Brief report
Emergence of lineage III of Shigella sonnei ST152 belonging to a high-risk clone harboring the blaCTX-M-15 gene in Peru
Emergencia del linaje III de Shigella sonnei ST152 perteneciente a un clon de alto riesgo portador del gen blaCTX-M-15 en Perú
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Agorio, Norma B. Fernández, María Silvia Relloso, Ivana Maldonado" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Iris L." "apellidos" => "Agorio" ] 1 => array:2 [ "nombre" => "Norma B." "apellidos" => "Fernández" ] 2 => array:2 [ "nombre" => "María Silvia" "apellidos" => "Relloso" ] 3 => array:2 [ "nombre" => "Ivana" "apellidos" => "Maldonado" ] ] ] ] "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">Filamentous fungi in hospital indoor air are risk for severely neutropenic patients.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall">Monitoring microbiology quality air to prevent invasive fungal diseases.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">Importance of mycology laboratory in air monitoring bone marrow transplant units.</p></li></ul></p></span>" ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754124000208?idApp=UINPBA00004N" "url" => "/03257541/0000005600000003/v1_202409170456/S0325754124000208/v1_202409170456/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S0325754124001081" "issn" => "03257541" "doi" => "10.1016/j.ram.2024.09.002" "estado" => "S300" "fechaPublicacion" => "2024-07-01" "aid" => "612" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Rev Argent Microbiol. 2024;56:203-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Metabiotics: do we need a new definition?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "203" "paginaFinal" => "204" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Metabióticos: ¿necesitamos una nueva definición?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gabriel Vinderola, Marcela Carina Audisio" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Gabriel" "apellidos" => "Vinderola" ] 1 => array:2 [ "nombre" => "Marcela Carina" "apellidos" => "Audisio" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754124001081?idApp=UINPBA00004N" "url" => "/03257541/0000005600000003/v1_202409170456/S0325754124001081/v1_202409170456/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Emergence of lineage III of <span class="elsevierStyleItalic">Shigella sonnei</span> ST152 belonging to a high-risk clone harboring the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> gene in Peru" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "205" "paginaFinal" => "209" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Arturo Gonzales Rodriguez, Edgar Gonzales Escalante, Lizet Lezameta Abarca, Jordana Saavedra Gutierrez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Arturo" "apellidos" => "Gonzales Rodriguez" "email" => array:1 [ 0 => "arturo.gonzales@udep.edu.pe" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Edgar" "apellidos" => "Gonzales Escalante" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Lizet" "apellidos" => "Lezameta Abarca" "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">d</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "Jordana" "apellidos" => "Saavedra Gutierrez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Facultad de Medicina Humana, Universidad de Piura, Peru" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Medicina, Universidad Peruana Cayetano Heredia, Peru" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Laboratorio de Resistencia Antibiótica e Inmunopatología, Universidad Peruana Cayetano Heredia, Peru" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Clínica Centenario Peruano Japonesa, Lima, Peru" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Emergencia del linaje III de <span class="elsevierStyleItalic">Shigella sonnei</span> ST152 perteneciente a un clon de alto riesgo portador del gen <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> en Perú" ] ] "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" => 1481 "Ancho" => 3341 "Tamanyo" => 167723 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">S. sonnei</span> phylogenetic analysis using 232 genomes belonging to PulseNet Latin America and Caribbean Network. Analysis of the core-genome phylogeny of 232 <span class="elsevierStyleItalic">S. sonnei</span> isolates, including SS1 and SS2. Colors indicate the country of origin for each strain. The assembled WGS of the strains are presented in a core-genome SNV tree. The scale bar (0.33) represents the average number of nucleotide substitutions per site. The core genome represents the maximum total coverage (81.8%) of the alignment among all 232 <span class="elsevierStyleItalic">S. sonnei</span> conserved sequences, corresponding to 3985 SNVs. Framed in a blue circle: SS1 and SS2.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0020" class="elsevierStylePara elsevierViewall">Shigellosis is a bacillary dysenteric disease that is responsible for approximately 1.1 million deaths annually, mainly involving children under 5 years old<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>. <span class="elsevierStyleItalic">Shigella</span> comprises four related species (<span class="elsevierStyleItalic">S. flexneri</span>, <span class="elsevierStyleItalic">S. boydii</span>, <span class="elsevierStyleItalic">S. dysenteriae</span> and <span class="elsevierStyleItalic">S. sonnei</span>), exhibiting a heterogenous geographic distribution. <span class="elsevierStyleItalic">Shigella flexneri</span> traditionally exhibits a predominant prevalence in low and middle income countries<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a>. However, in