{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T01:31:00Z","timestamp":1790472660936,"version":"4.1.0"},"reference-count":58,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2017,6,29]],"date-time":"2017-06-29T00:00:00Z","timestamp":1498694400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The environmental spread of antibiotic-resistant bacteria has been recognised as a growing public health threat for which hospitals play a significant role. The aims of this study were to investigate the prevalence of antibiotic resistance and antibiotic resistance genes (ARGs) in Escherichia coli isolates from hospital wastewater in Vietnam. Wastewater samples before and after treatment were collected using continuous sampling every month over a year. Standard disk diffusion and E-test were used for antibiotic susceptibility testing. Extended-spectrum beta-lactamase (ESBL) production was tested using combined disk diffusion. ARGs were detected by polymerase chain reactions. Resistance to at least one antibiotic was detected in 83% of isolates; multidrug resistance was found in 32%. The highest resistance prevalence was found for co-trimoxazole (70%) and the lowest for imipenem (1%). Forty-three percent of isolates were ESBL-producing, with the blaTEM gene being more common than blaCTX-M. Co-harbouring of the blaCTX-M, blaTEM and qepA genes was found in 46% of isolates resistant to ciprofloxacin. The large presence of antibiotic-resistant E. coli isolates combined with ARGs in hospital wastewater, even post-treatment, poses a threat to public health. It highlights the need to develop effective processes for hospital wastewater treatment plants to eliminate antibiotic resistant bacteria and ARGs.<\/jats:p>","DOI":"10.3390\/ijerph14070699","type":"journal-article","created":{"date-parts":[[2017,6,29]],"date-time":"2017-06-29T10:40:04Z","timestamp":1498732804000},"page":"699","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":69,"title":["Antibiotic Resistance and Antibiotic Resistance Genes in Escherichia coli Isolates from Hospital Wastewater in Vietnam"],"prefix":"10.3390","volume":"14","author":[{"given":"La","family":"Lien","sequence":"first","affiliation":[{"name":"Health Systems and Policy (HSP): Improving the Use of Medicines, Department of Public Health Sciences, Karolinska Institutet, Tomtebodav\u00e4gen 18A, 17177 Stockholm, Sweden"},{"name":"Department of Pharmaceutical Management and Pharmaco-Economics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi 110403, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pham","family":"Lan","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Department of Family Medicine, Department of Microbiology, Hanoi Medical University, 01 Ton That Tung, Dong Da District, Hanoi 116516, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nguyen","family":"Chuc","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Department of Family Medicine, Department of Microbiology, Hanoi Medical University, 01 Ton That Tung, Dong Da District, Hanoi 116516, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nguyen","family":"Hoa","sequence":"additional","affiliation":[{"name":"National Centralized Drug Procurement Centre, Vietnam Ministry of Health, 138A Giang Vo Street, Ba Dinh district, Hanoi 118401, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pham","family":"Nhung","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Department of Family Medicine, Department of Microbiology, Hanoi Medical University, 01 Ton That Tung, Dong Da District, Hanoi 116516, Vietnam"},{"name":"Department of Microbiology, Bach Mai Hospital, 78 Giai Phong, Dong Da District, Hanoi 116365, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nguyen","family":"Thoa","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Department of Family Medicine, Department of Microbiology, Hanoi Medical University, 01 Ton That Tung, Dong Da District, Hanoi 116516, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal","family":"Diwan","sequence":"additional","affiliation":[{"name":"Health Systems and Policy (HSP): Improving the Use of Medicines, Department of Public Health Sciences, Karolinska Institutet, Tomtebodav\u00e4gen 18A, 17177 Stockholm, Sweden"},{"name":"Department of Public Health &amp; Environment, R.D. Gardi Medical College, Agar Road, Ujjain 456006, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0731-1680","authenticated-orcid":false,"given":"Ashok","family":"Tamhankar","sequence":"additional","affiliation":[{"name":"Health Systems and Policy (HSP): Improving the Use of Medicines, Department of Public Health Sciences, Karolinska Institutet, Tomtebodav\u00e4gen 18A, 17177 Stockholm, Sweden"},{"name":"Indian Initiative for Management of Antibiotic Resistance, Department of Environmental Medicine, R.D. Gardi Medical College, Agar Road, Ujjain 456006, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6525-1861","authenticated-orcid":false,"given":"Cecilia","family":"St\u00e5lsby Lundborg","sequence":"additional","affiliation":[{"name":"Health Systems and Policy (HSP): Improving the Use of Medicines, Department of Public Health Sciences, Karolinska Institutet, Tomtebodav\u00e4gen 18A, 17177 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2017,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.2175\/106143016X14696400495974","article-title":"Antimicrobial resistance in the environment","volume":"88","author":"Williams","year":"2016","journal-title":"Water Environ. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1038\/nrmicro3439","article-title":"Tackling antibiotic resistance: The environmental framework","volume":"13","author":"Berendonk","year":"2015","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.scitotenv.2012.04.055","article-title":"Hospital effluent: Investigation of the concentrations and distribution of pharmaceuticals and environmental risk assessment","volume":"430","author":"Verlicchi","year":"2012","journal-title":"Sci. Total Environ."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Lien, L.T., Hoa, N.Q., Chuc, N.T., Thoa, N.T., Phuc, H.D., Diwan, V., Dat, N.T., Tamhankar, A.J., and Lundborg, C.S. (2016). Antibiotics in Wastewater of a Rural and an Urban Hospital before and after Wastewater Treatment, and the Relationship with Antibiotic Use-A One Year Study from Vietnam. Int. J. Environ. Res. Public Health, 13.","DOI":"10.3390\/ijerph13060588"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"246","DOI":"10.3389\/fmicb.2011.00246","article-title":"Extended-Spectrum Beta-Lactamases Producing E. coli in Wildlife, yet Another Form of Environmental Pollution?","volume":"2","author":"Guenther","year":"2011","journal-title":"Front. Microbiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s13756-016-0108-5","article-title":"Quantitative evaluation of extended-spectrum beta-lactamase-producing Escherichia coli strains in the wastewater of a French teaching hospital and relation to patient strain","volume":"5","author":"Drieux","year":"2016","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_7","unstructured":"World Health Organization (WHO) (2015). Antibiotic Resistance: Global Report on Surveillance 2014, WHO."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.3855\/jidc.4745","article-title":"High cost burden and health consequences of antibiotic resistance: The price to pay","volume":"8","author":"Chandy","year":"2014","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1016\/S1473-3099(15)00149-8","article-title":"Out-of-pocket health expenditures and antimicrobial resistance in low-income and middle-income countries: An economic analysis","volume":"15","author":"Alsan","year":"2015","journal-title":"Lancet Infect. Dis."},{"key":"ref_10","unstructured":"World Health Organization (WHO) (2015). Global Action Plan on Antimicrobial Resistance, WHO."},{"key":"ref_11","unstructured":"World Health Organization (WHO) (2015). Worldwide Country Situation Analysis: Response to Antimicrobial Resistance, WHO."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1886","DOI":"10.1111\/jocn.13246","article-title":"Combating antibiotic resistance, mitigating future threats and ongoing initiatives","volume":"25","author":"Velez","year":"2016","journal-title":"J. Clin. Nurs."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.nmni.2015.02.007","article-title":"The global threat of antimicrobial resistance: Science for intervention","volume":"6","author":"Roca","year":"2015","journal-title":"New Microbes New Infect."},{"key":"ref_14","unstructured":"(2016, November 07). General Assembly of the United Nations. Available online: http:\/\/www.un.org\/pga\/71\/2016\/09\/21\/press-release-hl-meeting-on-antimicrobial-resistance\/."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.jhin.2016.01.010","article-title":"What happens in hospitals does not stay in hospitals: Antibiotic-resistant bacteria in hospital wastewater systems","volume":"93","author":"Hocquet","year":"2016","journal-title":"J. Hosp. Infect."},{"key":"ref_16","unstructured":"Talaro, K.P., and Talaro, A. (2002). Foundations in Microbiology, The McGraw\u2212Hill Companies. [4th ed.]."},{"key":"ref_17","unstructured":"Cinical and Laboratory Standards Institute (CLSI) (2012). Performance Standards for Antimicrobial Disk Susceptibility Tests. Approved Standard-Eleventh Edition, CLSI."},{"key":"ref_18","unstructured":"(2016, December 02). EUCAST Antimicrobial Wild Type Distributions of Microorganisms. Available online: http:\/\/mic.eucast.org\/Eucast2\/SearchController\/search.jsp?action=performSearch&BeginIndex=0&Micdif=dif&NumberIndex50&Antib=\u22121&Specium=162."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1093\/jac\/dkp498","article-title":"Development of a set of multiplex PCR assays for the detection of genes encoding important beta-lactamases in Enterobacteriaceae","volume":"65","author":"Dallenne","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1099\/jmm.0.010033-0","article-title":"High prevalence of plasmid-mediated quinolone resistance determinants in commensal members of the Enterobacteriaceae in Ho Chi Minh City, Vietnam","volume":"58","author":"Le","year":"2009","journal-title":"J. Me\u0301d. Microbiol."},{"key":"ref_21","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_22","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1016\/j.chemosphere.2008.03.009","article-title":"Occurrence, fate and antibiotic resistance of fluoroquinolone antibacterials in hospital wastewaters in Hanoi, Vietnam","volume":"72","author":"Duong","year":"2008","journal-title":"Chemosphere"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1590\/S1517-83822013000300021","article-title":"Incidence and transferability of antibiotic resistance in the enteric bacteria isolated from hospital wastewater","volume":"44","author":"Alam","year":"2013","journal-title":"Braz. J. Microbiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.ecoenv.2013.01.014","article-title":"Antibiotic resistant Escherichia coli in hospital and municipal sewage and their emission to the environment","volume":"91","author":"Korzeniewska","year":"2013","journal-title":"Ecotoxicol. Environ. Saf."