{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:08:08Z","timestamp":1791331688878,"version":"4.3.1"},"reference-count":70,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T00:00:00Z","timestamp":1625788800000},"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>The emergence of multi-drug resistant (MDR) strains and even pan drug resistant (PDR) strains is alarming. In this study, we studied the resistance pattern of E. coli pathogens recovered from patients with different infections in different hospitals in Minia, Egypt and the co-existence of different resistance determinants. E. coli was the most prevalent among patients suffering from urinary tract infections (62%), while they were the least isolated from eye infections (10%). High prevalence of MDR isolates was found (73%) associated with high ESBLs and MBLs production (89.4% and 64.8%, respectively). blaTEM (80%) and blaNDM (43%) were the most frequent ESBL and MBL, respectively. None of the isolates harbored blaKPC and blaOXA-48 carbapenemase like genes. Also, the fluoroquinolone modifying enzyme gene aac-(6\u2032)-Ib-cr was detected in 25.2% of the isolates. More than one gene was found in 81% of the isolates. Azithromycin was one of the most effective antibiotics against MDR E. coli pathogens. The high MAR index of the isolates and the high prevalence of resistance genes, indicates an important public health concern and high-risk communities where antibiotics are abused.<\/jats:p>","DOI":"10.3390\/antibiotics10070835","type":"journal-article","created":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T10:50:38Z","timestamp":1625827838000},"page":"835","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Co-Existence of Certain ESBLs, MBLs and Plasmid Mediated Quinolone Resistance Genes among MDR E. coli Isolated from Different Clinical Specimens in Egypt"],"prefix":"10.3390","volume":"10","author":[{"given":"Salwa Mahmoud","family":"Masoud","sequence":"first","affiliation":[{"name":"Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia 61519, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6094-5653","authenticated-orcid":false,"given":"Rehab Mahmoud","family":"Abd El-Baky","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia 61519, Egypt"},{"name":"Department of Microbiology and Immunology, Faculty of Pharmacy, Deraya University, Minia 11566, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherine A.","family":"Aly","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71516, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reham Ali","family":"Ibrahem","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia 61519, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1080\/21505594.2020.1859852","article-title":"Antimicrobial Resistance and Gene Regulation in Enteroaggregative Escherichia Coli from Egyptian Children with Diarrhoea: Similarities and Differences","volume":"12","author":"Abdelwahab","year":"2021","journal-title":"Virulence"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1093\/femsre\/fux016","article-title":"Bacterial Pathogens, Antibiotics and Antibiotic Resistance","volume":"41","author":"Banin","year":"2017","journal-title":"FEMS Microbiol. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2066","DOI":"10.3389\/fmicb.2018.02066","article-title":"Antibiotics, Resistome and Resistance Mechanisms: A Bacterial Perspective","volume":"9","author":"Sultan","year":"2018","journal-title":"Front. Microbiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/s00239-019-09914-3","article-title":"Antimicrobial Resistance in Bacteria: Mechanisms, Evolution, and Persistence","volume":"88","author":"Christaki","year":"2020","journal-title":"J. Mol. Evol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Matlashewski, G., Berghuis, A., Sheppard, D., Wainberg, M.A., and Gotte, M. (2017). Handbook of Antimicrobial Resistance, Springer.","DOI":"10.1007\/978-1-4939-0694-9"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3472","DOI":"10.1016\/j.jmb.2019.04.002","article-title":"\u03b2-Lactamases and \u03b2-Lactamase Inhibitors in the 21st Century","volume":"431","author":"Tooke","year":"2019","journal-title":"J. Mol. Biol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.bmcl.2018.01.006","article-title":"Optimization of Novel Monobactams with Activity against Carbapenem-Resistant Enterobacteriaceae\u2014Identification of LYS228","volume":"28","author":"Reck","year":"2018","journal-title":"Bioorg. Med. Chem. Lett."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1038\/s41579-019-0159-8","article-title":"Interplay between \u03b2-Lactamases and New \u03b2-lactamase Inhibitors","volume":"17","author":"Bush","year":"2019","journal-title":"Nat. Rev. Genet."