{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T10:32:54Z","timestamp":1782124374002,"version":"3.54.5"},"reference-count":62,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T00:00:00Z","timestamp":1667520000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deanship of Scientific Research at Jouf University","award":["DSR-2021-01-0379"],"award-info":[{"award-number":["DSR-2021-01-0379"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Inappropriate antibiotic usage in hospitalized patients contributes to microbial resistance. Our study aimed to examine the incidence of clinical bacterial isolates and their antibiotic resistance burden among critically ill patients in different hospital units. Materials and Methods: A single-centered cross-sectional study was conducted in a 120-bed tertiary care hospital that included 221 critically ill patients with hospital-acquired infections. Bacterial cultures and sensitivity reports were obtained and followed by a formal analysis of the antibiogram results to explore recovered isolates\u2019 prevalence and antibiotic susceptibility patterns. Results: Gram-negative bacteria were the most predominant pathogens among recovered isolates from the various hospital units (71%). Klebsiella sp. was the most prevalent microbe, followed by Acinetobacter sp., with an incidence level of 28% and 16.2%, respectively. Among the Gram-positive organisms, the coagulase-negative Staphylococci were the most predominant organism (11.3%), while (6.3%) methicillin-resistant Staphylococcus aureus (MRSA) isolates were recovered from different hospital units. Antibiotic sensitivity testing showed that polymyxin B was the most effective antibiotic against Gram-negative bacteria, whereas vancomycin and linezolid were the most active antibiotics against Gram-positive pathogens. Moreover, 7% of the Gram-negative bacteria isolated from different units showed positive production of extended-spectrum beta-lactamase (ESBL). Conclusions: The current study describes the high antibiotic resistance patterns in various hospital units that need extra legislation to prevent healthcare providers from misprescription and overuse of antibiotics.<\/jats:p>","DOI":"10.3390\/medicina58111597","type":"journal-article","created":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T04:15:23Z","timestamp":1667535323000},"page":"1597","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Emergence of High Antimicrobial Resistance among Critically Ill Patients with Hospital-Acquired Infections in a Tertiary Care Hospital"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4434-6217","authenticated-orcid":false,"given":"Ahmed","family":"E. Abou Warda","sequence":"first","affiliation":[{"name":"Clinical Pharmacy Department, Faculty of Pharmacy, October 6 University, Giza 12585, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatma","family":"Molham","sequence":"additional","affiliation":[{"name":"Microbiology and Immunology Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba F.","family":"Salem","sequence":"additional","affiliation":[{"name":"Pharmaceutics and Industrial Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4947-0495","authenticated-orcid":false,"given":"Gomaa","family":"Mostafa-Hedeab","sequence":"additional","affiliation":[{"name":"Pharmacology Department, Medical College, Jouf University, Sakaka 72388, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2034-7709","authenticated-orcid":false,"given":"Bashayer F.","family":"ALruwaili","sequence":"additional","affiliation":[{"name":"Community and Family Medicine Department, Division of Family Medicine, Medical College, Jouf University, Sakaka 72388, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1479-5476","authenticated-orcid":false,"given":"Ayman N.","family":"Moharram","sequence":"additional","affiliation":[{"name":"Critical Care Medicine Department, Faculty of Medicine, Cairo University, Giza 12613, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9229-2965","authenticated-orcid":false,"given":"Mohamed","family":"Sebak","sequence":"additional","affiliation":[{"name":"Microbiology and Immunology Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0781-6454","authenticated-orcid":false,"given":"Rania M.","family":"Sarhan","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,4]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2015). Health Care-Associated Infections Fact Sheet, World Health Organization."},{"key":"ref_2","first-page":"76","article-title":"Catheter-related urinary nosocomial infections in intensive care units: An epidemiologic study in North of Iran","volume":"8","author":"Rezai","year":"2017","journal-title":"Casp. J. Intern. Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Mekonnen, H., Seid, A., Fenta, G.M., and Gebrecherkos, T. (2021). Antimicrobial resistance profiles and associated factors of Acinetobacter and Pseudomonas aeruginosa nosocomial infection among patients admitted at Dessie comprehensive specialized Hospital, North-East Ethiopia. A cross-sectional study. PLoS ONE, 16.","DOI":"10.21203\/rs.3.rs-360841\/v1"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.ajic.2008.03.002","article-title":"CDC\/NHSN surveillance definition of health care\u2013associated infection and criteria for specific types of infections in the acute care setting","volume":"36","author":"Horan","year":"2008","journal-title":"Am. J. Infect. Control."