{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T06:45:18Z","timestamp":1781592318344,"version":"3.54.5"},"reference-count":44,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,29]],"date-time":"2025-06-29T00:00:00Z","timestamp":1751155200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health of Tunisia","award":["rc0170146301"],"award-info":[{"award-number":["rc0170146301"]}]},{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","award":["rc0170146301"],"award-info":[{"award-number":["rc0170146301"]}],"id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: As antimicrobial resistance patterns of Gram-negative bacteria change over time, this study aimed to analyze the antimicrobial susceptibility trends of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii isolates in Tunisia. Methods: From 1999 to 2019, non-duplicate isolates of Gram-negative bacteria were collected from 11 Tunisian hospitals as part of an antimicrobial resistance surveillance program. Antimicrobial susceptibility testing was performed using the disk diffusion method according to the European Committee on Antimicrobial Susceptibility Testing guidelines. Results: Out of 213,434 isolates collected during the study period, 58.8% were E. coli, 22% were K. pneumoniae, 14.4% were A. baumannii, and 4.8% were P. aeruginosa, with 67% of the isolates sourced from urine samples. E. coli showed a significant increase in resistance to third-generation cephalosporins (3GC), from 5.4% in 2004 to 16.5% in 2019, but K. pneumoniae displayed a rising trend of resistance to imipenem, from 1% in 2005 to 18.6% in 2019; meanwhile, amikacin remained effective against K. pneumoniae isolates. P. aeruginosa did not exhibit a significant change in resistance to imipenem. A. baumannii had a high resistance rate to imipenem that increased from 34.5% in 2008 to 84.2% in 2019 and had low susceptibility rates to all other antibiotics tested. Conclusions: This study reveals high carbapenem resistance among K. pneumoniae and A. baumannii in Tunisia. A. baumannii shows alarming multidrug resistance that requires urgent control measures.<\/jats:p>","DOI":"10.3390\/antibiotics14070657","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T07:42:06Z","timestamp":1751355726000},"page":"657","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Historical Overview of the Evolution of Multidrug-Resistant Gram-Negative Infections in Tunisia from 1999 to 2019"],"prefix":"10.3390","volume":"14","author":[{"given":"Lamia","family":"Kanzari","sequence":"first","affiliation":[{"name":"National Reference Laboratory on Antimicrobial Resistance Surveillance, Tunis 1006, Tunisia"},{"name":"Microbiology laboratory, Charles Nicolle Hospital, Tunis 1006, Tunisia"},{"name":"Research Laboratory Antimicrobial Resistance LR99ES09, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1007, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Ferjani","sequence":"additional","affiliation":[{"name":"National Reference Laboratory on Antimicrobial Resistance Surveillance, Tunis 1006, Tunisia"},{"name":"Microbiology laboratory, Charles Nicolle Hospital, Tunis 1006, Tunisia"},{"name":"Research Laboratory Antimicrobial Resistance LR99ES09, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1007, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basma","family":"Mnif","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology of Sfax University Hospital Center, Sfax 3000, Tunisia"},{"name":"Research Laboratory LR03SP03 \u201cMicro-Organisme et Pathologie Humaine\u201d, Faculty of Medicine, University of Sfax 3000, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faouzia","family":"Mahjoubi","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology of Sfax University Hospital Center, Sfax 3000, Tunisia"},{"name":"Research Laboratory LR03SP03 \u201cMicro-Organisme et Pathologie Humaine\u201d, Faculty of Medicine, University of Sfax 3000, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4064-2142","authenticated-orcid":false,"given":"Mariem","family":"Zribi","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, La Rabta Hospital, Tunis 1007, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3312-8265","authenticated-orcid":false,"given":"Khaoula","family":"Meftah","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Bechir Hamza Children\u2019s Hospital, Tunis 1006, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asma","family":"Ferjani","sequence":"additional","affiliation":[{"name":"National Reference Laboratory on Antimicrobial Resistance Surveillance, 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LR99ES27, Faculty of Pharmacy, University of Monastir, Monastir 5000, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habiba","family":"Naija","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Military Hospital, Tunis 1008, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8175-1743","authenticated-orcid":false,"given":"Manel","family":"Hamdoun","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Biology, Aziza Othmana Hospital, Tunis 1008, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosra","family":"Chebbi","sequence":"additional","affiliation":[{"name":"Laboratory Department, Bone and