{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:39:02Z","timestamp":1791617942246,"version":"4.3.4"},"reference-count":75,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T00:00:00Z","timestamp":1715212800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007064","name":"University of Jaen","doi-asserted-by":"publisher","award":["RS-AGR230"],"award-info":[{"award-number":["RS-AGR230"]}],"id":[{"id":"10.13039\/501100007064","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>The heterogenicity of antimicrobial resistance genes described in clinically significant bacterial isolates and their potential role in reducing the efficacy of classically effective antibiotics pose a major challenge for global healthcare, especially in infections caused by Gram-negative bacteria. We analyzed 112 multidrug-resistant (MDR) isolates from clinical samples in order to detect high resistance profiles, both phenotypically and genotypically, among four Gram-negative genera (Acinetobacter, Escherichia, Klebsiella, and Pseudomonas). We found that 9.8% of the total selected isolates were classified as extensively drug-resistant (XDR) (six isolates identified as A. baumannii and five among P. pneumoniae isolates). All other isolates were classified as MDR. Almost 100% of the isolates showed positive results for blaOXA-23 and blaNDM-1 genes among the A. baumannii samples, one resistance gene (blaCTX-M) among E. coli, and two genetic determinants (blaCTX-M and aac(6\u2032)-Ib) among Klebsiella. In contrast, P. aeruginosa showed just one high-frequency antibiotic resistance gene (dfrA), which was present in 68.42% of the isolates studied. We also describe positive associations between ampicillin and cefotaxime resistance in A. baumannii and the presence of blaVEB and blaGES genes, as well as between the aztreonam resistance phenotype and the presence of blaGES gene in E. coli. These data may be useful in achieving a better control of infection strategies and antibiotic management in clinical scenarios where these multidrug-resistant Gram-negative pathogens cause higher morbidity and mortality.<\/jats:p>","DOI":"10.3390\/antibiotics13050429","type":"journal-article","created":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T10:31:16Z","timestamp":1715250676000},"page":"429","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Prevalence of Antibiotic Resistance Phenotypes and Genotypes in Multidrug-Resistant Bacterial Isolates from the Academic Hospital of Ja\u00e9n, Spain"],"prefix":"10.3390","volume":"13","author":[{"given":"Laura","family":"Morales","sequence":"first","affiliation":[{"name":"Microbiolgy Unit, Department of Health Sciences, Faculty of Experimental Sciences, University of Ja\u00e9n, 23071 Ja\u00e9n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Cobo","sequence":"additional","affiliation":[{"name":"Microbiolgy Unit, Department of Health Sciences, Faculty of Experimental Sciences, University of Ja\u00e9n, 23071 Ja\u00e9n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6886-0953","authenticated-orcid":false,"given":"Mar\u00eda Pilar","family":"Fr\u00edas","sequence":"additional","affiliation":[{"name":"Department of Statistics and Operation Research, Faculty of Experimental Sciences, University of Ja\u00e9n, 23071 Ja\u00e9n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5894-5029","authenticated-orcid":false,"given":"Antonio","family":"G\u00e1lvez","sequence":"additional","affiliation":[{"name":"Microbiolgy Unit, Department of Health Sciences, Faculty of Experimental Sciences, University of Ja\u00e9n, 23071 Ja\u00e9n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6281-5000","authenticated-orcid":false,"given":"Elena","family":"Ortega","sequence":"additional","affiliation":[{"name":"Microbiolgy Unit, Department of Health Sciences, Faculty of Experimental Sciences, University of Ja\u00e9n, 23071 Ja\u00e9n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Munita, J.M., and Arias, C.A. (2016). Mechanisms of Antibiotic Resistance. Microbiol. Spectr., 4.","DOI":"10.1128\/microbiolspec.VMBF-0016-2015"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1007\/s11756-021-00697-x","article-title":"Antibiotic resistance crisis: Challenges and imperatives","volume":"76","author":"Church","year":"2021","journal-title":"Biologia"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"196","DOI":"10.3201\/eid2501.181184","article-title":"Miracle cure, The creation of antibiotics and the birth of modern medicine","volume":"25","author":"Hamilton","year":"2019","journal-title":"Emerg. