{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:06:50Z","timestamp":1792026410526,"version":"4.4.0"},"reference-count":64,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T00:00:00Z","timestamp":1720569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:p>Sodium hypochlorite (NaOCl) is widely recognized for its broad-spectrum antimicrobial efficacy in skin wound care. This study investigates the effectiveness of NaOCl against a range of bacterial and fungal isolates from pressure ulcer (PU) patients.<\/jats:p><jats:p>We analyzed 20 bacterial isolates from PU patients, comprising carbapenem-resistant <jats:italic>Klebsiella pneumoniae<\/jats:italic> (CRKP), multidrug-resistant Acinetobacter baumannii (MDRAB), methicillin-resistant <jats:italic>Staphylococcus aureus<\/jats:italic> (MRSA), methicillin-susceptible <jats:italic>Staphylococcus aureus<\/jats:italic> (MSSA), along with 5 <jats:italic>Candida albicans<\/jats:italic> isolates. Antibiotic resistance profiles were determined using standard susceptibility testing. Whole-genome sequencing (WGS) was employed to identify antimicrobial resistance genes (ARGs) and disinfectant resistance genes (DRGs). Genetic determinants of biofilm formation were also assessed. The antimicrobial activity of NaOCl was evaluated by determining the minimum inhibitory concentration (MIC) and the minimal biofilm eradication concentration (MBEC) for both planktonic and biofilm-associated cells.<\/jats:p><jats:p>CRKP and MDRAB showed resistance to fluoroquinolones and carbapenems, while MRSA exhibited resistance to \u03b2-lactams and levofloxacin. MSSA displayed a comparatively lower resistance profile. WGS identified significant numbers of ARGs in CRKP and MDRAB, with fewer DRGs compared to MRSA and MSSA. All isolates possessed genes associated with fimbriae production and adhesion, correlating with pronounced biofilm biomass production. NaOCl demonstrated substantial antimicrobial activity against both planktonic cells and biofilms. The MIC<jats:sub>90<\/jats:sub> for planktonic bacterial cells was 0.125\u2009mg\/mL, and the MBEC<jats:sub>90<\/jats:sub> ranged from 0.225 to 0.5\u2009mg\/mL. For planktonic C. <jats:italic>albicans<\/jats:italic>, the MIC<jats:sub>90<\/jats:sub> was 0.150\u2009mg\/mL, and the MBEC<jats:sub>90<\/jats:sub> was 0.250\u2009mg\/mL.<\/jats:p><jats:p>These results highlight the challenge in treating biofilm-associated infections and underscore the potential of NaOCl as a robust antimicrobial agent against difficult-to-treat biofilm infections at concentrations lower than those typically found in commercial disinfectants.<\/jats:p>","DOI":"10.3389\/fmicb.2024.1432883","type":"journal-article","created":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T05:08:23Z","timestamp":1720588103000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":20,"title":["Efficacy of sodium hypochlorite in overcoming antimicrobial resistance and eradicating biofilms in clinical pathogens from pressure ulcers"],"prefix":"10.3389","volume":"15","author":[{"given":"Giorgia","family":"Fabrizio","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Sivori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Cavallo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Truglio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Toma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Sperati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Francalancia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Obregon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"Pamparau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Kovacs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fulvia","family":"Pimpinelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enea Gino","family":"Di Domenico","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,7,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"D690","DOI":"10.1093\/nar\/gkac920","article-title":"CARD 2023: expanded curation, support for machine learning, and resistome prediction at the comprehensive antibiotic resistance database","volume":"51","author":"Alcock","year":"2023","journal-title":"Nucleic Acids Res."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1016\/j.ajic.2010.05.019","article-title":"Povidone-iodine against sodium hypochlorite as skin antiseptics in volunteers","volume":"38","author":"Alvarez","year":"2010","journal-title":"Am. J. Infect. Control"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1089\/cmb.2012.0021","article-title":"SPAdes: a new genome assembly algorithm and its applications to single-cell sequencing","volume":"19","author":"Bankevich","year":"2012","journal-title":"J. Comput. Biol."