Marrow Transplantation Center, Tunis 1006, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarra","family":"Dhraief","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Biology, Burn and Trauma Center, Ben Arous 2013, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naglaa","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Pfizer Inc., New York, NY 10001-2192, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6907-6526","authenticated-orcid":false,"given":"Hela","family":"Zaghden","sequence":"additional","affiliation":[{"name":"Pfizer Inc., Tunis 1053, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lamia","family":"Thabet","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Biology, Burn and Trauma Center, Ben Arous 2013, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7245-9190","authenticated-orcid":false,"given":"Wafa","family":"Achour","sequence":"additional","affiliation":[{"name":"Laboratory Department, Bone and Marrow Transplantation Center, Tunis 1006, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olfa","family":"Bahri","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Biology, Aziza Othmana Hospital, Tunis 1008, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0494-8080","authenticated-orcid":false,"given":"Farouk","family":"Barguellil","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Military Hospital, Tunis 1008, Tunisia"},{"name":"Faculty of Pharmacy, University of Monastir, Monastir 5000, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3630-5255","authenticated-orcid":false,"given":"Maha","family":"Mastouri","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Fatouma Bourguiba Hospital, Monastir 5000, Tunisia"},{"name":"Laboratory of Transmissible Diseases and Biologically Active Substances LR99ES27, Faculty of Pharmacy, 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Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Oli, A.N., Itumo, C.J., Okam, P.C., Ezebialu, I.U., Okeke, K.N., Ifezulike, C.C., Ezeobi, I., Emechebe, G.O., Okezie, U.M., and Adejumo, S.A. (2019). Carbapenem-Resistant Enterobacteriaceae Posing a Dilemma in Effective Healthcare Delivery. Antibiotics, 8.","DOI":"10.3390\/antibiotics8040156"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"iv23","DOI":"10.1093\/jac\/dkab352","article-title":"Current and future perspectives in the treatment of multidrug-resistant Gram-negative infections","volume":"76","author":"Bassetti","year":"2021","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_3","unstructured":"(2025, May 25). Antimicrobial Resistance Threats in the United States, 2021\u20132022|Antimicrobial Resistance|CDC, Available online: https:\/\/www.cdc.gov\/antimicrobial-resistance\/data-research\/threats\/update-2022.html."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1080\/14787210.2024.2303028","article-title":"and van Duin, D. Reviewing novel treatment options for carbapenem-resistant Enterobacterales","volume":"22","author":"Mackow","year":"2024","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Ponce-de-Leon, A., Rodr\u00edguez-Noriega, E., Morf\u00edn-Otero, R., Cornejo-Ju\u00e1rez, D.P., Tinoco, J.C., Mart\u00ednez-Gamboa, A., Gaona-Tapia, C.J., Guerrero-Almeida, M.L., Martin-Onra\u00ebt, A., and Cervantes, J.L.V. (2018). Antimicrobial susceptibility of gram-negative bacilli isolated from intra-abdominal and urinary-tract infections in Mexico from 2009 to 2015: Results from the Study for Monitoring Antimicrobial Resistance Trends (SMART). PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0198621"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Breijyeh, Z., Jubeh, B., and Karaman, R. (2020). Resistance of Gram-Negative Bacteria to Current Antibacterial Agents and Approaches to Resolve It. Molecules, 25.","DOI":"10.3390\/molecules25061340"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Mancuso, G., Midiri, A., Gerace, E., and Biondo, C. (2021). Bacterial Antibiotic Resistance: The Most Critical Pathogens. Pathogens, 10.","DOI":"10.3390\/pathogens10101310"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Gauba, A., and Rahman, K.M. (2023). Evaluation of Antibiotic Resistance Mechanisms in Gram-Negative Bacteria. Antibiotics, 12.","DOI":"10.3390\/antibiotics12111590"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e46","DOI":"10.1093\/cid\/ciad499","article-title":"State of the Management of Infections Caused by Multidrug-Resistant Gram-Negative Organisms","volume":"77","author":"Yassin","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Bassetti, M., Peghin, M., Vena, A., and Giacobbe, D.R. (2019). Treatment of Infections Due to MDR Gram-Negative Bacteria. Front. Med., 6.","DOI":"10.3389\/fmed.2019.00074"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Larcher, R., Laffont-Lozes, P., Roger, C., Doncesco, R., Groul-Viaud, C., Martin, A., Loubet, P., Lavigne, J.-P., Pantel, A., and Sotto, A. (2022). Last resort beta-lactam antibiotics for treatment of New-Delhi Metallo-Beta-Lactamase producing Enterobacterales and other Difficult-to-Treat Resistance in Gram-negative bacteria: A real-life study. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.1048633"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e893","DOI":"10.1016\/S2542-5196(21)00280-1","article-title":"Global antibiotic consumption and usage in humans, 2000\u20132018: A spatial modelling study","volume":"5","author":"Browne","year":"2021","journal-title":"Lancet Planet. Health"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kasbi, Y., Sellami, F., Ferjani, A., Abbassi, A., and Ben Boubaker, I.B. (2025). Pharmaco-Epidemiological Study and Correlation Between Antibiotic Resistance and Antibiotic Consumption in a Tunisian Teaching Hospital from 2010 to 2022. Antibiotics, 14.","DOI":"10.3390\/antibiotics14020135"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Sallem, N., Ben Mansour, N., Amri, H., Boudaoura, M., Gargouri, O., Mahjoubi, F., Hammami, A., Mnif, B., and Chow, S.-K. (2024). Extended-spectrum beta-lactamase- and carbapenemase-producing Escherichia coli isolates causing hospital- and community-acquired infections in Tunisia (2001\u20132019): Expansion of CTX-M-15-C2 and CTX-M-27-C1 ST131 subclades. Microbiol. Spectr., 12.","DOI":"10.1128\/spectrum.01471-24"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.4314\/ahs.v18i4.41","article-title":"Tunisian antibiotic resistance problems: Three contexts but one health","volume":"18","author":"Mansour","year":"2018","journal-title":"Afr. Health Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1556\/030.2022.01630","article-title":"Detection of AmpC and ESBL-producing Enterobacterales isolated from urinary tract infections in Tunisia","volume":"69","author":"Amor","year":"2022","journal-title":"Acta Microbiol. Et Immunol. Hung."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Sola, M., Mani, Y., Saras, E., Drapeau, A., Grami, R., Aouni, M., Madec, J.-Y., Haenni, M., and Mansour, W. (2022). Prevalence and Characterization of Extended-Spectrum \u03b2-Lactamase- and Carbapenemase-Producing Enterobacterales from Tunisian Seafood. Microorganisms, 10.","DOI":"10.3390\/microorganisms10071364"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.ijfoodmicro.2015.02.023","article-title":"Detection of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in vegetables, soil and water of the farm environment in Tunisia","volume":"203","author":"Jouini","year":"2015","journal-title":"Int. J. Food Microbiol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Hassen, B., Abbassi, M.S., Ruiz-Ripa, L., Mama, O.M., Hassen, A., Torres, C., and Hammami, S. (2020). High prevalence of mcr-1 encoding colistin resistance and first identification of blaCTX-M-55 in ESBL\/CMY-2-producing Escherichia coli isolated from chicken faeces and retail meat in Tunisia. Int. J. Food Microbiol., 318.","DOI":"10.1016\/j.ijfoodmicro.2019.108478"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1093\/aje\/kwx286","article-title":"The Role of Mobile Genetic Elements in the Spread of Antimicrobial-Resistant Escherichia coli from Chickens to Humans in Small-Scale Production Poultry Operations in Rural Ecuador","volume":"187","author":"Moser","year":"2018","journal-title":"Am. J. Epidemiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e00088-17","DOI":"10.1128\/CMR.00088-17","article-title":"Mobile genetic elements associated with antimicrobial resistance","volume":"31","author":"Partridge","year":"2018","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"4177","DOI":"10.2147\/IDR.S259562","article-title":"Carbapenemase Producing Gram-Negative Bacteria in Tunisia: History of Thirteen Years of Challenge","volume":"13","author":"Dziri","year":"2020","journal-title":"Infect. Drug Resist."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"ciae403","DOI":"10.1093\/cid\/ciae403","article-title":"Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections","volume":"78","author":"Tamma","year":"2024","journal-title":"Clin. Infect. Dis."},{"key":"ref_24","unstructured":"(2025, May 31). R\u00e9sistance Bact\u00e9rienne. Available online: https:\/\/www.infectiologie.org.tn\/resistance.php."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1159\/000499238","article-title":"Antimicrobial Susceptibility Patterns of Escherichia coli among Tunisian Outpatients with Community-Acquired Urinary Tract Infection (2012\u20132018)","volume":"14","author":"Daoud","year":"2020","journal-title":"Curr. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.jgar.2017.09.004","article-title":"Susceptibility profiles of bacteria causing urinary tract infections in Southern Tunisia","volume":"12","author":"Boujlel","year":"2018","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_27","first-page":"824","article-title":"Coli Resistance to Ciprofloxacin and Common Associated Factors","volume":"25","author":"Jadoon","year":"2015","journal-title":"J. Coll Physicians Surg Pak."