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1086\/320532","article-title":"Resistance to trimethoprim-sulfamethoxazole","volume":"32","author":"Huovinen","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1111\/j.1365-2672.2011.05072.x","article-title":"Multiresistance, beta-lactamase-encoding genes and bacterial diversity in hospital wastewater in Rio de Janeiro, Brazil","volume":"111","author":"Chagas","year":"2011","journal-title":"J. Appl. Microbiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"263","DOI":"10.4103\/0974-777X.68531","article-title":"Extended-spectrum \u03b2-lactamases in Gram Negative Bacteria","volume":"2","author":"Rawat","year":"2010","journal-title":"J. Glob. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1128\/AAC.33.3.259","article-title":"Characterization of beta-lactamases","volume":"33","author":"Bush","year":"1989","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_29","first-page":"533","article-title":"Frequency of transferable multiple antibiotic resistance amongst coliform bacteria isolated from a treated sewage effluent in Antofagasta, Chile","volume":"5","author":"Silva","year":"2006","journal-title":"Electron. J. Biotechnol."},{"key":"ref_30","first-page":"302","article-title":"Transferable enzymatic resistance to third-generation cephalosporins during nosocomial outbreak of multiresistant Klebsiella pneumoniae","volume":"2","author":"Legrand","year":"1987","journal-title":"Lancet"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1111\/jam.12591","article-title":"Detection of carbapenem resistance genes and cephalosporin, and quinolone resistance genes along with oqxAB gene in Escherichia coli in hospital wastewater: A matter of concern","volume":"117","author":"Chandran","year":"2014","journal-title":"J. Appl. Microbiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1093\/jac\/dkr564","article-title":"Identification of extended-spectrum -lactamase and quinolone resistance genes in Escherichia coli isolated from hospital wastewater from central India","volume":"67","author":"Diwan","year":"2012","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1016\/j.ajic.2015.06.002","article-title":"Prevalence of extended-spectrum beta-lactamase-producing bacteria in hospital and community sewage in Saudi Arabia","volume":"43","author":"Abdulhaq","year":"2015","journal-title":"Am. J. Infect. Control"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1128\/AAC.01009-09","article-title":"Updated functional classification of beta-lactamases","volume":"54","author":"Bush","year":"2010","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Varela, A.R., Macedo, G.N., Nunes, O.C., and Manaia, C.M. (2015). Genetic characterization of fluoroquinolone resistant Escherichia coli from urban streams and municipal and hospital effluents. FEMS Microbiol. Ecol., 91.","DOI":"10.1093\/femsec\/fiv015"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1128\/AAC.01137-07","article-title":"Plasmid-mediated qepA gene among Escherichia coli clinical isolates from Japan","volume":"52","author":"Yamane","year":"2008","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2045","DOI":"10.3201\/eid2111.150750","article-title":"Fosfomycin Resistance in Escherichia coli, Pennsylvania, USA","volume":"21","author":"Alrowais","year":"2015","journal-title":"Emerg. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/jac\/45.1.1","article-title":"Carbapenems: The pinnacle of the \u03b2-lactam antibiotics or room for improvement?","volume":"45","author":"Edwards","year":"2000","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e4099","DOI":"10.1097\/MD.0000000000004099","article-title":"High prevalence of hospital-acquired infections caused by gram-negative carbapenem resistant strains in Vietnamese pediatric ICUs: A multi-centre point prevalence survey","volume":"95","author":"Le","year":"2016","journal-title":"Medicine"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.3389\/fmicb.2016.01128","article-title":"Hospital Effluents Are One of Several Sources of Metal, Antibiotic Resistance Genes, and Bacterial Markers Disseminated in Sub-Saharan Urban Rivers","volume":"7","author":"Laffite","year":"2016","journal-title":"Front. Microbiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e87","DOI":"10.1016\/j.ajic.2015.08.015","article-title":"Dissemination of antibiotic resistance in methicillin-resistant Staphylococcus aureus and vancomycin-resistant S. aureus strains isolated from hospital effluents","volume":"43","author":"Mandal","year":"2015","journal-title":"Am. J. Infect. Control"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/j.envpol.2016.04.033","article-title":"Ciprofloxacin residue and antibiotic-resistant biofilm bacteria in hospital effluent","volume":"214","author":"Ory","year":"2016","journal-title":"Environ. Pollut."