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Epidemiology and Mechanism of Bacterial Resistance to Antibiotics

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A special issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: 31 December 2025 | Viewed by 20174

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Prof. Dr. Gabriela Loredana Popa

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1. Department of Microbiology, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
2. Parasitic Disease Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
Interests: infectious diseases; microbiology; antimicrobial resistance; virulence
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Prof. Dr. Mircea Ioan Popa

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1. Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
2. Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania
Interests: infectious diseases; microbiology; chronic infections; bacteriophage; microcalorimetry; tuberculosis; blood-borne pathogens
Special Issues, Collections and Topics in MDPI journals

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Dear Colleagues,

Antibiotics still play an important role in global public health, especially in the case of infectious disease emergencies. However, the overuse of antibiotics and the decline in infection prevention and measures have accelerated the emergence and dissemination of multi- (MDR), extended- (XDR) and even pan-drug (PDR)-resistant clones. In addition, bacteria acquire drug resistance genes from other resistant bacteria in the environment through horizontal gene transfer mediated by mobile genetic elements such as plasmids, leading to the changes in the environmental resistome with the occurrence of complex resistance and even MDR phenotypes in the extraclinical sectors. In recent decades, the researchers focused not only on the clinical but also on the environmental drug-resistant strains. By utilizing phenotypic and genomic techniques, it is essential to understand the epidemiology of multi-drug-resistant bacteria isolated from human and environmental microbiomes as well as for the development of new and faster diagnostic tools.

In this Special Issue, we welcome papers of phenotypic and molecular epidemiology, diagnostic methods and antibiotic sensitivity with innovative phenotypic and molecular approaches. Submissions addressing the horizontal transfer of antibiotic resistance genes are also welcome.

Prof. Dr. Gabriela Loredana Popa
Prof. Dr. Mircea Ioan Popa
Guest Editors

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

multi-drug resistant (MDR)
classic and molecular epidemiology
plasmids
resistance gene

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Published Papers (10 papers)

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Research

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20 pages, 2643 KiB

Open AccessArticle

Oxacillin-Supplemented Mueller-Hinton Agar for In Vitro Inhibition of Ambler Class C β-Lactamases in Enterobacterales

by Edgar-Costin Chelaru, Andrei-Alexandru Muntean, Mădălina-Maria Muntean, Mihai-Octav Hogea, Costin-Ștefan Caracoti, Bogdan-Florin Ciomaga, Thierry Naas and Mircea Ioan Popa

Antibiotics 2025, 14(6), 616; https://doi.org/10.3390/antibiotics14060616 - 18 Jun 2025

Viewed by 241

Abstract

Background: The increasing incidence of infection with Gram-negative bacilli (GNB) producing broad-spectrum β-lactamases, such as extended-spectrum β-lactamases (ESBLs), cephalosporinases (AmpCs), and carbapenemases, has become a great clinical concern. AmpCs are found in many clinically relevant Enterobacterales, where they may compromise the effectiveness of most β-lactams, including carbapenems when associated with an impaired outer membrane. Detection and distinction between these resistance mechanisms are crucial for antimicrobial therapy and for implementation of proper infection control procedures to prevent further spread. Methods: The disk diffusion antibiogram using Mueller-Hinton agar (MHA) supplemented with cloxacillin (MHC), which inhibits AmpCs, was validated to identify AmpC-producing Enterobacterales (AmpC-PE). As cloxacillin is not available in several countries, we investigated the use of oxacillin as an alternative compound to inhibit AmpCs. The ability of MHA supplemented with oxacillin (MHO) to distinguish between carbapenem-resistant Enterobacterales (CREs) due to AmpC hyperproduction and the presence of a carbapenemase has particularly been investigated. Results: MHOs containing several concentrations of oxacillin were compared to MHA and MHC containing 250 mg/L cloxacillin (MHC250). A set of well-characterized Enterobacterales with different β-lactam resistance mechanisms were evaluated. MHO containing 300 mg/L of oxacillin (MHO300) gave similar results to MHC250. Conclusions: The use of MHO300 proved to be efficient in inhibiting AmpCs, allowing differentiation between AmpC hyperproducers and carbapenemase producers. In addition, the use of MHO300 allowed detection of resistance mechanisms hidden by AmpCs, such as ESBLs. Full article

