Point prevalence survey of antibiotic use in hospitals in Latin American countries
BACKGROUND: Point prevalence surveys (PPSs) on antibiotic use are useful for understanding different aspects related to prescription patterns in hospitals. METHODS: An adaptation of the WHO methodology for a PPS on antibiotic use was applied. Hospital wards were divided into medical (MED), surgical...
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| author | Gabriel Levy Hara Robin Rojas-Cortés Helvert Felipe Molina León Anahí Dreser Ismary Alfonso Orta José Noe Rizo-Amezquita René Guillermo Santos Herrera Silvia Mendoza de Ayala Marlen Arce Villalobos Hilda Mantilla Ponte Ever Davila Gloria Aguilar Analı́a Porrás Pilar Ramón-Pardo José L. Castro on behalf of the Latin American Point Prevalent Survey Study Group Daniela Guzmán María Luisa Rioseco Jaime Labarca José Pablo Díaz Madriz Josué Murillo Cubero Allan Robles Calderón Mónica Alfaro Luisa Arias Soto Alejandro Aayon Tania Jiménez Oreamuno Zulema Herrera Jiménez Adriana Sequeira Jorge Mederos Hernández Jorge Luis Campistrous Lavaut Damarys Castillo Meriño Elsa Fleitas Ruisánchez Damaris Portuondo Sánchez Humberto Guanche Garcell Juan José Pisonero Socías Evelyn Perera Díaz Norma America Cardoso Lunar Irene Fiterre Lancís José Antonio Ramírez Midsay López Leyte Ariadna Méndez Rosabal Ebel Aldana Estrada M. Bartolomé Cano L. García Méndez Anay Cordero Eiriz Liana Padrón Menéndez Gladys Fuentes Fernández Raunel Reyes Ayala Salomón Monroy Ramón Menjívar Carmen Elena Albanez Martínez Diana Cabrera Sofía Mercedes Menjivar Delgado Gustavo Guzman Rafael Jiménez-Mejía Carolina Rodríguez Sara Alvarenga Mirian Alvarado Ruth del Carmen Alvarado de Zelaya Germán Arévalo Guillermo Parada Luis Cuéllar Alexis Holguín Ruiz Yuan Almora Pinedo Eduardo Sánchez Vergaray Luis Enrique Vasquez Gil Bertha Gizel Injante Ibazeta Esther Dina Guadalupe Ricra Rony Estrada Segura Coralith García Apac Jennifer Cuadros Inga Roger Hernández Díaz Marie Vallejo Vigo Cesar Mujica Cuba Pierina Vilcapoma Eddie Angles-Yanqui Débora Rocío Mananita Terrones Rosa Terán Robles Cristhian Resurrección Alfredo Chiappe-Gonzalez Martha Antezana Socorro Torres Zegarra Miguel Villegas-Chiroque Roberto Díaz-Sipión Jorge Marko A. Benitez-Peche Jorge Alave Jhoselyn Laura Goytizolo Ruiz Angélica María Hernández Fernández José Antonio Flores Vargas Javier Araujo Francisco Javier Arriaga García Zoila Cruz Rivera Víctor Monroy Colín Katia Bustamante Ríos Jorge Israel Hernández Blanquel Eduardo Arias de la Garza Héctor Hernández Gutiérrez Karla Johanna Banegas León Hortencia Esther Peralta Lara Carlos Baltodano Arias Eduardo Alemán Garay Gladys Estigarribia Livio Mereles Menchaca Natalia Luraschi Viré Dasy Acuña Edgar Giménez Caballero |
| author_browse | Adriana Sequeira Alejandro Aayon Alexis Holguín Ruiz Alfredo Chiappe-Gonzalez Allan Robles Calderón Anahí Dreser Analı́a Porrás Anay Cordero Eiriz Angélica María Hernández Fernández Ariadna Méndez Rosabal Bertha Gizel Injante Ibazeta Carlos Baltodano Arias Carmen Elena Albanez Martínez Carolina Rodríguez Cesar Mujica Cuba Coralith García Apac Cristhian Resurrección Damaris Portuondo Sánchez Damarys Castillo Meriño Daniela Guzmán Dasy Acuña Diana Cabrera Débora Rocío Mananita Terrones Ebel Aldana Estrada Eddie Angles-Yanqui Edgar Giménez Caballero Eduardo Alemán Garay Eduardo Arias de la Garza Eduardo Sánchez Vergaray Elsa Fleitas Ruisánchez Esther Dina Guadalupe Ricra Evelyn Perera Díaz Ever Davila Francisco Javier Arriaga García Gabriel Levy Hara Germán Arévalo Gladys