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s12941-018-0286-5","article-title":"An Evaluation of Multidrug-Resistant Escherichia Coli Isolates in Urinary Tract Infections from Aguascalientes, Mexico: Cross-Sectional Study","volume":"17","author":"Harel","year":"2018","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3953","DOI":"10.1128\/AAC.00915-06","article-title":"Prevalence in the United States of aac(6\u2032)-Ib-cr Encoding a Ciprofloxacin-Modifying Enzyme","volume":"50","author":"Park","year":"2006","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1093\/jac\/dkm279","article-title":"Impact of Antibiotic Resistance and of Adequate Empirical Antibiotic Treatment in the Prognosis of Patients with Escherichia coli bacteraemia","volume":"60","author":"Peralta","year":"2007","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Amer, R., El-Baghdady, K., Kamel, I., and El-Shishtawy, H. (2019). Prevalence of Extended Spectrum Beta- Lactamase Genes among Escherichia Coli and Klebsiella Pneumoniae Clinical Isolates. Egypt. J. Microbiol.","DOI":"10.21608\/ejm.2019.16460.1113"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1089\/mdr.2010.0063","article-title":"CTX-M-15-Producing Escherichia Coli Clinical Isolates in Cairo (Egypt), Including Isolates of Clonal Complex ST10 and Clones ST131, ST73, and ST405 in Both Community and Hospital Settings","volume":"17","author":"Fam","year":"2011","journal-title":"Microb. Drug Resist."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s12941-018-0255-z","article-title":"An Evaluation of E. Coli in Urinary Tract Infection in Emergency Department at KAMC in Riyadh, Saudi Arabia: Retrospective Study","volume":"17","author":"Alanazi","year":"2018","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Koupetori, M., Retsas, T., Antonakos, N., Vlachogiannis, G., Perdios, I., Nathanail, C., Makaritsis, K., Papadopoulos, A., Sinapidis, D., and Giamarellos-Bourboulis, E.J. (2014). Bloodstream Infections and Sepsis in Greece: Over-Time Change of Epidemiology and Impact of de-escalation on final outcome. BMC Infect. Dis., 14.","DOI":"10.1186\/1471-2334-14-272"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.apjtm.2016.06.011","article-title":"Prevalence and antimicrobial resistance pat-tern of bacterial strains isolated from patients with urinary tract infection in Messalata Central Hospital, Libya","volume":"9","author":"Mohammed","year":"2016","journal-title":"Asian Pac. J. Trop. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1016\/S1473-3099(17)30394-8","article-title":"Trends in Antimicrobial Resistance in Bloodstream Infection Isolates at a Large Urban Hospital in Malawi (1998\u20132016): A Surveillance Study","volume":"17","author":"Musicha","year":"2017","journal-title":"Lancet Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"30","DOI":"10.4103\/meajo.MEAJO_276_16","article-title":"Update on the Epidemiology and Antibiotic Resistance of Ocular Infections","volume":"24","author":"Miller","year":"2017","journal-title":"Middle E. Afr. J. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Zhou, Y., Zhu, X., Hou, H., L\u00fc, Y., Yu, J., Mao, L., Mao, L., and Sun, Z. (2018). Characteristics of Diarrheagenic Escherichia Coli among Children under 5 Years of Age with Acute Diarrhea: A Hospital Based Study. BMC Infect. Dis., 18.","DOI":"10.1186\/s12879-017-2936-1"},{"key":"ref_20","first-page":"101","article-title":"Characterization of Verotoxigenic E.Coli and Enteropathogenic E.Coli Isolated from Infants with Diarrhea in Combination with Antimicrobial Resistance Pattern in Minia, Egypt","volume":"3","author":"Gad","year":"2020","journal-title":"J. Adv. Biomed. Pharm. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Jit, M., Ng, D.H.L., Luangasanatip, N., Sandmann, F., Atkins, K.E., Robotham, J.V., and Pouwels, K.B. (2020). Quantifying the Economic cost of Antibiotic Resistance and the Impact of Related Interventions: Rapid Methodological Review, Conceptual Framework and Recommendations for Future Studies. BMC Med., 18.","DOI":"10.1186\/s12916-020-1507-2"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s13756-018-0404-3","article-title":"Incidence and Outcomes of Multidrug-Resistant Gram-negative Bacteria Infections in Intensive Care Unit from Nepal- a Prospective Cohort Study","volume":"7","author":"Siwakoti","year":"2018","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Abdelaziz, S.M., Aboshanab, K.M., Yahia, I.S., Yassien, M.A., and Hassouna, N.A.J.A. (2021). Correlation between the Antibiotic Resistance Genes and Susceptibility to Antibiotics among the Carbapenem-Resistant Gram-Negative Pathogens. Antibiotics, 10.","DOI":"10.3390\/antibiotics10030255"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.2147\/IDR.S241073","article-title":"Prevalence of Virulence Genes and Their Association with Antimicrobial Resistance Among Pathogenic E. Coli Isolated from Egyptian Patients with Different Clinical Infections","volume":"13","author":"Ibrahim","year":"2020","journal-title":"Infect. Drug Resist."