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Reinseth I, Diep DB, Kjos M, Tønnesen HH, Carlsen H. Exploring the feasibility of bacteriocins EntK1 and EntEJ97s in treatment of systemic vancomycin resistant enterococci infections in mice. J Appl Microbiol 2024; 135:lxae054. [PMID: 38439668 DOI: 10.1093/jambio/lxae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/21/2024] [Accepted: 03/01/2024] [Indexed: 03/06/2024]
Abstract
AIMS Enterocins K1 and EJ97 have specific antimicrobial activity against Enterococcus faecium and Enterococcus faecalis, respectively. The aim of this study was to investigate the utility of these enterocins for in vivo treatment of systemic enterococcal infections. METHODS AND RESULTS The antimicrobial effect in blood was analysed and compared against the effect in saline. Colony forming unit counts revealed that the enterocins killed all the bacteria within 1 hour. Additionally, the bactericidal effect against E. faecalis was more rapid in blood, indicating a possible synergy between EntEJ97 and blood. Importantly, no enterocin resistant mutants emerged in these experiments. Injecting the enterocins intraperitoneally in an in vivo mouse model and using fluorescence and minimum inhibitory concentration determination to estimate concentrations of the peptides in plasma, indicate that the enterocins exist in circulation in therapeutic concentrations. Alanine aminotransferase detection, and haemolysis analysis indicates that there is no detectable liver damage or haemolytic effect after injection. CONCLUSIONS The study revealed that EntK1 and EntEJ97 are able to kill all bacteria ex vivo in the presence of blood. In vivo experiments determine that the enterocins exist in circulation in therapeutic concentrations without causing liver damage or haemolysis. Future experiments should test these peptides for treatment of infection in a relevant in vivo model.
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Affiliation(s)
- Ingvild Reinseth
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, P.O. Box 5003 1432 Ås, Norway
| | - Dzung B Diep
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, P.O. Box 5003 1432 Ås, Norway
| | - Morten Kjos
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, P.O. Box 5003 1432 Ås, Norway
| | - Hanne H Tønnesen
- Section of Pharmaceutics and Social Pharmacy, Department of Pharmacy, University of Oslo, P.O. Box 1068 Blindern 0316 Oslo, Norway
| | - Harald Carlsen
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, P.O. Box 5003 1432 Ås, Norway
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Kumar A, Taneja A, Pal Singh Y, Pratap Singh G, Jain S, Jain S. Relationship Between COVID-19 and Linezolid-Resistant Enterococci: A Retrospective Single-Center Study. Cureus 2024; 16:e57227. [PMID: 38686228 PMCID: PMC11056609 DOI: 10.7759/cureus.57227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
AIM AND OBJECTIVES To evaluate the correlation between whether the COVID-19 pandemic turned out to be a great premise for increasing the incidence of linezolid resistance infections. MATERIALS AND METHOD The current retrospective study included data from March 2018 to March 2023 from a single center. The clinical records of the patients were reviewed to extract clinical data. Data gathered from medical records included demographic information, the type of specimen taken, the organism identified, and its sensitivity. Antibiotic susceptibility testing and bacterial identification are both done using the fully automated VITEK system. RESULTS The total number of samples collected in all the groups, i.e., Group 1 (PRE-COVID), Group 2 (COVID), and Group 3 (POST-COVID), were 201, 127, and 1315, respectively. Out of a total of 201 samples in Group 1, i.e., from March 2018 to February 2020, 47 (23.38%) samples were collected from blood, 104 (51.74%) samples were collected from urine, and the rest of the samples were collected from other sources (pus, sputum, wound, stool, pleural fluid, etc.). In Group 2, i.e., from March 2020 to February 2021, the total number of samples collected was 127, of which 21 were collected from blood, 86 were from urine, and the remaining 20 samples were from other sources. A total of 1315 samples were collected between March 2021 and February 2023, i.e., in Group 3, 598 samples were collected from blood and 548 samples from urine. The most common isolates in the study were Enterococcus faecalis (35.7%) and Enterococcus faecium (61.0%). CONCLUSION A new threat seems to be emerging in the era of COVID-19, the Enterococcus genus. Though the mechanism remains unidentified, the viral infection seems to cause changes in the bacterial flora, favoring Enterococcus and increasing gut permeability, which provides the perfect environment for Enterococcus bacteria to develop invasive infections. In our study, the prevalence of linezolid resistance was 18.2% for five years.
