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a serious public health problem worldwide. Colistin or tigecycline are last-resort antibiotics against these carbapenemase-producing <span class="elsevierStyleItalic">Enterobacteriaceae</span>,<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a> but some resistant strains have been described.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Class A, B and D carbapenemases have been reported in <span class="elsevierStyleItalic">Enterobacteriaceae</span> worldwide since 1993,<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2,3</span></a> but were not described in Spain until 2003.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">4</span></a> VIM and IMP (class B) were initially the most frequent, but they have since then declined, and OXA-48 (class D), first documented in Spain in 2009, is currently the most prevalent.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The OXA-48 carbapenemase exhibits strong penicillin-hydrolysing activity and weak activity against carbapenems. Derivatives such as OXA-163 (first described in <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>), OXA-247 (<span class="elsevierStyleItalic">K. pneumoniae</span>) and OXA-405 (<span class="elsevierStyleItalic">Serratia marcescens</span>) hydrolyse penicillins, ceftazidime and cefotaxime, but as their carbapenem-hydrolysing activity is far lower than OXA-48 they are barely considered as carbapenemases.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">An OXA-48-producing <span class="elsevierStyleItalic">K. pneumoniae</span> strain was first identified in 2001 in Istanbul, with reservoirs becoming established in North Africa and the Mediterranean area. It has now spread through the rest of Europe, Asia and America.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6,7</span></a> The dissemination of this enzyme could be explained by two factors. First, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span> has been described in an IncL plasmid in <span class="elsevierStyleItalic">Enterobacteriaceae</span> as well as in both non-fermenters (<span class="elsevierStyleItalic">Acinetobacter baumannii</span> and <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>).<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a> Second, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span> gene is part of the transposon Tn<span class="elsevierStyleItalic">1999</span>, which is inserted in the <span class="elsevierStyleItalic">tir</span> gene of the plasmid IncL. Different Tn<span class="elsevierStyleItalic">1999</span> variants are known (Tn<span class="elsevierStyleItalic">1999</span>.<span class="elsevierStyleItalic">2</span>, Tn<span class="elsevierStyleItalic">1999</span>.<span class="elsevierStyleItalic">3</span> and Tn<span class="elsevierStyleItalic">1999</span>.<span class="elsevierStyleItalic">4</span>),<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a> varying in the presence or not of the insertion sequence IS<span class="elsevierStyleItalic">1R</span><a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a> or the transposon Tn<span class="elsevierStyleItalic">2015</span>, which also contains <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>. On the other hand, the insertion of Tn<span class="elsevierStyleItalic">1999</span> in the <span class="elsevierStyleItalic">tir</span> gene of this plasmid has been associated with an enhanced conjugation performance and could contribute to the high diffusion of this plasmid type and its resistance genes.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Enterobacteriaceae</span> strains carrying the OXA-48-carbapenemase can also co-express extended-spectrum β-lactamases (ESBLs) such as CTX-M-15 and SHV-12,<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a> or acquired AmpC β-lactamases (acAmpC) such as DHA-1,<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">4</span></a> mainly in different plasmids; strains resistant to quinolones, cotrimoxazole and aminoglycosides have also been described.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2,10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In a national study conducted in 2009,<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">4</span></a> we observed a very low prevalence of carbapenemase-producing <span class="elsevierStyleItalic">Enterobacteriaceae</span> in Catalonia (0.04%). However, in 2012, hospitals in the Barcelona area reported an increase in <span class="elsevierStyleItalic">K. pneumoniae</span> strains resistant to third generation cephalosporins and ertapenem and suspected of expressing carbapenemases. The aim of this study was to explain this growing prevalence by characterizing the β-lactamases involved in this resistance phenotype and establishing the genetic relationships between strains.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Ethics</span><p id="par0035" class="elsevierStylePara elsevierViewall">The study was approved by the Ethical Review Committee of the Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Strains and patients</span><p id="par0040" class="elsevierStylePara elsevierViewall">In a prospective study in 2012 (January to December) involving 12 hospitals in Catalonia, <span class="elsevierStyleItalic">K. pneumoniae</span> isolates resistant to β-lactams were collected, excluding those with a natural resistance pattern. Epidemiological data on patient gender, age, chronic diseases and treatment were collected in parallel. Only one strain per patient was included. The selected strains were resistant to any of the following β-lactams: cephalotin, cefoxitin, cefuroxime, cefotaxime, ceftazidime, cefepime, ertapenem, imipenem, aztreonam, amoxicillin/clavulanic acid and/or piperacillin/tazobactam.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Each hospital carried out identification and antibiotic susceptibility tests and provided epidemiological patient data. The participating hospitals were: Hospital Municipal de Badalona (HMB), Hospital de Barcelona (HB), Corporació de Salut del Maresme I la Selva (HC), Hospital General de Granollers (HGG), Hospital General Universitari de Catalunya at Sant Cugat del Vallès (HGC), Hospital General de L’Hospitalet (HGH), Hospital Sant Joan de Déu at Manresa (HSJDD), Hospital Sant Joan Martorell (HMLL), Hospital de Mataró (HM), Hospital Universitari de Vic (HGV), Hospital Universitari de Sant Joan de Reus (HUSJR) and Hospital de la Santa Creu i Sant Pau (HSCSP) (covering a population of approximately 250,000 inhabitants).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The patients were classified in three categories: nosocomial (the infection occurring after 48<span class="elsevierStyleHsp" style=""></span>h of hospital admission), healthcare centre (resident in a healthcare centre) and community (no recent contact with a medical environment).