the last decade, an abnormal increase in <span class="elsevierStyleItalic">S. sonnei</span> incidence has been observed globally<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>, including in Peru. Despite shigellosis being a self-limited disease, antimicrobial therapy is recommended in patients with severe or invasive infections and in cases associated with malnutrition and prolonged dysenteries<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a>. Furthermore, the World Health Organization (WHO) has proposed antimicrobial use in asymptomatic carriers as an approach for limiting its dissemination<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a>. However, the increase in <span class="elsevierStyleItalic">Shigella</span> antimicrobial resistance has modified the therapeutic alternatives for first- and second-line drugs. Since 2005, given the high levels of resistance against trimethoprim–sulfamethoxazole, tetracycline, chloramphenicol, ampicillin, and nalidixic acid, the WHO has suggested the use of ciprofloxacin and ceftriaxone, as first-line agents, and azithromycin as a second option<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a>. Nevertheless, the global dissemination of <span class="elsevierStyleItalic">S. sonnei</span> sequence type (ST) 152, known for its antimicrobial resistance profile to extended-spectrum cephalosporins (ESC), macrolides and quinolones, drastically limits the therapeutic options and has raised a global alert<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>.</p><p id="par0025" class="elsevierStylePara elsevierViewall">At the beginning of 2022, the United Kingdom reported a three-fold increase in <span class="elsevierStyleItalic">S. sonnei</span> isolates displaying resistance to ESC, quinolones, tetracycline, azithromycin and sulfamethoxazole<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>. A similar scenario has been reported in several countries of the European Union and Southeast Asia<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>. In Latin America, the Pan American Health Organization (PAHO) recently issued an alert, highlighting the need to strengthen the epidemiological surveillance of <span class="elsevierStyleItalic">S. sonnei</span><a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>. The aim of this study was to report the genetic features of two <span class="elsevierStyleItalic">S. sonnei</span> clinical isolates coharboring <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> and <span class="elsevierStyleItalic">qnrS1</span> that belong to an internationally successful clone.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Two isolates of <span class="elsevierStyleItalic">Shigella sonnei</span> resistant to ESC (SS1 and SS2) were isolated from stool samples of a 2-year-old male and a 37-year-old female in November 2019, at the “Clínica Centenario Peruano – Japonesa” in Lima, Peru, respectively. Susceptibility tests to ampicillin/sulbactam (AMS), ceftazidime (CAZ), ceftriaxone (CRO), cefepime (FEP), ertapenem (ETP), meropenem (MER), amikacin (AMI), gentamicin (GEN), ciprofloxacin (CIP) and trimethoprim/sulfamethoxazole (TMS) were performed using automated systems (VITEK® 2 COMPACT, Biomeriux). Azytromicin (AZT) resistance and extended-spectrum β-lactamase (ESBL) production were determined by the disk diffusion method. Interpretation was performed by following the recommendations outlined in CLSI M100-ED33 2023 (<a href="https://clsi.org/all-free-resources/">https://clsi.org/all-free-resources/</a>).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Bacterial DNA was extracted using the GeneJetGenomic DNA Purification kit (ThermoScientific), following the manufacturer's recommendations. The presence of the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M</span> gene was performed by polymerase chain reaction (PCR) amplification. In addition, the identification of <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-2</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-9</span> groups was conducted by PCR using specific primers: Fw-<span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-1</span> (5′-ATGGTTAAAAAATCACTGC-3′), Rv-<span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-1</span> (5′-GGTGACGATTTTAGCCGC-3′); Fw-<span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-2</span> (5′-CGTTAACGGCACGATGAC-3′), Rv-<span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M2</span> (5′-CGATATCGTTGGTGGTGCCAT-3′); Fw-<span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-9</span> (5′-GATTGACCGTATTGGGAGTTT-3′), Rv-<span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-9</span> (5′-CGGCTGGGTAAAATAGGTCA-3′). Plasmid conjugation assays were performed by a mating-out assay using <span class="elsevierStyleItalic">Escherichia coli</span> J53 sodium azide resistant (Az<span class="elsevierStyleSup">r</span>) as the recipient strain (ECJ53) and SS1 and SS2 as donor strains. Isolates were grown overnight in 5.0<span class="elsevierStyleHsp" style=""></span>ml of Luria Bertani (LB) broth and incubated until an optical density of 0.6 was reached. Subsequently, in each case, equal parts (0.5<span class="elsevierStyleHsp" style=""></span>ml) of the cultures were mixed, centrifuged, and the pellet was resuspended in 100<span class="elsevierStyleHsp" style=""></span>μl of LB broth. Transconjugants were initially selected on LB agar containing ampicillin (50<span class="elsevierStyleHsp" style=""></span>μg/ml) and sodium azide (150<span class="elsevierStyleHsp" style=""></span>μg/ml). Grown colonies were subcultured in LB agar supplemented with cefotaxime (2<span class="elsevierStyleHsp" style=""></span>μg/ml) and sodium azide (150<span class="elsevierStyleHsp" style=""></span>μg/ml). Transconjugants (TCSS1 and TCSS2) were evaluated by analyzing the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M</span> group and the antibiotic susceptibility profile as mentioned.