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Affiliation(s)
- Amber Kumar
- Critical Care Medicine, Max Super Specialty Hospital, Delhi, IND
| | - Akhil Taneja
- Critical Care Medicine, Max Super Specialty Hospital, Delhi, IND
| | | | | | - Saurabh Jain
- Critical Care Medicine, Max Super Specialty Hospital, Delhi, IND
| | - Suchitra Jain
- Microbiology, Max Super Specialty Hospital, Delhi, IND
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3
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Knobling B, Franke G, Belmar Campos C, Büttner H, Christner M, Klupp EM, Maurer PM, Knobloch JK. Tolerance of clinical vancomycin-resistant Enterococcus faecium isolates against UV-C light from a mobile source. Antimicrob Resist Infect Control 2023; 12:63. [PMID: 37403134 PMCID: PMC10320914 DOI: 10.1186/s13756-023-01259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 05/29/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Admission to a room previously occupied by patients carrying environmentally robust pathogens implies an increased risk of acquiring those pathogens. Therefore, 'No-touch' automated room disinfection systems, including devices based on UV-C irradiation, are discussed to improve terminal cleaning. It is still unclear if clinical isolates of relevant pathogens behave differently under UV-C irradiation compared to laboratory strains used in the approval process of disinfection procedures. In this study we analysed the susceptibility of well characterized clonally divergent vancomycin-resistant enterococci (VRE) strains, including a linezolid-resistant isolate, against UV-C radiation. METHODS Susceptibility against UV-C of ten clonally divergent clinical isolates of VRE was determined in comparison to the commonly used test organism Enterococcus hirae ATCC 10541. Ceramic tiles contaminated with 105 to 106 colony forming units/25 cm² of the different enterococci were positioned at a distance of 1.0 and 1.5 m and irradiated for 20 s, resulting in a UV-C dose of 50 and 22 mJ/cm², respectively. Reduction factors were calculated after quantitative culture of the bacteria recovered from treated and untreated surfaces. RESULTS Susceptibility to UV-C varied considerably among the strains studied, with the mean value of the most robust strain being up to a power of ten lower compared to the most sensitive strain at both UV-C doses. The two most tolerant strains belonged to MLST sequence types ST80 and ST1283. The susceptibility of the laboratory strain E. hirae ATCC 10541 ranged between the most sensitive and most tolerant isolates for both irradiation doses. However, for UV-C dose of 22 mJ/cm², the reduction of the most tolerant isolate of ST1283 was statistically significantly lower compared to E. hirae ATCC 10541. The most susceptible strains belonged to the MLST sequence types ST117 and ST203. CONCLUSIONS These results indicate that UV-C doses reported in the literature are sufficient for the reduction of commonly used reference strains of enterococci but could be insufficient for the reduction of tolerant patient VRE-isolates in a hospital setting. Therefore, for future studies, the most tolerant clinical isolates should be used to validate automated UV-C devices or longer exposure times should be expected to ensure efficacy in the real world.
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Affiliation(s)
- B Knobling
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Franke
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Belmar Campos
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Büttner
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Christner
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E M Klupp
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P M Maurer
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J K Knobloch
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Marbjerg L, Stougaard CL, Sørensen SAG, Thomsen AV, Wang L, Andersen L, Andersen TE, Kallipolitis B, Kemp M. A New Tool for Analyses of Whole Genome Sequences Reveals Dissemination of Specific Strains of Vancomycin-Resistant Enterococcus faecium in a Hospital. Front Med (Lausanne) 2021; 8:733676. [PMID: 34778297 PMCID: PMC8578741 DOI: 10.3389/fmed.2021.733676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/05/2021] [Indexed: 12/03/2022] Open
Abstract
A new easy-to-use online bioinformatic tool analyzing whole genome sequences of healthcare associated bacteria was used by a local infection control unit to retrospectively map genetic relationship of isolates of E. faecium carrying resistance genes to vancomycin in a hospital. Three clusters of isolates were detected over a period of 5 years, suggesting transmission between patients. Individual relatedness between isolates within each cluster was established by SNP analyses provided by the system. Genetic antimicrobial resistance mechanisms to antibiotics other than vancomycin were identified. The results suggest that the system is suited for hospital surveillance of E. faecium carrying resistance genes to vancomycin in settings with access to next Generation Sequencing without bioinformatic expertise for interpretation of the genome sequences.