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1111\/ajd.12015","article-title":"Use of bleach baths for the treatment of infected atopic eczema","volume":"54","author":"Barnes","year":"2013","journal-title":"Australas. J. Dermatol."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1587","DOI":"10.3390\/antibiotics12111587","article-title":"Prevalence of multidrug-resistant and ESBL-producing bacterial pathogens in patients with chronic wound infections and spinal cord injury admitted to a tertiary care rehabilitation hospital","volume":"12","author":"Binsuwaidan","year":"2023","journal-title":"Antibiotics"},{"key":"ref6","first-page":"24","article-title":"Toxicity and safety of topical sodium hypochlorite","volume-title":"Contributions to nephrology","author":"Bruch","year":"2006"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"5825","DOI":"10.1093\/molbev\/msab293","article-title":"eggNOG-mapper v2: functional annotation, Orthology assignments, and domain prediction at the metagenomic scale","volume":"38","author":"Cantalapiedra","year":"2021","journal-title":"Mol. Biol. Evol."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"109","DOI":"10.3390\/biology13020109","article-title":"Bacterial biofilm in chronic wounds and possible therapeutic approaches","volume":"13","author":"Cavallo","year":"2024","journal-title":"Biology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"21104","DOI":"10.1038\/s41598-022-25436-3","article-title":"Skin dysbiosis and Cutibacterium acnes biofilm in inflammatory acne lesions of adolescents","volume":"12","author":"Cavallo","year":"2022","journal-title":"Sci. Rep."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"D694","DOI":"10.1093\/nar\/gkv1239","article-title":"VFDB 2016: hierarchical and refined dataset for big data analysis\u201410 years on","volume":"44","author":"Chen","year":"2016","journal-title":"Nucleic Acids Res."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"i884","DOI":"10.1093\/bioinformatics\/bty560","article-title":"Fastp: an ultra-fast all-in-one FASTQ preprocessor","volume":"34","author":"Chen","year":"2018","journal-title":"Bioinformatics"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"955","DOI":"10.3390\/antibiotics11070955","article-title":"Whole-genome sequencing of ST2 A. baumannii causing bloodstream infections in COVID-19 patients","volume":"11","author":"Cherubini","year":"2022","journal-title":"Antibiotics"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.ajic.2017.08.012","article-title":"Skin antisepsis with 0.05% sodium hypochlorite before central venous catheter insertion in neonates: a 2-year single-center experience","volume":"46","author":"Ciccia","year":"2018","journal-title":"Am. J. Infect. Control"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2016\/4034517","article-title":"Changes in the expression of biofilm-associated surface proteins in Staphylococcus aureus food-environmental isolates subjected to sublethal concentrations of disinfectants","volume":"2016","author":"Cincarova","year":"2016","journal-title":"Biomed. Res. Int."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e0045324","DOI":"10.1128\/mbio.00453-24","article-title":"The Staphylococcus aureus regulatory program in a human skin-like environment","volume":"15","author":"Costa","year":"2024","journal-title":"MBio"},{"key":"ref16","first-page":"97","article-title":"Effectiveness of sodium hypochlorite in the prevention of catheter related infections","volume-title":"Contributions to nephrology","author":"Cruz","year":"2006"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1111\/j.1365-2672.2007.03299.x","article-title":"Antimicrobial activity and effectiveness of a combination of sodium hypochlorite and hydrogen peroxide in killing and removing Pseudomonas aeruginosa biofilms from surfaces","volume":"103","author":"DeQueiroz","year":"2007","journal-title":"J. Appl. Microbiol."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"foy025","DOI":"10.1093\/femsyr\/foy025","article-title":"The clinical biofilm ring test: a promising tool for the clinical assessment of biofilm-producing Candida species","volume":"18","author":"Di Domenico","year":"2018","journal-title":"FEMS Yeast Res."