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4314\/ejhs.v27i1.2","article-title":"Phenotypic Detection of Extended Spectrum Beta Lactamase and Carbapenemase Co-Producing Clinical Isolates from Two Tertiary Hospitals in Kano, North West Nigeria","volume":"27","author":"Ibrahim","year":"2017","journal-title":"Ethiop. J. Health Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.2147\/IDR.S198373","article-title":"Antimicrobial Resistance Pattern and Molecular Genetic Distribution of Metallo-\u03b2-Lactamases Producing Pseudomonas aeruginosa Isolated from Hospitals in Minia, Egypt","volume":"12","author":"Farhan","year":"2019","journal-title":"Infect. Drug Resist."},{"key":"ref_27","first-page":"291","article-title":"Detection of Metal-lo-\u0392-Lactamases-Encoding Genes among Clinical Isolates of Escherichia Coli in a Tertiary Care Hospital, Malaysia","volume":"11","author":"Fazlul","year":"2019","journal-title":"BMC Res. Notes"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1186\/s13756-020-00856-w","article-title":"Prevalence and Molecular Characteristics of ESBL and AmpC \u03b2 -Lactamase Producing Enterobacteriaceae Strains Isolated from UTIs in Egypt","volume":"9","author":"Mohamed","year":"2020","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_29","first-page":"733","article-title":"Molecular Characteristics of Extended-Spectrum Beta-Lactamases Among Gram-Negative Isolates Collected in Cairo University Hospital","volume":"22","author":"Maamoun","year":"2012","journal-title":"Comp. Haematol. Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"128","DOI":"10.2174\/1874285801913010128","article-title":"Genetic Study of Extended Spectrum Beta-Lactamase and Carbapenemase Producing Escherichia Coli Causing Sepsis among Egyptian Children","volume":"13","author":"Zaki","year":"2019","journal-title":"Open Microbiol. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"857","DOI":"10.3201\/eid2305.161100","article-title":"ESBL-and Carbapenemase-Producing Enterobacteriaceae in Patients with Bacteremia, Yangon, Myanmar","volume":"23","author":"Myat","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/s13756-019-0536-0","article-title":"Distribution of blaCTX\u2014M, blaTEM, blaSHV and blaOXA Genes in Extended-Spectrum-\u03b2-Lactamase-Producing Clinical Isolates: A Three-Year Multi-Center Study from Lahore, Pakistan","volume":"8","author":"Abrar","year":"2019","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1186\/s13756-018-0381-6","article-title":"Molecular Characterization of Extended Spectrum \u03b2 -Lactamases Enterobacteriaceae Causing Lower Urinary Tract Infection among Pediatric Population","volume":"7","author":"Eltai","year":"2018","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Ahmed, M.A.S., Bansal, D., Acharya, A., Elmi, A.A., Hamid, J.M., Ahmed, A.M.S., Chandra, P., Ibrahim, E., Sultan, A.A., and Doiphode, S. (2016). Antimicrobial Susceptibility and Molecular Epidemiology of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae from Intensive Care Units at Hamad Medical Corporation, Qatar. Clin. Microbiol. Rev., 5.","DOI":"10.1186\/s13756-016-0103-x"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/S1473-3099(10)70143-2","article-title":"Emergence of A New Antibiotic Resistance Mechanism in India, Pakistan, and the UK: A Molecular, Biological, and Epidemiological Study","volume":"10","author":"Kumarasamy","year":"2010","journal-title":"Lancet Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Amer, W.H., Khalil, H.S., and Abd EL Wahab, M.A. (2016). Risk Factors, Phenotypic and Genotypic Characterization of Carbapenem Resistant Enterobacteriaceae in Tanta University Hospitals, Egypt. Int. J. Infect. Control., 12.","DOI":"10.3396\/IJIC.v12i2.012.16"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1089\/mdr.2015.0339","article-title":"High Carbapenem Resistance in Clinical Gram-Negative Pathogens Isolated in Egypt","volume":"23","author":"Khalifa","year":"2017","journal-title":"Microb. Drug Resist."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.tcmj.2016.04.005","article-title":"Emergence of Carbapenemase-Producing Urinary Isolates at A Tertiary Care Hospital in Dhaka, Bangladesh","volume":"28","author":"Begum","year":"2016","journal-title":"Tzu Chi Med. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1089\/mdr.2014.0121","article-title":"Molecular Characterization of Carbapenemase Production Among Gram-Negative Bacteria in Saudi Arabia","volume":"21","author":"Memish","year":"2015","journal-title":"Microb. Drug Resist."