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Next generation sequencing (NGS) analysis was performed on both strains. Genomic libraries were prepared using the MiSeq chemistry, Illumina, with paired-end 2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>250<span class="elsevierStyleHsp" style=""></span>bp. Poor quality readings (Phred scores below 30) were filtered out using the Trimmomatic v0.39 program. <span class="elsevierStyleItalic">De novo</span> genome assembly was conducted using Unicycler v0.4.8. Assembled final sequence genomes were annotated using Prokka v1.14.6 and manually curated. Sequence type (ST) was identified with MLSTfinder v2.0, resistance genes with ResFinder v.1 and plasmid incompatibility groups with PlamidFinders v2.1 software. Genetic relationship based on single-nucleotide polymorphisms (SNPs) was assessed using genomic sequences of <span class="elsevierStyleItalic">S. sonnei</span> ST152 available on the GenBank public database. SNPs were identified and extracted using SNP-sites v.2.5.1 and maximum-likelihood clustering was inferred by IQ-TREE Phylogenomic v.1.5.5.3 using the best-fit model found and 1000 bootstraps. The complete, raw sequences were deposited in NCBI under BioProject ID: PRJNA968049.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Both <span class="elsevierStyleItalic">S. sonnei</span> bacterial isolates, designated as SS1 and SS2, respectively, exhibited a multidrug-resistant (MDR) profile against AMS, CRO, TMS, and CIP, remaining susceptible to CAZ, FEP, ETP, MER, IMP, GEN, AMI and AZT (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">PCRs for <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M</span> and <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-group-1</span> rendered positive results. The conjugation assay indicated that the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-group-1</span> gene was located on a conjugative plasmid that could be successfully transferred into <span class="elsevierStyleItalic">E. coli</span> J53. Two transconjugant strains were obtained (TCSS1 and TCSS2). Transconjugants showed resistance to β-lactams and TMS and exhibited reduced susceptibility to CIP (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0055" class="elsevierStylePara elsevierViewall">The whole genome of SS1 strain was composed of a 4<span class="elsevierStyleHsp" style=""></span>554<span class="elsevierStyleHsp" style=""></span>387 bp chromosome defined in 367 contigs, while the SS2 genome consisted of 4<span class="elsevierStyleHsp" style=""></span>557<span class="elsevierStyleHsp" style=""></span>581 bp, included in 369 contigs. NGS analysis confirmed that both isolates belonged to ST152. Replicons belonging to different incompatibility groups, such as IncFIB, Col156, ColRNAI, Col (BS512) and IncI-γ, were identified. In addition to the determinants of resistance to ESC (<span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>), a plethora of genes, associated with resistance to phenicols [<span class="elsevierStyleItalic">mdf(A)</span>], tetracycline [<span class="elsevierStyleItalic">tet(A)</span>], aminoglycosides [<span class="elsevierStyleItalic">aph (6)-Id, aph (3</span>″<span class="elsevierStyleItalic">)-Ib</span> and <span class="elsevierStyleItalic">ant(3</span>″<span class="elsevierStyleItalic">)-Ia</span>], sulfonamide (<span class="elsevierStyleItalic">sul2</span>), quinolones (<span class="elsevierStyleItalic">qnrS1</span>) and trimethoprim (<span class="elsevierStyleItalic">dfrA1</span>) were also identified. Mutations in GyrA S83I related to fluoroquinolone resistance were detected as well.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> and <span class="elsevierStyleItalic">qnrS1</span> genes were located in the same contig in both genomes. In SS1, they were identified in the same contig belonging to IncI-γ replicon. Additionally, the <span class="elsevierStyleItalic">tet(A)</span>, <span class="elsevierStyleItalic">aph(6)-Id</span>, <span class="elsevierStyleItalic">aph(3”)-Ib</span> and <span class="elsevierStyleItalic">sul2</span> genes were located in the same contig associated with the ColRNAI incompatibility group in both genomes. When analyzing the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> genetic context in SS1 and SS2, both genomes exhibited the same genetic platform, accompanied by the sequences: <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> –cupin <span class="elsevierStyleItalic">Wbuc-Tn3Δ</span>-IS<span class="elsevierStyleItalic">3Δ-qnrS1-hin</span>-IS<span class="elsevierStyleItalic">Kpn19</span>.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Phylogenetic analysis using a representative group composed of 230 genomes of <span class="elsevierStyleItalic">S. sonnei</span> from PulseNet Latin America and Caribbean surveillance network<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a>, indicated that SS1 was closely related to ERR200468, isolated in Argentina in 2005, with 374 SNPs differences, while SS2 was related with SRR7693709, isolated in Ecuador in 2014, with 261 SNPs differences (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Additionally, a further analysis indicates that SS1 and SS2 correspond to IIIb and IIIa sublineages, respectively.