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.3390\/ijms18051077","article-title":"Biofilm is a major virulence determinant in bacterial colonization of chronic skin ulcers independently from the multidrug resistant phenotype","volume":"18","author":"Di Domenico","year":"2017","journal-title":"Int J Mol Sci"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1259","DOI":"10.3390\/microorganisms10071259","article-title":"The current knowledge on the pathogenesis of tissue and medical device-related biofilm infections","volume":"10","author":"Di Domenico","year":"2022","journal-title":"Microorganisms"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"928","DOI":"10.1186\/s12879-019-4565-3","article-title":"Co-existence of virulence factors and antibiotic resistance in new Klebsiella pneumoniae clones emerging in south of Italy","volume":"19","author":"Fasciana","year":"2019","journal-title":"BMC Infect. Dis."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1046\/j.1365-2672.2001.01385.x","article-title":"Assessment of resistance towards biocides following the attachment of microorganisms to, and growth on, surfaces","volume":"91","author":"Gilbert","year":"2001","journal-title":"J. Appl. Microbiol."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1016\/j.suc.2020.05.001","article-title":"What makes wounds chronic","volume":"100","author":"Goldberg","year":"2020","journal-title":"Surg. Clin. N. Am."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1186\/s13073-020-00814-6","article-title":"A Klebsiella pneumoniae ST307 outbreak clone from Germany demonstrates features of extensive drug resistance, hypermucoviscosity, and enhanced iron acquisition","volume":"12","author":"Heiden","year":"2020","journal-title":"Genome Med."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"22859","DOI":"10.1038\/s41598-021-02251-w","article-title":"High prevalence of multiple antibiotic resistance in clinical E. coli isolates from Bangladesh and prediction of molecular resistance determinants using WGS of an XDR isolate","volume":"11","author":"Jain","year":"2021","journal-title":"Sci. Rep."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1093\/jac\/dkad039","article-title":"The emerging threat of methicillin-resistant Staphylococcus aureus (MRSA) clone ST22-PT, carrying both Panton\u2013valentine leucocidin and toxic shock syndrome toxin 1 genes","volume":"78","author":"Kaneko","year":"2023","journal-title":"J. Antimicrob. Chemother."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"6479","DOI":"10.1007\/s00784-022-04716-2","article-title":"Resistance profiles to antifungal agents in Candida albicans isolated from human oral cavities: systematic review and meta-analysis","volume":"26","author":"Kessler","year":"2022","journal-title":"Clin. Oral Invest."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1360645","DOI":"10.3389\/fmicb.2024.1360645","article-title":"Evaluating disinfectant efficacy on mixed biofilms comprising Shiga toxigenic Escherichia coli, lactic acid bacteria, and spoilage microorganisms","volume":"15","author":"Koti","year":"2024","journal-title":"Front. Microbiol."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.jtv.2019.01.001","article-title":"Prevention and treatment of pressure ulcers\/injuries: the protocol for the second update of the international clinical practice guideline 2019","volume":"28","author":"Kottner","year":"2019","journal-title":"J. Tissue Viability"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1159\/000481545","article-title":"Consensus on wound antisepsis: update 2018","volume":"31","author":"Kramer","year":"2018","journal-title":"Skin Pharmacol. Physiol."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1128\/aem.46.1.165-170.1983","article-title":"Multiple antibiotic resistance indexing of Escherichia coli to identify high-risk sources of fecal contamination of foods","volume":"46","author":"Krumperman","year":"1983","journal-title":"Appl. Environ. Microbiol."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/S0378-1097(99)00636-9","article-title":"Association of qacE and qacE \u03941 with multiple resistance to antibiotics and antiseptics in clinical isolates of gram-negative bacteria","volume":"183","author":"Kucken","year":"2000","journal-title":"FEMS Microbiol. Lett."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"103546","DOI":"10.1016\/j.ijnurstu.2020.103546","article-title":"Global prevalence and incidence of pressure injuries in hospitalised adult patients: a systematic review and meta-analysis","volume":"105","author":"Li","year":"2020","journal-title":"Int. J. Nurs. Stud."