Estigarribia Gladys Fuentes Fernández Gloria Aguilar Guillermo Parada Gustavo Guzman Helvert Felipe Molina León Hilda Mantilla Ponte Hortencia Esther Peralta Lara Humberto Guanche Garcell Héctor Hernández Gutiérrez Irene Fiterre Lancís Ismary Alfonso Orta Jaime Labarca Javier Araujo Jennifer Cuadros Inga Jhoselyn Laura Goytizolo Ruiz Jorge Alave Jorge Israel Hernández Blanquel Jorge Luis Campistrous Lavaut Jorge Marko A. Benitez-Peche Jorge Mederos Hernández Josué Murillo Cubero José Antonio Flores Vargas José Antonio Ramírez José L. Castro José Noe Rizo-Amezquita José Pablo Díaz Madriz Juan José Pisonero Socías Karla Johanna Banegas León Katia Bustamante Ríos L. García Méndez Liana Padrón Menéndez Livio Mereles Menchaca Luis Cuéllar Luis Enrique Vasquez Gil Luisa Arias Soto M. Bartolomé Cano Marie Vallejo Vigo Marlen Arce Villalobos Martha Antezana María Luisa Rioseco Midsay López Leyte Miguel Villegas-Chiroque Mirian Alvarado Mónica Alfaro Natalia Luraschi Viré Norma America Cardoso Lunar Pierina Vilcapoma Pilar Ramón-Pardo Rafael Jiménez-Mejía Ramón Menjívar Raunel Reyes Ayala René Guillermo Santos Herrera Roberto Díaz-Sipión Robin Rojas-Cortés Roger Hernández Díaz Rony Estrada Segura Rosa Terán Robles Ruth del Carmen Alvarado de Zelaya Salomón Monroy Sara Alvarenga Silvia Mendoza de Ayala Socorro Torres Zegarra Sofía Mercedes Menjivar Delgado Tania Jiménez Oreamuno Víctor Monroy Colín Yuan Almora Pinedo Zoila Cruz Rivera Zulema Herrera Jiménez on behalf of the Latin American Point Prevalent Survey Study Group |
| author_facet | Gabriel Levy Hara Robin Rojas-Cortés Helvert Felipe Molina León Anahí Dreser Ismary Alfonso Orta José Noe Rizo-Amezquita René Guillermo Santos Herrera Silvia Mendoza de Ayala Marlen Arce Villalobos Hilda Mantilla Ponte Ever Davila Gloria Aguilar Analı́a Porrás Pilar Ramón-Pardo José L. Castro on behalf of the Latin American Point Prevalent Survey Study Group Daniela Guzmán María Luisa Rioseco Jaime Labarca José Pablo Díaz Madriz Josué Murillo Cubero Allan Robles Calderón Mónica Alfaro Luisa Arias Soto Alejandro Aayon Tania Jiménez Oreamuno Zulema Herrera Jiménez Adriana Sequeira Jorge Mederos Hernández Jorge Luis Campistrous Lavaut Damarys Castillo Meriño Elsa Fleitas Ruisánchez Damaris Portuondo Sánchez Humberto Guanche Garcell Juan José Pisonero Socías Evelyn Perera Díaz Norma America Cardoso Lunar Irene Fiterre Lancís José Antonio Ramírez Midsay López Leyte Ariadna Méndez Rosabal Ebel Aldana Estrada M. Bartolomé Cano L. García Méndez Anay Cordero Eiriz Liana Padrón Menéndez Gladys Fuentes Fernández Raunel Reyes Ayala Salomón Monroy Ramón Menjívar Carmen Elena Albanez Martínez Diana Cabrera Sofía Mercedes Menjivar Delgado Gustavo Guzman Rafael Jiménez-Mejía Carolina Rodríguez Sara Alvarenga Mirian Alvarado Ruth del Carmen Alvarado de Zelaya Germán Arévalo Guillermo Parada Luis Cuéllar Alexis Holguín Ruiz Yuan Almora Pinedo Eduardo Sánchez Vergaray Luis Enrique Vasquez Gil Bertha Gizel Injante Ibazeta Esther Dina Guadalupe Ricra Rony Estrada Segura Coralith García Apac Jennifer Cuadros Inga Roger Hernández Díaz Marie Vallejo Vigo Cesar Mujica Cuba Pierina Vilcapoma Eddie Angles-Yanqui Débora Rocío Mananita Terrones Rosa Terán Robles Cristhian Resurrección Alfredo Chiappe-Gonzalez Martha Antezana Socorro Torres Zegarra Miguel Villegas-Chiroque Roberto Díaz-Sipión Jorge Marko A. Benitez-Peche Jorge Alave Jhoselyn Laura Goytizolo Ruiz Angélica María Hernández Fernández José Antonio Flores Vargas Javier Araujo Francisco Javier Arriaga García Zoila Cruz Rivera Víctor Monroy Colín Katia Bustamante Ríos Jorge Israel Hernández Blanquel Eduardo Arias de la Garza Héctor Hernández Gutiérrez Karla Johanna Banegas León Hortencia Esther Peralta Lara Carlos Baltodano Arias Eduardo Alemán Garay Gladys Estigarribia Livio Mereles Menchaca Natalia Luraschi Viré Dasy Acuña Edgar Giménez Caballero |