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Affiliation(s)
- Lis Marbjerg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Amalie Vørs Thomsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lis Wang
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lise Andersen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Thomas Emil Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Birgitte Kallipolitis
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Michael Kemp
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Regional Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark
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Bhat NR, Shivashankar SBK, Dhanashree B. Antibiogram of Urinary Enterococcus Isolates from a Tertiary Care Hospital. Infect Disord Drug Targets 2020; 21:146-150. [PMID: 32242789 DOI: 10.2174/1871526520666200403140618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Urinary tract infection (UTI) is one of the serious infections caused by the bacteria Enterococci. Vancomycin-Resistant Enterococci (VRE) is a persevering clinical problem globally. This study aims to detect high-level aminoglycoside and vancomycin resistance in uropathogenic Enterococcus spp. METHODOLOGY A total of 75 clinically relevant Enterococcus spp. grown from urine samples, were collected following convenience non-random sampling method. Identified by standard biochemical tests and susceptibility to antibiotics was studied by Kirby Bauer's disc diffusion method. The MIC of vancomycin was detected by agar dilution test. Van A, and Van B genes in VREs were detected by PCR. RESULTS Among 75 Enterococcal isolates, 43 (57.3%) were E. faecalis, 12 (16%) were E. faecium, 6 (8%) of each were E. pseudoavium and E. casseliflavus, 5(6.66%) were E. dispar and 3 (4%) were E. durans. E. faecalis (n=19) and E. faecium (n=3) were resistant to High Level Streptomycin (HLS). E. faecalis (n=21) and E. faecium (n=6) were resistant to High Level Gentamicin (HLG). 4 (9.3%) E. faecalis were vancomycin-resistant, out of which 3 were of Van A, and one was both Van A and Van B genotype. CONCLUSION Isolation of high level aminoglycoside resistant (HLAR) Enterococci is a challenge for the treating physician because aminoglycoside cannot be used in combination with glycopeptide or ampicillin for such isolates. The occurrence of HLAR, Van A, and Van B VRE genotypes is a cause of concern as they may transfer drug resistance genes to other bacterial isolates, thus leading to limited therapeutic options.
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Affiliation(s)
- Nanditha Rajaram Bhat
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | | | - Biranthabail Dhanashree
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
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Coombs GW, Daley DA, Mowlaboccus S, Lee YT, Pang S. Australian Group on Antimicrobial Resistance (AGAR) Australian Enterococcal Sepsis Outcome Programme (AESOP) Annual Report 2018. ACTA ACUST UNITED AC 2020; 44. [PMID: 32178603 DOI: 10.33321/cdi.2020.44.19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
From 1 January to 31 December 2018, thirty-six institutions around Australia participated in the Australian Enterococcal Sepsis Outcome Programme (AESOP). The aim of AESOP 2018 was to determine the proportion of enterococcal bacteraemia isolates in Australia that were antimicrobial resistant, and to characterise the molecular epidemiology of the E. faecium isolates. Of the 1,248 unique episodes of bacteraemia investigated, 93.5% were caused by either E. faecalis (54.2%) or E. faecium (39.3%). Ampicillin resistance was not detected in E. faecalis but was detected in 89.4% of E. faecium. Vancomycin non-susceptibility was not detected in E. faecalis but was reported in 45.0% of E. faecium. Overall 49.3% of E. faecium isolates harboured vanA or vanB genes. Of the vanA/vanB positive E. faecium isolates, 52.9% harboured vanA genes and 46.2% vanB genes; 0.8% harboured both vanA and vanB genes. The percentage of E. faecium bacteraemia isolates resistant to vancomycin in Australia is substantially higher than that seen in most European countries. E. faecium consisted of 59 multilocus sequence types (STs) of which 74.4% of isolates were classified into six major STs containing ten or more isolates. All major STs belong to clonal cluster (CC) 17, a major hospital-adapted polyclonal E. faecium cluster. The predominant STs (ST17, ST1424, ST796, ST80, ST1421, and ST262) were found across most regions of Australia. The most predominant clone was ST17 which was identified in all regions except the Australian Capital Territory and the Northern Territory. Overall, 55.8% of isolates belonging to the six predominant STs harboured vanA or vanB genes. The AESOP 2018 study has shown that enterococcal bacteraemias in Australia are frequently caused by polyclonal ampicillin-resistant high-level gentamicin-resistant vanA- or vanB-harbouring E. faecium which have limited treatment options.