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"4727","DOI":"10.2147\/IDR.S338627","article-title":"Pathogenic characteristics and risk factors for ESKAPE pathogens infection in burn patients","volume":"14","author":"Li","year":"2021","journal-title":"IDR"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"5486","DOI":"10.1128\/JB.187.15.5486-5492.2005","article-title":"Global regulation of gene expression by ArlRS, a two-component signal transduction regulatory system of Staphylococcus aureus","volume":"187","author":"Liang","year":"2005","journal-title":"J. Bacteriol."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1186\/s13756-018-0447-5","article-title":"Hydrogen peroxide and sodium hypochlorite disinfectants are more effective against Staphylococcus aureus and Pseudomonas aeruginosa biofilms than quaternary ammonium compounds","volume":"7","author":"Lineback","year":"2018","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"3026","DOI":"10.1093\/jac\/dkw287","article-title":"Antimicrobial stewardship in wound care: a position paper from the British Society for Antimicrobial Chemotherapy and European wound management association","volume":"71","author":"Lipsky","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1390","DOI":"10.1086\/344059","article-title":"Infected pressure ulcers in elderly individuals","volume":"35","author":"Livesley","year":"2002","journal-title":"Clin. Infect. Dis."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"3189","DOI":"10.3390\/jcm12093189","article-title":"Effect of sodium hypochlorite 0.05% on MMP-9 extracellular release in chronic wounds","volume":"12","author":"Maniscalco","year":"2023","journal-title":"J Clin Med"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fcimb.2015.00001","article-title":"Methicillin resistance and the biofilm phenotype in Staphylococcus aureus","volume":"5","author":"McCarthy","year":"2015","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1097\/SAP.0b013e3182a634f7","article-title":"Dakin\u2019s solution: historical perspective and current practice","volume":"73","author":"McCullough","year":"2014","journal-title":"Ann. Plast. Surg."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"4092","DOI":"10.1073\/pnas.1421437112","article-title":"Community participation in biofilm matrix assembly and function","volume":"112","author":"Mitchell","year":"2015","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"136108","DOI":"10.1016\/j.scitotenv.2019.136108","article-title":"Developing chlorine-based antiseptic by electrolysis","volume":"709","author":"Mourad","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2020\/3123084","article-title":"In vivo comparison of chlorine-based antiseptics versus alcohol antiseptic for surgical hand antisepsis","volume":"2020","author":"Myltykbayeva","year":"2020","journal-title":"Scientifica"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"CD011586","DOI":"10.1002\/14651858.CD011586.pub2","article-title":"Antibiotics and antiseptics for pressure ulcers","volume":"2017","author":"Norman","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"749685","DOI":"10.3389\/fmicb.2021.749685","article-title":"Biofilm-related infections in gram-positive Bacteria and the potential role of the long-acting agent Dalbavancin","volume":"12","author":"Oliva","year":"2021","journal-title":"Front. Microbiol."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"3691","DOI":"10.1093\/bioinformatics\/btv421","article-title":"Roary: rapid large-scale prokaryote pan genome analysis","volume":"31","author":"Page","year":"2015","journal-title":"Bioinformatics"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1099\/jmm.0.000032","article-title":"Healthcare-associated infections, medical devices and biofilms: risk, tolerance and control","volume":"64","author":"Percival","year":"2015","journal-title":"J. Med. Microbiol."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"1919","DOI":"10.1093\/jac\/dkq195","article-title":"Molecular and functional characterization of a novel efflux pump, AmvA, mediating antimicrobial and disinfectant resistance in Acinetobacter baumannii","volume":"65","author":"Rajamohan","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"S32","DOI":"10.12968\/jowc.2022.31.Sup2.S32","article-title":"The efficacy of sodium hypochlorite antiseptic: a double-blind, randomised controlled pilot study","volume":"31","author":"Serena","year":"2022","journal-title":"J. Wound Care"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1038\/s42003-021-02629-6","article-title":"The Acinetobacter baumannii disinfectant resistance protein, AmvA, is a spermidine and spermine efflux pump","volume":"4","author":"Short","year":"2021","journal-title":"Commun. Biol."