-19. Doce aislamientos se identificaron como clon hiperepidémico <span class="elsevierStyleItalic">E. coli</span> ST131 y uno como ST69. El análisis de las secuencias del genoma de siete aislamientos seleccionados de <span class="elsevierStyleItalic">E. coli</span><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> confirmó la circulación de los clones internacionales de alto riesgo ST131, ST617 y ST405 en la ciudad de Ushuaia.</p></span>" ] ] "multimedia" => array:1 [ 0 => 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:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">AMP: ampicillin; AMC: amoxicillin-clavulanate; FGC: first generation cephalosporins; TGC: third generation cephalosporins; FOX: cefoxitin; PTZ: piperacillin-tazobactam; FEP: cefepime; CIP: ciprofloxacin; TMS: trimethoprim-sulfamethoxazole; AKN: amikacin; GEN: gentamicin; TET: tetracycline. NA: not available.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ECO1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ECO2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ECO5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ECO3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ECO4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ECO6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ECO7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sample \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urine \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Community/Hospital onset \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Community \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Community \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Community \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Community \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Community \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Community \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antimicrobial resistance profile \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AMP, FGC, TGC, FOX, CIP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AMP, AMC, FGC, TGC, PTZ, FEP, CIP, TMS, AKN, GEN, TET \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AMP, FGC, TGC, FEP, FOX, CIP, TMS, TET \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AMP, FGC, TGC, FEP, CIP, TMS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AMP, FGC, TGC, PTZ, FEP, CIP, TMS, AKN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AMP, FGC, TGC, PTZ, FEP, CIP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AMP, FGC, TGC, FEP, CIP, TMS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sample date \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4-15-14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2-4-15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10-1-14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7-19-13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11-20-14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3-16-15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sequence type (CC) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST617 (CC10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST617(CC10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST405 (CC405) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST131 (CC131) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST131 (CC131) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST131 (CC131) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST131 (CC131) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acquired resistance genes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">mdf(A), mph(A), tetB, aac(6</span>′<span class="elsevierStyleItalic">)-Ib-cr, aadA5, dfrA17, catB3, qacE, sul1</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">mdf(A), mph(A), tetB, tetA, aac(6</span>′<span class="elsevierStyleItalic">)-Ib-cr, aadA5, aac(3)-IIa, aph(3</span>″<span class="elsevierStyleItalic">)-Ib, aph(6)-Id, dfrA17, catB3, qacE, sul1, sul2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">mdf(A), mph(A), tetB, aadA5, aac(3)-IIa, dfrA17, qacE, sul1</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">mdf(A), mph(A), tetA, aac(6</span>′<span class="elsevierStyleItalic">)-Ib-cr, aadA5, catB3, dfrA17, qacE, sul1</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">mdf(A), mph(A), tetA, aac(6</span>′<span class="elsevierStyleItalic">)-Ib-cr, aadA5, aac(3)-IIa, catB3, dfrA17, qacE, sul1</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">mdf(A), mph(A), tetA, aac(6</span>′<span class="elsevierStyleItalic">)-Ib-cr, aadA1, aac(3)-IIa, ant(2</span>″<span class="elsevierStyleItalic">)-Ia, catB3, sul1, qacE, cmlA1</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">mdf(A), mph(A), tetA, aac(6</span>′<span class="elsevierStyleItalic">)-Ib-cr, aadA5, aac(3)-IIa, dfrA17, catB3, qacE, sul1</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chromosomal mutations associated with fluoroquinolone resistance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">gyrA (S83L; D87N), parC (S80I), parE (S458A) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">gyrA (S83L; D87N), parC (S80I), parE (S458A) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">gyrA (S83L; D87N), parC (S80I), parE (S458A) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">gyrA (S83L; D87N), parC (S80I; E84V), parE (I529L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">gyrA (S83L; D87N), parC (S80I; E84V), parE (I529L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">gyrA (S83L; D87N), parC (S80I; E84V), parE (I529L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">gyrA (S83L; D87N), parC (S80I; E84V), parE (I529L) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Plasmidic incompatibility groups \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Col(MG828), IncFIA, IncFIB, IncFII \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Col156, IncFIA, IncFIB, IncFII \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Col156, IncFIB, IncFII \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Col(MG828), Col156, IncFIA, IncFII, IncY \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Col(MG828), IncFIA, IncFII \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Col(MG828), Col156, IncFIA, IncFII \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IncFIA, IncFIB, IncFII \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SerotypeFinder \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O101, H10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O101, H10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O102, H6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O25, H4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O25, H4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O25, H4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O25, H4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">fimTyper \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">fimH27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">fimH30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">fimH1516-like \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">fimH30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">fimH30 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Epidemiological and genomic results of five selected TGC-resistant <span class="elsevierStyleItalic">E. coli</span> isolates.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0090" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Performance standards for antimicrobial susceptibility testing; 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 0 | 1 |
| 2024 October | 20 | 10 | 30 |
| 2024 September | 40 | 12 | 52 |
| 2024 August | 28 | 12 | 40 |
| 2024 July | 37 | 5 | 42 |
| 2024 June | 46 | 8 | 54 |
| 2024 May | 27 | 8 | 35 |
| 2024 April | 53 | 27 | 80 |
| 2024 March | 29 | 12 | 41 |
| 2024 February | 38 | 4 | 42 |
| 2024 January | 59 | 16 | 75 |
| 2023 December | 42 | 17 | 59 |
| 2023 November | 12 | 14 | 26 |
| 2023 October | 38 | 3 | 41 |
| 2023 September | 15 | 4 | 19 |
| 2023 August | 11 | 7 | 18 |
| 2023 July | 12 | 2 | 14 |
| 2023 June | 25 | 10 | 35 |
| 2023 May | 42 | 15 | 57 |
| 2023 April | 27 | 4 | 31 |
| 2023 March | 26 | 5 | 31 |
| 2023 February | 0 | 0 | 0 |
| 2023 January | 0 | 3 | 3 |
| 2022 December | 0 | 9 | 9 |
| 2022 November | 0 | 13 | 13 |
| 2022 October | 0 | 3 | 3 |
| 2022 September | 0 | 2 | 2 |
Show all
