{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T23:39:34Z","timestamp":1793403574920,"version":"4.5.0"},"reference-count":85,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T00:00:00Z","timestamp":1614124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>(1) Background: Colistin is a last-resort antibiotic used in treating multidrug-resistant Gram-negative infections. The growing emergence of colistin resistance in Escherichia coli (E. coli) represents a serious health threat, particularly to intensive care unit (ICU) patients. (2) Methods: In this work, we investigated the emergence of colistin resistance in 140 nosocomial E. coli isolated from patients with pneumonia and admitted to the chest ICU over 36 months. Virulence and resistance-related genes and E. coli pathotypes in colistin-resistant and colistin-sensitive isolates were determined. (3) Results: Colistin resistance was observed in 21\/140 (15%) of the nosocomial E. coli isolates. The MIC50 of the resistant strains was 4 mg\/L, while MIC90 was 16 mg\/L. Colistin-resistant isolates were also co-resistant to amoxicillin, amoxicillin\/clavulanic, aztreonam, ciprofloxacin, and chloramphenicol. The mechanism of colistin resistance was represented by the presence of mcr-1 in all resistant strains. Respectively, 42.9% and 36.1% of colistin-resistant and colistin-sensitive groups were extended-spectrum \u03b2-lactamase (ESBL) producers, while 23.8% and 21% were metallo \u03b2-lactamase (MBL) producers. blaTEM-type was the most frequently detected ESBL gene, while blaIMP-type was the most common MBL in both groups. Importantly, most resistant strains showed a significantly high prevalence of astA (76.2%), aggR (76.2%), and pic (52.4%) virulence-related genes. Enteroaggregative E. coli (76%) was the most frequently detected genotype among the colistin-resistant strains. (4) Conclusion: The high colistin resistance rate observed in E. coli strains isolated from patients with nosocomial pneumonia in our university hospital is worrisome. These isolates carry different drug resistance and virulence-related genes. Our results indicate the need for careful monitoring of colistin resistance in our university hospital. Furthermore, infection control policies restricting the unnecessary use of extended-spectrum cephalosporins and carbapenems are necessary.<\/jats:p>","DOI":"10.3390\/antibiotics10030226","type":"journal-article","created":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T20:53:21Z","timestamp":1614200001000},"page":"226","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Emergence of Nosocomial Pneumonia Caused by Colistin-Resistant Escherichia coli in Patients Admitted to Chest Intensive Care Unit"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1943-8419","authenticated-orcid":false,"given":"Mohamed A.","family":"El-Mokhtar","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt"},{"name":"Microbiology and Immunology Department, Faculty of Pharmacy, Sphinx University, Assiut 71515, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1858-7033","authenticated-orcid":false,"given":"Enas","family":"Daef","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7111-2195","authenticated-orcid":false,"given":"Aliae A. R.","family":"Mohamed Hussein","sequence":"additional","affiliation":[{"name":"Chest Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7179-5865","authenticated-orcid":false,"given":"Maiada K.","family":"Hashem","sequence":"additional","affiliation":[{"name":"Chest Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0417-449X","authenticated-orcid":false,"given":"Hebatallah M.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1099\/jmm.0.000425","article-title":"Detection and dissemination of the colistin resistance gene, mcr-1, from isolates and faecal samples in China","volume":"66","author":"Chen","year":"2017","journal-title":"J. Med. Microbiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1086\/432803","article-title":"Overview of nosocomial infections caused by gram-negative bacilli","volume":"41","author":"Weinstein","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/S1473-3099(06)70580-1","article-title":"Colistin: The re-emerging antibiotic for multidrug-resistant Gram-negative bacterial infections","volume":"6","author":"Li","year":"2006","journal-title":"Lancet Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1080\/22221751.2020.1754133","article-title":"Colistin and its role in the Era of antibiotic resistance: An extended review (2000\u20132019)","volume":"9","author":"Ahmed","year":"2020","journal-title":"Emerg. Microbes Infect."