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2312","DOI":"10.2174\/1381612828666220608120238","article-title":"Antibiotics and Antibiotic Resistance- Flipsides of the Same Coin","volume":"28","author":"Bhardwaj","year":"2022","journal-title":"Curr. Pharm. Des."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"105923","DOI":"10.1016\/j.micpath.2022.105923","article-title":"Emergent crisis of antibiotic resistance: A silent pandemic threat to 21st century","volume":"174","author":"Akram","year":"2023","journal-title":"Microb. Pathog."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Li, L., Ma, J., Yu, Z., Li, M., Zhang, W., and Sun, H. (2023). Epidemiological characteristics and antibiotic resistance mechanisms of Streptococcus pneumoniae: An updated review. Microbiol. Res., 266.","DOI":"10.1016\/j.micres.2022.127221"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"de Kraker, M.E., Stewardson, A.J., and Harbarth, S. (2016). Will 10 million people die a year due to antimicrobial resistance by 2050?. PLoS Med., 13.","DOI":"10.1371\/journal.pmed.1002184"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"488","DOI":"10.3322\/caac.21697","article-title":"Antibiotic resistance in the patient with cancer: Escalating challenges and paths forward","volume":"71","author":"Nanayakkara","year":"2021","journal-title":"CA Cancer. J. Clin."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"5831","DOI":"10.2147\/IJN.S328767","article-title":"Emerging Trends in nanomaterials for Antibacterial Applications","volume":"16","author":"Mutalik","year":"2021","journal-title":"Int. J. Nanomed."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"6600","DOI":"10.1002\/anie.201506818","article-title":"Targeting antibiotic resistance","volume":"55","author":"Chellat","year":"2016","journal-title":"Angew. Chem. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"7329","DOI":"10.2147\/IJN.S265934","article-title":"Recent advances in nanotechnology-aided materials in combating microbial resistance and functioning as antibiotics substitutes","volume":"15","author":"Munir","year":"2020","journal-title":"Int. J. Nanomed."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e2305465120","DOI":"10.1073\/pnas.2305465120","article-title":"Antimicrobial resistance heterogeneity among multidrug-resistant Gram-negative pathogens: Phenotypic, genotypic, and proteomic analysis","volume":"120","author":"Mehrotra","year":"2023","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1038\/s41564-019-0445-2","article-title":"Emergence of plasmid-mediated high-level tigecycline resistance genes in animals and humans","volume":"4","author":"He","year":"2019","journal-title":"Nat. Microbiol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Xanthopoulou, K., Urrutikoetxea-Guti\u00e9rrez, M., Vidal-Garcia, M., Diaz de Tuesta del Arco, J.-L., S\u00e1nchez-Urtaza, S., Wille, J., Seifert, H., Higgins, P.G., and Gallego, L. (2020). First report of New Delhi metallo-\u03b2-lactamase-6 (NDM-6) in a clinical Acinetobacter baumannii isolate from Northern Spain. Front. Microbiol., 11.","DOI":"10.3389\/fmicb.2020.589253"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Hassan, R.M., Salem, S.T., Hassan, S.I.M., Hegab, A.S., and Elkholy, Y.S. (2021). Molecular characterization of carbapenem-resistant Acinetobacter baumannii clinical isolates from egyptian patients. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0251508"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e0069521","DOI":"10.1128\/mSphere.00695-21","article-title":"Emergence of plasmid-mediated resistance genes tet (X) and mcr-1 in Escherichia coli clinical isolates from Pakistan","volume":"6","author":"Li","year":"2021","journal-title":"mSphere"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"S\u00e1nchez-Urtaza, S., Ocampo-Sosa, A., Molins-Bengoetxea, A., Rodr\u00edguez-Grande, J., El-Kholy, M.A., Hernandez, M., Abad, D., Shawky, S.M., Alkorta, I., and Gallego, L. (2023). Co-existence of blaNDM-1, blaOXA-23, blaOXA-64, blaPER-7 and blaADC-57 in a clinical isolate of Acinetobacter baumannii from Alexandria, Egypt. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241512515"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1038\/s41586-021-04264-x","article-title":"A naturally inspired antibiotic to target multi-drug-resistant pathogens","volume":"601","author":"Wang","year":"2022","journal-title":"Nature"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/S1473-3099(17)30753-3","article-title":"WHO Pathogens Priority List Working Group. Discovery, research, and development of new antibiotics: The WHO priority list of antibiotic-resistant bacteria and tuberculosis","volume":"18","author":"Tacconelli","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.medin.2022.02.004","article-title":"Mecanismos de resistencia en bacterias gramnegativas","volume":"46","author":"Lepe","year":"2022","journal-title":"Med. Intensiv."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1128\/CMR.00058-07","article-title":"Acinetobacter baumannii; emergence of a successful pathogen","volume":"21","author":"Peleg","year":"2008","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/jac\/dkp428","article-title":"Global spread of carbapenem-resistant Acinetobacter baumannii","volume":"65","author":"Higgins","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_23","first-page":"1068840","article-title":"Susceptibility profile of blaOXA-23 and metallo-\u03b2-lactamases co-harbouring isolates of carbapenem resistant Acinetobacter baumannii (CRAB) against standard drugs and combinations","volume":"12","author":"Sharma","year":"2023","journal-title":"Frontier"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1007\/s40121-022-00597-w","article-title":"Carbapenem-resistant Acinetobacter baumannii: Colonization, infection and current treatment options","volume":"11","author":"Bartal","year":"2022","journal-title":"Infect. Dis. Ther."},{"key":"ref_25","first-page":"485","article-title":"Prevalence of quinolone resistance mechanisms in Enterobacteriaceae producing acquired AmpC \u00df\u2014Lactamases and\/or carbapenemases in Spain","volume":"35","author":"Machuca","year":"2017","journal-title":"Enferm. Infecc. Microbiol. Clin."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.eimc.2022.06.004","article-title":"Executive summary of the consensus document of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) on the diagnosis and antimicrobial treatment of infections due to carbapenem-resistant Gram-negative bacteria","volume":"41","author":"Pintado","year":"2023","journal-title":"Enferm. Infecc. Microbiol. Clin."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_28","first-page":"243","article-title":"Metallo-beta-lactamase-producing clinical isolates of Acinetobacter species and Pseudomonas aeruginosa from intensive care unit patients of a tertiary care hospital","volume":"26","author":"Irfan","year":"2008","journal-title":"Indian J. Med. Microbiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3127","DOI":"10.1128\/AAC.02656-15","article-title":"Clinical and epidemiological significance of carbapenem resistance in Acinetobacter baumannii infections","volume":"60","author":"Katz","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1586\/eri.13.21","article-title":"Carbapenem resistance in Acinetobacter baumannii: Laboratory challenges, mechanistic insights and therapeutic strategies","volume":"11","author":"Abbott","year":"2013","journal-title":"Expert Rev. Anti Infect. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2121","DOI":"10.1128\/AAC.02413-12","article-title":"OXA-235, a novel class D beta-lactamase involved in resistance to carbapenems in Acinetobacter baumannii","volume":"57","author":"Higgins","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1128\/CMR.00117-13","article-title":"OXA beta-lactamases","volume":"27","author":"Evans","year":"2014","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_33","unstructured":"M\u00fcller, C., Stefanik, D., Wille, J., Hackel, M., Higgins, P.G., and Siefert, H. (2019, January 13\u201316). Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii clinical isolates and identification of the novel international clone IC9, results from a worldwide surveillance study (2012\u20132016). Proceedings of the ECCMID 2019, Amsterdam, The Netherlands."