{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:24:27Z","timestamp":1791559467784,"version":"4.3.4"},"reference-count":63,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,3,24]],"date-time":"2024-03-24T00:00:00Z","timestamp":1711238400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CONAHCYT, Mexico","award":["FORDECY-PRONACES\/682339\/2019"],"award-info":[{"award-number":["FORDECY-PRONACES\/682339\/2019"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>The objective of the study was to detect multidrug-resistant Staphylococcus sp. and Enterococcus sp. isolates in municipal and hospital wastewater and to determine their elimination or persistence after wastewater treatment. Between August 2021 and September 2022, raw and treated wastewater samples were collected at two hospital and two community wastewater treatment plants (WWTPs). In each season of the year, two treated and two raw wastewater samples were collected in duplicate at each of the WWTPs studied. Screening and presumptive identification of staphylococci and enterococci was performed using chromoagars, and identification was performed with the Matrix Assisted Laser Desorption Ionization Time of Flight mass spectrometry (MALDI-TOF MS\u00ae). Antimicrobial susceptibility was performed using VITEK 2\u00ae automated system. There were 56 wastewater samples obtained during the study period. A total of 182 Staphylococcus sp. and 248 Enterococcus sp. were identified. The highest frequency of Staphylococcus sp. isolation was in spring and summer (n = 129, 70.8%), and for Enterococcus sp. it was in autumn and winter (n = 143, 57.7%). Sixteen isolates of Staphylococcus sp. and sixty-three of Enterococcus sp. persisted during WWTP treatments. Thirteen species of staphylococci and seven species of enterococci were identified. Thirty-one isolates of Staphylococcus sp. and ninety-four of Enterococcus sp. were multidrug-resistant. Resistance to vancomycin (1.1%), linezolid (2.7%), and daptomycin (8.2%\/10.9%%), and a lower susceptibility to tigecycline (2.7%), was observed. This study evidences the presence of Staphylococcus sp. and Enterococcus sp. resistant to antibiotics of last choice of clinical treatment, in community and hospital wastewater and their ability to survive WWTP treatment systems.<\/jats:p>","DOI":"10.3390\/microorganisms12040645","type":"journal-article","created":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T14:00:23Z","timestamp":1711375223000},"page":"645","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Multidrug-Resistant Staphylococcus sp. and Enterococcus sp. in Municipal and Hospital Wastewater: A Longitudinal Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Maria Elena","family":"Velazquez-Meza","sequence":"first","affiliation":[{"name":"Centro de Investigaci\u00f3n Sobre Enfermedades Infecciosas, Instituto Nacional de Salud P\u00fablica, Cuernavaca City 62100, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9609-6419","authenticated-orcid":false,"given":"Miguel","family":"Galarde-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Sobre Enfermedades Infecciosas, Instituto Nacional de Salud P\u00fablica, Cuernavaca City 62100, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Cornejo-Ju\u00e1rez","sequence":"additional","affiliation":[{"name":"Departamento de Infectolog\u00eda, Instituto Nacional de Cancerolog\u00eda, Mexico City 14080, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berta Alicia","family":"Carrillo-Quiroz","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Sobre Enfermedades Infecciosas, Instituto Nacional de Salud P\u00fablica, Cuernavaca City 62100, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Consuelo","family":"Vel\u00e1zquez-Acosta","sequence":"additional","affiliation":[{"name":"Departamento de Infectolog\u00eda, Instituto Nacional de Cancerolog\u00eda, Mexico City 14080, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Bobadilla-del-Valle","sequence":"additional","affiliation":[{"name":"Laboratorio Nacional de M\u00e1xima Seguridad para el Estudio de Tuberculosis y Enfermedades Emergentes, Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n \u201cSalvador Zubir\u00e1n\u201d, Mexico City 14080, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2640-2916","authenticated-orcid":false,"given":"Alfredo","family":"Ponce-de-Le\u00f3n","sequence":"additional","affiliation":[{"name":"Laboratorio Nacional de M\u00e1xima Seguridad para el Estudio de Tuberculosis y Enfermedades Emergentes, Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n \u201cSalvador Zubir\u00e1n\u201d, Mexico City 14080, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celia Mercedes","family":"Alpuche-Aranda","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Sobre Enfermedades Infecciosas, Instituto Nacional de Salud P\u00fablica, Cuernavaca City 62100, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1002\/jor.23656","article-title":"Bacteria Antibiotic Resistance: New Challenges and Opportunities for Implant-Associated Orthopedic Infections","volume":"36","author":"Li","year":"2018","journal-title":"J. Orthop. Res."