},{"key":"ref_5","first-page":"1949","article-title":"Acinetobacter species: Prevalence and sensitivity pattern of Acinetobacter species among clinical isolates of tertiary care hospital","volume":"25","author":"Khawaja","year":"2018","journal-title":"Prof. Med. J."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Warda, A.E.A., Sarhan, R.M., Al-Fishawy, H.S., Moharram, A.N., and Salem, H.F. (2022). Continuous Versus Intermittent Linezolid Infusion for Critically Ill Patients with Hospital-Acquired and Ventilator-Associated Pneumonia: Efficacy and Safety Challenges. Pharmaceuticals, 15.","DOI":"10.3390\/ph15030296"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/2110-5820-1-47","article-title":"The rising problem of antimicrobial resistance in the intensive care unit","volume":"1","author":"Brusselaers","year":"2011","journal-title":"Ann. Intensiv. Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1097\/QCO.0b013e32832e0736","article-title":"Care bundles: The holy grail of infectious risk management in hospital?","volume":"22","author":"Marwick","year":"2009","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1001\/jama.2020.2717","article-title":"Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017","volume":"323","author":"Vincent","year":"2020","journal-title":"JAMA"},{"key":"ref_10","unstructured":"Kuhlen, R., Moreno, R., Ranieri, V.M., and Rhodes , A. (2007). Multidrug resistant infections in the ICU: Mechanisms, prevention and treatment. 25 Years of Progress and Innovation in Intensive Care Medicine, Medizinisch Wissenschaftliche Verlagsgesellschaft."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"aad3292","DOI":"10.1126\/science.aad3292","article-title":"Multidrug evolutionary strategies to reverse antibiotic resistance","volume":"351","author":"Baym","year":"2016","journal-title":"Science"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1089\/mdr.2021.0109","article-title":"Prevalence of Antibiotic Resistance Over Time in a Third-Level University Hospital","volume":"28","author":"Scaglione","year":"2022","journal-title":"Microb. Drug Resist."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"i5","DOI":"10.1093\/jacamr\/dlab052","article-title":"Antibiotic resistance during and beyond COVID-19","volume":"3","author":"Livermore","year":"2021","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Sulayyim, H.J.A., Ismail, R., Al Hamid, A., and Ghafar, N.A. (2022). Antibiotic Resistance during COVID-19: A Systematic Review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191911931"},{"key":"ref_15","first-page":"393","article-title":"Medicaci\u00f3n prehospitalaria en pacientes hospitalizados por COVID-19 en un hospital p\u00fablico de Lima-Per\u00fa","volume":"37","year":"2020","journal-title":"Acta M\u00e9dica Peru."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"442","DOI":"10.2471\/BLT.20.268573","article-title":"Tackling antimicrobial resistance in the COVID-19 pandemic","volume":"98","author":"Getahun","year":"2020","journal-title":"Bull. World Health Organ."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/1472-6963-12-122","article-title":"Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition","volume":"12","author":"Morales","year":"2012","journal-title":"BMC Health Serv. Res."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Huang, H., Chen, B., Liu, G., Ran, J., Lian, X., Huang, X., Wang, N., and Huang, Z. (2018). A multi-center study on the risk factors of infection caused by multi-drug resistant Acinetobacter baumannii. BMC Infect. Dis., 18.","DOI":"10.1186\/s12879-017-2932-5"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2978","DOI":"10.1016\/j.sjbs.2022.01.015","article-title":"Prevalence, antimicrobial resistance profile, and characterization of multi-drug resistant bacteria from various infected wounds in North Egypt","volume":"29","author":"Hassan","year":"2022","journal-title":"Saudi J. Biol. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.apjtb.2017.01.019","article-title":"Nosocomial infections: Epidemiology, prevention, control and surveillance","volume":"7","author":"Khan","year":"2017","journal-title":"Asian Pac. J. Trop. Biomed."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.2147\/DDDT.S251171","article-title":"Bacteriophages, a New Therapeutic Solution for Inhibiting Multidrug-Resistant Bacteria Causing Wound Infection: Lesson from Animal Models and Clinical Trials","volume":"14","author":"Moghadam","year":"2020","journal-title":"Drug Des. Dev. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet"},{"key":"ref_23","unstructured":"(2018). Performance Standards for Antimicrobial Susceptibility Testing, 28th Edition (Standard No. CLSI M100-S15)."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1099\/jmm.0.032219-0","article-title":"Evaluation of various methods for the detection of meticillin-resistant Staphylococcus aureus strains and susceptibility patterns","volume":"60","author":"Datta","year":"2011","journal-title":"J. Med. Microbiol."},{"key":"ref_25","unstructured":"(2022, March 16). WHONET Software. Available online: https:\/\/whonet.org\/."