| author_sort | Gabriel Levy Hara |
| collection | Producción científica |
| description | BACKGROUND: Point prevalence surveys (PPSs) on antibiotic use are useful for understanding different aspects related to prescription patterns in hospitals. METHODS: An adaptation of the WHO methodology for a PPS on antibiotic use was applied. Hospital wards were divided into medical (MED), surgical (SUR), ICUs, gynaecology and obstetrics (GO), high-risk (HR) and mixed wards (MIX). A web application (RedCap©) through a mobile device was used for data collection. RESULTS: Between December 2018 and August 2019, 5444 patients in 33 hospitals in five countries were included (10 hospitals in Cuba, 7 in Paraguay, 6 in El Salvador, 5 in Mexico and 5 in Peru). Of these patients, 54.6% received at least one antibiotic, with variations between and within hospitals and countries. Antibiotics were more frequently used in ICUs (67.2%), SUR (64.5%) and MED wards (54.2%), with 51.2% of antibiotics prescribed for community-acquired infections (CAIs), 22.9% for healthcare-associated infections (HAIs), 11.1% for surgical prophylaxis and 6.1% for unknown reasons. Adherence to guidelines was observed in 68.6% of cases (72.8% for CAIs, 72.4% for HAIs and 44.3% for prophylaxis). Third-generation cephalosporins were the class of antibiotics most frequently used (26.8%), followed by carbapenems (10.3%) and fluoroquinolones (8%). Targeted treatments were achieved in 17.3% of cases. CONCLUSIONS: Antibiotic use was generally higher than that published in other studies. There is an urgent need to promote and strengthen the antimicrobial stewardship programmes in Latin America. |
| format | Article |
| id | oai:cris.upeu.edu.pe:20.500.15037/175 |
| institution | UPeU |
| language | English |
| publishDate | 2021 |
| publishDateRange | 2021 |
| publishDateSort | 2021 |
| record_format | dspace |
| spelling | oai:cris.upeu.edu.pe:20.500.15037/1752026-10-30T16:14:32ZPoint prevalence survey of antibiotic use in hospitals in Latin American countriesGabriel Levy HaraRobin Rojas-CortésHelvert Felipe Molina LeónAnahí DreserIsmary Alfonso OrtaJosé Noe Rizo-AmezquitaRené Guillermo Santos HerreraSilvia Mendoza de AyalaMarlen Arce VillalobosHilda Mantilla PonteEver DavilaGloria AguilarAnalı́a PorrásPilar Ramón-PardoJosé L. Castroon behalf of the Latin American Point Prevalent Survey Study GroupDaniela GuzmánMaría Luisa RiosecoJaime LabarcaJosé Pablo Díaz MadrizJosué Murillo CuberoAllan Robles CalderónMónica AlfaroLuisa Arias SotoAlejandro AayonTania Jiménez OreamunoZulema Herrera JiménezAdriana SequeiraJorge Mederos HernándezJorge Luis Campistrous LavautDamarys Castillo MeriñoElsa Fleitas RuisánchezDamaris Portuondo SánchezHumberto Guanche GarcellJuan José Pisonero SocíasEvelyn Perera DíazNorma America Cardoso LunarIrene Fiterre LancísJosé Antonio RamírezMidsay López LeyteAriadna Méndez RosabalEbel Aldana EstradaM. Bartolomé CanoL. García MéndezAnay Cordero EirizLiana Padrón MenéndezGladys Fuentes FernándezRaunel Reyes AyalaSalomón MonroyRamón MenjívarCarmen Elena Albanez MartínezDiana CabreraSofía Mercedes Menjivar DelgadoGustavo GuzmanRafael Jiménez-MejíaCarolina RodríguezSara AlvarengaMirian AlvaradoRuth del Carmen Alvarado de ZelayaGermán ArévaloGuillermo ParadaLuis