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Affiliation(s)
- Geoffrey W Coombs
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia; Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Denise A Daley
- Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Australian Group on Antimicrobial Resistance, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Shakeel Mowlaboccus
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia
| | - Yung Thin Lee
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia
| | - Stanley Pang
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia; Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Sanderson H, Ortega-Polo R, McDermott K, Hall G, Zaheer R, Brown RS, Majury A, McAllister TA, Liss SN. Quantification and Multidrug Resistance Profiles of Vancomycin-Resistant Enterococci Isolated from Two Wastewater Treatment Plants in the Same Municipality. Microorganisms 2019; 7:microorganisms7120626. [PMID: 31795349 PMCID: PMC6956375 DOI: 10.3390/microorganisms7120626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 11/16/2022] Open
Abstract
Wastewater treatment plants (WWTPs) are points of control for the environmental dissemination of antimicrobial resistant bacteria. Vancomycin-resistant enterococci (VRE) were used as indicators of antimicrobial resistance (AMR) in two WWTPs (biologically aerated filter (BAF) and conventional activated sludge (CAS)) in the same municipality. The removal and abundance of enterococci and VRE as well as the species and antimicrobial resistance profiles of VRE were assessed. Enterococci and VRE from the primary and final effluents were enumerated. Results were assessed from an ecological context. VRE was not selected for by either WWTP but the BAF system outperformed the CAS system for the removal of enterococci/VRE. Enterococcus faecalis (n = 151), E. faecium (n = 94) and E. casseliflavus/E. gallinarum (n = 59) were the dominant VRE species isolated. A decrease in levofloxacin resistance in enterococci was observed in the BAF WWTP. An increase in nitrofurantoin resistant (p < 0.001) and a decrease in quinupristin/dalfopristin (p = 0.003) and streptomycin (p = 0.022) resistant enterococci were observed in the CAS WWTP, corresponding to a shift of VRE from E. faecalis to E. faecium. Wastewater treatment processes can be managed to limit the dissemination of antimicrobial resistance determinants into the surrounding environment.
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Affiliation(s)
- Haley Sanderson
- School of Environmental Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (H.S.); (G.H.); (R.S.B.); (A.M.)
- Agriculture and Agri-Food Canada, Lethbridge Research and Development Center, Lethbridge, AB T1J 4B1, Canada; (R.O.-P.); (R.Z.)
| | - Rodrigo Ortega-Polo
- Agriculture and Agri-Food Canada, Lethbridge Research and Development Center, Lethbridge, AB T1J 4B1, Canada; (R.O.-P.); (R.Z.)
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 6T5, Canada
| | | | - Geoffrey Hall
- School of Environmental Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (H.S.); (G.H.); (R.S.B.); (A.M.)
- Department of Civil Engineering, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Rahat Zaheer
- Agriculture and Agri-Food Canada, Lethbridge Research and Development Center, Lethbridge, AB T1J 4B1, Canada; (R.O.-P.); (R.Z.)
| | - R. Stephen Brown
- School of Environmental Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (H.S.); (G.H.); (R.S.B.); (A.M.)
- Department of Chemistry, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Anna Majury
- School of Environmental Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (H.S.); (G.H.); (R.S.B.); (A.M.)
- Public Health Ontario, Kingston, ON K7L 3K3, Canada;
| | - Tim A. McAllister
- Agriculture and Agri-Food Canada, Lethbridge Research and Development Center, Lethbridge, AB T1J 4B1, Canada; (R.O.-P.); (R.Z.)
- Correspondence: (T.A.M.); (S.N.L.)
| | - Steven N. Liss
- School of Environmental Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (H.S.); (G.H.); (R.S.B.); (A.M.)
- Department of Biology, Ryerson University, Toronto, ON M5B 2K3, Canada
- Correspondence: (T.A.M.); (S.N.L.)