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Bacterial identification and antimicrobial susceptibility testing</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">K</span>. <span class="elsevierStyleItalic">pneumoniae</span> identification and antimicrobial susceptibility tests were performed in each hospital following routine laboratory methods, either manual or automated [MicroScan WalkAway (Siemens) and Vitek system (bioMérieux, Marcy l’Etoile, France)]. The susceptibility pattern to β-lactams, quinolones and aminoglycosides was obtained by the disc-diffusion method (Rosco Diagnostica A/S, Taastrup, Denmark) following Clinical and Laboratory Standards Institute (CLSI) criteria, as used routinely in the laboratory.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a> The antibiotics used were: ampicillin (AMP), piperacillin (PIP), amoxicillin/clavulanic acid (AMC), piperacillin/tazobactam (TZP), cephalotin (CEF), cefoxitin (FOX), cefuroxime (CXM), cefotaxime (CTX), ceftazidime (CAZ), aztreonam (ATM), cefepime (FEP), ertapenem (ERT), imipenem (IMP), kanamycin (K), gentamicin (G), tobramycin (T), amikacin (A), netilmicin (Nt), neomycin (Nm), nalidixic acid (NAL), ciprofloxacin (CIP), and cotrimoxazole (SXT).</p><p id="par0060" class="elsevierStylePara elsevierViewall">The then recommended Modified Hodge Test (MHT) was performed to detect carbapenemase activity, using imipenem according to CLSI criteria.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a> The strains selected for analysis were resistant to any of the studied β-lactams. Strains with positive or weakly positive MHT results were included for the molecular characterization of carbapenemase resistance mechanisms.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Amplification of antimicrobial resistance genes</span><p id="par0065" class="elsevierStylePara elsevierViewall">The polymerase chain reaction (PCR) was used to detect the following genes in all studied strains according to their resistance phenotype: carbapenemases (<span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">O<span class="elsevierStyleItalic">XA</span>-48</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">VIM</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SPM</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">IMP</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">GIM</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SME</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">NMC</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">KPC</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">IMI</span> and <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">GES</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">NDM</span>), ESBLs (<span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M</span>), acquired AmpC genes (acAmpC) (<span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">ACC</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CIT</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">EBC</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">DHA</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">FOX</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">MOX</span>) and the penicillinase <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, quinolones (<span class="elsevierStyleItalic">qep</span>A and <span class="elsevierStyleItalic">qnr</span>A, <span class="elsevierStyleItalic">qnr</span>B, <span class="elsevierStyleItalic">qnr</span>S, <span class="elsevierStyleItalic">qnrC, qnrD</span>) and aminoglycoside modifying enzymes (AME) (<span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6)-Ib</span>, <span class="elsevierStyleItalic">aph(3′)-Ia</span>, <span class="elsevierStyleItalic">ant(2′)-Ia</span> and <span class="elsevierStyleItalic">aac(2′)-Ia</span>).<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4,12,13</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span> genetic platform was determined by PCR using specific primers for IS<span class="elsevierStyleItalic">1999</span>, <span class="elsevierStyleItalic">lysR</span> and IS<span class="elsevierStyleItalic">1R</span> of Tn<span class="elsevierStyleItalic">1999</span> and Tn<span class="elsevierStyleItalic">1999</span>.<span class="elsevierStyleItalic">2</span><a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6,14</span></a> in all <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span>-carrying strains.</p><p id="par0075" class="elsevierStylePara elsevierViewall">All amplicon sequences were obtained by Sanger sequencing in an external genome service enterprise (Macrogen Europe, Amsterdam, The Netherlands).</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Molecular typing of <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span>-carrying <span class="elsevierStyleItalic">K. pneumoniae</span> strains</span><p id="par0080" class="elsevierStylePara elsevierViewall">Pulsed-field gel electrophoresis (PFGE) with genomic DNA digestion by the enzyme <span class="elsevierStyleItalic">Xba</span>I was performed with the CHEF-DRIII system (Bio-Rad, Hemel Hempstead, UK) and analyzed by BioNumerics 6.6 (Applied-Maths, Ghent, Belgium).<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2,12,15</span></a> The relatedness was calculated by the unweighted-pair group method using an average linkage (UPGMA) algorithm, with band similarity calculated using the Dice coefficient with a 2% optimization value and 1% tolerance. PFGE patterns were interpreted as previously described.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">11,12</span></a> MultiLocus Sequence Typing (MLST) was performed according to the Pasteur Institute website (<a id="intr0005" class="elsevierStyleInterRef" href="http://www.pasteur.fr/recherche/genopole/P8/mlst">www.pasteur.fr/recherche/genopole/P8/mlst</a>)<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a> in 11 strains selected according to their PFGE pattern (A-E). For cluster E, we selected the majority and minority patterns consulting the resistance pattern.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conjugation assay</span><p id="par0085" class="elsevierStylePara elsevierViewall">Conjugation was performed in the aforementioned 11 isolates. Rifampicin-resistant-GFP <span class="elsevierStyleItalic">E. coli</span> VA6190 was used as a recipient,<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a> which also expresses a green fluorescent protein (GFP) marker. Luria-Bertani broth (LB) was used for the conjugation or, if LB results were negative, solid mating with HA 45<span class="elsevierStyleHsp" style=""></span>μm-pore-size filters (Millipore, Billerica, MA). Putative transconjugants were selected on LB agar supplemented with ceftazidime (10<span class="elsevierStyleHsp" style=""></span>mg/L) and rifampicin (100<span class="elsevierStyleHsp" style=""></span>mg/L), and exposed to UV illumination to check for GFP fluorescence. The transfer frequency was expressed as the ratio of transconjugants to total recipient cells. The presence of <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span> in the transconjugants was confirmed by PCR.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Plasmid typing</span><p id="par0090" class="elsevierStylePara elsevierViewall">Plasmid Identification was performed in 37 strains by a homemade PCR-based replicon typing (PBRT-PCR) method based on Carattoli et al. (2009).