CuéllarAlexis Holguín RuizYuan Almora PinedoEduardo Sánchez VergarayLuis Enrique Vasquez GilBertha Gizel Injante IbazetaEsther Dina Guadalupe RicraRony Estrada SeguraCoralith García ApacJennifer Cuadros IngaRoger Hernández DíazMarie Vallejo VigoCesar Mujica CubaPierina VilcapomaEddie Angles-YanquiDébora Rocío Mananita TerronesRosa Terán RoblesCristhian ResurrecciónAlfredo Chiappe-GonzalezMartha AntezanaSocorro Torres ZegarraMiguel Villegas-ChiroqueRoberto Díaz-SipiónJorge Marko A. Benitez-PecheJorge AlaveJhoselyn Laura Goytizolo RuizAngélica María Hernández FernándezJosé Antonio Flores VargasJavier AraujoFrancisco Javier Arriaga GarcíaZoila Cruz RiveraVíctor Monroy ColínKatia Bustamante RíosJorge Israel Hernández BlanquelEduardo Arias de la GarzaHéctor Hernández GutiérrezKarla Johanna Banegas LeónHortencia Esther Peralta LaraCarlos Baltodano AriasEduardo Alemán GarayGladys EstigarribiaLivio Mereles MenchacaNatalia Luraschi ViréDasy AcuñaEdgar Giménez CaballeroMedicineAntibioticsMedical prescriptionAntimicrobial stewardshipCephalosporinPediatricsEmergency medicineAntibiotic resistanceFamily medicineNursingMicrobiologyBiologyMedicineAntibioticsMedical prescriptionAntimicrobial stewardshipCephalosporinPediatricsEmergency medicineAntibiotic resistanceFamily medicineNursingAnti-Bacterial Agents therapeutic useAnti-Bacterial Agents therapeutic useAnti-Bacterial Agents therapeutic useAnti-Bacterial Agents therapeutic useCross Infection epidemiologyCross Infection epidemiologyCross Infection epidemiologyCross Infection epidemiologyHospitalsHospitalsHospitalsHospitalsHumansHumansHumansHumansLatin America epidemiologyLatin America epidemiologyLatin America epidemiologyLatin America epidemiologyPrevalencePrevalencePrevalencePrevalenceLife Sciences Immunology and Microbiology Applied Microbiology and Biotechnology Antibiotic Use and ResistanceHealth Sciences Medicine Critical Care and Intensive Care Medicine Nosocomial Infections in ICULife Sciences Biochemistry, Genetics and Molecular Biology Molecular Medicine Antibiotic Resistance in BacteriaBACKGROUND: Point prevalence surveys (PPSs) on antibiotic use are useful for understanding different aspects related to prescription patterns in hospitals. METHODS: An adaptation of the WHO methodology for a PPS on antibiotic use was applied. Hospital wards were divided into medical (MED), surgical (SUR), ICUs, gynaecology and obstetrics (GO), high-risk (HR) and mixed wards (MIX). A web application (RedCap©) through a mobile device was used for data collection. RESULTS: Between December 2018 and August 2019, 5444 patients in 33 hospitals in five countries were included (10 hospitals in Cuba, 7 in Paraguay, 6 in El Salvador, 5 in Mexico and 5 in Peru). Of these patients, 54.6% received at least one antibiotic, with variations between and within hospitals and countries. Antibiotics were more frequently used in ICUs (67.2%), SUR (64.5%) and MED wards (54.2%), with 51.2% of antibiotics prescribed for community-acquired infections (CAIs), 22.9% for healthcare-associated infections (HAIs), 11.1% for surgical prophylaxis and 6.1% for unknown reasons. Adherence to guidelines was observed in 68.6% of cases (72.8% for CAIs, 72.4% for HAIs and 44.3% for prophylaxis). Third-generation cephalosporins were the class of antibiotics most frequently used (26.8%), followed by carbapenems (10.3%) and fluoroquinolones (8%). Targeted treatments were achieved in 17.3% of cases. CONCLUSIONS: Antibiotic use was generally higher than that published in other studies. There is an urgent need to promote and strengthen the antimicrobial stewardship programmes in Latin America.Articlehttps://pubmed.ncbi.nlm.nih.gov/34957520https://academic.oup.com/jac/article-pdf/77/3/807/43669652/dkab459.pdfhttps://doi.org/10.1093/jac/dkab45910.1093/jac/dkab459https://hdl.handle.net/20.500.15037/175W4200102383enJournal of Antimicrobial Chemotherapy0305-74531460-20912021-12-012026-06-13T07:48:58Z2026-06-13T07:48:58Z |