},{"key":"ref_2","unstructured":"O\u2019Neill, J. (2023, December 15). Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations. Available online: https:\/\/www.who.int\/news\/item\/29-04-2019-new-report-calls-for-urgent-action-to-avert-antimicrobial-resistance-crisis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"133","DOI":"10.4103\/0970-258X.255752","article-title":"Antimicrobial Resistance: Threat, Consequences and Options","volume":"31","author":"Bhatia","year":"2018","journal-title":"Natl. Med. J. India"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1128\/AAC.01041-09","article-title":"Attributable Hospital Cost and Length of Stay Associated with Health Care-Associated Infections Caused by Antibiotic-Resistant Gram-Negative Bacteria","volume":"54","author":"Mauldin","year":"2010","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"151433","DOI":"10.1016\/j.scitotenv.2021.151433","article-title":"Antibiotic Resistance Genes of Emerging Concern in Municipal and Hospital Wastewater from a Major Swedish City","volume":"812","author":"Hutinel","year":"2022","journal-title":"Sci. Total Environ."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"eaau9124","DOI":"10.1126\/sciadv.aau9124","article-title":"Antibiotic Resistance in European Wastewater Treatment Plants Mirrors the Pattern of Clinical Antibiotic Resistance Prevalence","volume":"5","author":"Kneis","year":"2019","journal-title":"Sci. Adv."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1126\/science.aba3432","article-title":"Using Sewage for Surveillance of Antimicrobial Resistance","volume":"367","author":"Aarestrup","year":"2020","journal-title":"Science"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"105689","DOI":"10.1016\/j.envint.2020.105689","article-title":"Future Perspectives of Wastewater-Based Epidemiology: Monitoring Infectious Disease Spread and Resistance to the Community Level","volume":"139","author":"Sims","year":"2020","journal-title":"Environ. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s15010-016-0945-4","article-title":"Clinical Significance of Coagulase-Negative Staphylococci Other than S. epidermidis Blood Stream Isolates at a Tertiary Care Hospital","volume":"45","author":"Hitzenbichler","year":"2017","journal-title":"Infection"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1099\/jmm.0.015800-0","article-title":"Diversity of Staphylococcal Cassette Chromosome Mec Structures in Coagulase-Negative Staphylococci and Relationship to Drug Resistance","volume":"59","author":"Pezina","year":"2010","journal-title":"J. Med. Microbiol."},{"key":"ref_11","first-page":"001008","article-title":"Taking Hospital Pathogen Surveillance to the next Level","volume":"9","author":"Werner","year":"2023","journal-title":"Microb. Genom."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"5892","DOI":"10.3382\/ps\/pez288","article-title":"Molecular Characterization of Antimicrobial-Resistant Enterococcus faecalis and Enterococcus faecium Isolated from Layer Parent Stock","volume":"98","author":"Seo","year":"2019","journal-title":"Poult. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"761","DOI":"10.22207\/JPAM.17.2.59","article-title":"Enterococcus Species: A Systemic Review","volume":"17","author":"Kalode","year":"2023","journal-title":"J. Pure Appl. Microbiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"191","DOI":"10.7705\/biomedica.v34i0.2210","article-title":"Resistance to \u201cLast Resort\u201d Antibiotics in Gram-Positive Cocci: The Post-Vancomycin Era","volume":"34","author":"Panesso","year":"2014","journal-title":"Biomedica"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1101\/gr.232629.117","article-title":"Detection of Vancomycin-Resistant Enterococcus faecium Hospital-Adapted Lineages in Municipal Wastewater Treatment Plants Indicates Widespread Distribution and Release into the Environment","volume":"29","author":"Gouliouris","year":"2019","journal-title":"Genome Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3937","DOI":"10.1038\/s41598-020-61002-5","article-title":"Surveillance of Enterococcus spp. Reveals Distinct Species and Antimicrobial Resistance Diversity across a One-Health Continuum","volume":"10","author":"Zaheer","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"105914","DOI":"10.1016\/j.envint.2020.105914","article-title":"The Prevalence of Drug-Resistant and Virulent Staphylococcus spp. in a Municipal Wastewater Treatment Plant and Their Spread in the Environment","volume":"143","author":"Korzeniewska","year":"2020","journal-title":"Environ. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"178","DOI":"10.2166\/wh.2023.199","article-title":"Occurrence of Staphylococcus spp. in the wastewaters from Iran: Diversity, Antimicrobial Resistance, and Virulence Potential","volume":"21","author":"Omid","year":"2023","journal-title":"J. Water Health"},{"key":"ref_19","unstructured":"Duncan, D., Harvey, F., and Walker, M. (2023, December 15). EPA Guidelines: Regulatory Monitoring and Testing. Water and Wastewater Sampling, Available online: https:\/\/www.epa.sa.gov.au\/files\/8494_guide_wws.pdf."},{"key":"ref_20","unstructured":"Clinical and Laboratory Standards Institute (CLSI) (2022). Performance Standards for Antimicrobial Susceptibility Testing, CLSI. [31st ed.]. CLSI Supplement M100."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1007\/s00449-020-02352-2","article-title":"The Seasonal Changes of Core Bacterial Community Decide Sewage Purification in Sub-Plateau Municipal Sewage Treatment Plants","volume":"43","author":"Kang","year":"2020","journal-title":"Bioprocess Biosyst. Eng."},{"key":"ref_22","first-page":"1488","article-title":"Microbial Community Structure of Wastewater Treatment Plants in Different Seasons","volume":"42","author":"He","year":"2021","journal-title":"Huanjing Kexue\/Environ. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Regasa Dadi, B., Girma, E., Tesfaye, M., and Seid, M. (2021). Assessment of the Bacteriological Profile and Antibiotic Susceptibility Patterns of Wastewater in Health Facilities of Ethiopia. Int. J. Microbiol., 2021.","DOI":"10.1155\/2021\/9969479"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.envpol.2016.01.038","article-title":"Characterization of Staphylococci in Urban Wastewater Treatment Plants in Spain, with Detection of Methicillin Resistant Staphylococcus aureus ST398","volume":"212","author":"Lozano","year":"2016","journal-title":"Environ. Pollut."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1111\/1574-6941.12268","article-title":"Demonstration of Staphylococci with Inducible Macrolide-Lincosamide-Streptogramin B (MLSB) Resistance in Sewage and River Water and of the Capacity of Anhydroerythromycin to Induce MLSB","volume":"88","author":"Gallert","year":"2014","journal-title":"FEMS Microbiol. Ecol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3876","DOI":"10.1016\/j.scitotenv.2009.02.034","article-title":"Antibiotic Resistance in Coagulase Negative Staphylococci Isolated from Wastewater and Drinking Water","volume":"407","author":"Faria","year":"2009","journal-title":"Sci. Total Environ."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"890","DOI":"10.2166\/wh.2020.019","article-title":"Antibiotic-Resistant Staphylococci from the Wastewater Treatment Plant and Grey-Water Samples in Obafemi Awolowo University, Ile-Ife, Nigeria","volume":"18","author":"Adesoji","year":"2020","journal-title":"J. Water Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.2147\/IDR.S358248","article-title":"Prevalence of CRISPR-Cas Systems and Their Possible Association with Antibiotic Resistance in Enterococcus faecalis and Enterococcus faecium Collected from Hospital Wastewater","volume":"15","author":"Alduhaidhawi","year":"2022","journal-title":"Infect. Drug Resist."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Gotkowska-P\u0142achta, A. (2021). The Prevalence of Virulent and Multidrug-Resistant Enterococci in River Water and in Treated and Untreated Municipal and Hospital Wastewater. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18020563"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"753","DOI":"10.2166\/wh.2020.086","article-title":"Prevalence, Antibiotic Resistance and Virulence of Enterococcus spp. from Wastewater Treatment Plant Effluent and Receiving Waters in South Africa","volume":"18","author":"Bezuidenhout","year":"2020","journal-title":"J. Water Health"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Sanderson, H., Ortega-Polo, R., Zaheer, R., Goji, N., Amoako, K.K., Brown, R.S., Majury, A., Liss, S.N., and McAllister, T.A. (2020). Comparative Genomics of Multidrug-Resistant Enterococcus spp. Isolated from Wastewater Treatment Plants. BMC Microbiol., 20.","DOI":"10.1186\/s12866-019-1683-4"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1097\/IPC.0000000000000329","article-title":"Postneurosurgical Central Nervous System Infection due to Enterococcus faecalis Successfully Treated with Intraventricular Vancomycin","volume":"24","author":"Patel","year":"2016","journal-title":"Infect. Dis. Clin. Pract."