<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a> The studied strains represented each PFGE subcluster, adding some strains with the same PFGE pattern but different resistance patterns. Poirel et al. (2012)<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a> observed that PBRT-PCR did not detect a <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span>-carrying IncL/M replicon. Carattoli et al. (2015)<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> described specific primers to detect the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span>-carrying IncL plasmid, which distinguished IncL from IncM. We used these primers to describe the plasmid in our OXA-48-producing <span class="elsevierStyleItalic">K</span>. <span class="elsevierStyleItalic">pneumoniae</span> strains.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The plasmid localization of the <span class="elsevierStyleItalic">bla</span> genes was determined in the same 11 strains by PFGE using <span class="elsevierStyleItalic">S1</span> nuclease and Southern blot hybridization methods, as previously described.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a> The probes were obtained by the DIG Probe Synthesis Kit (Sigma–Aldrich) using primers corresponding to the <span class="elsevierStyleItalic">bla</span> and replicon genes.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analysis</span><p id="par0100" class="elsevierStylePara elsevierViewall">Categorical variables were compared by the <span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span> test and continuous variables by the Student's <span class="elsevierStyleItalic">t</span>-test or Mann–Whitney test. <span class="elsevierStyleItalic">P</span>-values of <0.005 were considered statistically significant. The software GraphPad Prism (GraphPad Software, Inc., CA, USA) was used for the analyses.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Bacterial isolates and susceptibility data</span><p id="par0105" class="elsevierStylePara elsevierViewall">Between January and December 2012, we collected a total of 3901 <span class="elsevierStyleItalic">K. pneumoniae</span> isolates resistant to β-lactams, not including those with a natural resistance pattern. Among these, 171 (4.38%) gave positive MHT results, including strains with only a weak growth around the streak. And among these171 strains, 98 (57.3%) were resistant to ertapenem and 22 (12.8%) to imipenem. After the PCR and sequencing, 85 strains gave positive results for <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span>, nine of them from faecal carriers. These 85 strains were from eight out of the 12 participating hospitals. Thus, the prevalence of OXA-48-producing <span class="elsevierStyleItalic">K</span>. <span class="elsevierStyleItalic">pneumoniae</span> strains in Catalonia was 1.9% (subtracting the nine faecal carriers). No other targeted carbapenemases were detected. The 85 OXA-48-producing strains were resistant to ampicillin, piperacillin and the association amoxicillin/clavulanic acid. Only 23.5% were resistant to imipenem, whereas 95.3% were resistant to ertapenem, which is the most sensitive drug for OXA-48-producing strain detection. Most strains were resistant to cephalosporins, in some cases remaining susceptible to cefoxitin and cefepime (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). These different phenotypes were due to the presence of an ESBL, as 89.4% co-expressed the CTX-M-15, together with the penicillinases OXA-1 (94.1%) and TEM-1 (85.4%). All 85 isolates also expressed the chromosomal penicillinase SHV characteristic of this species: in 77.64% we detected <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span>, 20% <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-1</span>, 1.1% <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-11</span> and 1.1% <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-42</span>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">These strains were also resistant to aminoglycosides (90.5%), cotrimoxazole (89.4%) and ciprofloxacin (83.5%). Only four strains remained susceptible to all aminoglycosides and quinolones tested. Regarding aminoglycoside resistance, we found nine different phenotype patterns: KTG (64.7%), KTGN (14.1%), KTGNm (4.7%), KTA (1.1%), G (2.3%), KTAGN (1.1%), KTAN (3.5%), KT (2.3%) and KTN (1.1%). The AMEs present in these strains were AAC(3′)-IIa (83.5%), AAC(6′)-Ib (81.2%), APH(3′)-Ia (3.5%), AAC(2′)-Ia (2.4%) and ANT (2′)-Ia (1.2%). Finally, 88.2% carried QnrB and in one case QnrS (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">As mentioned above, 86 out of 171 positive MHT strains (50.3%) were non-carbapenemase-producing. Among these isolates, 17 (19.7%) were resistant to ertapenem and 1 (1%) to imipenem. To explain the positive MHT results, we checked for the presence of ESBLs and acAmpC. The PCR results revealed that 47 strains (54.6%) carried an acAmpC (80.8% DHA, 10.6% ACC and 8.6% CMY), 21 (24.4%) carried an ESBL (CTX-M-1-type) and 14 (16.3%) co-expressed both ESBL and acAmpC (64.3% CTX-M-1-type<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>DHA, 14.3% CTX-M-9-type<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>DHA, 14.3% CTX-M-1-type<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>ACC and 7.1% CTX-M-1-type with CMY). Finally, four strains (4.6%) did not show any studied acAmpC or ESBL. The 86 strains without carbapenemase production were excluded from further studies.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Clinical and molecular epidemiological data</span><p id="par0120" class="elsevierStylePara elsevierViewall">The origin of the 85 OXA-48-producing strains was: 47 (55.3%) from urine samples, 13 (15.3%) from respiratory tract samples, six (7%) from blood, four (4.7%) from surgical wounds, six (7%) from other samples (vaginal discharge, peritoneal fluid, sore, cellulitis, bile, post-operative ulcer) and nine (10.6%) were isolated from faeces (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The demographic data collected from the 85 patients with OXA-48-producing <span class="elsevierStyleItalic">K</span>. <span class="elsevierStyleItalic">pneumoniae</span> infection showed that 52 were female (61.2%) of an average age of 76 years (range 26–98 years). There was no significant difference between genders (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>>0.005). In 41 (48.2%) cases the infection had a nosocomial origin, 30 (35.3%) were related to a healthcare centre, and the remaining 14 (16.5%) were acquired in the community (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><p id="par0130" class="elsevierStylePara elsevierViewall">The PFGE analysis revealed five well-defined clusters (A–E), which were subdivided in multiple subclusters, with 76% homology between the main clusters. Cluster A, B, C, D and E represented 18.8%, 1.1%, 1.1%, 1.1% and 77.6% of all isolates, respectively. Clusters A and E showed subclusters