(This article belongs to the Special Issue Epidemiology and Mechanism of Bacterial Resistance to Antibiotics)

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12 pages, 342 KiB

Open AccessArticle

Activity of β-Lactamase Inhibitor Combinations Against Enterobacterales Isolated from Patients with Intra-Abdominal Infection from United States Medical Centres (2019–2023)

by Helio S. Sader, John H. Kimbrough, Marisa L. Winkler, Rodrigo E. Mendes and Mariana Castanheira

Antibiotics 2025, 14(6), 544; https://doi.org/10.3390/antibiotics14060544 - 27 May 2025

Viewed by 395

Abstract

Objective: To evaluate the antimicrobial susceptibility of Enterobacterales isolated from patients with intra-abdominal infections (IAI) in United States (US) medical centres. Methods: A total of 2036 isolates (1/patient) were consecutively collected from patients with IAI in 63 US hospitals in 2019–2023 and susceptibility tested by broth microdilution. Carbapenem-resistant Enterobacterales (CRE) were screened for carbapenemases by whole genome sequencing. Results: The most common Enterobacterales species were E. coli (47.1%), K. pneumoniae (18.7%), and E. cloacae species complex (9.8%). The most active agents were aztreonam-avibactam (MIC_50/90, ≤0.03/0.12 mg/L), ceftazidime-avibactam (MIC_50/90, 0.12/0.25 mg/L), and meropenem-vaborbactam (MIC_50/90, 0.03/0.06 mg/L) with 99.9% susceptibility. A multidrug-resistant (MDR) phenotype (nonsusceptibility to ≥3 classes) was observed in 21.4% of Enterobacterales (n = 436). Piperacillin-tazobactam was active against 87.2% of Enterobacterales overall and 50.2% of MDR isolates, and meropenem was active against 99.2% of Enterobacterales and 96.1% of MDR isolates. Only 51.6% of Enterobacterales were susceptible to ampicillin-sulbactam. An acquired broad-spectrum β-lactamase gene was identified in 207 (10.2%) isolates and included extended-spectrum β-lactamases (ESBL; n = 182), transferable AmpC (n = 24) and carbapenemases (n = 9). Eight isolates produced two β-lactamase classes. Conclusions: Aztreonam-avibactam, ceftazidime-avibactam, and meropenem-vaborbactam exhibited almost complete activity (99.9% susceptibility) against Enterobacterales causing IAI in US hospitals. In contrast, piperacillin-tazobactam exhibited limited activity against these organisms, especially those with a MDR phenotype. Full article

(This article belongs to the Special Issue Epidemiology and Mechanism of Bacterial Resistance to Antibiotics)

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25 pages, 1114 KiB

Open AccessArticle

Molecular Detection of Antibiotic Resistance Genes Using Respiratory Sample from Pneumonia Patients

by Eman Abdullah Alsuof, Ahmad R. Alsayed, Manar Saleh Zraikat, Heba A. Khader, Luai Z. Hasoun, Mamoon Zihlif, Osama Abu Ata, Malek A. Zihlif, Mahmoud Abu-Samak and Mohammed Al Maqbali

Antibiotics 2025, 14(5), 502; https://doi.org/10.3390/antibiotics14050502 - 13 May 2025