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The high level of antimicrobial resistance in <span class="elsevierStyleItalic">S. sonnei</span>, attributed to the dissemination of ST152, global III lineage, has narrowed the antimicrobial options against shigellosis<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> and has alerted about the need to strengthen epidemiological surveillance systems. Nowadays, there are several reports of <span class="elsevierStyleItalic">S. sonnei</span> ESBL producers, primarily related to CTX-M-15 and CTX-M-3, mainly<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>. To the best of our knowledge, although ESBL-producing <span class="elsevierStyleItalic">S. flexneri</span> isolates have been previously described in Peru by Gonzales et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>, this study would be the first documentation of <span class="elsevierStyleItalic">S. sonnei</span> isolates harboring the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> gene in Peru. The ESBL gene was detected on a conjugative plasmid, conveying antimicrobial resistance capacity to β-lactams, TMS and reduced susceptibility to CIP.</p><p id="par0075" class="elsevierStylePara elsevierViewall">As mentioned above in SS1, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> was identified in the IncI-γ group-contig (contig 3: 84<span class="elsevierStyleHsp" style=""></span>778 bp). In <span class="elsevierStyleItalic">S. sonnei</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> has been associated with several incompatibility groups (IncFII, IncZ), with IncI being relevant for its successful dissemination since 2006<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a>. Contig 3 in SS1 exhibited an identity of 99.2% with the plasmid p202102843-3 (GenBank: OP038292.1), recently reported in France in 2022<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>. The genetic environment of <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> is similar to that described in a IncFII plasmid from <span class="elsevierStyleItalic">S. sonnei</span> in 2020 (GenBank: CP045525)<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> and in an IncFII plasmid from <span class="elsevierStyleItalic">K. pneumoniae</span> isolated in China in 2014 (GenBank: CP026158)<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a>. The genetic context of <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> described in the present study suggests the risk of dissemination of this genetic platform in different types of plasmids.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The global dissemination of ciprofloxacin-resistant <span class="elsevierStyleItalic">S. sonnei</span>, evolved from the sequential accumulation of mutations in <span class="elsevierStyleItalic">gyrA</span>-S83L, <span class="elsevierStyleItalic">parC</span>-S80I and <span class="elsevierStyleItalic">gyrA</span>-D87G, from Central Asia<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>. The former isolates reported only the gyrA-S83L mutation, accompanied by the <span class="elsevierStyleItalic">qnrS1</span> gene, harbored in the same genetic environment as <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>. A Latin American surveillance study with 22<span class="elsevierStyleHsp" style=""></span>273 <span class="elsevierStyleItalic">S. sonnei</span> collected over 15 years revealed that Peru was one of the countries in the region with the highest annual increase in resistance to ciprofloxacin (1–5%)<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a>. Fortunately, the regional levels of resistance are still as low as 2.7% (9/329)<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a>. Nevertheless, in several European and Asian countries, such as France or India, ciprofloxacin resistance has reached levels of up to 38.7% and 61.5%, respectively<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The isolates SS1 and SS2, belonging to the global III lineage, were recognized for their role in the global dissemination of multidrug-resistant <span class="elsevierStyleItalic">S. sonnei</span> clones. We highlight their belonging to sublineage IIIb, described for the very first time in Peru<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a>. These results support the evidence of clonal expansion of sublineages IIIa and IIIb in Latin America, as postulated by Baker et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">However, the low number of isolates and the lack of clinical information limit the scope of this study. Nevertheless, this research contributes to the characterization of the circulating strains of <span class="elsevierStyleItalic">S. sonnei</span> in our environment. Both isolates presented <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> associated with <span class="elsevierStyleItalic">qnrS1</span>, presumably on a conjugative plasmid of the IncI-γ group; in both cases azithromycin susceptibility was observed. The global spread of strains with a profile of extreme resistance to antimicrobials makes it necessary to strengthen epidemiological surveillance systems.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Funding</span><p id="par0095" class="elsevierStylePara elsevierViewall">This work was supported by the <span class="elsevierStyleGrantSponsor" id="gs1">Faculty of Medicine of the University of Piura</span> (<span class="elsevierStyleGrantNumber" refid="gs1">PI2204</span>).