A<span class="elsevierStyleInf">1-3</span> and E<span class="elsevierStyleInf">1-18</span>. The cluster distribution is depicted in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">By MLST, the five PFGE clusters corresponded to five different <span class="elsevierStyleItalic">K. pneumoniae</span> sequence types (STs) as follows: cluster A belonged to ST101 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16); B to ST17 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1); C to ST1233 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1); D to ST14 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) and E to ST405 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>66). ST1233 is described here for the first time and is a single-locus variant (SLV) of ST540 in the <span class="elsevierStyleItalic">gapA</span> gene. Cluster E, which corresponds with ST405, was isolated in six of the eight OXA-48-detecting hospitals; cluster A, all ST101, was present in three of the eight hospitals. The minor clusters B (ST17), C (ST1233) and D (ST14), with one strain each, were from HGG, HM and HGV, and were isolated in different hospitals together with isolates belonging to major clones.</p><p id="par0140" class="elsevierStylePara elsevierViewall">We observed that all OXA-48-producing <span class="elsevierStyleItalic">K</span>. <span class="elsevierStyleItalic">pneumoniae</span> strains, except those belonging to ST14, ST17 and ST1233, were resistant to multiple antimicrobial drugs (mainly aminoglycosides and quinolones) by acquiring resistance genes. <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span> seemed to be associated with <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">aac(3</span>′<span class="elsevierStyleItalic">)-IIa</span>, <span class="elsevierStyleItalic">aac(6</span>′<span class="elsevierStyleItalic">)-Ib</span> and <span class="elsevierStyleItalic">qnrB</span>, and in most cases with <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> and <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span> (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Plasmid characterization and the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span>-carrying genetic platform</span><p id="par0145" class="elsevierStylePara elsevierViewall">The PBRT-PCR data show that the 37 selected strains carried a plasmid with an IncL plasmid, 96% out of the 37 a plasmid replicon FIIK and 33.3% a plasmid replicon ColE (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). Two cluster A-ST101 strains also carried one plasmid replicon R and the strain of cluster E<span class="elsevierStyleInf">16</span>-ST405 showed the plasmid replicon FIA. The strains belonging to ST17 and ST14 were the only ones without plasmid replicons other than IncL.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">PFGE and Southern blot studies revealed that that <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span> was present in all 85 OXA-48-producing strains in an approx. 62<span class="elsevierStyleHsp" style=""></span>kb plasmid belonging to the IncL incompatibility group. These data were confirmed by conjugation assays. In all 11 conjugated strains we found OXA-48-producing <span class="elsevierStyleItalic">E. coli</span> transconjugants with a conjugation frequency between 1.3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−5</span> and 5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−7</span>. All transconjugants with <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span> were resistant to penicillins, remaining susceptible to cefotaxime and ceftazidime and with a reduction in their susceptibility to ertapenem. In all cases the carbapenemase had transferred alone, as confirmed by PCR.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Southern blot experiments revealed that <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> and <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span> were carried in FIIK plasmids of approx. 240Kb in ST101strains and approx. 290Kb in ST405.</p><p id="par0160" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span>-carrying genetic platform was related with the transposon Tn<span class="elsevierStyleItalic">1999</span> (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). Seventy-eight strains (91.8%) showed Tn<span class="elsevierStyleItalic">1999</span>.<span class="elsevierStyleItalic">2</span> and seven the intact <span class="elsevierStyleItalic">Tn1999</span>. We sequenced the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span> genetic surroundings in eleven randomly selected strains (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) (GenBank accession numbers: KT265174, KT265175, KT265176, KT265177, KT265178, KT265179, KT265180, KT265181, KT265182, KT265183 and KT265173). In 10 cases a unique sequence between the IS1R element, upstream of <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span> and <span class="elsevierStyleItalic">lysR</span>, was found, with 100% homology with the Tn<span class="elsevierStyleItalic">1999</span>.<span class="elsevierStyleItalic">2</span> sequence from pKpn-E1.Nr7 (<a id="intr0010" class="elsevierStyleInterRef" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=nucleotide&doptcmdl=genbank&term=KM406491.1">KM406491.1</a>). The remaining strain had 100% homology with <span class="elsevierStyleItalic">K. pneumoniae</span> E71T (<a id="intr0015" class="elsevierStyleInterRef" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=nucleotide&doptcmdl=genbank&term=KC335143.1">KC335143.1</a>) and pKPoxa-48N1 (<a id="intr0020" class="elsevierStyleInterRef" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=nucleotide&doptcmdl=genbank&term=KC757416.2">KC757416.2</a>). The only difference between the two groups was due to a transversion T-G at position 911, where the <span class="elsevierStyleItalic">K. pneumoniae</span> E71T (<a id="intr0025" class="elsevierStyleInterRef" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=nucleotide&doptcmdl=genbank&term=KC335143.1">KC335143.1</a>) and pKPoxa-48N1 (<a id="intr0030" class="elsevierStyleInterRef" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=nucleotide&doptcmdl=genbank&term=KC757416.2">KC757416.2</a>) sequences have a guanine.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0165" class="elsevierStylePara elsevierViewall">Determining OXA-48-producing strain prevalence is hampered by the lack of a standard method.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a> The MHT, in 2012 recommended by the CLSI for carbapenemase detection,<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1,11</span></a> is now considered unsuitable as a single screening method, being too unspecific and insensitive for metallo-β-lactamase detection. In this study, 51% of positive MHT strains did not express any carbapenemase. These false positives were due to the presence of ESBLs such as CTX-M-15, acAmpCs such as DHA or porin alterations, which may be involved in reduced susceptibility to carbapenems.