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Sonnevend, A., Ghazawi, A.A., Hashmey, R., Jamal, W., Rotimi, V.O., Shibl, A.M., Al-Jardani, A., Al-Abri, S.S., Tariq, W.U.Z., and Weber, S. (2015). Characterization of Carbapenem-Resistant Enterobacteriaceae with High Rate of Autochthonous Transmission in the Arabian Peninsula. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0131372"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1089\/mdr.2015.0053","article-title":"The Molecular Epidemiology and Genetic Environment of Carbapenemases Detected in Africa","volume":"22","author":"Sekyere","year":"2016","journal-title":"Microb. Drug Resist."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"133","DOI":"10.2147\/IDR.S26613","article-title":"Overview of the Epidemiology and the Threat of Klebsiella Pneumoniae Carbapenemases (KPC) Resistance","volume":"5","author":"Chen","year":"2012","journal-title":"Infect. Drug Resist."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.jiph.2017.03.010","article-title":"Characterization of Carbapenemases, ESBLs, and Plasmid-Mediated Quinolone Determinants in Carbapenem-Insensitive Escherichia coli and Klebsiella pneumoniae in Riyadh hospitals","volume":"11","author":"Aljallal","year":"2018","journal-title":"J. Infect. Public Health"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Hassuna, N.A., Khairalla, A.S., Farahat, E.M., Hammad, A.M., and Abdel-Fattah, M. (2020). Molecular Characterization of Extended-Spectrum \u03b2 Lactamase- Producing E. coli Recovered from Community-Acquired Urinary Tract Infections in Upper Egypt. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-59772-z"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Ouedraogo, A.-S., Sanou, M., Kissou, A., Sanou, S., Solar\u00e9, H., Kabor\u00e9, N.F., Poda, A., Aberkane, S., Bouzinbi, N., and Sano, I. (2016). High Prevalence of Extended-Spectrum \u00df-Lactamase producing Enterobacteriaceae among Clinical Isolates in Burkina Faso. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-1655-3"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"10","DOI":"10.4103\/abr.abr_17_17","article-title":"Prevalence of CTX-M and TEM \u03b2-lactamases in Klebsiella pneumoniae Isolates from Patients with Urinary Tract Infection, Al-Zahra Hospital, Isfahan, Iran","volume":"7","author":"Faghri","year":"2018","journal-title":"Adv. Biomed. Res."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Kamel, N.A., El-Tayeb, W.N., El-Ansary, M.R., Mansour, M.T., and Aboshanab, K.M. (2018). Phenotypic Screening and Molecular Characterization of Carbapenemase-Producing Gram-Negative Bacilli Recovered from Febrile Neutropenic Pediatric Cancer Patients in Egypt. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0202119"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.jgar.2016.02.001","article-title":"CTX-M-15 in Combination with aac(6\u2032)-Ib-cr is the Most Prevalent Mechanism of Resistance both in Escherichia coli and Klebsiella pneumoniae, including K. pneumoniae ST258, in an ICU in Uruguay","volume":"6","author":"Bado","year":"2016","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"43","DOI":"10.3855\/jidc.6918","article-title":"Extended-Spectrum \u03b2-lactamases, Transferable Quinolone Resistance, and Virulotyping in Extra-Intestinal E. coli in Uruguay","volume":"10","author":"Vignoli","year":"2016","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.2147\/IDR.S160720","article-title":"The Prevalence of Plasmid-mediated Quinolone Resistance and ESBL-Production in Enterobacteriaceae Isolated from Urinary tract Infections","volume":"ume 11","author":"Azargun","year":"2018","journal-title":"Infect. Drug Resist."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1089\/mdr.2016.0004","article-title":"High Prevalence of Plasmid-Mediated Quinolone Resistance Determinants in Escherichia coli and Klebsiella pneumoniae Isolates from Pediatric Patients in China","volume":"23","author":"Xue","year":"2017","journal-title":"Microb. Drug Resist."},{"key":"ref_52","first-page":"09","article-title":"Prevalence and identification of uropathogens in eastern Nepal and under-standing their antibiogram due to multidrug resistance and Esbl","volume":"2","author":"Mahato","year":"2018","journal-title":"Asian Pac. J. Microbiol. Res."