{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T01:38:47Z","timestamp":1793497127200,"version":"4.5.0"},"reference-count":38,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical Practice Plan"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Introduction: Carbapenem-resistant Gram-negative bacteria (CR-GNB) are rapidly spreading pathogens that increase morbidity and mortality in hospital settings and significantly restrict available treatment options worldwide. The lack of molecular epidemiological data and the limited use of next-generation sequencing (NGS) in South Lebanon have hindered comprehensive surveillance efforts. This study represents the first molecular characterization of CR-GNB in this region. Methods: A total of 477 clinical Gram-negative bacterial isolates were collected from intensive care unit (ICU) patients admitted to various hospitals in South Lebanon in 2023. Of these, 131 CR-GNB were subjected to whole-genome sequencing using the Illumina MiSeq platform. K-mer-based species identification, multilocus sequence typing (MLST), antimicrobial resistance (AMR) gene profiling, and plasmid analysis were performed using multiple bioinformatic tools. Phylogenetic analysis was conducted using SaffronTree. Results: K-mer-based identification revealed that the predominant species among CR-GNB isolates were Pseudomonas spp. and Escherichia coli (26.7% each), followed by Klebsiella pneumoniae (19.8%), Acinetobacter baumannii (17.6%), Proteus mirabilis (4.6%), Enterobacter cloacae (2.3%), Achromobacter spp. (1.5%), and Citrobacter freundii (0.8%). Based on antimicrobial susceptibility testing, isolates were classified as follows: 0.8% as pan drug-resistant (PDR), 40.5% as extensively drug-resistant (XDR), and 52.7% as multidrug-resistant (MDR) and 6.1% as antimicrobial-resistant (AMR). All isolates harbored AMR genes, with the following distribution: 2% blaVIM, 5% blaNDM-1, 27% blaNDM-5, 65% blaOXA-type, and 1% blaDIM-1. Plasmid-associated AMR genes were detected in 58% of isolates; among these, 96% carried Inc-family plasmids, 57% Col plasmids, and 11% replication-associated elements (rep). Phylogenetic analysis demonstrated that certain isolates exhibited both hospital-specific and shared genetic profiles, indicating widespread dissemination across multiple healthcare facilities, as well as evidence of local emergence and ongoing transmission. Conclusions: The high prevalence of CR-GNB harboring resistance genes and plasmids underscores the urgent need for NGS-based genomic surveillance in South Lebanon. Implementing such strategies is essential for tracking resistance genes, identifying clonal outbreaks, and guiding effective infection control interventions to mitigate the spread of CR-GNB.<\/jats:p>","DOI":"10.3390\/antibiotics14111124","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:14:45Z","timestamp":1762506885000},"page":"1124","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Molecular Epidemiological Surveillance of Carbapenem-Resistant Gram-Negative Bacteria in Southern Lebanon"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1329-9326","authenticated-orcid":false,"given":"Anwar","family":"Al Souheil","sequence":"first","affiliation":[{"name":"Department of Biological Sciences, Faculty of Science, Beirut Arab University, Beirut 1107 2809, Lebanon"},{"name":"Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9146-9397","authenticated-orcid":false,"given":"Hadi","family":"Hussein","sequence":"additional","affiliation":[{"name":"Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon"},{"name":"Center for Infectious Diseases Research, American University of Beirut, Beirut 1107 2020, Lebanon"},{"name":"World Health Organization (WHO) Collaborating Center for Reference and Research on Bacterial Pathogens, Beirut 1107 2020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9623-3478","authenticated-orcid":false,"given":"Ziad","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon"},{"name":"Center for Infectious Diseases Research, American University of Beirut, Beirut 1107 2020, Lebanon"},{"name":"World Health Organization (WHO) Collaborating Center for Reference and Research on Bacterial Pathogens, Beirut 1107 2020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Barada","sequence":"additional","affiliation":[{"name":"Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon"},{"name":"Center for Infectious Diseases Research, American University of Beirut, Beirut 1107 2020, Lebanon"},{"name":"World Health Organization (WHO) Collaborating Center for Reference and Research on Bacterial Pathogens, Beirut 1107 2020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose-Rita","family":"Gerges","sequence":"additional","affiliation":[{"name":"Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon"},{"name":"Center for Infectious Diseases Research, American