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Abstract

Introduction/Objectives: Antibiotic resistance makes the treatment of pneumonia challenging. Effective management depends on accurate diagnostic techniques to identify resistance genes and customize drugs. This study primarily aimed to identify antibiotic resistance genes in respiratory samples from patients with pneumonia using polymerase chain reaction (PCR) to determine the prevalence of specific resistance genes and analyze clinical factors contributing to antibiotic resistance, as well as to provide actionable insights into resistance patterns in Jordan and support efforts to improve pneumonia management. Methods: This retrospective observational study included 114 patients who were diagnosed with pneumonia. Clinical data, including prior antibiotic exposure and treatment history, were collected. PCR diagnostics were used to detect resistance genes in respiratory samples. In this study, we evaluated 14 antibiotic resistance genes in pneumonia pathogens, highlighting their diverse resistance mechanisms. Results: Mec A was the most frequently detected gene, appearing in 87 samples (77.3%). Additionally, Tem in 80 samples (70.2%), Oxa-48-like in 15 samples (13.2%), and Ctx-M-1 in 38 samples (33.3%) were among the most commonly detected genes. In contrast, Oxa-40-like (7.0%), Vim (8.8%), and Imp (4.4%) genes exhibited a lower prevalence. The Oxa-51-like gene showed the only significant association with ertapenem resistance (p-value = 0.046). Further analysis revealed statistically significant associations between Mec A and methicillin resistance (p < 0.001), underscoring its critical role. However, other genes, such as Oxa-40-like and Oxa-48-like, showed no significant correlation with the antibiotic resistance patterns of imipenem and meropenem (p > 0.05). Conclusions: This study demonstrates the utility of PCR-based diagnostics for detecting resistance genes and highlights the critical clinical factors associated with antibiotic resistance in patients with pneumonia. These findings underscore the importance of integrating molecular diagnostics into routine care to improve treatment outcomes and combat the growing threat of antibiotic resistance in Jordan. This highlights PCR’s value in guiding effective treatment strategies and addressing multidrug-resistant pneumonia. Full article

(This article belongs to the Special Issue Epidemiology and Mechanism of Bacterial Resistance to Antibiotics)

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23 pages, 3766 KiB

Open AccessArticle

Dynamic Spread of Antibiotic Resistance Determinants by Conjugation to a Human-Derived Gut Microbiota in a Transplanted Mouse Model

by Azam A. Sher, Charles E. Whitehead-Tillery, Ashley M. Peer, Julia A. Bell, Daniel B. Vocelle, Joshua T. Dippel, Lixin Zhang and Linda S. Mansfield

Antibiotics 2025, 14(2), 152; https://doi.org/10.3390/antibiotics14020152 - 4 Feb 2025

Cited by 1 | Viewed by 1764

Abstract

Background. Antibiotic-resistant (AR) bacteria pose an increasing threat to public health, but the dynamics of antibiotic resistance gene (ARG) spread in complex microbial communities are poorly understood. Conjugation is a predominant direct cell-to-cell mechanism for the horizontal gene transfer (HGT) of ARGs. We hypothesized that commensal Escherichia coli donor strains would mediate the conjugative transfer of ARGs to phylogenetically distinct bacteria without antibiotic selection pressure in gastrointestinal tracts of mice carrying a human-derived microbiota with undetectable levels of E. coli. Our objective was to identify a mouse model to study the factors regulating AR transfer by conjugation in the gut. Methods. Two donor E. coli strains were engineered to carry chromosomally encoded red fluorescent protein, and an ARG- and green fluorescent protein (GFP)-encoding broad host range RP4 conjugative plasmid. Mice were orally gavaged with two donor strains (1) E. coli MG1655 or (2) human-derived mouse-adapted E. coli LM715-1 and their colonization assessed by culture over time. Fluorescence-activated cell sorting (FACS) and 16S rDNA sequencing were performed to trace plasmid spread to the microbiota. Results. E. coli LM715-1 colonized mice for ten days, while E. coli MG1655 was not recovered after 72 h. Bacterial cells from fecal samples on days 1 and 3 post inoculation were sorted by FACS. Samples from mice given donor E. coli LM715-1 showed an increase in cells expressing green but not red fluorescence compared to pre-inoculation samples. 16S rRNA gene sequencing analysis of FACS GFP positive cells showed that bacterial families Lachnospiraceae, Clostridiaceae, Pseudomonadaceae, Rhodanobacteraceae, Erysipelotrichaceae, Oscillospiraceae, and Butyricicoccaceae were the primary recipients of the RP4 plasmid. Conclusions. Results show this ARG-bearing conjugative RP4 plasmid spread to diverse human gut bacterial taxa within a live animal where they persisted. These fluorescent marker strategies and human-derived microbiota transplanted mice provided a tractable model for investigating the dynamic spread of ARGs within gut microbiota and could be applied rigorously to varied microbiotas to understand conditions facilitating their spread. Full article