},{"key":"ref52","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1016\/j.clindermatol.2010.03.009","article-title":"Chronic wound infection: facts and controversies","volume":"28","author":"Siddiqui","year":"2010","journal-title":"Clin. Dermatol."},{"key":"ref53","doi-asserted-by":"publisher","first-page":"e0035122","DOI":"10.1128\/spectrum.00351-22","article-title":"Role of extracellular DNA in Dalbavancin activity against methicillin-resistant Staphylococcus aureus (MRSA) biofilms in patients with skin and soft tissue infections","volume":"10","author":"Sivori","year":"2022","journal-title":"Microbiol Spectr."},{"key":"ref54","doi-asserted-by":"publisher","first-page":"4449","DOI":"10.1128\/AAC.02284-12","article-title":"KpnEF, a new member of the Klebsiella pneumoniae cell envelope stress response regulon, is an SMR-type efflux pump involved in broad-Spectrum antimicrobial resistance","volume":"57","author":"Srinivasan","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref55","doi-asserted-by":"publisher","first-page":"e37","DOI":"10.1016\/j.ajic.2017.12.015","article-title":"Sodium hypochlorite is more effective than 70% ethanol against biofilms of clinical isolates of Staphylococcus aureus","volume":"46","author":"Tiwari","year":"2018","journal-title":"Am. J. Infect. Control"},{"key":"ref600","doi-asserted-by":"publisher","first-page":"2722","DOI":"10.1038\/s41598-024-53016-0","article-title":"Modulating the skin mycobiome-bacteriome and treating seborrheic dermatitis with a probiotic-enriched oily suspension","volume":"14","author":"Truglio","year":"2024","journal-title":"Sci Rep."},{"key":"ref56","doi-asserted-by":"publisher","first-page":"2395","DOI":"10.1128\/JB.187.7.2395-2405.2005","article-title":"MgrA is a multiple regulator of two new efflux pumps in Staphylococcus aureus","volume":"187","author":"Truong-Bolduc","year":"2005","journal-title":"J. Bacteriol."},{"key":"ref57","doi-asserted-by":"publisher","first-page":"148","DOI":"10.3390\/pathogens10020148","article-title":"Interplay between ESKAPE pathogens and immunity in skin infections: an overview of the major determinants of virulence and antibiotic resistance","volume":"10","author":"Vale De Macedo","year":"2021","journal-title":"Pathogens"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1093\/jac\/dkt366","article-title":"High genetic diversity of methicillin-susceptible Staphylococcus aureus (MSSA) from humans and animals on livestock farms and presence of SCCmec remnant DNA in MSSA CC398","volume":"69","author":"Vandendriessche","year":"2014","journal-title":"J. Antimicrob. Chemother."},{"key":"ref59","doi-asserted-by":"publisher","first-page":"e000110","DOI":"10.1099\/mgen.0.000110","article-title":"Diversity, virulence, and antimicrobial resistance of the KPC-producing Klebsiella pneumoniae ST307 clone","volume":"3","author":"Villa","year":"2017","journal-title":"Microb. Genom."},{"key":"ref60","doi-asserted-by":"publisher","first-page":"104642","DOI":"10.1016\/j.ijnurstu.2023.104642","article-title":"Risk factors predicting hospital-acquired pressure injury in adult patients: an overview of reviews","volume":"150","author":"Wang","year":"2024","journal-title":"Int. J. Nurs. Stud."},{"key":"ref61","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1248\/bpb.29.554","article-title":"Gene cloning and characterization of SdrM, a chromosomally-encoded multidrug efflux pump, from Staphylococcus aureus","volume":"29","author":"Yamada","year":"2006","journal-title":"Biol. Pharm. Bull."},{"key":"ref62","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1089\/wound.2012.0381","article-title":"Biofilms and inflammation in chronic wounds","volume":"2","author":"Zhao","year":"2013","journal-title":"Adv. Wound Care"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"514","DOI":"10.3390\/antibiotics9080514","article-title":"Clinical and economic burden of Carbapenem-resistant infection or colonization caused by Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii: a multicenter study in China","volume":"9","author":"Zhen","year":"2020","journal-title":"Antibiotics"}],"container-title":["Frontiers in Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2024.1432883\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T05:08:28Z","timestamp":1720588108000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2024.1432883\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,10]]},"references-count":64,"alternative-id":["10.3389\/fmicb.2024.1432883"],"URL":"https:\/\/doi.org\/10.3389\/fmicb.2024.1432883","relation":{},"ISSN":["1664-302X"],"issn-type":[{"value":"1664-302X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,10]]},"article-number":"1432883"}}