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1017\/ice.2016.174","article-title":"Antimicrobial-Resistant Pathogens Associated with Healthcare-Associated Infections: Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011\u20132014","volume":"37","author":"Weiner","year":"2016","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Tiwari, A., Oliver, D.M., Bivins, A., Sherchan, S.P., and Pitk\u00e4nen, T. (2021). Bathing Water Quality Monitoring Practices in Europe and the United States. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18115513"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"711","DOI":"10.2166\/wh.2018.293","article-title":"Categorical Performance Characteristics of Method ISO 7899-2 and Indicator Value of Intestinal Enterococci for Bathing Water Quality Monitoring","volume":"16","author":"Tiwari","year":"2018","journal-title":"J. Water Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"118052","DOI":"10.1016\/j.envres.2023.118052","article-title":"Antibiotic Resistance Monitoring in Wastewater in the Nordic Countries: A Systematic Review","volume":"246","author":"Tiwari","year":"2024","journal-title":"Environ. Res."},{"key":"ref_37","unstructured":"WHO (2022, July 18). The 2019 WHO AWaRe Classification of Antibiotics for Evaluation and Monitoring of Use. Available online: https:\/\/www.who.int\/publications\/i\/item\/WHOEMPIAU2019.11."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"4134","DOI":"10.1007\/s10661-014-4134-6","article-title":"Prevalence of Multidrug-Resistant, Coagulase-Positive Staphylococcus aureus in Nasal Carriage, Food, Wastewater and Paper Currency in Jalandhar City (North-Western), an Indian State of Punjab","volume":"187","author":"Kumar","year":"2015","journal-title":"Environ. Monit. Assess."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.scitotenv.2018.05.165","article-title":"Relationship between Modification of Activated Sludge Wastewater Treatment and Changes in Antibiotic Resistance of Bacteria","volume":"639","author":"Korzeniewska","year":"2018","journal-title":"Sci. Total Environ."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Jendrzejewska, N., and Karwowska, E. (2022). Bacterial Resistance to \u03b2-Lactam Antibiotics in Municipal Wastewater: Insights from a Full-Scale Treatment Plant in Poland. Microorganisms, 10.","DOI":"10.3390\/microorganisms10122323"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1289\/ehp.1205436","article-title":"Methicillin-Resistant Staphylococcus aureus (MRSA) Detected at Four U.S. Wastewater Treatment Plants","volume":"120","author":"Micallef","year":"2012","journal-title":"Environ. Health Perspect."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1016\/j.watres.2008.11.036","article-title":"A Seasonal Study of the MecA Gene and Staphylococcus aureus Including Methicillin-Resistant, S. aureus in a Municipal Wastewater Treatment Plant","volume":"43","author":"Melin","year":"2009","journal-title":"Water Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"6249","DOI":"10.3390\/ijerph120606249","article-title":"Class 1 Integrons and the Antiseptic Resistance Gene (QacE\u03941) in Municipal and Swine Slaughterhouse Wastewater Treatment Plants and Wastewater\u2014Associated Methicillin-Resistant Staphylococcus aureus","volume":"12","author":"Wan","year":"2015","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1111\/jam.12037","article-title":"Antibiotic Resistant Staphylococcus aureus in Hospital Wastewaters and Sewage Treatment Plants with Special Reference to Methicillin-Resistant Staphylococcus aureus (MRSA)","volume":"114","author":"Thompson","year":"2013","journal-title":"J. Appl. Microbiol."},{"key":"ref_45","first-page":"134","article-title":"Antibiotic Resistance of Staphylococcus spp. Isolated from Sewage in Manaus, Amazonas","volume":"3","author":"Nogueira","year":"2021","journal-title":"Eur. J. Med. Health Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.envint.2018.02.003","article-title":"Presence of Antibiotic Residues in Various Environmental Compartments of Shandong Province in Eastern China: Its Potential for Resistance Development and Ecological and Human Risk","volume":"114","author":"Hanna","year":"2018","journal-title":"Environ. Int."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Limayem, A., Wasson, S., Mehta, M., Pokhrel, A.R., Patil, S., Nguyen, M., Chen, J., and Nayak, B. (2019). High-Throughput Detection of Bacterial Community and Its Drug-Resistance Profiling from Local Reclaimed Wastewater Plants. Front. Cell. Infect. Microbiol., 9.","DOI":"10.3389\/fcimb.2019.00303"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e00944-20","DOI":"10.1128\/AAC.00944-20","article-title":"Vancomycin Heteroresistance and Clinical Outcomes in Bloodstream Infections Caused by Coagulase-Negative Staphylococci","volume":"64","author":"Dao","year":"2020","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1099\/jmm.0.001117","article-title":"Methicillin-Resistant Staphylococcus epidermidis Isolates with Reduced Vancomycin Susceptibility from Bloodstream Infections in a Neonatal Intensive Care Unit","volume":"69","author":"Peixoto","year":"2020","journal-title":"J. Med. Microbiol."