University of Beirut, Beirut 1107 2020, Lebanon"},{"name":"World Health Organization (WHO) Collaborating Center for Reference and Research on Bacterial Pathogens, Beirut 1107 2020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghada","family":"Derbaj","sequence":"additional","affiliation":[{"name":"Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon"},{"name":"Center for Infectious Diseases Research, American University of Beirut, Beirut 1107 2020, Lebanon"},{"name":"World Health Organization (WHO) Collaborating Center for Reference and Research on Bacterial Pathogens, Beirut 1107 2020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8321-4025","authenticated-orcid":false,"given":"Abdallah","family":"Kurdi","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan Jamil","family":"Kazma","sequence":"additional","affiliation":[{"name":"Laboratory Department, Hammoud Hospital University Medical Center, Saida 11-2644, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nour","family":"Nahouli","sequence":"additional","affiliation":[{"name":"Laboratory Department, Al-Raee Hospital, Saida 1600, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Hasan","family":"Najem","sequence":"additional","affiliation":[{"name":"Laboratory Department, Lebanese Italian Hospital, Tyre 1645, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8820-7238","authenticated-orcid":false,"given":"Abdallah","family":"Medlej","sequence":"additional","affiliation":[{"name":"Molecular Biology Unit, Laboratory Department, Sheikh Ragheb Harb University Hospital, Nabatieh 11-2064, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4261-6474","authenticated-orcid":false,"given":"Wael","family":"Zorkot","sequence":"additional","affiliation":[{"name":"Faculty of Public Health, Lebanese University, Beirut 14-6573, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9125-5137","authenticated-orcid":false,"given":"Rana El","family":"Hajj","sequence":"additional","affiliation":[{"name":"Department of Biological Sciences, Faculty of Science, Beirut Arab University, Beirut 1107 2809, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7629-4357","authenticated-orcid":false,"given":"Mahmoud I.","family":"Khalil","sequence":"additional","affiliation":[{"name":"Department of Biological Sciences, Faculty of Science, Beirut Arab University, Beirut 1107 2809, Lebanon"},{"name":"Molecular Biology Unit, Department of Zoology, Faculty of Science, Alexandria University, Alexandria 21511, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghassan M.","family":"Matar","sequence":"additional","affiliation":[{"name":"Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon"},{"name":"Center for Infectious Diseases Research, American University of Beirut, Beirut 1107 2020, Lebanon"},{"name":"World Health Organization (WHO) Collaborating Center for Reference and Research on Bacterial Pathogens, Beirut 1107 2020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7516-7919","authenticated-orcid":false,"given":"Antoine","family":"Abou Fayad","sequence":"additional","affiliation":[{"name":"Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon"},{"name":"Center for Infectious Diseases Research, American University of Beirut, Beirut 1107 2020, Lebanon"},{"name":"World Health Organization (WHO) Collaborating Center for Reference and Research on Bacterial Pathogens, Beirut 1107 2020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"ref_1","unstructured":"CDC (2025, February 22). Antimicrobial Resistance Threats in the United States, 2021\u20132022, Available online: https:\/\/www.cdc.gov\/antimicrobial-resistance\/data-research\/threats\/update-2022.html."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Sheu, C.-C., Chang, Y.-T., Lin, S.-Y., Chen, Y.-H., and Hsueh, P.-R. (2019). Infections Caused by Carbapenem-Resistant Enterobacteriaceae: An Update on Therapeutic Options. Front. Microbiol., 10.","DOI":"10.3389\/fmicb.2019.00080"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/S1473-3099(17)30753-3","article-title":"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_4","unstructured":"(2025, February 22). WHO Regional Office for Europe\/European Centre for Disease Prevention and Control Antimicrobial Resistance Surveillance in Europe 2022\u20132020 Data. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/antimicrobial-resistance-surveillance-europe-2022-2020-data."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Zhao, Y., Chen, D., Chen, K., Xie, M., Guo, J., Chan, E.W.C., Xie, L., Wang, J., Chen, E., and Chen, S. (2023). Epidemiological and Genetic Characteristics of Clinical Carbapenem-Resistant Pseudomonas Aeruginosa Strains in Guangdong Province, China. Microbiol. Spectr., 11.","DOI":"10.1128\/spectrum.04261-22"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Li, Q., Zhou, X., Yang, R., Shen, X., Li, G., Zhang, C., Li, P., Li, S., Xie, J., and Yang, Y. (2024). Carbapenem-Resistant Gram-Negative Bacteria (CR-GNB) in ICUs: Resistance Genes, Therapeutics, and Prevention\u2014A Comprehensive Review. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1376513"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2101","DOI":"10.1016\/j.jiph.2019.02.019","article-title":"Carbapenem Resistant Organisms: A 9-Year Surveillance and Trends at Saint George University Medical Center","volume":"13","author":"Chamieh","year":"2020","journal-title":"J. Infect. Public Health"},{"key":"ref_8","unstructured":"(2025, August 14). Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240062702."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s13756-021-00931-w","article-title":"Surveillance of Antimicrobial Resistance in Low- and Middle-Income Countries: A Scattered Picture","volume":"10","author":"Iskandar","year":"2021","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Hilt, E.E., and Ferrieri, P. (2022). Next Generation and Other Sequencing Technologies in Diagnostic Microbiology and Infectious Diseases. Genes, 13.","DOI":"10.3390\/genes13091566"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2023\/8831804","article-title":"Updates on the Status of Carbapenem-Resistant Enterobacterales in Lebanon","volume":"2023","author":"Fadlallah","year":"2023","journal-title":"Int. J. Microbiol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Daaboul, D., Oueslati, S., Rima, M., Kassem, I.I., Mallat, H., Birer, A., Girlich, D., Hamze, M., Dabboussi, F., and Osman, M. (2023). The Emergence of Carbapenemase-Producing Enterobacterales in Hospitals: A Major Challenge for a Debilitated Healthcare System in Lebanon. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1290912"},{"key":"ref_13","first-page":"10","article-title":"Antimicrobial Resistance in ESKAPE Pathogens","volume":"33","author":"Forde","year":"2020","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Rima, M., Oueslati, S., Dabos, L., Daaboul, D., Mallat, H., Bou Raad, E., Achkar, M., Mawlawi, O., Bernabeu, S., and Bonnin, R.A. (2022). Prevalence and Molecular Mechanisms of Carbapenem Resistance among Gram-Negative Bacilli in Three Hospitals of Northern Lebanon. Antibiotics, 11.","DOI":"10.3390\/antibiotics11101295"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"107353","DOI":"10.1016\/j.ijantimicag.2024.107353","article-title":"Investigating an Outbreak of Extensively Drug-Resistant Acinetobacter Baumannii in a Tertiary Healthcare Centre in Lebanon Using next-Generation Sequencing","volume":"64","author":"Darwiche","year":"2024","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.2147\/IDR.S176049","article-title":"The Threat of Carbapenem-Resistant Gram-Negative Bacteria in a Middle East Region","volume":"11","author":"Khalili","year":"2018","journal-title":"Infect. Drug Resist."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.jgar.2021.02.033","article-title":"Prevalence and Molecular Epidemiology of Carbapenem-Resistant Gram-Negative Bacilli and Their Resistance Determinants in the Eastern Mediterranean Region over the Last Decade","volume":"25","author":"Sleiman","year":"2021","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Lodise, T.P., Nguyen, S.T., Margiotta, C., and Cai, B. (2025). Clinical Burden of Acinetobacter Baumannii, Including Carbapenem-Resistant A. Baumannii, in Hospitalized Adult Patients in the USA between 2018 and 2022. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-025-10749-1"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Piotrowski, M., Alekseeva, I., Arnet, U., and Y\u00fccel, E. (2024). Insights into the Rising Threat of Carbapenem-Resistant Enterobacterales and Pseudomonas Aeruginosa Epidemic Infections in Eastern Europe: A Systematic Literature Review. Antibiotics, 13.","DOI":"10.3390\/antibiotics13100978"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Huang, J., Lv, C., Li, M., Rahman, T., Chang, Y.-F., Guo, X., Song, Z., Zhao, Y., Li, Q., and Ni, P. (2024). Carbapenem-Resistant Escherichia Coli Exhibit Diverse Spatiotemporal Epidemiological Characteristics across the Globe. Commun. Biol., 7.","DOI":"10.1038\/s42003-023-05745-7"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Sobh, G., Araj, G.F., Finianos, M., Sourenian, T., Hrabak, J., Papagiannitsis, C.C., Chaar, M.E., and Bitar, I. (2024). Molecular Characterization of Carbapenem and Ceftazidime-Avibactam-Resistant Enterobacterales and Horizontal Spread of {blaNDM-5} Gene at a Lebanese Medical Center. Front. Cell. Infect. Microbiol., 14.","DOI":"10.3389\/fcimb.2024.1466718"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Samadi, Z.F., Hodroj, Z.R., Jabbour, Z.C., Hussein, H.M., Kurdi, A., Shoukair, D., Bitar, R.F., Chebaro, H.H., Al Semaani, J.M.J., and Al Hajjar, M.T. (2025). Nationwide Surveillance of Carbapenem-Resistant