Multidrug- and Extensively Drug-Resistant Acinetobacter baumannii in a Tertiary Hospital from Brazil: The Importance of Carbapenemase Encoding Genes and Epidemic Clonal Complexes in a 10-Year Study
This study aimed to characterize the main mechanisms of acquired antimicrobial resistance of 103 multidrug-resistant Acinetobacter baumannii isolated from bloodstream from 2006 to 2016 from a hospital in Londrina, Brazil. All 103 isolates were identified as A. baumannii by amplification of the bla O...
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| Veröffentlicht in: | Microbial drug resistance (Larchmont, N.Y.) N.Y.), 2019-11, Vol.25 (9), p.1365-1373 |
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| creator | Romanin, Priscila Palermo, Raquel Lima Cavalini, Jônatas Fernando Fávaro, Larissa dos Santos De Paula-Petroli, Suelen Balero Fernandes, Eduardo Vignoto dos Anjos Szczerepa, Márcia Maria Tognim, Maria Cristina Bronharo Yamada-Ogatta, Sueli Fumie Carrara-Marroni, Floristher Elaine Yamauchi, Lucy Megumi |
| description | This study aimed to characterize the main mechanisms of acquired antimicrobial resistance of 103 multidrug-resistant
Acinetobacter baumannii
isolated from bloodstream from 2006 to 2016 from a hospital in Londrina, Brazil. All 103 isolates were identified as
A. baumannii
by amplification of the
bla
OXA-51-like
and
rpo
B genes. Mortality was observed in the majority (81.6%) of the patients. High non-susceptibility rates (100.0–10.7%) were obtained for the evaluated antimicrobials, including colistin, polymyxin B, and tigecycline, and most isolates were classified as extensively drug-resistant (78.6%). Carbapenemase production was observed in 92.2% of the isolates. All carbapenem-resistant isolates showed a carbapenem-hydrolyzing class D β-lactamase being either
bla
OXA-23-like
(97.9%) or
bla
OXA-143-like
(2.1%). None of the isolates had the genes
bla
OXA-24-like
,
bla
OXA-58-like
,
bla
OXA-48
,
bla
KPC
,
bla
NDM
,
bla
SPM-1
,
bla
SIM-1
,
bla
VIM
,
bla
IMP
,
bla
GIM
,
bla
GES
,
mcr
-1,
qnr
A,
qnr
B,
qnr
C,
qnr
S, and
qnr
Vc. As a genetic context of the
bla
OXA-23-like
gene, Tn
2006
was predominated (86.0%), and Tn
2008
was less frequent (12.9%). Isolates harboring the
bla
OXA-143-like
gene showed the
bla
OXA-253-like
variant. A polyclonal profile was observed among the
A. baumannii
isolates. The presence of the international clonal complexes CC113/79, CC109/1, CC110/25, and CC103/15 was detected, with prevalence of CC113/79 (38.8%). This study provides essential information to understand the antimicrobial resistance patterns of
A. baumannii
and can be used to strengthen infection control measures in our hospital. Also, the study reinforces the urgent need to develop stewardship programs to avoid the spread and potential outbreaks by this pathogen. |
| doi_str_mv | 10.1089/mdr.2019.0002 |
| format | Article |
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Acinetobacter baumannii
isolated from bloodstream from 2006 to 2016 from a hospital in Londrina, Brazil. All 103 isolates were identified as
A. baumannii
by amplification of the
bla
OXA-51-like
and
rpo
B genes. Mortality was observed in the majority (81.6%) of the patients. High non-susceptibility rates (100.0–10.7%) were obtained for the evaluated antimicrobials, including colistin, polymyxin B, and tigecycline, and most isolates were classified as extensively drug-resistant (78.6%). Carbapenemase production was observed in 92.2% of the isolates. All carbapenem-resistant isolates showed a carbapenem-hydrolyzing class D β-lactamase being either
bla
OXA-23-like
(97.9%) or
bla
OXA-143-like
(2.1%). None of the isolates had the genes
bla
OXA-24-like
,
bla
OXA-58-like
,
bla
OXA-48
,
bla
KPC
,
bla
NDM
,
bla
SPM-1
,
bla
SIM-1
,
bla
VIM
,
bla
IMP
,
bla
GIM
,
bla
GES
,
mcr
-1,
qnr
A,
qnr
B,
qnr
C,
qnr
S, and
qnr
Vc. As a genetic context of the
bla
OXA-23-like
gene, Tn
2006
was predominated (86.0%), and Tn