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflict of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres2244577" "titulo" => "Highlights" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:3 [ "identificador" => "xres2244576" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 2 => array:2 [ "identificador" => "xpalclavsec1877144" "titulo" => "Keywords" ] 3 => array:3 [ "identificador" => "xres2244578" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0015" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec1877143" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 6 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 7 => array:2 [ "identificador" => "xack774411" "titulo" => "Acknowledgements" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-05-09" "fechaAceptado" => "2024-02-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1877144" "palabras" => array:4 [ 0 => "<span class="elsevierStyleItalic">Shigella sonnei</span>" 1 => "Beta-lactams" 2 => "Multi-resistance" 3 => "Peru" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1877143" "palabras" => array:4 [ 0 => "<span class="elsevierStyleItalic">Shigella sonnei</span>" 1 => "Betalactámicos" 2 => "Multirresistencia" 3 => "Perú" ] ] ] ] "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">First <span class="elsevierStyleItalic">S. sonnei</span> isolates report with <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> in Peru.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> associated with <span class="elsevierStyleItalic">qnrS1</span>, presumably in a conjugative plasmid of the IncI-γ group; in both cases azithromycin susceptible.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">Clonal expansion of sublinage IIIa and IIIb in Latin America.</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">Multidrug-resistant <span class="elsevierStyleItalic">Shigella sonnei</span> ST152, global lineage III, is a high-risk clone, whose dissemination has limited therapeutic options for shigellosis. This study aimed to characterize two isolates of <span class="elsevierStyleItalic">S. sonnei</span>, which were recovered in Lima, Peru, during November 2019, exhibiting resistance to extended-spectrum cephalosporins and quinolones, and concurrently harboring <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> and <span class="elsevierStyleItalic">qnrS1</span> genes, in addition to mutations in <span class="elsevierStyleItalic">gyrA</span>-S83L. These isolates were resistant to ceftriaxone, ciprofloxacin and trimethoprim/sulfamethoxazole. The molecular analysis showed that both isolates belonged to lineage III, sublineages IIIa and IIIb. The <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> gene was located in the same genetic platform as <span class="elsevierStyleItalic">qnrS1</span>, flanked upstream by ISKpn19, on a conjugative plasmid belonging to the IncI-γ group. To the best of our knowledge, this would be the first report on <span class="elsevierStyleItalic">S. sonnei</span> isolates carrying the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> gene in Peru. The global dissemination of <span class="elsevierStyleItalic">S. sonnei</span> ST152, co-resistant to β-lactams and quinolones, could lead to a worrisome scenario in the event of potential acquisition of genetic resistance mechanisms to azithromycin.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La bacteria multidrogorresistente <span class="elsevierStyleItalic">Shigella sonnei</span> ST152, del linaje global III, es un clon de alto riesgo, cuya diseminación ha limitado las opciones terapéuticas contra la shigellosis. En este estudio se caracterizaron dos aislamientos de <span class="elsevierStyleItalic">S. sonnei</span> resistentes a cefalosporinas de espectro extendido y a quinolonas, recuperados durante noviembre de 2019 en Lima, Perú. Ambos aislamientos albergaban simultáneamente <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> y <span class="elsevierStyleItalic">qnrS1</span>, además de mutaciones en <span class="elsevierStyleItalic">gyrA</span> S83L. Estos aislamientos fueron resistentes a ceftriaxona, ciprofloxacina y trimetoprima/sulfametoxazol. El análisis molecular mostró que ambos aislamientos pertenecían al linaje III, sublinajes IIIa y IIIb; <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> se encontró ubicado en la misma plataforma genética que <span class="elsevierStyleItalic">qnrS1</span>, rodeado aguas arriba por <span class="elsevierStyleItalic">ISKpn19</span>, en un plásmido conjugativo perteneciente al grupo IncI-γ. En nuestro conocimiento, esta es la primera comunicación de <span class="elsevierStyleItalic">S. sonnei</span> productora de <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> en Perú. La propagación global de <span class="elsevierStyleItalic">S. sonnei</span> ST152 corresistente a β-lactámicos y quinolonas podría conducir a un escenario preocupante, llegado el caso de la adquisición de mecanismos genéticos de resistencia a azitromicina.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1481 "Ancho" => 3341 "Tamanyo" => 167723 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">S. sonnei</span> phylogenetic analysis using 232 genomes belonging to PulseNet Latin America and Caribbean Network. Analysis of the core-genome phylogeny of 232 <span class="elsevierStyleItalic">S. sonnei</span> isolates, including SS1 and SS2. Colors indicate the country of origin for each strain. The assembled WGS of the strains are presented in a core-genome SNV tree. The scale bar (0.33) represents the average number of nucleotide substitutions per site. The core genome represents the maximum total coverage (81.8%) of the alignment among all 232 <span class="elsevierStyleItalic">S. sonnei</span> conserved sequences, corresponding to 3985 SNVs. Framed in a blue circle: SS1 and SS2.