| spellingShingle | Medicine Antibiotics Medical prescription Antimicrobial stewardship Cephalosporin Pediatrics Emergency medicine Antibiotic resistance Family medicine Nursing Microbiology Biology Medicine Antibiotics Medical prescription Antimicrobial stewardship Cephalosporin Pediatrics Emergency medicine Antibiotic resistance Family medicine Nursing Anti-Bacterial Agents therapeutic use Anti-Bacterial Agents therapeutic use Anti-Bacterial Agents therapeutic use Anti-Bacterial Agents therapeutic use Cross Infection epidemiology Cross Infection epidemiology Cross Infection epidemiology Cross Infection epidemiology Hospitals Hospitals Hospitals Hospitals Humans Humans Humans Humans Latin America epidemiology Latin America epidemiology Latin America epidemiology Latin America epidemiology Prevalence Prevalence Prevalence Prevalence Life Sciences Immunology and Microbiology Applied Microbiology and Biotechnology Antibiotic Use and Resistance Health Sciences Medicine Critical Care and Intensive Care Medicine Nosocomial Infections in ICU Life Sciences Biochemistry, Genetics and Molecular Biology Molecular Medicine Antibiotic Resistance in Bacteria Gabriel Levy Hara Robin Rojas-Cortés Helvert Felipe Molina León Anahí Dreser Ismary Alfonso Orta José Noe Rizo-Amezquita René Guillermo Santos Herrera Silvia Mendoza de Ayala Marlen Arce Villalobos Hilda Mantilla Ponte Ever Davila Gloria Aguilar Analı́a Porrás Pilar Ramón-Pardo José L. Castro on behalf of the Latin American Point Prevalent Survey Study Group Daniela Guzmán María Luisa Rioseco Jaime Labarca José Pablo Díaz Madriz Josué Murillo Cubero Allan Robles Calderón Mónica Alfaro Luisa Arias Soto Alejandro Aayon Tania Jiménez Oreamuno Zulema Herrera Jiménez Adriana Sequeira Jorge Mederos Hernández Jorge Luis Campistrous Lavaut Damarys Castillo Meriño Elsa Fleitas Ruisánchez Damaris Portuondo Sánchez Humberto Guanche Garcell Juan José Pisonero Socías Evelyn Perera Díaz Norma America Cardoso Lunar Irene Fiterre Lancís José Antonio Ramírez Midsay López Leyte Ariadna Méndez Rosabal Ebel Aldana Estrada M. Bartolomé Cano L. García Méndez Anay Cordero Eiriz Liana Padrón Menéndez Gladys Fuentes Fernández Raunel Reyes Ayala Salomón Monroy Ramón Menjívar Carmen Elena Albanez Martínez Diana Cabrera Sofía Mercedes Menjivar Delgado Gustavo Guzman Rafael Jiménez-Mejía Carolina Rodríguez Sara Alvarenga Mirian Alvarado Ruth del Carmen Alvarado de Zelaya Germán Arévalo Guillermo Parada Luis Cuéllar Alexis Holguín Ruiz Yuan Almora Pinedo Eduardo Sánchez Vergaray Luis Enrique Vasquez Gil Bertha Gizel Injante Ibazeta Esther Dina Guadalupe Ricra Rony Estrada Segura Coralith García Apac Jennifer Cuadros Inga Roger Hernández Díaz Marie Vallejo Vigo Cesar Mujica Cuba Pierina Vilcapoma Eddie Angles-Yanqui Débora Rocío Mananita Terrones Rosa Terán Robles Cristhian Resurrección Alfredo Chiappe-Gonzalez Martha Antezana Socorro Torres Zegarra Miguel Villegas-Chiroque Roberto Díaz-Sipión Jorge Marko A. Benitez-Peche Jorge Alave Jhoselyn Laura Goytizolo Ruiz Angélica María Hernández Fernández José Antonio Flores Vargas Javier Araujo Francisco Javier Arriaga García Zoila Cruz Rivera Víctor Monroy Colín Katia Bustamante Ríos Jorge Israel Hernández Blanquel Eduardo Arias de la Garza Héctor Hernández Gutiérrez Karla Johanna Banegas León Hortencia Esther Peralta Lara Carlos Baltodano Arias Eduardo Alemán Garay Gladys Estigarribia Livio Mereles Menchaca Natalia Luraschi Viré Dasy Acuña Edgar Giménez Caballero Point prevalence survey of antibiotic use in hospitals in Latin American countries |