2008
was less frequent (12.9%). Isolates harboring the
bla
OXA-143-like
gene showed the
bla
OXA-253-like
variant. A polyclonal profile was observed among the
A. baumannii
isolates. The presence of the international clonal complexes CC113/79, CC109/1, CC110/25, and CC103/15 was detected, with prevalence of CC113/79 (38.8%). This study provides essential information to understand the antimicrobial resistance patterns of
A. baumannii
and can be used to strengthen infection control measures in our hospital. Also, the study reinforces the urgent need to develop stewardship programs to avoid the spread and potential outbreaks by this pathogen.</description><identifier>ISSN: 1076-6294</identifier><identifier>EISSN: 1931-8448</identifier><identifier>DOI: 10.1089/mdr.2019.0002</identifier><identifier>PMID: 31361565</identifier><language>eng</language><publisher>United States: Mary Ann Liebert, Inc., publishers</publisher><subject>Acinetobacter baumannii ; Acinetobacter baumannii - drug effects ; Acinetobacter baumannii - genetics ; Acinetobacter baumannii - isolation & purification ; Acinetobacter Infections - drug therapy ; Acinetobacter Infections - epidemiology ; Acinetobacter Infections - microbiology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - pharmacology ; Antibiotics ; Antiinfectives and antibacterials ; Antimicrobial agents ; Antimicrobial resistance ; Bacterial Proteins - genetics ; beta-Lactamases - genetics ; Brazil ; Carbapenemase ; Carbapenems - pharmacology ; Child ; Child, Preschool ; Colistin ; Drug resistance ; Drug Resistance, Multiple, Bacterial ; Epidemics ; Epidemiology ; Female ; Genes ; Humans ; Infant ; Infant, Newborn ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Multidrug resistance ; Polymyxin B ; RpoB protein ; Tertiary Care Centers ; Tigecycline ; Young Adult</subject><ispartof>Microbial drug resistance (Larchmont, N.Y.), 2019-11, Vol.25 (9), p.1365-1373</ispartof><rights>2019, Mary Ann Liebert, Inc., publishers</rights><rights>Copyright Mary Ann Liebert, Inc. Nov 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-ca7abd6839a0947c41be028b539c539ceb4c0de5f0f5d3b06eef8f562884ae613</citedby><cites>FETCH-LOGICAL-c365t-ca7abd6839a0947c41be028b539c539ceb4c0de5f0f5d3b06eef8f562884ae613</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31361565$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Romanin, Priscila</creatorcontrib><creatorcontrib>Palermo, Raquel Lima</creatorcontrib><creatorcontrib>Cavalini, Jônatas Fernando</creatorcontrib><creatorcontrib>Fávaro, Larissa dos Santos</creatorcontrib><creatorcontrib>De Paula-Petroli, Suelen Balero</creatorcontrib><creatorcontrib>Fernandes, Eduardo Vignoto</creatorcontrib><creatorcontrib>dos Anjos Szczerepa, Márcia Maria</creatorcontrib><creatorcontrib>Tognim, Maria Cristina Bronharo</creatorcontrib><creatorcontrib>Yamada-Ogatta, Sueli Fumie</creatorcontrib><creatorcontrib>Carrara-Marroni, Floristher Elaine</creatorcontrib><creatorcontrib>Yamauchi, Lucy Megumi</creatorcontrib><title>Multidrug- and Extensively Drug-Resistant Acinetobacter baumannii in a Tertiary Hospital from Brazil: The Importance of Carbapenemase Encoding Genes and Epidemic Clonal Complexes in a 10-Year Study</title><title>Microbial drug resistance (Larchmont, N.Y.)</title><addtitle>Microb Drug Resist</addtitle><description>This study aimed to characterize the main mechanisms of acquired antimicrobial resistance of 103 multidrug-resistant
Acinetobacter baumannii
isolated from bloodstream from 2006 to 2016 from a hospital in Londrina, Brazil. All 103 isolates were identified as
A. baumannii
by amplification of the
bla
OXA-51-like
and
rpo
B genes. Mortality was observed in the majority (81.6%) of the patients. High non-susceptibility rates (100.0–10.7%) were obtained for the evaluated antimicrobials, including colistin, polymyxin B, and tigecycline, and most isolates were classified as extensively drug-resistant (78.6%). Carbapenemase production was observed in 92.2% of the isolates. All carbapenem-resistant isolates showed a carbapenem-hydrolyzing class D β-lactamase being either