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/jac\/dki425","article-title":"OXA, \u03b2-lactamases in Acinetobacter: The story so far","volume":"57","author":"Brown","year":"2006","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1016\/j.meegid.2012.02.008","article-title":"Genetic support and diversity of acquired extended-spectrum \u03b2-lactamases in Gram-negative rods","volume":"12","author":"Poirel","year":"2012","journal-title":"Infect. Genet. Evol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1128\/AAC.00773-10","article-title":"Carbapenem hydrolyzing GES-type extended-spectrum beta-lactamase in Acinetobacter baumannii","volume":"55","author":"Bonnin","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1128\/AAC.01384-12","article-title":"Wide dissemination of GES-type carbapenemases in Acinetobacter baumannii isolates in Kuwait","volume":"57","author":"Bonnin","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_38","first-page":"751","article-title":"Prevalence of PER and VEB type extended spectrum beta lactamases among multidrug resistant Acinetobacter baumannii isolates in north-west of Iran","volume":"16","author":"Farajnia","year":"2013","journal-title":"Iran J. Basic Med. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"52","DOI":"10.14715\/cmb\/2021.67.3.7","article-title":"Evaluation of blaGES-5 and blaveb-1 genes with multidrug-resistant extend, pandrug resistance patterns (MDR, XDR, PDR), and biofilm formation in Pseudomonas aeruginosa isolates","volume":"67","author":"Ali","year":"2021","journal-title":"Cell. Mol. Biol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1934","DOI":"10.1093\/jac\/dkz149","article-title":"ESBLs and resistance to ceftazidime\/avibactam and ceftolozane\/tazobactam combinations in Escherichia coli and Pseudomonas aeruginosa","volume":"74","author":"Nordmann","year":"2019","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3191","DOI":"10.2147\/IDR.S360945","article-title":"Isolation and identification of Escherichia coli and Klebsiella pneumoniae strains resistant to the oxyimino-cephalosporins and the monobactam by production of GES type extended spectrum beta-lactamase (ESBL) at Saint Camille Hospital Center in Ouagadougou, Burkina Faso","volume":"15","author":"Ouermi","year":"2022","journal-title":"Infect. Drug Resist."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.ijantimicag.2017.02.026","article-title":"Correlation between phenotypic antibiotic susceptibility and the resistome in Pseudomonas aeruginosa","volume":"50","author":"Jaillard","year":"2017","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Baran, I., and Aksu, N. (2016). Phenotypic and genotypic characteristics of carbapenem-resistant Enterobacteriaceae in a tertiary-level reference hospital in Turkey. Ann. Clin. Microbiol. Antimicrob., 15.","DOI":"10.1186\/s12941-016-0136-2"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"104922","DOI":"10.1016\/j.micpath.2021.104922","article-title":"Phenotypic and genotypic characteristics of Acinetobacter baumannii enrolled in the relationship among antibiotic resistance, biofilm formation and motility","volume":"155","author":"Zhang","year":"2021","journal-title":"Microb. Pathog."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1157\/13085012","article-title":"Prevalence of the tet (A) and tet (B) genes as mechanisms of resistance to tetracycline and minocycline in Acinetobacter baumannii clinical isolates","volume":"24","author":"Pascual","year":"2006","journal-title":"Enferm. Infecc. Microbiol. Clin."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Nowroozi, J., Akhavan, S.A., Tahmasebinejad Kamarposhti, L., Razavipour, R., and Mazhar, F. (2014). Evaluation of ciprofloxacin (gyrA, parC Genes) and tetracycline (tet (B) Gene) resistance in nosocomial Acinetobacter baumannii infections. Jundishapur J. Microbiol., 7.","DOI":"10.5812\/jjm.8976"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1186\/s13756-019-0612-5","article-title":"Study of genetic diversity, biofilm formation, and detection of Carbapenemase, MBL, ESBL, and tetracycline resistance genes in multidrug-resistant Acinetobacter baumannii isolated from burn wound infections in Iran","volume":"8","author":"Ranjbar","year":"2019","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2401","DOI":"10.2147\/IDR.S357344","article-title":"Minocycline susceptibility and tet (B) gene in carbapenem-resistant Acinetobacter baumannii in Taiwan","volume":"15","author":"Yang","year":"2022","journal-title":"Infect. Drug Resist."