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"32","DOI":"10.5152\/tud.2016.90836","article-title":"Antimicrobial susceptibilities of Escherichia coli isolates as agents of community-acquired urinary tract infection (2008\u20132014)","volume":"42","author":"Yilmaz","year":"2016","journal-title":"Urol. Res. Pr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"32","DOI":"10.4103\/ijmm.IJMM_17_415","article-title":"Antimicrobial susceptibility profiles of gram-negative bacteria causing infections collected across India during 2014\u20132016: Study for monitoring antimicrobial resistance trend report","volume":"36","author":"Veeraraghavan","year":"2018","journal-title":"Indian J. Med Microbiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"346","DOI":"10.4314\/ahs.v17i2.8","article-title":"Dissemination and genetic support of broad-spectrum beta-lactam-resistant Escherichia coli strain isolated from two Tunisian hospitals during 2004\u20132012","volume":"17","author":"Ayari","year":"2017","journal-title":"Afr. Health Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.2147\/IDR.S358788","article-title":"Antimicrobial Susceptibility Trends Among Gram-Negative Bacilli Causing Bloodstream Infections: Results from the China Antimicrobial Resistance Surveillance Trial (CARST) Program, 2011\u20132020","volume":"15","author":"Yan","year":"2022","journal-title":"Infect. Drug Resist."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Lin, W.-P., Wang, J.-T., Chang, S.-C., Chang, F.-Y., Fung, C.-P., Chuang, Y.-C., Chen, Y.-S., Shiau, Y.-R., Tan, M.-C., and Wang, H.-Y. (2016). The Antimicrobial Susceptibility of Klebsiella pneumoniae from Community Settings in Taiwan, a Trend Analysis. Sci. Rep., 6.","DOI":"10.1038\/srep36280"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1016\/j.clinthera.2013.03.022","article-title":"Antimicrobial susceptibility of inpatient urinary tract isolates of gram-negative bacilli in the United States: Results from the study for monitoring antimicrobial resistance trends (SMART) program: 2009\u20132011","volume":"35","author":"Bouchillon","year":"2013","journal-title":"Clin. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.jgar.2017.03.017","article-title":"Outbreak of colistin-resistant carbapenemase-producing Klebsiella pneumoniae in Tunisia","volume":"10","author":"Mansour","year":"2017","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_35","unstructured":"(2025, June 17). Monography-Ceftazidime Avibactam-Stabilis 4.0. Available online: https:\/\/www.stabilis.org\/Monographie.php?IdMolecule=997."},{"key":"ref_36","first-page":"31","article-title":"In vitro activity of ceftazidime- avibactam and ceftolozane- tazobactam against clinical isolates of Enterobacteriaceae and Pseudomonas \u00e6ruginosa: Results from a trauma center and burn unit in Tunisia","volume":"38","author":"Megdiche","year":"2025","journal-title":"Ann Burn. Fire Disasters"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Fethi, M., Rojo-Bezares, B., Arfaoui, A., Dziri, R., Chich\u00f3n, G., Barguellil, F., L\u00f3pez, M., El Asli, M.S., Toledano, P., and Ouzari, H.-I. (2023). High Prevalence of GES-5 Variant and Co-Expression of VIM-2 and GES-45 among Clinical Pseudomonas aeruginosa Strains in Tunisia. Antibiotics, 12.","DOI":"10.3390\/antibiotics12091394"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/j.medmal.2008.05.002","article-title":"Susceptibility patterns of Pseudomonas aeruginosa strains isolated in the Monastir region, Tunisia","volume":"38","author":"Abdallah","year":"2008","journal-title":"Med. Et Mal. Infect."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Ferjani, S., Maamar, E., Ferjani, A., Kanzari, L., and Ben Boubaker, I.B. (2022). Evaluation of Three Carbapenemase-Phenotypic Detection Methods and Emergence of Diverse VIM and GES Variants among Pseudomonas aeruginosa Isolates in Tunisia. Antibiotics, 11.","DOI":"10.3390\/antibiotics11070858"},{"key":"ref_40","first-page":"100736","article-title":"Pseudomonas aeruginosa antibiotic susceptibility profiles, genomic epidemiology and resistance mechanisms: A nation-wide five-year time lapse analysis","volume":"34","author":"Taltavull","year":"2023","journal-title":"Lancet Reg. Health-Eur."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"106","DOI":"10.2174\/1874285801913010106","article-title":"Temporal Variation in Antibiotic Resistance of Acinetobacter baumannii in a Teaching Hospital in Tunisia: Correlation with Antimicrobial Consumption","volume":"13","author":"Nadia","year":"2019","journal-title":"Open Microbiol. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.idnow.2022.09.003","article-title":"Extensively drug-resistant Acinetobacter baumannii co-producing VIM-2 and OXA-23 in intensive care units: Results of a one-day point prevalence in a Tunisian hospital","volume":"52","author":"Ferjani","year":"2022","journal-title":"Infect. Dis. Now"},{"key":"ref_43","unstructured":"(2025, May 29). Tunisia in Figures 2022. Institut National de Statistiques\/Publications|INS. Available online: https:\/\/www.ins.tn\/publication."},{"key":"ref_44","unstructured":"(2020, January 01). Eucast: Clinical Breakpoints and Dosing of Antibiotics. Available online: http:\/\/www.eucast.org\/clinical_breakpoints."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/7\/657\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:01:12Z","timestamp":1760032872000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/7\/657"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,29]]},"references-count":44,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["antibiotics14070657"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14070657","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,29]]}}}