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Skjøt-Arkil H, Mogensen CB, Lassen AT, Johansen IS, Chen M, Petersen P, Andersen KV, Ellermann-Eriksen S, Møller JM, Ludwig M, Fuglsang-Damgaard D, Nielsen FE, Petersen DB, Jensen US, Rosenvinge FS. Carrier prevalence and risk factors for colonisation of multiresistant bacteria in Danish emergency departments: a cross-sectional survey. BMJ Open 2019; 9:e029000. [PMID: 31253624 PMCID: PMC6609076 DOI: 10.1136/bmjopen-2019-029000] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The aim of this study was to describe the carrier prevalence and demographic variation of four different multiresistant bacteria (MRB) among acute patients in Danish emergency departments (EDs): methicillin-resistant Staphylococcus aureus (MRSA), carbapenemase-producing enterobacteria (CPE), extended-spectrum beta-lactamase-producing enterobacteria (ESBL) and vancomycin-resistant enterococci (VRE), and to analyse the association of MRB carriage to a range of potential risk factors. DESIGN Multicentre descriptive and analytic cross-sectional survey. SETTING Eight EDs and four clinical microbiology departments in Denmark. PARTICIPANTS Adults visiting the ED. MAIN OUTCOME MEASURES Swabs from nose, throat and rectum were collected and analysed for MRSA, ESBL, VRE and CPE. The primary outcome was the prevalence of MRB carriage, and secondary outcomes relation to risk factors among ED patients. RESULTS We included 5117 patients in the study. Median age was 68 years (54-77) and gender was equally distributed. In total, 266 (5.2%, 95% CI 4.6 to 5.8) were colonised with at least one MRB. No significant difference was observed between male and female patients, between age groups and between university and regional hospitals. Only 5 of the 266 patients with MRB were colonised with two of the included bacteria and none with more than two. CPE prevalence was 0.1% (95% CI 0.0 to 0.2), MRSA prevalence was 0.3% (95% CI 0.2 to 0.5), VRE prevalence was 0.4% (95% CI 0.3 to 0.6) and ESBL prevalence was 4.5% (95% CI 3.9 to 5.1). Risk factors for MRB carriage were previous antibiotic treatment, previous hospital stay, having chronic respiratory infections, use of urinary catheter and travel to Asia, Oceania or Africa. CONCLUSION Every 20th patient arriving to a Danish ED brings MRB to the hospital. ESBL is the most common MRB in the ED. The main risk factors for MRB carriage are recent antibiotic use and travel abroad. TRIAL REGISTRATION NUMBER NCT03352167;Post-results.
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Affiliation(s)
- Helene Skjøt-Arkil
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
| | | | | | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Hospital Sønderjylland, Soenderborg, Denmark
| | | | - Karen V Andersen
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jørn M Møller
- Emergency Department, Aalborg University Hospital, Aalborg, Denmark
| | - Marc Ludwig
- Emergency Department, North Denmark Regional Hospital, Hjørring, Denmark
| | | | | | - Dan B Petersen
- Emergency Department, Zealand University Hospital, Køge, Denmark
| | - Ulrich S Jensen
- Department of Clinical Microbiology, Slagelse Sygehus, Slagelse, Denmark
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Jovanovic M, Tosic T, Jovanovic S, Stevanovic G, Drakulovic M, Stosovic R, Zervos M. Local spread of Tn1546-like element among three species of vancomycin resistant enterococci in an intensive care unit. J Infect Dev Ctries 2017; 11:684-690. [PMID: 31600159 DOI: 10.3855/jidc.7959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 12/20/2016] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION In an intensive care unit (ICU) of the Emergency Center in the Clinical Center of Serbia, four species of vancomycin resistant enterococci (VRE) were isolated in a 17-month period mostly from blood cultures, including E. faecalis, E. faecium, E. raffinosus and E.gallinarum. METHODOLOGY The relationship between isolates from each species was investigated by PFGE, and PCR experiments for detection of pathogenicity factor genes and van genes to determine the nature of each clone. A PCR-based method, using 10 primer pairs (p1/2-p19/20), was used to investigate the presence of the Tn1546-like structure. RESULTS PFGE indicated the presence of two different E. faecium clones, while the three other enterococcal species belonged to one clone each. Transposon typing revealed that isolates of E. raffinosus (4), E. gallinarum (4) and E. faecalis (3) yielded gene sequences identical to 10 primer pairs (p1/2-p19/20), suggesting the possibility of identical transposon-like structure in these species. CONCLUSIONS The results of the study indicate probable horizontal spread of Tn1546-like structure in three species of VRE obtained from the same ICU.
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Affiliation(s)
| | - Tanja Tosic
- Clinical Center of Serbia, Belgrade, Serbia.
| | | | | | - Mitra Drakulovic
- National Public Health Institute "Milan Jovanovic Batut", Belgrade, Serbia.
| | | | - Marcus Zervos
- Henry Ford Health System, Detroit, Michigan, United States.