bla
OXA-23-like
(97.9%) or
bla
OXA-143-like
(2.1%). None of the isolates had the genes
bla
OXA-24-like
,
bla
OXA-58-like
,
bla
OXA-48
,
bla
KPC
,
bla
NDM
,
bla
SPM-1
,
bla
SIM-1
,
bla
VIM
,
bla
IMP
,
bla
GIM
,
bla
GES
,
mcr
-1,
qnr
A,
qnr
B,
qnr
C,
qnr
S, and
qnr
Vc. As a genetic context of the
bla
OXA-23-like
gene, Tn
2006
was predominated (86.0%), and Tn
2008
was less frequent (12.9%). Isolates harboring the
bla
OXA-143-like
gene showed the
bla
OXA-253-like
variant. A polyclonal profile was observed among the
A. baumannii
isolates. The presence of the international clonal complexes CC113/79, CC109/1, CC110/25, and CC103/15 was detected, with prevalence of CC113/79 (38.8%). This study provides essential information to understand the antimicrobial resistance patterns of
A. baumannii
and can be used to strengthen infection control measures in our hospital. Also, the study reinforces the urgent need to develop stewardship programs to avoid the spread and potential outbreaks by this pathogen.</description><subject>Acinetobacter baumannii</subject><subject>Acinetobacter baumannii - drug effects</subject><subject>Acinetobacter baumannii - genetics</subject><subject>Acinetobacter baumannii - isolation & purification</subject><subject>Acinetobacter Infections - drug therapy</subject><subject>Acinetobacter Infections - epidemiology</subject><subject>Acinetobacter Infections - microbiology</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Antibiotics</subject><subject>Antiinfectives and antibacterials</subject><subject>Antimicrobial agents</subject><subject>Antimicrobial resistance</subject><subject>Bacterial Proteins - genetics</subject><subject>beta-Lactamases - genetics</subject><subject>Brazil</subject><subject>Carbapenemase</subject><subject>Carbapenems - pharmacology</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Colistin</subject><subject>Drug resistance</subject><subject>Drug Resistance, Multiple, Bacterial</subject><subject>Epidemics</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Genes</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Male</subject><subject>Microbial Sensitivity Tests</subject><subject>Middle Aged</subject><subject>Multidrug resistance</subject><subject>Polymyxin B</subject><subject>RpoB protein</subject><subject>Tertiary Care Centers</subject><subject>Tigecycline</subject><subject>Young Adult</subject><issn>1076-6294</issn><issn>1931-8448</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkTtv1TAYhiMEohcYWZElFpYc7PiShK2EQ1upCAkOA1Pk2F-KK8dObQf19P_xv3A4hYGFwbL1-tHry1MULwjeENy0byYdNhUm7QZjXD0qjklLSdkw1jzOa1yLUlQtOypOYrzJBCeCPi2OKKGCcMGPi58fF5uMDst1iaTTaHuXwEXzA-wevV_TzxBNTNIldKaMg-QHqRIENMhlks4Zg4xDEu0gJCPDHl34OJskLRqDn9C7IO-NfYt23wFdTrMPuUkB8iPqZBjkDA4mGQFtnfLauGt0npN4uMlsNExGoc56l_s6P80W7vLu7wMJLr-BDOhLWvT-WfFklDbC84f5tPj6YbvrLsqrT-eX3dlVqajgqVSyloMWDW0lblmtGBkAV83AaavWAQNTWAMf8cg1HbAAGJuRi6ppmARB6Gnx-tA7B3-7QEz9ZKICa6UDv8S-qkTNMGVtldFX_6A3fgn5IZmihOCW15xlqjxQKvgYA4z9HMyU_7EnuF_99tlvv_rtV7-Zf_nQugwT6L_0H6EZoAdgjbMfa2DIav5T-wtt5bSR</recordid><startdate>20191101</startdate><enddate>20191101</enddate><creator>Romanin, Priscila</creator><creator>Palermo, Raquel Lima</creator><creator>Cavalini, Jônatas Fernando</creator><creator>Fávaro, Larissa dos Santos</creator><creator>De Paula-Petroli, Suelen Balero</creator><creator>Fernandes, Eduardo Vignoto</creator><creator>dos Anjos Szczerepa, Márcia Maria</creator><creator>Tognim, Maria Cristina Bronharo</creator><creator>Yamada-Ogatta, Sueli Fumie</creator><creator>Carrara-Marroni, Floristher Elaine</creator><creator>Yamauchi, Lucy Megumi</creator><general>Mary Ann Liebert, Inc., publishers</general><general>Mary Ann