| title | Point prevalence survey of antibiotic use in hospitals in Latin American countries |
| title_full | Point prevalence survey of antibiotic use in hospitals in Latin American countries |
| title_fullStr | Point prevalence survey of antibiotic use in hospitals in Latin American countries |
| title_full_unstemmed | Point prevalence survey of antibiotic use in hospitals in Latin American countries |
| title_short | Point prevalence survey of antibiotic use in hospitals in Latin American countries |
| title_sort | point prevalence survey of antibiotic use in hospitals in latin american countries |
| topic | Medicine Antibiotics Medical prescription Antimicrobial stewardship Cephalosporin Pediatrics Emergency medicine Antibiotic resistance Family medicine Nursing Microbiology Biology Medicine Antibiotics Medical prescription Antimicrobial stewardship Cephalosporin Pediatrics Emergency medicine Antibiotic resistance Family medicine Nursing Anti-Bacterial Agents therapeutic use Anti-Bacterial Agents therapeutic use Anti-Bacterial Agents therapeutic use Anti-Bacterial Agents therapeutic use Cross Infection epidemiology Cross Infection epidemiology Cross Infection epidemiology Cross Infection epidemiology Hospitals Hospitals Hospitals Hospitals Humans Humans Humans Humans Latin America epidemiology Latin America epidemiology Latin America epidemiology Latin America epidemiology Prevalence Prevalence Prevalence Prevalence Life Sciences Immunology and Microbiology Applied Microbiology and Biotechnology Antibiotic Use and Resistance Health Sciences Medicine Critical Care and Intensive Care Medicine Nosocomial Infections in ICU Life Sciences Biochemistry, Genetics and Molecular Biology Molecular Medicine Antibiotic Resistance in Bacteria |
| topic_facet | Medicine Antibiotics Medical prescription Antimicrobial stewardship Cephalosporin Pediatrics Emergency medicine Antibiotic resistance Family medicine Nursing Microbiology Biology Medicine Antibiotics Medical prescription Antimicrobial stewardship Cephalosporin Pediatrics Emergency medicine Antibiotic resistance Family medicine Nursing Anti-Bacterial Agents therapeutic use Anti-Bacterial Agents therapeutic use Anti-Bacterial Agents therapeutic use Anti-Bacterial Agents therapeutic use Cross Infection epidemiology Cross Infection epidemiology Cross Infection epidemiology Cross Infection epidemiology Hospitals Hospitals Hospitals Hospitals Humans Humans Humans Humans Latin America epidemiology Latin America epidemiology Latin America epidemiology Latin America epidemiology Prevalence Prevalence Prevalence Prevalence Life Sciences Immunology and Microbiology Applied Microbiology and Biotechnology Antibiotic Use and Resistance Health Sciences Medicine Critical Care and Intensive Care Medicine Nosocomial Infections in ICU Life Sciences Biochemistry, Genetics and Molecular Biology Molecular Medicine Antibiotic Resistance in Bacteria |
| url | https://pubmed.ncbi.nlm.nih.gov/34957520 https://academic.oup.com/jac/article-pdf/77/3/807/43669652/dkab459.pdf https://doi.org/10.1093/jac/dkab459 https://hdl.handle.net/20.500.15037/175 |
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