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.jgar.2019.06.009","article-title":"Use of colistin in adult patients: A cross-sectional study","volume":"20","author":"Giacobbe","year":"2020","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1093\/jac\/dkg014","article-title":"A national surveillance of antimicrobial resistance in Escherichia coli isolated from food-producing animals in Japan","volume":"51","author":"Ishihara","year":"2003","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/S1473-3099(15)00424-7","article-title":"Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: A microbiological and molecular biological study","volume":"16","author":"Liu","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2340","DOI":"10.1093\/jac\/dkw181","article-title":"Location of colistin resistance gene mcr-1 in Enterobacteriaceae from livestock and meat","volume":"71","author":"Veldman","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e00853-19","DOI":"10.1128\/mBio.00853-19","article-title":"Identification of novel mobilized colistin resistance gene mcr-9 in a multidrug-resistant, colistin-susceptible salmonella enterica serotype typhimurium isolate","volume":"10","author":"Carroll","year":"2019","journal-title":"mBio"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"17","DOI":"10.2807\/1560-7917.ES.2018.23.6.17-00672","article-title":"Multiplex PCR for detection of plasmid-mediated colistin resistance determinants, mcr-1, mcr-2, mcr-3, mcr-4 and mcr-5 for surveillance purposes","volume":"23","author":"Rebelo","year":"2018","journal-title":"Eurosurveillance"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1080\/22221751.2020.1732231","article-title":"Identification of novel mobile colistin resistance gene mcr-10","volume":"9","author":"Wang","year":"2020","journal-title":"Emerg. Microbes Infect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"30280","DOI":"10.2807\/1560-7917.ES.2016.21.27.30280","article-title":"Identification of a novel plasmid-mediated colistin-resistance gene, mcr-2, in Escherichia coli, Belgium, June 2016","volume":"21","author":"Xavier","year":"2016","journal-title":"Eurosurveillance"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e00543-17","DOI":"10.1128\/mBio.00543-17","article-title":"Novel plasmid-mediated colistin resistance gene mcr-3 in Escherichia coli","volume":"8","author":"Yin","year":"2017","journal-title":"MBio"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Hadjadj, L., Riziki, T., Zhu, Y., Linda, H., Diene, S.M., and Rolain, J.-M. (2017). Study of mcr-1 gene-mediated colistin resistance in enterobacteriaceae isolated from humans and animals in different countries. Genes, 8.","DOI":"10.3390\/genes8120394"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.bsheal.2020.05.001","article-title":"Prevalence and transmission of mobilized colistin resistance (mcr) gene in bacteria common to animals and humans","volume":"2","author":"Luo","year":"2020","journal-title":"Biosaf. Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1164\/ajrccm\/142.3.523","article-title":"Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients","volume":"142","author":"Torres","year":"1990","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1007\/s10096-016-2703-z","article-title":"Nosocomial pneumonia in 27 ICUs in Europe: Perspectives from the EU-VAP\/CAP study","volume":"36","author":"Koulenti","year":"2017","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"American Thoracic Society, and Infectious Diseases Society of America (2005). Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am. J. Respir. Crit. Care Med., 171, 388\u2013416.","DOI":"10.1164\/rccm.200405-644ST"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1128\/AAC.3.3.418","article-title":"Rapid, modified Kirby-Bauer susceptibility test with single, high-concentration antimicrobial disks","volume":"3","author":"Boyle","year":"1973","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_20","unstructured":"CLSI (2020). Performance Standards for Antimicrobial Susceptibility Testing, CLSI. [30th ed.]. CLSI Suppl. M100."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e02067-17","DOI":"10.1128\/AAC.02067-17","article-title":"Is colistin susceptibility testing finally on the right track?","volume":"62","author":"Prim","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1089\/mdr.2017.0251","article-title":"Comparative evaluation of broth microdilution with polystyrene and glass-coated plates, agar dilution, E-test, vitek, and disk diffusion for susceptibility testing of colistin and polymyxin b on carbapenem-resistant clinical isolates of acinetobacter baumannii","volume":"24","author":"Singhal","year":"2018","journal-title":"Microb. Drug Resist."