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10
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Sun L, Zhang P, Qu T, Chen Y, Hua X, Shi K, Yu Y. Identification of Novel Conjugative Plasmids with Multiple Copies of fosB that Confer High-Level Fosfomycin Resistance to Vancomycin-Resistant Enterococci. Front Microbiol 2017; 8:1541. [PMID: 28861056 PMCID: PMC5559704 DOI: 10.3389/fmicb.2017.01541] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/31/2017] [Indexed: 12/24/2022] Open
Abstract
To further characterize the fosB-carrying plasmids of 19 vancomycin-resistant enterococci, the complete sequences of the fosB- and vanA-containing plasmids of Enterococcus faecium (pEMA120) and E. avium (pEA19081) were obtained by single-molecule, real-time sequencing. We found that these two plasmids are essentially identical (99.99% nucleotide sequence identity), which proved the possibility of interspecies transmission. Comparative analysis of the plasmids revealed that the backbone of pEMA120 is 99% similar to a conjugative fosB-negative E. faecium plasmid, pZB18. There is a traE disrupted in the transfer region of pEMA120, in comparison to pZB18 with an intact traE. The difference of their transfer frequencies between pEMA120 and pZB18 suggests this interruption of traE might affect conjugative transfer. Two copies of the fosB gene linked to a tnpA gene, forming an ISL3-like transposon, were found at separate locations within pEMA120, which had not been reported previously. These two fosB-carrying transposons were confirmed to form circular intermediates by inverse PCR. The hybridization of plasmid DNA digested by BsaI, having restriction site within the fosB sequence, demonstrated that the presence of multiple copies of fosB per plasmid is common. The total copy number of the fosB gene as revealed by qRT-PCR did not correlate with fosfomycin MICs or growth rates at sub-MICs of fosfomycin in different transconjugants. From susceptibility tests, the fosB gene, regardless of the copy number, conferred high fosfomycin MICs that ranged from 16384 to 65536 μg/ml. This first complete nucleotide sequence of a plasmid carrying two copies of fosB in VRE suggests that the fosB gene can transfer to multiple loci of plasmids by the ISL3 family transposase TnpA, possibly in the form of circular intermediates, leading to the dissemination of high fosfomycin resistance in VRE.
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Affiliation(s)
- Lingyan Sun
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang UniversityHangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang ProvinceHangzhou, China
| | - Ping Zhang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang UniversityHangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang ProvinceHangzhou, China
| | - Tingting Qu
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou, China
| | - Yan Chen
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang UniversityHangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang ProvinceHangzhou, China
| | - Xiaoting Hua
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang UniversityHangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang ProvinceHangzhou, China
| | - Keren Shi
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang UniversityHangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang ProvinceHangzhou, China
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang UniversityHangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang ProvinceHangzhou, China
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11
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Abstract
BACKGROUND Urinary tract infections (UTIs) remain a major problem both in hospitalized and outdoor patients. Multidrug-resistant enterococci are emerging as a major nosocomial pathogen with increasing frequency. However, the incidence of community-acquired enterococcal infections and species prevalent in India is not thoroughly investigated. OBJECTIVES This study aims to estimate the burden of community-acquired UTIs seen at a tertiary care hospital and to identify the Enterococcus species isolated from these patients. The study also aims to determine the antibiotic susceptibility pattern with reference to high-level aminoglycosides and vancomycin. MATERIALS AND METHODS Semi-quantitative cultures from a total of 22,810 urine samples obtained from patients seen at various Outpatient Departments were analyzed. From them 115 nonduplicate isolates of enterococci were obtained as significant pure growth (>10(5) cfu/ml) and speciated. Antibiotic susceptibility was performed by Kirby-Bauer disc diffusion method. Vancomycin resistance screening was performed by the vancomycin screen agar method recommended by Clinical and Laboratory Standards Institute and confirmed by determination of minimum inhibitory concentration by agar dilution method. RESULTS Of 115 enterococcal isolates, 61 were identified as Enterococcus faecalis, 42 as Enterococcus faecium, 3 each as Enterococcus dispar, and Enterococcus pseudoavium. High-level gentamicin resistance (HLGR) was higher in E. faecium (47.6%) than E. faecalis (32.7%) and HLSR also showed the same pattern with 47.6% and 27.9% resistance, respectively. Vancomycin resistant enterococci accounted for 11.3% of the isolates, and out of them 53.8% were E. faecium by agar dilution method. CONCLUSION High rate of resistance to antibiotics of penicillin group and aminoglycosides was observed in our tertiary care hospital even in community acquired UTIs. Hence, there is an urgent need for more rational and restricted use of antimicrobials.