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e0065122","DOI":"10.1128\/msphere.00651-22","article-title":"Molecular mechanisms of resistance to ceftazidime\/avibactam in clinical isolates of Enterobacterales and Pseudomonas aeruginosa in Latin American hospitals","volume":"8","author":"Mojica","year":"2023","journal-title":"mSphere"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Glen, K.A., and Lamont, I.L. (2021). \u03b2-lactam resistance in Pseudomonas aeruginosa: Current status, future prospects. Pathogens, 10.","DOI":"10.3390\/pathogens10121638"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e01698-19","DOI":"10.1128\/mBio.01698-19","article-title":"Pseudomonas aeruginosa inter strain dynamics and selection of hyperbiofilm mutants during a chronic infection","volume":"10","author":"Gloag","year":"2019","journal-title":"mBio"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Kovach, K., Davis-Fields, M., Irie, Y., Jain, K., Doorwar, S., Vuong, K., Dhamani, N., Mohanty, K., Touhami, A., and Gordon, V.D. (2017). Evolutionary adaptations of biofilms infecting cystic fibrosis lungs promote mechanical toughness by adjusting polysaccharide production. NPJ Biofilms Microbiomes, 3.","DOI":"10.1038\/s41522-016-0007-9"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1089\/mdr.2018.0327","article-title":"Identification of blaVIM-1 gene in ST307 and ST661 Klebsiella pneumoniae clones in Italy: Old acquaintances for new combinations","volume":"25","author":"Piazza","year":"2019","journal-title":"Microb. Drug Resist."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Carvalho, I., Chenouf, N.S., Carvalho, J.A., Castro, A.P., Silva, V., Capita, R., Alonso-Calleja, C., Enes Dapkevicius, M.L.N., Igrejas, G., and Torres, C. (2021). Multidrug-resistant Klebsiella pneumoniae harboring extended spectrum \u03b2-lactamase encoding genes isolated from human septicemias. PLoS ONE., 16.","DOI":"10.1371\/journal.pone.0250525"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"S18","DOI":"10.1093\/infdis\/jiw378","article-title":"Clinical implications of genomic adaptation and evolution of carbapenem-resistant Klebsiella pneumoniae","volume":"215","author":"Uhlemann","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Gonz\u00e1lez, N., Beamud, B., Fuster, B., Giner, S., Dom\u00ednguez, M.V., S\u00e1nchez, A., Sevilla, J., Coque, T.M., Gimeno, C., and Gonz\u00e1lez-Candelas, F. (2023). Tracking the Emergence and Dissemination of a blaNDM-23 Gene in a Multidrug Resistance Plasmid of Klebsiella pneumoniae. Microbiol. Spectr., 11.","DOI":"10.1128\/spectrum.02585-22"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e01954-20","DOI":"10.1128\/mBio.01954-20","article-title":"Emergence of the novel aminoglycoside acetyltransferase variant aac(6\u2032)-Ib-D179Y and acquisition of colistin heteroresistance in carbapenem-resistant Klebsiella pneumoniae due to a disrupting mutation in the DNA repair enzyme MutS","volume":"11","author":"Sato","year":"2020","journal-title":"mBio"},{"key":"ref_58","first-page":"71","article-title":"Molecular epidemiological analysis of integron gene cassettes and tet (A)\/tet (B)\/tet (D) gene associations in Escherichia coli strains producing extended-spectrum \u03b2-lactamase (ESBL) in urine cultures","volume":"31","author":"Ejder","year":"2022","journal-title":"Adv. Clin. Exp. Med."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Perewari, D.O., Otokunefor, K., and Agbagwa, O.E. (2022). Tetracycline-resistant genes in Escherichia coli from clinical and nonclinical sources in Rivers State, Nigeria. Int. J. Microbiol., 2022.","DOI":"10.1155\/2022\/9192424"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"4801","DOI":"10.1073\/pnas.75.10.4801","article-title":"Complete nucleotide sequence of a 16S ribosomal RNA gene from Escherichia coli","volume":"75","author":"Brosius","year":"1978","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1073\/pnas.77.1.201","article-title":"Complete nucleotide sequence of a 23S ribosomal RNA gene from Escherichia coli","volume":"77","author":"Brosius","year":"1980","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"3996","DOI":"10.1128\/AAC.48.10.3996-4001.2004","article-title":"Mechanisms of resistance