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a> A low affinity for carbapenems of some ESBLs has been described, specifically for the CTX-M-15 enzyme, which can hydrolyse ertapenem when highly expressed.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a> The three OXA-48-producing <span class="elsevierStyleItalic">K. pneumoniae</span> strains without additional β-lactamases were only resistant to ampicillin, piperacillin and amoxicillin/clavulanic acid, remaining susceptible to ertapenem and imipenem. In contrast, all the OXA-48- and ESBL- or acAmpC-producing strains were resistant to penicillins, cephalosporins and ertapenem, and 23.5% also to imipenem.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Therefore, assuming that the phenotypic method might not be accurate to determine the prevalence of oxa-48 producing strains, prevalence was determined according to PCR results. The prevalence of OXA-48-producing-<span class="elsevierStyleItalic">K</span>. <span class="elsevierStyleItalic">pneumoniae</span> strains in 2012 in Catalonia was 1.9%, matching previous studies in some Spanish tertiary hospitals<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2,9</span></a> a 0.04% and 5.3% prevalence was described. A recent European survey of carbapenemase-producing <span class="elsevierStyleItalic">Enterobacteriaceae</span> (EuSCAPE),<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a> found a 69.8% prevalence of OXA-48-producing <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> strains among 136 strains collected by Instituto de Salud Carlos III (Majadahonda, Spain).</p><p id="par0175" class="elsevierStylePara elsevierViewall">The lack of standardization in detection methods affects not only prevalence data, but also the implementation of a policy to avoid the establishment of multiresistant strains,<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a> although new chromogenic plate methods have been described.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Like ESBL- or acAmpC-producing strains,<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4,12,13</span></a> OXA-48-producing <span class="elsevierStyleItalic">K</span>. <span class="elsevierStyleItalic">pneumoniae</span> isolates are also resistant to aminoglycosides, cotrimoxazole and ciprofloxacin. Nevertheless, the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span>-carrying IncL plasmids described to date (such as pkPoxa-48N1),<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> responsible for OXA-48 dissemination, do not include any associated antimicrobial resistance genes. Our results show that <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span> is present in an IncFIIk plasmid, in agreement with other authors,<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a> together with quinolone and aminoglycoside resistance genes.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">The worldwide expansion of <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span> could be due to its association with Tn<span class="elsevierStyleItalic">1999</span>, located on a characteristic IncL plasmid.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a> In turn, Tn<span class="elsevierStyleItalic">1999</span> is inserted into the <span class="elsevierStyleItalic">tir</span> gene responsible for plasmid transfer inhibition. We found the increasing OXA-48 prevalence was also due to the expansion of the ST405 clone, present in all hospitals with OXA-48-producing <span class="elsevierStyleItalic">K</span>. <span class="elsevierStyleItalic">pneumoniae</span> except two. This major clone was originally identified in Casablanca (Morocco)<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a> in a <span class="elsevierStyleItalic">K</span>. <span class="elsevierStyleItalic">pneumoniae</span> strain carrying <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span> and <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, but not <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span>, and has been widely described in Europe, including Spain<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a> As described by Baquero et al.,<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">26</span></a> this expansion could be due to colonization and transmission between particular hosts, which acquire antibiotic resistance and enhanced survival capacity. In this study, the ST405 clone was found in six of the eight hospitals with OXA-48 carbapenemase.</p><p id="par0190" class="elsevierStylePara elsevierViewall">The expansion of all these clones is taking place in the elderly population and is related to the healthcare system. These results are similar to those obtained from patients infected by ESBL- or acAmpC-producing strains.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">27</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Like ST405, the sequence types ST101, ST14 and ST17 are also described as multiresistant clones present in various European and American countries.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">7,28–31</span></a> Nevertheless, in our case, ST14 and ST17 were only detected exceptionally and did not carry additional resistances. Finally, ST1233, described here for the first time, was a single locus variant of ST540, and did not show resistance to aminoglycosides or quinolones. All these clones were isolated in a timely manner.</p><p id="par0200" class="elsevierStylePara elsevierViewall">Taken together, our results show that the increasing prevalence of carbapenemase OXA-48 in Catalonia is due to the expansion of the <span class="elsevierStyleItalic">K. pneumoniae</span> ST405 clone. All clones described preserved the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span> genetic environment as well as the mobile genetic elements (Tn<span class="elsevierStyleItalic">1999</span>). Curiously, the three strains with minority ST were not resistant to multiple drugs, perhaps because of an absence of selection pressure due to their infrequency and therefore low exposure to antibiotics.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflict of interest</span><p id="par0205" class="elsevierStylePara elsevierViewall">There is no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1156266" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methodology" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1083512" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1156265" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1083511" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Ethics" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Strains and patients" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Bacterial identification and antimicrobial susceptibility testing" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Amplification of antimicrobial resistance genes" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Molecular typing of bla-carrying K. pneumoniae strains" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Conjugation assay" ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Plasmid typing" ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0055" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Bacterial isolates and susceptibility data" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Clinical and molecular epidemiological data" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Plasmid characterization and the bla-carrying genetic platform" ] ] ] 7 => array:2 [ "identificador" => "sec0075" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflict of interest" ] 9 => array:2 [ "identificador" => "xack394600" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-10-26" "fechaAceptado" => "2018-02-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1083512" "palabras" => array:5 [ 0 => "Antibiotic resistance" 1 => "OXA-48" 2 => "Carbapenemase" 3 => "PFGE" 4 => "MLST" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1083511" "palabras" => array:5 [ 0 => "Resistencia a los antibióticos" 1 => "OXA-48" 2 => "Carbapenemasa" 3 => "PFGE" 4 => "MLST" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To characterize OXA-48 carbapenemase-producing <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> strains isolated after an increase in carbapenem resistance in Catalonia.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methodology</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">K. pneumoniae</span> identification, antimicrobial susceptibility studies, the Modified Hodge Test method, amplification of antimicrobial resistance genes (against β-lactamases, quinolones and aminoglycosides), molecular typing (by PFGE and MLST), conjugation assays, plasmid characterization (PBRT-PCR and Southern blot), a description of mobile genetic elements and statistical analysis were done.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">OXA-48 was the only carbapenemase detected, with a prevalence of 1.9%. The <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span> gene was located in an IncL conjugative plasmid of 62<span class="elsevierStyleHsp" style=""></span>kb and integrated into the transposons Tn<span class="elsevierStyleItalic">1999</span>.<span class="elsevierStyleItalic">2</span> (91.7%) or Tn<span class="elsevierStyleItalic">1999</span>.<span class="elsevierStyleItalic">1</span>. Five PFGE profiles (A to E) were found, which exactly matched the MLST: ST101, ST17, ST1233, ST14 and ST405, respectively. ST1233 is described here for the first time. <span class="elsevierStyleItalic">K</span>. <span class="elsevierStyleItalic">pneumoniae</span> OXA-48-producing strains were also CTX-M-15 carriers, some producing OXA-1 and TEM-1 penicillinases. The acquired <span class="elsevierStyleItalic">qnrB66</span> and <span class="elsevierStyleItalic">qnrB1</span> and <span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span> genes were also identified.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The <span class="elsevierStyleItalic">K. pneumoniae</span> ST405 clone has played an important role in the growing prevalence of OXA-48 in Catalonia. All clones described preserved the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span> genetic environment and mobile genetic elements (Tn<span class="elsevierStyleItalic">1999</span>). Notably, the three strains with minor sequence types in this study are not multiresistant strains. These strains are expanding in elderly patients (average age of 76 years) with serious underlying diseases, mainly women (61.2%).</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methodology" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue caracterizar las cepas de <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> productoras de carbapenemasa OXA-48 aisladas tras observar un aumento de estos aislados resistentes a los carbapenémicos en Cataluña.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realizó la identificación de <span class="elsevierStyleItalic">K. pneumoniae</span>, estudios de sensibilidad antimicrobiana, el test de Hodge modificado, amplificación de genes de resistencia antimicrobiana (contra β-lactamasas, quinolonas y aminoglucósidos), tipificación molecular (por PFGE y MLST), ensayos de conjugación, caracterización de plásmidos (PBRT-PCR y <span class="elsevierStyleItalic">Southern blot</span>), descripción de los elementos genéticos móviles y el análisis estadístico.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">OXA-48 fue la única carbapenemasa presente, con una prevalencia del 1,9%. El gen <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span> se localizó en un plásmido conjugativo IncL de 62<span class="elsevierStyleHsp" style=""></span>kb e integrado en los transposones Tn<span class="elsevierStyleItalic">1999</span>.<span class="elsevierStyleItalic">2</span> (91,7%) o Tn<span class="elsevierStyleItalic">1999</span>.<span class="elsevierStyleItalic">1</span>. Se encontraron 5 perfiles diferentes de PFGE (A a E), que tenían una concordancia exacta con el MLST: ST101, ST17, ST1233, ST14 y ST405, respectivamente. El ST1233 se describe aquí por primera vez. Las cepas productoras de <span class="elsevierStyleItalic">K. pneumoniae</span> OXA-48 también fueron portadoras de CTX-M-15 y algunas de ellas productoras también de penicilinasas OXA-1 y TEM-1. Los genes adquiridos <span class="elsevierStyleItalic">qnrB66</span> y <span class="elsevierStyleItalic">qnrB1</span> y <span class="elsevierStyleItalic">aac(3’)-IIa</span>, <span class="elsevierStyleItalic">aac(6’)-Ib</span> también se identificaron.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El clon <span class="elsevierStyleItalic">K. pneumoniae</span> ST405 tiene un papel importante en la creciente prevalencia de OXA-48 en Cataluña. Todos los clones descritos preservaron el entorno genético de <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span>, así como los elementos genéticos móviles (Tn<span class="elsevierStyleItalic">1999</span>). Notablemente, las 3 cepas con tipos de secuencia menos prevalentes en este estudio no son cepas multirresistentes. Además, la expansión de estas cepas con <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span> se está produciendo en pacientes de edad avanzada (promedio de edad de 76 años), la mayoría mujeres (61,2%) con enfermedades subyacentes graves.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1116 "Ancho" => 1642 "Tamanyo" => 76750 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of the different PFGE clusters by hospital. HC (Consorci de Salut del Maresme), HGC (Hospital General Universitari de Catalunya), HGG (Hospital General de Granollers), HGH (Hospital General de l’Hospitalet), HGV (Consorci hospitalari de Vic), HM (Hospital de Mataró), HSCSP (Hospital de la Santa Creu i Sant Pau) and HSJDD (Hospital Sant Joan de Déu de Manresa).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1060 "Ancho" => 2500 "Tamanyo" => 96925 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Genetic backgrounds of the <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-48</span> gene in our <span class="elsevierStyleItalic">K</span>. <span class="elsevierStyleItalic">pneumoniae</span> carbapenemase-producing strains (Genbank Access Numbers of fragment sequenced: KT265173, KT265174, KT265175, KT265176, KT265177, KT265178, KT265179, KT265180, KT265181, KT265182 and KT265183).