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1016\/j.cmi.2017.11.020","article-title":"Antimicrobial susceptibility testing of colistin\u2013Evaluation of seven commercial MIC products against standard broth microdilution for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter spp.","volume":"24","author":"Matuschek","year":"2018","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1097\/INF.0b013e31823c0e9d","article-title":"Extended-spectrum beta-lactamases: A brief clinical update","volume":"30","author":"Malloy","year":"2011","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3798","DOI":"10.1128\/JCM.40.10.3798-3801.2002","article-title":"Imipenem-edta disk method for differentiation of metallo-beta-lactamase-producing clinical isolates of Pseudomonas spp. and Acinetobacter spp.","volume":"40","author":"Yong","year":"2002","journal-title":"J. Clin. Microbiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3380","DOI":"10.1128\/AEM.02855-06","article-title":"Identification of unconventional intestinal pathogenic escherichia coli isolates expressing intermediate virulence factor profiles by using a novel single-step multiplex PCR","volume":"73","author":"Greune","year":"2007","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3317","DOI":"10.1093\/jac\/dkx327","article-title":"Identification of a novel transposon-associated phosphoethanolamine transferase gene, mcr-5, conferring colistin resistance in d-tartrate fermenting Salmonella enterica subsp. enterica serovar Paratyphi B","volume":"72","author":"Borowiak","year":"2017","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.diagmicrobio.2010.12.002","article-title":"Multiplex PCR for detection of acquired carbapenemase genes","volume":"70","author":"Poirel","year":"2011","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"242","DOI":"10.3201\/eid1702.101313","article-title":"New delhi metallo-beta-lactamase from traveler returning to Canada","volume":"17","author":"Peirano","year":"2011","journal-title":"Emerg. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"5058","DOI":"10.1128\/JCM.43.10.5058-5064.2005","article-title":"SHV-type extended-spectrum beta-lactamase production is associated with reduced cefepime susceptibility in enterobacter cloacae","volume":"43","author":"Bonomo","year":"2005","journal-title":"J. Clin. Microbiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1093\/jac\/43.1.157","article-title":"Extended-spectrum \u03b2-lactamase-producing strain of Acinetobacter baumannii isolated from a patient in France","volume":"43","author":"Poirel","year":"1999","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.diagmicrobio.2009.05.021","article-title":"Predominance of CTX-M\u2013type extended-spectrum \u03b2-lactamase genes among enterobacterial isolates from outpatients in Brazil","volume":"65","author":"Minarini","year":"2009","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1093\/jac\/dkp201","article-title":"Update on the treatment of Pseudomonas aeruginosa pneumonia","volume":"64","author":"Alhajhusain","year":"2009","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2478","DOI":"10.1097\/01.CCM.0000089936.09573.F3","article-title":"Clinical impact of pneumonia caused by Acinetobacter baumannii in intubated patients: A matched cohort study","volume":"31","author":"Garnacho","year":"2003","journal-title":"Crit. Care Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1345\/aph.18426","article-title":"Polymyxin B sulfate and colistin: Old antibiotics for emerging multiresistant gram-negative bacteria","volume":"33","author":"Evans","year":"1999","journal-title":"Ann. Pharmacother."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Ahmed, S.H., Daef, E.A., Badary, M.S., Mahmoud, M.A., and Abd-Elsayed, A.A. (2009). Nosocomial blood stream infection in intensive care units at Assiut University hospitals (Upper Egypt) with special reference to extended spectrum beta-lactamase producing organisms. BMC Res. Notes, 2.","DOI":"10.1186\/1756-0500-2-76"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/2110-5820-1-47","article-title":"The rising problem of antimicrobial resistance in the intensive care unit","volume":"1","author":"Brusselaers","year":"2011","journal-title":"Ann. Intensiv. Care"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"587","DOI":"10.2147\/IDR.S151783","article-title":"Ambulance vehicles as a source of multidrug-resistant infections: A multicenter study in Assiut City, Egypt","volume":"11","author":"Hetta","year":"2018","journal-title":"Infect. Drug Resist."