},{"key":"ref_26","unstructured":"(2022, March 22). R-Project. Available online: https:\/\/www.r-project.org\/about.html."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.1001\/jama.2009.1754","article-title":"International Study of the Prevalence and Outcomes of Infection in Intensive Care Units","volume":"302","author":"Vincent","year":"2009","journal-title":"JAMA"},{"key":"ref_28","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_29","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1002\/phar.1636","article-title":"Infections Caused by Resistant Gram-Negative Bacteria: Epidemiology and Management","volume":"35","author":"Kaye","year":"2015","journal-title":"Pharmacother. J. Hum. Pharmacol. Drug Ther."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.jiph.2021.02.011","article-title":"Antimicrobial Resistance Threats in the emerging COVID-19 pandemic: Where do we stand?","volume":"14","author":"Ghosh","year":"2021","journal-title":"J. Infect. Public Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1159\/000440867","article-title":"Acute Kidney Injury and Renal Recovery with the Use of Aminoglycosides: A Large Retrospective Study","volume":"131","author":"Paquette","year":"2015","journal-title":"Nephron"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3352","DOI":"10.1128\/JCM.01284-07","article-title":"Antimicrobial Resistance among Gram-Negative Bacilli Causing Infections in Intensive Care Unit Patients in the United States between 1993 and 2004","volume":"45","author":"Lockhart","year":"2007","journal-title":"J. Clin. Microbiol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Morris, S., and Cerceo, E. (2020). Trends, Epidemiology, and Management of Multi-Drug Resistant Gram-Negative Bacterial Infections in the Hospitalized Setting. Antibiotics, 9.","DOI":"10.3390\/antibiotics9040196"},{"key":"ref_34","first-page":"25","article-title":"Changing trends in antimicrobial susceptibility and hospital acquired infections over an 8 year period in a tertiary care hospital in relation to introduction of an infection control programme","volume":"58","author":"Gopalakrishnan","year":"2010","journal-title":"J. Assoc. Physicians India"},{"key":"ref_35","first-page":"335","article-title":"Bacteriological profile and antibiogram of Gram negative organisms isolated from medical and neurology intensive care unit with special reference to multi-drug resistant organisms","volume":"2","author":"Patel","year":"2012","journal-title":"Natl. J. Med. Res."},{"key":"ref_36","first-page":"2173","article-title":"Prevalence and antibiogram of Extended Spectrum \u03b2-Lactamase (ESBL) producing Gram negative bacilli and further molecular characterization of ESBL producing Escherichia coli and Klebsiella spp","volume":"7","author":"Sharma","year":"2013","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"66","DOI":"10.20546\/ijcmas.2016.502.007","article-title":"Identification and Antibiogram of Various Gram Positive Bacterial Isolates from Pyogenic Samples by VITEK\u00ae 2 Compact System","volume":"5","author":"Khullar","year":"2016","journal-title":"Int. J. Curr. Microbiol. Appl. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"903","DOI":"10.2217\/fmb.12.51","article-title":"Nosocomial Gram-positive antimicrobial susceptibility pattern at a referral teaching hospital in Tehran, Iran","volume":"7","author":"Soltani","year":"2012","journal-title":"Futur. Microbiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12941-021-00450-x","article-title":"Antimicrobial susceptibility of gram-positive and gram-negative bacteria: A 5-year retrospective analysis at a multi-hospital healthcare system in Saudi Arabia","volume":"20","author":"Alhumaid","year":"2021","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_40","first-page":"231","article-title":"Prevalence and Antimicrobial Susceptibility of methicillin resistant Staphylococcus aureus and coagulase-negative Staphylococci in a tertiary care hospital","volume":"6","author":"Mir","year":"2013","journal-title":"Asian J. Pharm. Clin. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"082","DOI":"10.4103\/0974-2727.72155","article-title":"Prevalence and Antimicrobial Susceptibility Pattern of Methicillin-resistant Staphylococcus Aureus [MRSA] Isolates at a Tertiary Care Hospital in Mangalore, South India","volume":"2","author":"Pai","year":"2010","journal-title":"J. Lab. Physicians"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/S1473-3099(13)70190-7","article-title":"Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases","volume":"13","author":"Poirel","year":"2013","journal-title":"Lancet Infect. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1001\/jama.289.7.885","article-title":"Antibiotic resistance among Gram-negative bacilli in US intensive care units: Implications for fluoroquinolone use","volume":"289","author":"Neuhauser","year":"2003","journal-title":"JAMA"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"258","DOI":"10.4103\/ejb.ejb_43_18","article-title":"Incidence of ventilator-associated pneumonia: Egyptian study","volume":"13","author":"Elkolaly","year":"2019","journal-title":"Egypt. J. Bronchol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s43168-021-00059-w","article-title":"Antibiograms of intensive care units at an Egyptian tertiary care hospital","volume":"15","author":"Negm","year":"2021","journal-title":"Egypt. J. Bronchol."