</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Antibiotic \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Resistance (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ampicillin (AMP) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Piperacillin (PIP) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Amoxicillin/clavulanic acid (AMC) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Piperacillin/tazobactam (TZP) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cephalotin (CEF) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cefoxitin (FOX) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cefuroxime (CXM) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cefotaxime (CTX) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ceftazidime (CAZ) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Aztreonam (ATM) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cefepime (FEP) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ertapenem (ERT) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Imipenem (IMP) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kanamycin (K) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gentamicin (G) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tobramycin (T) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Amikacin (A) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Netilmicin (Nt) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neomycin (Nm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nalidixic acid (NAL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ciprofloxacin (CIP) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cotrimoxazole (SXT) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1974138.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Antibiotic resistance in OXA-48-producing <span class="elsevierStyleItalic">K</span>. <span class="elsevierStyleItalic">pneumoniae</span> strains.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ST \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PFGE \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">β-Lactamase genes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AME \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Qnr \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">ST101</td><td class="td" title="table-entry " align="left" valign="top">A<span class="elsevierStyleInf">1</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-1</span> (100%<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="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib (66.6%)</span><br><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span>, <span class="elsevierStyleItalic">aph(3′)-Ia (33.3%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span><br><span class="elsevierStyleItalic">qnrS</span> (50%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">A<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-1</span> (55.5%)<br><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">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-1</span> (44.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib (66.6%)</span><br><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span>, <span class="elsevierStyleItalic">aac(2′)-Ia (11.1%)</span><br><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span>, <span class="elsevierStyleItalic">ant(2′)-Ia</span>, <span class="elsevierStyleItalic">aac(2′)-Ia (11.1%)</span><br><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span>, <span class="elsevierStyleItalic">aph(3′)-Ia (11.1%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> (45.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">A<span class="elsevierStyleInf">3</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-1</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span>, <span class="elsevierStyleItalic">aph(3′)-Ia</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB1</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ST17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-11</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">–</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ST1233 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-42</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">–</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ST14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-1</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">–</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="18" align="left" valign="top">ST405</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">1</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> (9%)<br><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> (9%)<br><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">bla</span><span class="elsevierStyleInf">SHV-76</span> (9%)<br><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> (18%)<br><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">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> (55%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib (36.3%)</span><br><span class="elsevierStyleItalic">aac(3′)-IIa (36.3%)</span><br><span class="elsevierStyleItalic">aac(6′)-Ib (18.1%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> (91%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">3</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(6′)-Ib</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">4</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">5</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib (90%)</span><br><span class="elsevierStyleItalic">aac(3′)-IIa (10%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> (96%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">6</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> (50%)<br><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> (50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib (50%)</span><br><span class="elsevierStyleItalic">aac(6′)-Ib (50%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">7</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">8</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">9</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">10</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(6′)-Ib</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">11</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>,<span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">12</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>,<span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">13</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>,<span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">14</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">15</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">16</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">17</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E<span class="elsevierStyleInf">18</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-15</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">OXA-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-1</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-76</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">aac(3′)-IIa</span>, <span class="elsevierStyleItalic">aac(6′)-Ib</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">qnrB66</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1974137.