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1099\/jmm.0.000770","article-title":"Tigecycline resistance among Klebsiella pneumoniae isolated from febrile neutropenic patients","volume":"67","author":"Elgendy","year":"2018","journal-title":"J. Med. Microbiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"283","DOI":"10.4103\/1687-8426.193640","article-title":"Acute exacerbations of chronic obstructive pulmonary disease: Etiological bacterial pathogens and antibiotic resistance in Upper Egypt","volume":"10","author":"Mohamed","year":"2016","journal-title":"Egypt. J. Bronchol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1080\/21505594.2020.1809962","article-title":"Pathogenesis of Staphylococcus haemolyticus on primary human skin fibroblast cells","volume":"11","author":"Eltwisy","year":"2020","journal-title":"Virulence"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3389\/fpubh.2019.00151","article-title":"The \u201cold\u201d and the \u201cnew\u201d antibiotics for mdr gram-negative pathogens: For whom, when, and how","volume":"7","author":"Karaiskos","year":"2019","journal-title":"Front. Public Health"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.21608\/bfsa.2020.93523","article-title":"Detection of proteus species in diabetic wounds and their antibiotic resistance profile analysis","volume":"43","author":"Thabit","year":"2020","journal-title":"Bull. Pharm. Sci. Assiut"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"215","DOI":"10.3389\/fmicb.2020.00215","article-title":"Emergence of Cronobacter sakazakii in cases of neonatal sepsis in Upper Egypt: First report in North Africa","volume":"11","author":"Elkhawaga","year":"2020","journal-title":"Front. Microbiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.3906\/sag-1506-125","article-title":"Colistin efficacy in the treatment of multidrug-resistant and extremelydrug-resistant gram-negative bacterial infections","volume":"46","author":"Horasan","year":"2016","journal-title":"Turk. J. Med. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1016\/j.chest.2016.04.009","article-title":"A case-control study assessing the impact of nonventilated hospital-acquired pneumonia on patient outcomes","volume":"150","author":"Micek","year":"2016","journal-title":"Chest"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-020-03091-2","article-title":"Update of the treatment of nosocomial pneumonia in the ICU","volume":"24","author":"Zaragoza","year":"2020","journal-title":"Crit. Care"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2147\/IDR.S25985","article-title":"Update on management options in the treatment of nosocomial and ventilator assisted pneumonia: Review of actual guidelines and economic aspects of therapy","volume":"7","author":"Wilke","year":"2013","journal-title":"Infect. Drug Resist."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Di Pasquale, M., Aliberti, S., Mantero, M., Bianchini, S., and Blasi, F. (2016). Non-intensive care unit acquired pneumonia: A new clinical entity?. Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17030287"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"11","DOI":"10.21608\/ejmm.2019.282662","article-title":"Colistin resistance among multidrug-resistant E. coli isolated from Upper Egypt","volume":"28","author":"Mandour","year":"2019","journal-title":"Egypt. J. Med. Microbiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"056","DOI":"10.7324\/JAPS.2020.102009","article-title":"The prevalence of colistin-resistant Gram-negative bacteria isolated from hospitalized patients with bacteremia","volume":"10","author":"Santimaleeworagun","year":"2020","journal-title":"J. Appl. Pharm. Sci."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"33","DOI":"10.3126\/jbs.v7i1.29851","article-title":"Colistin resistance among Gram-negative isolates in Nepal: A review","volume":"7","author":"Devkota","year":"2020","journal-title":"J. Biomed. Sci."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2300","DOI":"10.1093\/jac\/dkw093","article-title":"Detection of the plasmid-mediated mcr-1 gene conferring colistin resistance in human and food isolates of Salmonella enterica and Escherichia coli in England and Wales","volume":"71","author":"Doumith","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2070","DOI":"10.1093\/jac\/dkr239","article-title":"Contemporary activity of colistin and polymyxin B against a worldwide collection of Gram-negative pathogens: Results from the SENTRY Antimicrobial Surveillance Program (2006\u201309)","volume":"66","author":"Gales","year":"2011","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1185\/03007995.2015.1018989","article-title":"Colistin, mechanisms and prevalence of resistance","volume":"31","author":"Bialvaei","year":"2015","journal-title":"Curr. Med Res. Opin."