Gram-Negative Pathogens in the Lebanese Environment. Appl. Environ. Microbiol., e01932-24.","DOI":"10.1128\/aem.01932-24"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Garcia-Fernandez, A., Villa, L., Bibbolino, G., Bressan, A., Trancassini, M., Pietropaolo, V., Venditti, M., Antonelli, G., and Carattoli, A. (2020). Novel Insights and Features of the NDM-5-Producing Escherichia Coli Sequence Type 167 High-Risk Clone. mSphere, 5.","DOI":"10.1128\/mSphere.00269-20"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"ofad649","DOI":"10.1093\/ofid\/ofad649","article-title":"The Global and Regional Prevalence of Hospital-Acquired Carbapenem-Resistant Klebsiella Pneumoniae Infection: A Systematic Review and Meta-Analysis","volume":"11","author":"Lin","year":"2024","journal-title":"Open Forum Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"401","DOI":"10.15585\/mmwr.mm7423a2","article-title":"Notes from the Field: Increase in New Delhi Metallo-\u03b2-Lactamase\u2013Producing Carbapenem-Resistant Enterobacterales\u2014New York City, 2019\u20132024","volume":"74","author":"Devinney","year":"2025","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_26","unstructured":"European Centre for Disease Prevention and Control (2024). Antimicrobial Resistance in the EU\/EEA (EARS-Net)\u2014Annual Epidemiological Report 2023, ECDC."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Hammour, K.A., Abu-Farha, R., Itani, R., Karout, S., Allan, A., Manaseer, Q., and Hammour, W.A. (2023). The Prevalence of Carbapenem Resistance Gram Negative Pathogens in a Tertiary Teaching Hospital in Jordan. BMC Infect. Dis., 23.","DOI":"10.1186\/s12879-023-08610-4"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Yao, Y., Imirzalioglu, C., Falgenhauer, L., Falgenhauer, J., Heinm\u00fcller, P., Domann, E., and Chakraborty, T. (2024). Plasmid-Mediated Spread of Carbapenem Resistance in Enterobacterales: A Three-Year Genome-Based Survey. Antibiotics, 13.","DOI":"10.3390\/antibiotics13080682"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1186\/s13756-021-01022-6","article-title":"Nosocomial Cluster of Carbapenemase-Producing Enterobacter Cloacae in an Intensive Care Unit Dedicated {COVID}-19","volume":"10","author":"Miltgen","year":"2021","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Papalia, M., Gonz\u00e1lez-Espinosa, F., Castedo, F.Q., Gutkind, G., Ram\u00edrez, M.S., Power, P., and Radice, M. (2024). Genetic and Biochemical Characterization of AXC-2 from Achromobacter Ruhlandii. Pathogens, 13.","DOI":"10.3390\/pathogens13020115"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Tsekoura, M., Petridis, G., Koutsouflianiotis, K., Pappa, S., Papa, A., and Kontopoulou, K. (2025). Bacteremia Outbreak Due to Achromobacter Xylosoxidans in Hospitalized COVID-19 Patients. Microbiol. Res., 16.","DOI":"10.3390\/microbiolres16070156"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Liu, L., Zhang, L., Zhou, H., Yuan, M., Hu, D., Wang, Y., Sun, H., Xu, J., and Lan, R. (2021). Antimicrobial Resistance and Molecular Characterization of Citrobacter spp. Causing Extraintestinal Infections. Front. Cell. Infect. Microbiol., 11.","DOI":"10.3389\/fcimb.2021.737636"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e01384-21","DOI":"10.1128\/msystems.01384-21","article-title":"Genomic Diversity of Hospital-Acquired Infections Revealed through Prospective Whole-Genome Sequencing-Based Surveillance","volume":"7","author":"Mustapha","year":"2022","journal-title":"mSystems"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1086\/323761","article-title":"Understanding the Spread of Antibiotic Resistant Pathogens in Hospitals: Mathematical Models as Tools for Control","volume":"33","author":"Weinstein","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_35","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_36","unstructured":"(2025, August 13). M100 | Performance Standards for Antimicrobial Susceptibility Testing. Available online: https:\/\/clsi.org\/shop\/standards\/m100\/."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1086\/505494","article-title":"Tigecycline: A Critical Analysis","volume":"43","author":"Stein","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_38","unstructured":"(2025, May 30). EUCAST: Clinical Breakpoints and Dosing of Antibiotics. Available online: https:\/\/www.eucast.org\/clinical_breakpoints."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/11\/1124\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:47:56Z","timestamp":1762508876000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/11\/1124"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,7]]},"references-count":38,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["antibiotics14111124"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14111124","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,7]]}}}