in multiple-antibiotic-resistant Escherichia coli strains of human, animal, and food origins","volume":"48","author":"Ruiz","year":"2004","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1093\/jac\/dkf069","article-title":"Identification of PSE and OXA \u03b2-lactamase genes in Pseudomonas aeruginosa using PCR\u2013restriction fragment length polymorphism","volume":"50","author":"Bert","year":"2002","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"3309","DOI":"10.1128\/JCM.43.7.3309-3313.2005","article-title":"Countrywide spread of community- and hospital-acquired extended-spectrum \u03b2-lactamase (CTX-M-15)-producing Enterobacteriaceae in Lebanon","volume":"43","author":"Moubareck","year":"2005","journal-title":"J. Clin. Microbiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1093\/jac\/dki324","article-title":"Dissemination of SHV-12 and CTX-M-type extended-spectrum \u03b2-lactamases among clinical isolates of Escherichia coli and Klebsiella pneumoniae and emergence of GES-3 in Korea","volume":"56","author":"Ryoo","year":"2005","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"3129","DOI":"10.1128\/JCM.43.7.3129-3135.2005","article-title":"Detection of Pseudomonas aeruginosa producing metallo-beta-lactamases in a large centralized laboratory","volume":"43","author":"Pitout","year":"2005","journal-title":"J. Clin. Microbiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"4114","DOI":"10.1128\/AAC.00778-06","article-title":"Analysis of antibiotic resistance genes in multidrug-resistant Acinetobacter sp. isolates from military and civilian patients treated at the Walter Reed Army Medical Center","volume":"50","author":"Hujer","year":"2006","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1093\/jac\/35.2.281","article-title":"Transferable production of PER-1 \u03b2-lactamase in Pseudomonas aeruginosa","volume":"35","author":"Danel","year":"1995","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1128\/AAC.44.3.622-632.2000","article-title":"Biochemical sequence analyses of GES-1, a novel class A extended-spectrum \u03b2-lactamase, and the class 1 integron In52 from Klebsiella pneumoniae","volume":"44","author":"Poirel","year":"2000","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.1128\/AAC.45.6.1615-1620.2001","article-title":"Oxacillinase-mediated resistance to cefepime and susceptibility to ceftazidime in Pseudomonas aeruginosa","volume":"45","author":"Aubert","year":"2001","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1590\/0037-8682-0478-2016","article-title":"Distribution of the blaOXA, blaVEB-1, and blaGES-1 genes and resistance patterns of ESBL-producing Pseudomonas aeruginosa isolated from hospitals in Tehran and Qazvin, Iran","volume":"50","author":"Amirkamali","year":"2017","journal-title":"Rev. Soc. Bras. Med. Trop."},{"key":"ref_72","unstructured":"Persing, D.H., Smith, T.F., Tenover, F.C., and White, T.J. (1993). Diagnostic Molecular Microbiology, American Society Microbiology."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1099\/0022-1317-49-10-929","article-title":"Distribution and in-vitro transfer of tetracycline resistance determinants in clinical and aquatic Acinetobacter strains","volume":"49","author":"Guardabassi","year":"2000","journal-title":"J. Med. Microbiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1128\/AAC.00996-10","article-title":"Expression of multidrug efflux genes acrAB-tolC, mdfA, and norE in Escherichia coli clinical isolates as a function of fluoroquinolone and multidrug resistance","volume":"55","author":"Swick","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"3582","DOI":"10.1128\/AAC.01574-08","article-title":"oqxAB encoding a multidrug efflux pump in human clinical isolates of Enterobacteriaceae","volume":"53","author":"Wang","year":"2009","journal-title":"Antimicrob. Agents Chemother."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/5\/429\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:42:55Z","timestamp":1760107375000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/5\/429"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,9]]},"references-count":75,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["antibiotics13050429"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics13050429","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,9]]}}}