},{"key":"ref_46","first-page":"e809","article-title":"Antibiogram of Medical Intensive Care Unit at Tertiary Care Hospital Setting of Pakistan","volume":"8","author":"Qadeer","year":"2016","journal-title":"Cureus"},{"key":"ref_47","first-page":"344","article-title":"Antibiogram of Gram-negative bacterial isolates from intensive care unit at a tertiary care hospital","volume":"6","author":"Rajan","year":"2016","journal-title":"IJAR"},{"key":"ref_48","first-page":"991","article-title":"Antibiotic Sensitivity Pattern of Bacterial Isolates from the Intensive Care Unit of a Tertiary Care Hospital in India","volume":"11","author":"Sheth","year":"2013","journal-title":"Trop. J. Pharm. Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"281","DOI":"10.7439\/ijbar.v3i5.375","article-title":"A Cross-sectional study to determine the profile and antibiotic resistance pattern of gram negative bacilli isolated from intensive care unit patients in a tertiary care hospital in ahmednagar, maharashtra","volume":"3","author":"Gunjal","year":"2012","journal-title":"Int. J. Biomed. Adv. Res."},{"key":"ref_50","first-page":"64","article-title":"Bacterial spectrum and susceptibility patterns of pathogens in ICU and IMCU of a secondary care hospital in Kingdom of Saudi Arabia","volume":"16","author":"Khan","year":"2018","journal-title":"Int. J. Pathol."},{"key":"ref_51","first-page":"527","article-title":"Prevalence and resistance pattern of Pseudomonas strains isolated from ICU patients","volume":"3","author":"Raakhee","year":"2014","journal-title":"Int. J. Curr. Microbiol. App. Sci."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/S2221-1691(11)60065-8","article-title":"Antibiotic sensitivity pattern of bacterial pathogens in the intensive care unit of Fatmawati Hospital, Indonesia","volume":"1","author":"Radji","year":"2011","journal-title":"Asian Pac. J. Trop. Biomed."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"547","DOI":"10.5005\/jp-journals-10071-23295","article-title":"Study of Antibiotic Sensitivity and Resistance Pattern of Bacterial Isolates in Intensive Care Unit Setup of a Tertiary Care Hospital","volume":"23","author":"Savanur","year":"2019","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_54","first-page":"543","article-title":"A retrospective study on blood stream infections and antibiotic susceptibility patterns in a tertiary care teaching hospital","volume":"4","author":"Vanitha","year":"2012","journal-title":"Int. J. Pharm. Pharm. Sci."},{"key":"ref_55","first-page":"160","article-title":"Antimicrobial profile of clinical isolates in intensive care unit at a tertiary care hospital","volume":"8","author":"Chidambaram","year":"2019","journal-title":"Int. J. Med. Res. Health Sci."},{"key":"ref_56","first-page":"105","article-title":"Bacterial isolates and their antibiotic sensitivity pattern in clinically suspected cases of fever of unknown origin","volume":"16","author":"Kaur","year":"2014","journal-title":"JK Sci."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"288","DOI":"10.5539\/gjhs.v8n2p288","article-title":"Resistance Pattern of Antibiotics in Patient Underwent Open Heart Surgery With Nosocomial Infection in North of Iran","volume":"8","author":"Davoudi","year":"2015","journal-title":"Glob. J. Health Sci."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"176","DOI":"10.4103\/1596-3519.117629","article-title":"Isolation, identification, and antibiogram of Enterococci isolated from patients with urinary tract infection","volume":"12","author":"Parameswarappa","year":"2013","journal-title":"Ann. Afr. Med."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Almqvist, M., Mattsson, G., Razmi, R., and Magnusson, P. (2019). Cardiac Implantable Electronic Device-Related Infections, IntechOpen.","DOI":"10.5772\/intechopen.86395"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1756-0500-6-298","article-title":"Antimicrobial resistance in hospitalized surgical patients: A silently emerging public health concern in Uganda","volume":"6","author":"Seni","year":"2013","journal-title":"BMC Res. Notes"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13104-017-2695-5","article-title":"Nosocomial bacterial infections and their antimicrobial susceptibility patterns among patients in Ugandan intensive care units: A cross sectional study","volume":"10","author":"Agaba","year":"2017","journal-title":"BMC Res. Notes"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Valsamatzi-Panagiotou, A., Popova, K.B., and Penchovsky, R. (2021). Strategies for Prevention and Containment of Antimicrobial Resistance, Springer. Sustainable Agriculture Reviews 49.","DOI":"10.1007\/978-3-030-58259-3_1"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/11\/1597\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:10:27Z","timestamp":1760145027000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/11\/1597"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,4]]},"references-count":62,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["medicina58111597"],"URL":"https:\/\/doi.org\/10.3390\/medicina58111597","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,4]]}}}