(This article belongs to the Special Issue Epidemiology and Mechanism of Bacterial Resistance to Antibiotics)

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21 pages, 4269 KiB

Open AccessArticle

Machine Learning in FTIR Spectrum for the Identification of Antibiotic Resistance: A Demonstration with Different Species of Microorganisms

by Claudia Patricia Barrera Patiño, Jennifer Machado Soares, Kate Cristina Blanco and Vanderlei Salvador Bagnato

Antibiotics 2024, 13(9), 821; https://doi.org/10.3390/antibiotics13090821 - 30 Aug 2024

Cited by 1 | Viewed by 2004

Abstract

Recent studies introduced the importance of using machine learning algorithms in research focused on the identification of antibiotic resistance. In this study, we highlight the importance of building solid machine learning foundations to differentiate antimicrobial resistance among microorganisms. Using advanced machine learning algorithms, we established a methodology capable of analyzing the FTIR structural profile of the samples of Streptococcus pyogenes and Streptococcus mutans (Gram-positive), as well as Escherichia coli and Klebsiella pneumoniae (Gram-negative), demonstrating cross-sectional applicability in this focus on different microorganisms. The analysis focuses on specific biomolecules—Carbohydrates, Fatty Acids, and Proteins—in FTIR spectra, providing a multidimensional database that transcends microbial variability. The results highlight the ability of the method to consistently identify resistance patterns, regardless of the Gram classification of the bacteria and the species involved, reinforcing the premise that the structural characteristics identified are universal among the microorganisms tested. By validating this approach in four distinct species, our study proves the versatility and precision of the methodology used, in addition to bringing support to the development of an innovative protocol for the rapid and safe identification of antimicrobial resistance. This advance is crucial for optimizing treatment strategies and avoiding the spread of resistance. This emphasizes the relevance of specialized machine learning bases in effectively differentiating between resistance profiles in Gram-negative and Gram-positive bacteria to be implemented in the identification of antibiotic resistance. The obtained result has a high potential to be applied to clinical procedures. Full article

(This article belongs to the Special Issue Epidemiology and Mechanism of Bacterial Resistance to Antibiotics)

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11 pages, 779 KiB

Open AccessArticle

Clinical Outcomes of Patients with AmpC-Beta-Lactamase-Producing Enterobacterales Bacteremia Treated with Carbapenems versus Non-Carbapenem Regimens: A Single-Center Study

by Orjowan Shalabi, Livnat Kashat, Omer Murik, Shoshana Zevin, Marc V. Assous and Eli Ben-Chetrit

Antibiotics 2024, 13(8), 709; https://doi.org/10.3390/antibiotics13080709 - 29 Jul 2024

Cited by 1 | Viewed by 1755

Abstract

Introduction: Bloodstream infections caused by AmpC-producing Enterobacterales pose treatment challenges due to the risk of AmpC overproduction and treatment failure. Current guidelines recommend carbapenems or cefepime as optimal therapy. We aimed to evaluate empiric and definitive non-carbapenem regimens for these infections. Methods: In a retrospective study from June 2014 to March 2023, adult bacteremic patients with Enterobacter cloacae complex strains and Morganella morganii were evaluated. Demographic, clinical and lab data and outcomes were assessed. Results: The cohort comprised 120 bacteremic patients, 17 receiving empiric carbapenem and 103 non-carbapenem regimens. Both groups had similar Charlson and Norton scores and previous antimicrobial exposure. The most common sources of bacteremia were urinary, abdominal and central-line-associated sources. Empiric non-carbapenem regimens (primarily piperacillin–tazobactam and cephalosporins) were not associated with recurrent bacteremia or 30-day mortality. Definitive regimens included mainly carbapenems (n = 41) and ciprofloxacin (n = 46). Beta-lactams were administered to 25 patients. Recurrent bacteremia and 30-day mortality rates were similar among treatment groups. Ciprofloxacin showed comparable outcomes to carbapenems, however, severity of illness among these patients was lower. Conclusions: Empiric and definitive non-carbapenem regimens for bacteremia with AmpC-producing organisms were not associated with treatment failure or increased 30-day mortality. Ciprofloxacin appears promising for selected, stable patients, potentially enabling early discharge. Full article