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Affiliation(s)
- Varun Goel
- Department of Laboratory Medicine, Division of Clinical Microbiology and Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Dinesh Kumar
- Department of Laboratory Medicine, Division of Clinical Microbiology and Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajendra Kumar
- Department of Laboratory Medicine, Division of Clinical Microbiology and Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Purva Mathur
- Department of Laboratory Medicine, Division of Clinical Microbiology and Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sarman Singh
- Department of Laboratory Medicine, Division of Clinical Microbiology and Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India
- Address for correspondence: Prof. Sarman Singh, E-mail:
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12
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Emre JC, Baysak A, Oz AT, Ece G, Arda B, Bacakoglu F. Vancomycin resistant enterococcus bacteremia in a patient with Pneumocystis jiroveci pneumonia, granulocystic sarcoma and acute respiratory distress syndrome. Pan Afr Med J 2014; 17:49. [PMID: 25018799 PMCID: PMC4085949 DOI: 10.11604/pamj.2014.17.49.3246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/24/2013] [Indexed: 11/11/2022] Open
Abstract
In this case report we aimed to present a patient with granulocytic sarcomaa, neutropenic fever, ARDS and Pneumocystis jirovecii pneumoniae that was hospitalized in our intensive care unit. The patient recovered and then developed vancomycin resistant enterococci (VRE) bacteremia due to port catheter during follow up. The patient had risk factors for VRE bacteremia and he was administered linezolide without removing the catheter. He was discharged with recovery.
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Affiliation(s)
| | - Aysegul Baysak
- Izmir University School of Medicine, Department of Chest Diseases, Izmir, Turkey
| | - Adnan Tolga Oz
- Izmir University School of Medicine, Department of Chest Diseases, Izmir, Turkey
| | - Gulfem Ece
- Izmir University School of Medicine, Department of Medical Microbiology, Izmir, Turkey
| | - Bilgin Arda
- Ege University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Feza Bacakoglu
- Ege University School of Medicine, Department of Chest Diseases, Izmir, Turkey
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13
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Jovanović M, Milošević B, Dulović O, Pelemiš M, Stevanović G, Tošić T, Stošović B, Zervos MJ. Molecular characterization of vancomycin-resistant enterococci in Serbia: intensive care unit as the source. Acta Microbiol Immunol Hung 2013; 60:433-46. [PMID: 24292087 DOI: 10.1556/amicr.60.2013.4.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to evaluate the molecular relatedness of clinical isolates of vancomycin-resistant enterococci (VRE) collected from patients of the Clinic for Infectious and Tropical Diseases in Belgrade. Among 40 isolates available for the investigation, 36 were identified as Enterococcus faecium, whereas 2 were Enterococcus faecalis and Enterococcus raffinosus, respectively. Pulsed-field gel electrophoresis (PFGE) typing revealed 21 strain types, comprising 7 clusters which contained at least two isolates and 14 unique PFGE patterns. Although we searched for pathogenicity factor genes (gelE, cylB, asa1, efaAfs, esp, cpd, cob) in representatives of all macro-restriction patterns, they have been confirmed in only one clone of E. faecalis. Genes esp and hyl, commonly found in E. faecium, were yilded in 10 macro-restriction patterns of this species, and their presence could not be ascribed to clonally related strains (p = 0.05). All VRE isolates were multiresistant and positive for vanA gene. Twenty strains of VRE and 6 clusters obtained from Intensive care unit (ICU) are proof of intensive transmission of these microorganisms at this department. The results of this study suggest wide genotypic variability among the clinical VRE isolates, but also intrahospital dissemination of some of them.
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Affiliation(s)
- Milica Jovanović
- Department of Microbiology of Clinical Center of Serbia Belgrade Serbia
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14
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Fernandes SC, Dhanashree B. Drug resistance & virulence determinants in clinical isolates of Enterococcus species. Indian J Med Res 2013; 137:981-5. [PMID: 23760387 PMCID: PMC3734693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND & OBJECTIVES Enterococci are the leading cause of nosocomial infections, and are thus a persisting clinical problem globally. We undertook this study to determine the virulence factors and the antibiotic resistance in Enterococcus clinical isolates. METHODS One hundred and fifty Enterococcus isolates obtained from various clinical specimens were speciated biochemically and subjected to antibiotic susceptibility testing using Kirby-Bauer disk diffusion method. Resistance to vancomycin was determined by using agar screen method. Haemolysin and gelatinase productions were detected using 5 per cent sheep blood agar and 12 per cent gelatin agar, respectively. RESULTS Among the 150 Enterococcus isolates, 84 (56%) were E. faecalis. 51(34%) E. faecium, and 15 (10%) were other Enterococcus spp. Haemolysin production was seen among 123 (82%) isolates while 61 (40.6%) isolates produced gelatinase. Nearly 50 per cent of the isolates showed high level aminoglycoside resistance (HLAR). A total of 13 (8.6%) isolates showed vancomycin resistance, of which 11(7.3%) had an MIC >8 μg/ml. INTERPRETATION & CONCLUSIONS Presence of VRE was found to be low among the isolates studied. However, occurrence of VRE along with HLAR calls for regular detection of vancomycin resistance promptly and accurately to recognize VRE colonization and infection. Early detection of VRE and HLAR along with their virulence trait will help in preventing the establishment and spread of multidrug resistant Enterococcus species.