Liebert, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QP</scope><scope>7QR</scope><scope>7T7</scope><scope>7TK</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20191101</creationdate><title>Multidrug- and Extensively Drug-Resistant Acinetobacter baumannii in a Tertiary Hospital from Brazil: The Importance of Carbapenemase Encoding Genes and Epidemic Clonal Complexes in a 10-Year Study</title><author>Romanin, Priscila ; Palermo, Raquel Lima ; Cavalini, Jônatas Fernando ; Fávaro, Larissa dos Santos ; De Paula-Petroli, Suelen Balero ; Fernandes, Eduardo Vignoto ; dos Anjos Szczerepa, Márcia Maria ; Tognim, Maria Cristina Bronharo ; Yamada-Ogatta, Sueli Fumie ; Carrara-Marroni, Floristher Elaine ; Yamauchi, Lucy Megumi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-ca7abd6839a0947c41be028b539c539ceb4c0de5f0f5d3b06eef8f562884ae613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Acinetobacter baumannii</topic><topic>Acinetobacter baumannii - drug effects</topic><topic>Acinetobacter baumannii - genetics</topic><topic>Acinetobacter baumannii - isolation & purification</topic><topic>Acinetobacter Infections - drug therapy</topic><topic>Acinetobacter Infections - epidemiology</topic><topic>Acinetobacter Infections - microbiology</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Antibiotics</topic><topic>Antiinfectives and antibacterials</topic><topic>Antimicrobial agents</topic><topic>Antimicrobial resistance</topic><topic>Bacterial Proteins - genetics</topic><topic>beta-Lactamases - genetics</topic><topic>Brazil</topic><topic>Carbapenemase</topic><topic>Carbapenems - pharmacology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Colistin</topic><topic>Drug resistance</topic><topic>Drug Resistance, Multiple, Bacterial</topic><topic>Epidemics</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Genes</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Male</topic><topic>Microbial Sensitivity Tests</topic><topic>Middle Aged</topic><topic>Multidrug resistance</topic><topic>Polymyxin B</topic><topic>RpoB protein</topic><topic>Tertiary Care Centers</topic><topic>Tigecycline</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Romanin, Priscila</creatorcontrib><creatorcontrib>Palermo, Raquel Lima</creatorcontrib><creatorcontrib>Cavalini, Jônatas Fernando</creatorcontrib><creatorcontrib>Fávaro, Larissa dos Santos</creatorcontrib><creatorcontrib>De Paula-Petroli, Suelen Balero</creatorcontrib><creatorcontrib>Fernandes, Eduardo Vignoto</creatorcontrib><creatorcontrib>dos Anjos Szczerepa, Márcia Maria</creatorcontrib><creatorcontrib>Tognim, Maria Cristina Bronharo</creatorcontrib><creatorcontrib>Yamada-Ogatta, Sueli Fumie</creatorcontrib><creatorcontrib>Carrara-Marroni, Floristher Elaine</creatorcontrib><creatorcontrib>Yamauchi, Lucy Megumi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Chemoreception Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Microbial drug resistance (Larchmont, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Romanin, Priscila</au><au>Palermo, Raquel Lima</au><au>Cavalini, Jônatas Fernando</au><au>Fávaro, Larissa dos Santos</au><au>De Paula-Petroli, Suelen Balero</au><au>Fernandes, Eduardo Vignoto</au><au>dos Anjos Szczerepa, Márcia Maria</au><au>Tognim, Maria Cristina Bronharo</au><au>Yamada-Ogatta, Sueli Fumie</au><au>Carrara-Marroni, Floristher Elaine</au><au>Yamauchi, Lucy Megumi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multidrug- and Extensively Drug-Resistant Acinetobacter baumannii in a Tertiary Hospital from Brazil: The Importance of Carbapenemase Encoding Genes and Epidemic Clonal Complexes in a 10-Year Study</atitle><jtitle>Microbial drug resistance (Larchmont, N.Y.)</jtitle><addtitle>Microb Drug Resist</addtitle><date>2019-11-01</date><risdate>2019</risdate><volume>25</volume><issue>9</issue><spage>1365</spage><epage>1373</epage><pages>1365-1373</pages><issn>1076-6294</issn><eissn>1931-8448</eissn><abstract>This study aimed to characterize the main mechanisms of acquired antimicrobial resistance of 103 multidrug-resistant