(This article belongs to the Special Issue Epidemiology and Mechanism of Bacterial Resistance to Antibiotics)

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13 pages, 1531 KiB

Open AccessArticle

Comparative Genomics of an Emerging Multidrug-Resistant bla_NDM-Carrying ST182 Lineage in Enterobacter cloacae Complex

by Angeliki Mavroidi, Elisavet Froukala and Athanasios Tsakris

Antibiotics 2024, 13(6), 535; https://doi.org/10.3390/antibiotics13060535 - 8 Jun 2024

Cited by 1 | Viewed by 2996

Abstract

Background: Enterobacter cloacae, E. hormaechei and related subspecies remain the most clinically relevant among the Enterobacter cloacae complex (ECC). Carbapenemase-producing ECC strains are increasingly identified in hospital-acquired infections and usually belong to four main multilocus sequence types (MLST STs) named ST114, ST93, ST90 and ST78. Instead, ST182 has been sporadically reported among E. hormaechei strains, and recently, outbreaks of bla_NDM-producing ST182 clonal strains have emerged. Herein, we aimed to investigate the presence of ST182 and explore its evolution and modes of bla_NDM acquisition. Methods: A phylogenetic analysis of 646 MLST STs identified among 4685 E. hormaechei whole-genome sequencing (WGS) assemblies deposited in public repositories was performed, as well as an in silico comparative and phylogenomic analyses for 55 WGS assemblies of ST182. bla_NDM-harboring contigs were also compared to published plasmid sequences. Results: ST182 E. hormaechei strains were recovered from patients on five continents during 2011–2021. They were divided into three major genomic clusters, comprising a separate clonal complex with six other STs. In 30 out of 55 ST182 WGS assemblies, bla_NDM-harboring structures were identified that were similar to the plasmids predominant in Gram-negative bacteria, harboring resistance genes to multiple antibiotic classes and virulence genes. No associations between the genomic clusters and the country/continent of isolation or the presence and the plasmid types of the bla_NDM-harboring contigs were observed. Conclusions: Our findings show that ST182 E. hormaechei strains have been identified in the past decade worldwide; 54.5% of them carried diverse bla_NDM genetic structures, suggesting recent acquisition of the bla_NDM alleles. Thus, bla_NDM-harboring ST182 is an emerging multidrug-resistant and virulent lineage in ECC strains that requires close monitoring. Full article

(This article belongs to the Special Issue Epidemiology and Mechanism of Bacterial Resistance to Antibiotics)

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14 pages, 920 KiB

Open AccessArticle

Synergistic Activity of Temocillin and Fosfomycin Combination against KPC-Producing Klebsiella pneumoniae Clinical Isolates

by Venera Costantino, Luigi Principe, Jai Mehat, Marina Busetti, Alessandra Piccirilli, Mariagrazia Perilli, Roberto Luzzati, Verena Zerbato, Antonietta Meliadò, Roberto La Ragione and Stefano Di Bella

Antibiotics 2024, 13(6), 526; https://doi.org/10.3390/antibiotics13060526 - 4 Jun 2024