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Affiliation(s)
- Sanal C. Fernandes
- M.B.B.S. Third year student, Kasturba Medical College, Manipal University, Mangalore, India
| | - B. Dhanashree
- Department of Microbiology, Kasturba Medical College, Manipal University, Mangalore, India,Reprint requests: Dr (Mrs) Dhanashree B., Associate Professor, Department of Microbiology, Kasturba Medical College, Manipal University, Mangalore 575 001, India e-mail:
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Chitnis S, Katara G, Hemvani N, Pareek S, Chitnis DS. In vitro activity of daptomycin & linezolid against methicillin resistant Staphylococcus aureus & vancomycin resistant enterococci isolated from hospitalized cases in Central India. Indian J Med Res 2013; 137:191-6. [PMID: 23481072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND & OBJECTIVES Growing incidence of methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant enteroccoci (VRE) is posing a therapeutic problem due to limited drug options. Therefore, the present study was undertaken to check susceptibility of MRSA and VRE isolates against new antimicrobials such as daptomycin and linezolid. METHODS A total of 586 Gram-positive isolates comprising 442 S. aureus and 144 enterococci isolated from hospitalized cases included in the study, were subjected to in vitro antimicrobial susceptibility testing by disc diffusion method. One hundred twenty four enterococci obtained from rectal swabs of neonates were also included. Minimum inhibitory concentration (MIC) was determined for daptomycin, linezolid, vancomycin and teicoplanin against 50 each isolates of MRSA and VRE by E strip. RESULTS Among the staphylococci, 326 (73.85%) isolates were MRSA. MIC for vancomycin and teicoplanin among MRSA was ≤ 3 μg/ml. MIC for daptomycin among MRSA was found to be in the range of 0.064-1.5 μg/ml. Percentage of VRE among clinical samples was 14.29 per cent while it was 47.06 per cent among enterococci from rectal swabs of neonates. MIC was >256 μg/ml for vancomycin among VRE and was associated with van A genotype. MIC range for daptomycin among VRE was 0.38-3 μg/ml. MIC for linezolid among MRSA and VRE was in the range of 0.25 to 1 and 0.38 -1.5 μg/ml, respectively. INTERPRETATION & CONCLUSIONS The present study showed a rise in MIC to vancomycin for sizable number of MRSA and growing percentage of VRE at our centre. Daptomycin and linezolid showed 100 per cent activity against MRSA and VRE.
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Shridhar DM, Mahajan GB, Kamat VP, Naik CG, Parab RR, Thakur NR, Mishra PD. Antibacterial activity of 2-(2',4'-dibromophenoxy)-4,6-dibromophenol from Dysidea granulosa. Mar Drugs 2009; 7:464-71. [PMID: 19841726 DOI: 10.3390/md7030464] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 09/01/2009] [Accepted: 09/21/2009] [Indexed: 11/16/2022] Open
Abstract
2-(2′,4′-Dibromophenoxy)-4,6-dibromophenol isolated from the marine sponge Dysidea granulosa (Bergquist) collected off the coast of Lakshadweep islands, Indian Ocean, exhibited potent and broad spectrum in-vitro antibacterial activity, especially against methicillin resistant Staphylococcus aureus (MRSA), methicillin sensitive Staphylococcus aureus (MSSA), vancomycin resistant Enterococci (VRE), vancomycin sensitive Enterococci (VSE) and Bacillus spp. Minimal inhibitory concentration (MIC) was evaluated against 57 clinical and standard strains of Gram positive and Gram negative bacteria. The observed MIC range was 0.117–2.5 μg/mL against all the Gram positive bacteria and 0.5–2 μg/mL against Gram negative bacteria. The in-vitro antibacterial activity observed was better than that of the standard antibiotic linezolid, a marketed anti-MRSA drug. The results establish 2-(2′,4′-dibromophenoxy)-4,6-dibromophenol, as a potential lead molecule for anti-MRSA and anti-VRE drug development.
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