</p>" ] ] 1 => 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:3 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">AMS: ampicillin/sulbactam; CAZ: ceftazidime; CRO: ceftriaxone; FEP: cefepime; ETP: ertapenem; MER: meropenem; AMI: amikacin; GEN: gentamicin; CIP: ciprofloxacin; TMS: trimethoprim/sulfamethoxazole; R: resistant; S: susceptible; I: intermediate.</p>" "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-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Isolates \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="10" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Minimum inhibitory concentration (μg/ml)<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a></th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AMS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CAZ \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CRO \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FEP \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ETP \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MER \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AMI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">GEN \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CIP \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TMS \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><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">SS1 \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥64<span class="elsevierStyleSup">R</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.5<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤0.12<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤0.25<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤1<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤1<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥4<span class="elsevierStyleSup">R</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥320<span class="elsevierStyleSup">R</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">TCSS1<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32<span class="elsevierStyleSup">R</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.5<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤0.12<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤0.25<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤1<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤1<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.5<span class="elsevierStyleSup">I</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥320<span class="elsevierStyleSup">R</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">SS2 \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥64<span class="elsevierStyleSup">R</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.5<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤0.12<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤0.25<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤1<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤1<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥4<span class="elsevierStyleSup">R</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥320<span class="elsevierStyleSup">R</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">TCSS2<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32<span class="elsevierStyleSup">R</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.5<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤0.12<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤0.25<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤1<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤1<span class="elsevierStyleSup">S</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.5<span class="elsevierStyleSup">I</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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥320<span class="elsevierStyleSup">R</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">EJ53 \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤2 \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤0.12 \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤0.25 \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤0.12 \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤0.12 \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤0.25 \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤1 \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤1 \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤0.06 \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤20 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3657406.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><span class="elsevierStyleItalic">E. coli</span> J53 transconjugant with the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-group-1</span>-harboring plasmid, obtained from strain SS1.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010"><span class="elsevierStyleItalic">E. coli</span> J53 transconjugant with the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-group-1</span>-harboring plasmid, obtained from strain SS2.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">R: resistant; S: susceptible.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Antibiotic susceptibility profiles of <span class="elsevierStyleItalic">Shigella sonnei</span> strains and their transconjugants.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Whole genome sequencing of <span class="elsevierStyleItalic">Shigella sonnei</span> through PulseNet Latin America and Caribbean: advancing global surveillance of foodborne illnesses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:29 [ 0 => "K.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 50 | 14 | 64 |
| 2024 September | 51 | 11 | 62 |
| 2024 August | 34 | 5 | 39 |
| 2024 July | 41 | 11 | 52 |
| 2024 June | 61 | 35 | 96 |