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.medmal.2012.04.008","article-title":"Epidemiological study of Enterobacte-riaceae resistance to colistin in Sfax (Tunisia)","volume":"42","author":"Mahjoubi","year":"2012","journal-title":"Med. Mal. Infect."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1136\/thorax.58.9.794","article-title":"Survey of resistance of Pseudomonas aeruginosa from UK patients with cystic fibrosis to six commonly prescribed antimicrobial agents","volume":"58","author":"Pitt","year":"2003","journal-title":"Thorax"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1128\/JCM.43.2.903-905.2005","article-title":"Reliability of the E-test method for detection of colistin resistance in clinical isolates of acinetobacter baumannii","volume":"43","author":"Arroyo","year":"2005","journal-title":"J. Clin. Microbiol."},{"key":"ref_59","first-page":"478","article-title":"Antimicrobial resistance profile of E. coli and Klebsiella spp. from urine in the infectious diseases hospital Iasi","volume":"112","author":"Miftode","year":"2008","journal-title":"Rev. Med. Chir. Soc. Med. Nat. Iasi"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Piskin, N., Aydemir, H., Oztoprak, N., Akduman, D., Comert, F., Kokturk, F., and Celebi, G. (2012). Inadequate treat-ment of ventilator-associated and hospital-acquired pneumonia: Risk factors and impact on outcomes. BMC Infect. Dis., 12.","DOI":"10.1186\/1471-2334-12-268"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"3249","DOI":"10.1128\/AAC.00269-16","article-title":"Emergence of plasmid-mediated colistin resistance gene mcr-1 in a clinical Escherichia coli isolate from Egypt","volume":"60","author":"Elnahriry","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1637\/10503-012513-Reg.1","article-title":"Molecular and phenotypic characterization of escherichia coli isolated from broiler chicken flocks in Egypt","volume":"57","author":"Hussein","year":"2013","journal-title":"Avian Dis."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12941-019-0339-4","article-title":"Emergence of colistin resistance in multidrug-resistant Klebsiella pneumoniae and Escherichia coli strains isolated from cancer patients","volume":"18","author":"Zafer","year":"2019","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Yamaguchi, T., Kawahara, R., Hamamoto, K., Hirai, I., Khong, D.T., Nguyen, T.N., Tran, H.T., Motooka, D., Nakamura, S., and Yamamoto, Y. (2020). High prevalence of colistin-resistant Escherichia coli with chromosomally carried mcr-1 in healthy residents in Vietnam. Msphere, 5.","DOI":"10.1128\/mSphere.00117-20"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"5623","DOI":"10.1128\/AAC.01267-16","article-title":"Detection of mcr-1 among Escherichia coli clinical isolates collected worldwide as part of the sentry antimicrobial surveillance program in 2014 and 2015","volume":"60","author":"Castanheira","year":"2016","journal-title":"J. Antimicrob. Agents"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.jinf.2017.09.008","article-title":"Prevalence of colistin resistance in clinical isolates of Enterobacteriaceae: A four-year cross-sectional study","volume":"75","author":"Prim","year":"2017","journal-title":"J. Infect."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Snesrud, E., McGann, P., and Chandler, M. (2018). The birth and demise of the isapl1-mcr-1-isapl1 composite transpos-on: The vehicle for transferable colistin resistance. MBio, 9.","DOI":"10.1128\/mBio.02381-17"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1097\/01.ccm.0000435665.07446.50","article-title":"Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients","volume":"42","author":"Blot","year":"2014","journal-title":"Crit. Care Med."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.ijantimicag.2009.11.015","article-title":"Patterns of antimicrobial therapy in severe nosocomial infections: Empiric choices, proportion of appropriate therapy, and adaptation rates\u2014A multicentre, observational survey in critically ill patients","volume":"35","author":"Vogelaers","year":"2010","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"529","DOI":"10.3201\/eid2303.161553","article-title":"Zoonotic transmission of mcr-1 colistin resistance gene from small-scale poultry farms, Vietnam","volume":"23","author":"Trung","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2023","DOI":"10.3201\/eid2312.170883","article-title":"High rate of mcr-1\u2013producing Escherichia coli and Klebsiella pneumoniae among pigs, Portugal","volume":"23","author":"Kieffer","year":"2017","journal-title":"J. Emerg. Infect. Dis."