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Sakimura, T., Kajiyama, S., Adachi, S., Chiba, K., Yonekura, A., Tomita, M., Koseki, H., Miyamoto, T., Tsurumoto, T., and Osaki, M. (2015). Biofilm-Forming Staphylococcus epidermidis Expressing Vancomycin Resistance Early after Adhesion to a Metal Surface. Biomed Res. Int., 2015.","DOI":"10.1155\/2015\/943056"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"304","DOI":"10.35366\/108784","article-title":"Endocarditis Infecciosa Por Staphylococcus lentus","volume":"67","author":"Pedraza","year":"2022","journal-title":"An. M\u00e9dicos Asoc. M\u00e9dica Cent. M\u00e9dico ABC"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"NP62","DOI":"10.1177\/0145561319848990","article-title":"Staphylococcus lentus Sinusitis: A New Sinonasal Pathogen","volume":"99","author":"Hay","year":"2020","journal-title":"Ear Nose Throat J."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"118","DOI":"10.14295\/p.v52i3.132","article-title":"Meningitis por Staphylococcus lentus Resistente a Meticilina Asociado a Derivaci\u00f3n Ventriculoperitoneal en Lactante Menor","volume":"52","year":"2019","journal-title":"Pediatria"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"469","DOI":"10.3747\/pdi.2012.00303","article-title":"Staphylococcus lentus Peritonitis: A Case Report","volume":"34","author":"Rivera","year":"2014","journal-title":"Perit. Dial. Int."},{"key":"ref_55","first-page":"177","article-title":"Isolation and Diagnosis of Staphylococcus lentus from Different Operation Theater Hospitals","volume":"2","author":"Shaker","year":"2018","journal-title":"Sci. J. Med. Res."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Nishiyama, M., Praise, S., Tsurumaki, K., Baba, H., Kanamori, H., and Watanabe, T. (2021). Prevalence of Antibiotic-Resistant Bacteria ESKAPE among Healthy People Estimated by Monitoring of Municipal wastewater. Antibiotics, 10.","DOI":"10.3390\/antibiotics10050495"},{"key":"ref_57","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_58","doi-asserted-by":"crossref","unstructured":"Hricov\u00e1, K., R\u00f6derov\u00e1, M., Fry\u010d\u00e1k, P., Pauk, V., Kurka, O., Mezerov\u00e1, K., \u0160tosov\u00e1, T., Bardo\u0148, J., Milde, D., and Ku\u010dov\u00e1, P. (2021). Prevalence of Vancomycin-Resistant Enterococci and Antimicrobial Residues in Wastewater and Surface Water. Life, 11.","DOI":"10.3390\/life11121403"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"129477","DOI":"10.1016\/j.jhazmat.2022.129477","article-title":"Evaluation of Culturable \u2018Last-Resort\u2019 Antibiotic Resistant Pathogens in Hospital Wastewater and Implications on the Risks of Nosocomial Antimicrobial Resistance Prevalence","volume":"438","author":"Li","year":"2022","journal-title":"J. Hazard. Mater."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.drup.2018.10.002","article-title":"Update on Prevalence and Mechanisms of Resistance to Linezolid, Tigecycline and Daptomycin in Enterococci in Europe: Towards a Common Nomenclature","volume":"40","author":"Bender","year":"2018","journal-title":"Drug Resist. Updat."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"4168","DOI":"10.1007\/s10661-014-4168-9","article-title":"Hierarchal Clustering Yields Insight into Multidrug-Resistant Bacteria Isolated from a Cattle Feedlot Wastewater Treatment System","volume":"187","author":"Jahne","year":"2015","journal-title":"Environ. Monit. Assess."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"3245","DOI":"10.1093\/jac\/dkx321","article-title":"Detection of OptrA in the African Continent (Tunisia) within a Mosaic Enterococcus faecalis Plasmid from Urban Wastewaters","volume":"72","author":"Freitas","year":"2017","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_63","first-page":"51","article-title":"Potential Role of Staphylococcus cohnii in a Hospital Environment","volume":"15","author":"Szewczyk","year":"2003","journal-title":"Microb. Ecol. Health Dis."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/12\/4\/645\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:17:48Z","timestamp":1760105868000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/12\/4\/645"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,24]]},"references-count":63,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["microorganisms12040645"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms12040645","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,24]]}}}