{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T05:25:11Z","timestamp":1769145911781,"version":"3.49.0"},"reference-count":43,"publisher":"American Society for Microbiology","issue":"9","license":[{"start":{"date-parts":[[2011,9,1]],"date-time":"2011-09-01T00:00:00Z","timestamp":1314835200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2011,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            Increasing resistance to quinolones, aminoglycosides, and\/or cephamycins in extended-spectrum-\u03b2-lactamase (ESBL)-producing\n            <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">Enterobacteriaceae<\/jats:named-content>\n            exacerbates the already limited antibiotic treatment options for infections due to these microbes. In this study, the presence of resistance determinants for these antimicrobial agents was examined by PCR among ESBL-producing\n            <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">Klebsiella pneumoniae<\/jats:named-content>\n            (ESBL-KP) isolates that caused bacteremia. Pulsed-field gel electrophoresis was used to differentiate the clonal relationship among the isolates studied. Transferability and the location of the resistance genes were analyzed by conjugation experiments, followed by DNA-DNA hybridization. Among the 94 ESBL-KP isolates studied, 20 isolates of flomoxef-resistant ESBL-KP were identified. They all carried a DHA-1 gene and were genetically diverse. CTX-M genes were found in 18 of the isolates. Among these DHA-1\/CTX-M-producing\n            <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">K. pneumoniae<\/jats:named-content>\n            isolates, IS\n            <jats:italic>CR1<\/jats:italic>\n            was detected in 13 (72%) isolates,\n            <jats:italic>qnr<\/jats:italic>\n            genes (1\n            <jats:italic>qnrA<\/jats:italic>\n            and 17\n            <jats:italic>qnrB<\/jats:italic>\n            genes) were detected in 18 (100%),\n            <jats:italic>aac(6<\/jats:italic>\n            \u2032\n            <jats:italic>)-Ib-cr<\/jats:italic>\n            was detected in 11 (61%), and 16S rRNA methylase (all\n            <jats:italic>armA<\/jats:italic>\n            genes) was detected in 14 (78%). Four transconjugants were available for further analysis, and\n            <jats:italic>qnrB4<\/jats:italic>\n            ,\n            <jats:italic>aac(6<\/jats:italic>\n            \u2032\n            <jats:italic>)-Ib-cr<\/jats:italic>\n            ,\n            <jats:italic>armA<\/jats:italic>\n            , and\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>DHA-1<\/jats:sub>\n            were all identified on these self-transferable\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>CTX-M<\/jats:sub>\n            -carrying plasmids. The genetic environments of IS\n            <jats:italic>CR1<\/jats:italic>\n            associated with\n            <jats:italic>armA<\/jats:italic>\n            ,\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>DHA-1<\/jats:sub>\n            , and\n            <jats:italic>qnrB4<\/jats:italic>\n            genes in the four transconjugants were identical. Replicon-type analysis revealed a FIIA plasmid among the four self-transferable plasmids, although the other three were nontypeable. The cotransfer of multiple resistance genes with the IS\n            <jats:italic>CR1<\/jats:italic>\n            element-carrying plasmids has a clinical impact and warrants close monitoring and further study.\n          <\/jats:p>","DOI":"10.1128\/aac.00259-11","type":"journal-article","created":{"date-parts":[[2011,7,12]],"date-time":"2011-07-12T06:10:11Z","timestamp":1310451011000},"page":"4058-4063","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":33,"title":["Spread of IS\n            <i>CR1<\/i>\n            Elements Containing\n            <i>bla<\/i>\n            <sub>DHA-1<\/sub>\n            and Multiple Antimicrobial Resistance Genes Leading to Increase of Flomoxef Resistance in Extended-Spectrum-\u03b2-Lactamase-Producing Klebsiella pneumoniae"],"prefix":"10.1128","volume":"55","author":[{"given":"Chen-Hsiang","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jien-Wei","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chia-Chin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Chih","family":"Chien","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ya-Fen","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lin-Hui","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China"},{"name":"Department of Medical Biotechnology and Laboratory Science, Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01480-06"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/7.6.1513"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkl527"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mimet.2005.03.018"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid1207.051555"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1089\/mdr.2009.0048"},{"key":"e_1_3_2_8_2","unstructured":"Clinical and Laboratory Standards Institute. 2009. 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