Viewed by 1686

Abstract

Infections caused by KPC-producing K. pneumoniae continue to pose a significant clinical challenge due to their emerging resistance to new antimicrobials. We investigated the association between two drugs whose roles have been repurposed against multidrug-resistant bacteria: fosfomycin and temocillin. Temocillin exhibits unusual stability against KPC enzymes, while fosfomycin acts as a potent “synergizer”. We conducted in vitro antimicrobial activity studies on 100 clinical isolates of KPC-producing K. pneumoniae using a combination of fosfomycin and temocillin. The results demonstrated synergistic activity in 91% of the isolates. Subsequently, we assessed the effect on Galleria mellonella larvae using five genetically different KPC-Kp isolates. The addition of fosfomycin to temocillin increased larvae survival from 73 to 97% (+Δ 32%; isolate 1), from 93 to 100% (+Δ 7%; isolate 2), from 63 to 86% (+Δ 36%; isolate 3), from 63 to 90% (+Δ 42%; isolate 4), and from 93 to 97% (+Δ 4%; isolate 10). Among the temocillin-resistant KPC-producing K. pneumoniae isolates (24 isolates), the addition of fosfomycin reduced temocillin MIC values below the resistance breakpoint in all isolates except one. Temocillin combined with fosfomycin emerges as a promising combination against KPC-producing K. pneumoniae, warranting further clinical evaluation. Full article

(This article belongs to the Special Issue Epidemiology and Mechanism of Bacterial Resistance to Antibiotics)

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27 pages, 796 KiB

Open AccessReview

The Importance of Carbapenemase-Producing Enterobacterales in African Countries: Evolution and Current Burden

by Edgar-Costin Chelaru, Andrei-Alexandru Muntean, Mihai-Octav Hogea, Mădălina-Maria Muntean, Mircea-Ioan Popa and Gabriela-Loredana Popa

Antibiotics 2024, 13(4), 295; https://doi.org/10.3390/antibiotics13040295 - 24 Mar 2024

Cited by 4 | Viewed by 2961

Abstract

Antimicrobial resistance (AMR) is a worldwide healthcare problem. Multidrug-resistant organisms (MDROs) can spread quickly owing to their resistance mechanisms. Although colonized individuals are crucial for MDRO dissemination, colonizing microbes can lead to symptomatic infections in carriers. Carbapenemase-producing Enterobacterales (CPE) are among the most important MDROs involved in colonizations and infections with severe outcomes. This review aimed to track down the first reports of CPE in Africa, describe their dissemination throughout African countries and summarize the current status of CRE and CPE data, highlighting current knowledge and limitations of reported data. Two database queries were undertaken using Medical Subject Headings (MeSH), employing relevant keywords to identify articles that had as their topics beta-lactamases, carbapenemases and carbapenem resistance pertaining to Africa or African regions and countries. The first information on CPE could be traced back to the mid-2000s, but data for many African countries were established after 2015–2018. Information is presented chronologically for each country. Although no clear conclusions could be drawn for some countries, it was observed that CPE infections and colonizations are present in most African countries and that carbapenem-resistance levels are rising. The most common CPE involved are Klebsiella pneumoniae and Escherichia coli, and the most prevalent carbapenemases are NDM-type and OXA-48-type enzymes. Prophylactic measures, such as screening, are required to combat this phenomenon. Full article

(This article belongs to the Special Issue Epidemiology and Mechanism of Bacterial Resistance to Antibiotics)

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27 pages, 1503 KiB

Open AccessReview

Pan-Genome Plasticity and Virulence Factors: A Natural Treasure Trove for Acinetobacter baumannii

by Theodoros Karampatakis, Katerina Tsergouli and Payam Behzadi

Antibiotics 2024, 13(3), 257; https://doi.org/10.3390/antibiotics13030257 - 14 Mar 2024

Cited by 29 | Viewed by 4170

Abstract

Acinetobacter baumannii is a Gram-negative pathogen responsible for a variety of community- and hospital-acquired infections. It is recognized as a life-threatening pathogen among hospitalized individuals and, in particular, immunocompromised patients in many countries. A. baumannii, as a member of the ESKAPE group, encompasses high genomic plasticity and simultaneously is predisposed to receive and exchange the mobile genetic elements (MGEs) through horizontal genetic transfer (HGT). Indeed, A. baumannii is a treasure trove that contains a high number of virulence factors. In accordance with these unique pathogenic characteristics of A. baumannii, the authors aim to discuss the natural treasure trove of pan-genome and virulence factors pertaining to this bacterial monster and try to highlight the reasons why this bacterium is a great concern in the global public health system. Full article

(This article belongs to the Special Issue Epidemiology and Mechanism of Bacterial Resistance to Antibiotics)

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