Acinetobacter baumannii
isolated from bloodstream from 2006 to 2016 from a hospital in Londrina, Brazil. All 103 isolates were identified as
A. baumannii
by amplification of the
bla
OXA-51-like
and
rpo
B genes. Mortality was observed in the majority (81.6%) of the patients. High non-susceptibility rates (100.0–10.7%) were obtained for the evaluated antimicrobials, including colistin, polymyxin B, and tigecycline, and most isolates were classified as extensively drug-resistant (78.6%). Carbapenemase production was observed in 92.2% of the isolates. All carbapenem-resistant isolates showed a carbapenem-hydrolyzing class D β-lactamase being either
bla
OXA-23-like
(97.9%) or
bla
OXA-143-like
(2.1%). None of the isolates had the genes
bla
OXA-24-like
,
bla
OXA-58-like
,
bla
OXA-48
,
bla
KPC
,
bla
NDM
,
bla
SPM-1
,
bla
SIM-1
,
bla
VIM
,
bla
IMP
,
bla
GIM
,
bla
GES
,
mcr
-1,
qnr
A,
qnr
B,
qnr
C,
qnr
S, and
qnr
Vc. As a genetic context of the
bla
OXA-23-like
gene, Tn
2006
was predominated (86.0%), and Tn
2008
was less frequent (12.9%). Isolates harboring the
bla
OXA-143-like
gene showed the
bla
OXA-253-like
variant. A polyclonal profile was observed among the
A. baumannii
isolates. The presence of the international clonal complexes CC113/79, CC109/1, CC110/25, and CC103/15 was detected, with prevalence of CC113/79 (38.8%). This study provides essential information to understand the antimicrobial resistance patterns of
A. baumannii
and can be used to strengthen infection control measures in our hospital. Also, the study reinforces the urgent need to develop stewardship programs to avoid the spread and potential outbreaks by this pathogen.</abstract><cop>United States</cop><pub>Mary Ann Liebert, Inc., publishers</pub><pmid>31361565</pmid><doi>10.1089/mdr.2019.0002</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1076-6294 |
| ispartof | Microbial drug resistance (Larchmont, N.Y.), 2019-11, Vol.25 (9), p.1365-1373 |
| issn | 1076-6294 1931-8448 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2267403492 |
| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Acinetobacter baumannii Acinetobacter baumannii - drug effects Acinetobacter baumannii - genetics Acinetobacter baumannii - isolation & purification Acinetobacter Infections - drug therapy Acinetobacter Infections - epidemiology Acinetobacter Infections - microbiology Adolescent Adult Aged Aged, 80 and over Anti-Bacterial Agents - pharmacology Antibiotics Antiinfectives and antibacterials Antimicrobial agents Antimicrobial resistance Bacterial Proteins - genetics beta-Lactamases - genetics Brazil Carbapenemase Carbapenems - pharmacology Child Child, Preschool Colistin Drug resistance Drug Resistance, Multiple, Bacterial Epidemics Epidemiology Female Genes Humans Infant Infant, Newborn Male Microbial Sensitivity Tests Middle Aged Multidrug resistance Polymyxin B RpoB protein Tertiary Care Centers Tigecycline Young Adult |
| title | Multidrug- and Extensively Drug-Resistant Acinetobacter baumannii in a Tertiary Hospital from Brazil: The Importance of Carbapenemase Encoding Genes and Epidemic Clonal Complexes in a 10-Year Study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-13T04%3A34%3A20IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Multidrug-%20and%20Extensively%20Drug-Resistant%20Acinetobacter%20baumannii%20in%20a%20Tertiary%20Hospital%20from%20Brazil:%20The%20Importance%20of%20Carbapenemase%20Encoding%20Genes%20and%20Epidemic%20Clonal%20Complexes%20in%20a%2010-Year%20Study&rft.jtitle=Microbial%20drug%20resistance%20(Larchmont,%20N.Y.)&rft.au=Romanin,%20Priscila&rft.date=2019-11-01&rft.volume=25&rft.issue=9&rft.spage=1365&rft.epage=1373&rft.pages=1365-1373&rft.issn=1076-6294&rft.eissn=1931-8448&rft_id=info:doi/10.1089/mdr.2019.0002&rft_dat=%3Cproquest_cross%3E2267403492%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2311095754&rft_id=info:pmid/31361565&rfr_iscdi=true |