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"3409","DOI":"10.2147\/IDR.S272605","article-title":"Predictors of severity and co-infection resistance profile in COVID-19 patients: First report from upper Egypt","volume":"13","author":"Ramadan","year":"2020","journal-title":"Infect. Drug. Resist."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1128\/AAC.01870-15","article-title":"Correlation of \u03b2-lactamase production and colistin resistance among Enterobacteriaceae isolates from a global surveillance program","volume":"60","author":"Bradford","year":"2016","journal-title":"J. Antimicrob. Agents Chemother."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.jhin.2010.03.021","article-title":"Hospital outbreak caused by Klebsiella pneumoniae producing KPC-2 beta-lactamase resistant to colistin","volume":"76","author":"Kontopoulou","year":"2010","journal-title":"J. Hosp. Infect."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.jgar.2017.03.017","article-title":"Outbreak of colistin-resistant carbapenemase-producing Klebsiella pneu-moniae in Tunisia","volume":"10","author":"Mansour","year":"2017","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1172\/JCI115151","article-title":"Enteroaggregative Escherichia coli elaborate a heat-stable enterotoxin demonstrable in an in vitro rabbit intestinal model","volume":"87","author":"Savarino","year":"1991","journal-title":"J. Clin. Investig."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"251","DOI":"10.3201\/eid0402.980212","article-title":"Enteroaggregative Escherichia coli","volume":"4","author":"Nataro","year":"1998","journal-title":"Emerg. Infect. Dis."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1038\/nrurol.2010.190","article-title":"The epidemiology of urinary tract infection","volume":"7","author":"Foxman","year":"2010","journal-title":"Nat. Rev. Urol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1586\/eri.12.110","article-title":"Extraintestinal pathogenic Escherichia coli: An update on antimicrobial resistance, laboratory diagnosis and treatment","volume":"10","author":"Pitout","year":"2012","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1080\/1040-840291046687","article-title":"Enteroaggregative Escherichia coli heat-stable Enterotoxin 1 (EAST1): A new toxin with an old twist","volume":"28","author":"Dubreuil","year":"2002","journal-title":"Crit. Rev. Microbiol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2010\/254159","article-title":"Enteroaggregative Escherichia coli: An emerging enteric food Borne pathogen","volume":"2010","author":"Kaur","year":"2010","journal-title":"Interdiscip. Perspect. Infect. Dis."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"5587","DOI":"10.1128\/IAI.67.11.5587-5596.1999","article-title":"Characterization of Pic, a Secreted Protease of Shigella flexneri and Enteroaggregative Escherichia coli","volume":"67","author":"Henderson","year":"1999","journal-title":"Infect. Immun."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"5338","DOI":"10.1128\/IAI.67.10.5338-5344.1999","article-title":"Involvement of the enteroaggregative Escherichia coli plasmid-encoded toxin in causing human intestinal damage","volume":"67","author":"Henderson","year":"1999","journal-title":"Infect. Immun."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"4101","DOI":"10.1128\/IAI.00523-10","article-title":"Pic, an autotransporter protein secreted by different pathogens in the enterobacteriaceae family, is a potent mucus secretagogue","volume":"78","author":"Castro","year":"2010","journal-title":"Infect. Immun."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.1001\/jama.2009.1754","article-title":"International study of the prevalence and outcomes of infection in intensive care units","volume":"302","author":"Vincent","year":"2009","journal-title":"JAMA"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/10\/3\/226\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:27:55Z","timestamp":1760160475000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/10\/3\/226"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,24]]},"references-count":85,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["antibiotics10030226"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics10030226","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,24]]}}}