},{"key":"ref_43","first-page":"124","article-title":"Occurrence of bacteria producing broad-spectrum beta-lactamases and qnr genes in hospital and urban wastewater samples","volume":"39","author":"Roderova","year":"2016","journal-title":"New Microbiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1111\/jam.12936","article-title":"Diversity and antibiotic resistance profiles of Pseudomonads from a hospital wastewater treatment plant","volume":"119","author":"Santoro","year":"2015","journal-title":"J. Appl. Microbiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.scitotenv.2015.10.124","article-title":"Quinolone resistant Aeromonas spp. as carriers and potential tracers of acquired antibiotic resistance in hospital and municipal wastewater","volume":"542","author":"Varela","year":"2016","journal-title":"Sci. Total Environ."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1089\/mdr.2015.0118","article-title":"Multidrug Resistance in Quinolone-Resistant Gram-Negative Bacteria Isolated from Hospital Effluent and the Municipal Wastewater Treatment Plant","volume":"22","author":"Varela","year":"2016","journal-title":"Microb. Drug Resist."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"728","DOI":"10.3855\/jidc.6727","article-title":"Characteristics of ciprofloxacin-resistant Enterobacteriaceae isolates recovered from wastewater of an Algerian hospital","volume":"10","author":"Anssour","year":"2016","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"15111","DOI":"10.1007\/s11356-016-6688-z","article-title":"Exploring the correlations between antibiotics and antibiotic resistance genes in the wastewater treatment plants of hospitals in Xinjiang, China","volume":"23","author":"Li","year":"2016","journal-title":"Environ. Sci. Pollut. Res. Int."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1016\/j.scitotenv.2013.09.017","article-title":"Antimicrobial resistant Escherichia coli in the municipal wastewater system: Effect of hospital effluent and environmental fate","volume":"468\u2013469","author":"Harris","year":"2014","journal-title":"Sci. Total Environ."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"4231","DOI":"10.3390\/ijerph120404231","article-title":"Antibiotic susceptibilities of enterococcus species isolated from hospital and domestic wastewater effluents in alice, eastern cape province of South Africa","volume":"12","author":"Iweriebor","year":"2015","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"4772","DOI":"10.1128\/AEM.02898-09","article-title":"Enumeration and Characterization of Antimicrobial-Resistant Escherichia coli Bacteria in Effluent from Municipal, Hospital, and Secondary Treatment Facility Sources","volume":"76","author":"Galvin","year":"2010","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1111\/j.1574-6941.2006.00268.x","article-title":"Antimicrobial resistance patterns in Enterobacteriaceae isolated from an urban wastewater treatment plant","volume":"60","author":"Nunes","year":"2007","journal-title":"FEMS Microbiol. Ecol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.scitotenv.2013.01.032","article-title":"Urban wastewater treatment plants as hotspots for antibiotic resistant bacteria and genes spread into the environment: A review","volume":"447","author":"Rizzo","year":"2013","journal-title":"Sci. Total Environ."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"82","DOI":"10.2175\/106143008X304596","article-title":"Occurrence of ciprofloxacin-, trimethoprim-sulfamethoxazole-, and vancomycin-resistant bacteria in a municipal wastewater treatment plant","volume":"81","author":"Nagulapally","year":"2009","journal-title":"Water Environ. Res."},{"key":"ref_55","first-page":"404","article-title":"Detection of vancomycin-resistant enterococci (VRE) at four U.S. wastewater treatment plants that provide effluent for reuse","volume":"466\u2013467","author":"Micallef","year":"2014","journal-title":"Sci. Total Environ."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jgar.2016.01.008","article-title":"Emergence of ciprofloxacin-resistant extended-spectrum beta-lactamase-producing enteric bacteria in hospital wastewater and clinical sources","volume":"5","author":"Maheshwari","year":"2016","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"11993","DOI":"10.1021\/acs.est.5b02566","article-title":"Role of the Environment in the Transmission of Antimicrobial Resistance to Humans: A Review","volume":"49","author":"Huijbers","year":"2015","journal-title":"Environ. Sci. Technol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1007\/s00248-013-0178-3","article-title":"Clonally related methicillin-resistant Staphylococcus aureus isolated from short-finned pilot whales (Globicephala macrorhynchus), human volunteers, and a bayfront cetacean rehabilitation facility","volume":"65","author":"Hower","year":"2013","journal-title":"Microb. Ecol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/7\/699\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:40:53Z","timestamp":1760208053000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/7\/699"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,6,29]]},"references-count":58,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2017,7]]}},"alternative-id":["ijerph14070699"],"URL":"https:\/\/doi.org\/10.3390\/ijerph14070699","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,6,29]]}}}