},{"key":"ref_53","first-page":"6","article-title":"Phenotypic and Genotypic Characterization of ESBL-Producing Escherichia coli and Klebsiella pneumonia Isolates from Patient\u2019s Urine Specimens","volume":"6","author":"Alfola","year":"2016","journal-title":"Int. Arab. J. Antimicrob. Agents"},{"key":"ref_54","first-page":"042","article-title":"Prevalence and Molecular Epidemiology of Extended Spectrum \u03b2-Lactamase Producing Escherichia coli from Hospital and Community Settings in Egypt","volume":"6","author":"Mohamed","year":"2016","journal-title":"J. Appl. Pharm. Sci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s12941-017-0236-7","article-title":"Extended Spectrum Beta-Lactamase and Metallo Beta-Lactamase Production among Escherichia coli and Klebsiella pneumoniae Isolated from Different Clinical Samples in A Tertiary Care Hospital in Kathmandu, Nepal","volume":"16","author":"Nepal","year":"2017","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_56","first-page":"1068","article-title":"Metallo-Beta-Lactamase Producing Escherichia coli and Klebsiella pneumoniae: A Rising Threat for Hospitalized Children","volume":"66","author":"Javed","year":"2016","journal-title":"J. Pak. Med. Assoc."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1093\/jac\/47.6.755","article-title":"Outer membrane protein change combined with co-existing TEM-1 and SHV-1 \u03b2-lactamases lead to false identification of ESBL-producing Klebsiella pneu-moniae","volume":"47","author":"Wu","year":"2001","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_58","unstructured":"WHO (2011). Egypt: Pharmaceutical Country Profile, WHO."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.3382\/ps\/pew493","article-title":"Expanded Spectrum \u03b2\u2013Lactamase Producing Escherichia coli Isolated from Chickens with Colibacillosis in Egypt","volume":"96","author":"Nasef","year":"2017","journal-title":"Poult. Sci."},{"key":"ref_60","unstructured":"Tille, P. (2015). Bailey & Scott\u2019s Diagnostic Microbiology-E-Book, Elsevier Health Sciences."},{"key":"ref_61","first-page":"1","article-title":"Kirby-Bauer Disk Diffusion Susceptibility Test Protocol","volume":"3189","author":"Hudzicki","year":"2009","journal-title":"Am. Soc. Microbiol."},{"key":"ref_62","unstructured":"CLSI (2018). Performance Standards for Antimicrobial Susceptibility Testing, CLSI supplement M100; Clinical and Laboratory Standards Institute. [28th ed.]."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1046\/j.1469-0691.2001.00204.x","article-title":"Modified Hodge and EDTA-Disk Synergy Tests to Screen Metallo-\u03b2-Lactamase-Producing Strains of Pseudomonas and Acinetobactet Species","volume":"7","author":"Lee","year":"2001","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1128\/JCM.01773-10","article-title":"How to detect NDM-1 producers","volume":"49","author":"Nordmann","year":"2011","journal-title":"J. Clin. Microbiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1093\/jac\/dkh334","article-title":"A novel extended-spectrum \u03b2-lactamase CTX-M-23 with a P167T substitution in the active-site omega loop associated with ceftazidime resistance","volume":"54","author":"Mack","year":"2004","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_66","first-page":"1257","article-title":"Molecular epidemiology of ESBL genes and multi-drug resistance in diarrheagenic Escherichia coli strains isolated from adults in Iran","volume":"14","author":"Kargar","year":"2015","journal-title":"Iran. J. Pharm. Res."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1093\/jac\/dkl481","article-title":"Multiplex PCR for rapid detection of genes encoding acquired metallo-\u03b2-lactamases","volume":"59","author":"Ellington","year":"2007","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1099\/jmm.0.005850-0","article-title":"Emergence of carbapenem-non-susceptible extended-spectrum \u03b2-lactamase-producing Klebsiella pneumoniae isolates at the university hospital of T\u00fcbingen, Germany","volume":"58","author":"Linke","year":"2009","journal-title":"J. Med. Microbiol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1128\/AAC.48.1.15-22.2004","article-title":"Emergence of oxacillinase-mediated resistance to imipenem in Klebsiella pneumoniae","volume":"48","author":"Poirel","year":"2004","journal-title":"J. Antimicrob. Agents. Chemother."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1093\/jac\/dkn063","article-title":"Plasmid-mediated quinolone resistance determinants qnr and aac (6\u2032)-Ib-cr in extended-spectrum \u03b2-lactamase-producing Escherichia coli and Klebsiella pneumoniae in China","volume":"61","author":"Jiang","year":"2008","journal-title":"J. Antimicrob. Chemother."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/10\/7\/835\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:28:15Z","timestamp":1760164095000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/10\/7\/835"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,9]]},"references-count":70,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["antibiotics10070835"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics10070835","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,9]]}}}