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The percentages represent the total of strains with a genetic endowment in each subcluster.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Antimicrobial resistance genes present in the different MLST and PFGE profiles of the 85 OXA-48-producing <span class="elsevierStyleItalic">K. pneumoniae</span> strains.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Origin of samples</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urinary tract \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Respiratory tract \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Blood \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Surgical wound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Faeces \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Men/women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33/52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39/61 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Average age</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age (range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76 (26–96) years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Men/women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72/79 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Men/women over 65 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20/46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Origin of infection</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nosocomial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Residential healthcare centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Community \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1974139.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Clinical data of the 85 patients with OXA-48-producing <span class="elsevierStyleItalic">K</span>. <span class="elsevierStyleItalic">pneumoniae</span>.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ST \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Plasmid replicons (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Genetic platform \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Subtypes (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="middle">101</td><td class="td" title="table-entry " align="left" valign="top">L, FIIK, ColE, R \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A<span class="elsevierStyleInf">1</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK, ColE, R \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A<span class="elsevierStyleInf">2</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK, ColE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A<span class="elsevierStyleInf">3</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">122 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">L, ColE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">C(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">D(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="18" align="left" valign="middle">405</td><td class="td" title="table-entry " align="left" valign="top">L, FIIK (100%) ColE (50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">1</span>(8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">2</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">3</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">4</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK (100%) ColE (50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">5</span>(4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">6</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">7</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">8</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">9</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">10</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">11</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">12</span>(2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">13</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">14</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">15</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK, FIA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">16</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK, ColE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">17</span>(1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L, FIIK (100%) ColE (50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tn1999.2/Tn1999 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E<span class="elsevierStyleInf">18</span>(2) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1974140.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Plasmid typing (PBRT-PCR) in 37 OXA-48-producing <span class="elsevierStyleItalic">K</span>. <span class="elsevierStyleItalic">pneumoniae</span> strains.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0160" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "OXA-48-like carbapenemases: the phantom menace" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. 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Original article
Molecular characterization of OXA-48 carbapenemase-producing Klebsiella pneumoniae strains after a carbapenem resistance increase in Catalonia
Caracterización molecular de las cepas de Klebsiella pneumoniae productoras de carbapenemasa OXA-48 tras un aumento de la resistencia a las carbapenemas en Cataluña
Marc Argentea, Elisenda Miróa, Carmina Martíb,c, Ana Vilamalab,d, Carles Alonso-Tarrésb,e, Frederic Ballesterb,f, Ana Calderónb,g, Carmen Gallésb,h, Asunción Gasósb,i, Beatriz Mirelisa, Montserrat Mortab,j, Montserrat Olsinab,k, Goretti Saucab,l, Montserrat Sierrab,m, Alba Riveraa, Ferran Navarroa,
Autor para correspondencia
a Hospital de la Santa Creu i Sant Pau and Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
b Grup de Microbiòlegs dels Hospitals Comarcals de Catalunya i Balears, Spain
c Hospital General de Granollers, Barcelona, Spain
d Consorci hospitalari de Vic, Barcelona, Spain
e Hospital General de l’Hospitalet (Consorci Sanitari Integral and Consorci de Laboratoris Intercomarcal), Currently Fundació Puigvert, Barcelona, Spain
f Hospital Universitari Sant Joan de Reus, Tarragona, Spain
g Hospital Municipal de Badalona, Barcelona, Spain
h Corporació de Salut del Maresme i la Selva, Spain
i Hospital Sant Joan Martorell, Barcelona, Spain
j Hospital Sant Joan de Déu de Manresa, Barcelona, Spain
k Hospital General Universitari de Catalunya-Quionsalud, Barcelona, Spain
l Hospital de Mataró, Barcelona, Spain
m Hospital de Barcelona-SCIAS, Barcelona, Spain
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