The Molecular Epidemiology of Antimicrobial Resistance

  • D. M. Shlaes
  • C. A. Currie-McCumber
Part of the Handbook of Experimental Pharmacology book series (HEP, volume 91)

Abstract

Endemic antibiotic resistance is a problem worldwide. Six task forces have recently been organized to address this global problem in a quantitative way. Condensed reports from these task forces were recently published in the Reviews of Infectious Diseases (Levy et al. 1987). It is clear that large amounts of a variety of antibiotics, but especially of tetracyclines, broad spectrum penicillins and sulfamethoxazole-trimethoprim, are being used throughout the world (Col and O’Connor 1987). In many countries, this usage is uncontrolled, and widespread underdosing from use of over-the-counter combinations obtained without prescription is the rule.

Keywords

Bacillus Resis Glycoside Ampicillin Tetracycline 

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References

  1. Ambrosio RE, van Wyk AJ, deKlerk HC (1979) Antibiotic resistant Serratia marcescens infection in a hospital. S Afr Med J 55: 584–587PubMedGoogle Scholar
  2. Archer GL, Mayhall CG (1983) Comparison of epidemiological markers used in the investigation of an outbreak of methicillin-resistant Staphylococcus aureus infection. J Clin Microbiol 18: 395–399PubMedGoogle Scholar
  3. Archer GL, Vishniaysky N, Stiver HG (1982) Plasmid pattern analysis of Staphylococcus epidermidis isolates from patients with prosthetic valve endocarditis. Infect Immun 35: 627–632PubMedGoogle Scholar
  4. Archer GL, Karchmer AW, Vishniaysky N, Johnston JL (1984) Plasmid pattern analysis for the differentiation of infecting from non-infecting Staphylococcus epidermidis. J Infect Dis 149: 913–920PubMedCrossRefGoogle Scholar
  5. Betts RF, Valenti WM, Chapman SW et al. (1984) Five year surveillance of aminoglycoside usage in a university hospital. Ann Intern Med 100: 219–222PubMedGoogle Scholar
  6. Bidwell JL, Reeves RS, Bullock DW (1981) Diversity of R plasmids in epidemic Serratia marcescens from the south west of England. In: Grassi GG, Sabath LD (eds) New trends in antibiotics: research and therapy. Elsevier/North Holland, Amsterdam, pp 268–270Google Scholar
  7. Birnboim HC, Doly J (1979) A rapid alkaline extraction procedure for screening recombinant plasmid DNA. Nucleic Acids Res 7: 1513–1523PubMedCrossRefGoogle Scholar
  8. Brunner F, Margadant A, Peduzzi R, Piffaretti J-C (1983) The plasmid pattern as an epidemiologic tool for Salmonella typhimurium epidemics: comparison with the lysotype. J Infect Dis 148: 7–11PubMedCrossRefGoogle Scholar
  9. Bryan CS, Parker E, Schoenlein PV, Northey J, Ely B, John JF (1980) Plasmid mediated antibiotic resistance in a changing hospital environment: efficacy of control measures. Am J Infect Control 8: 65–71CrossRefGoogle Scholar
  10. Casewell MW, Webster M, Dalton MT, Phillips I (1977) Gentamicin resistant Klebsiella aerogenes in a urological ward. Lancet I1: 444–446CrossRefGoogle Scholar
  11. Chaslus-Dancla E, Martel JL, Cartier C et al. (1986) Emergence of aminoglycoside 3-Nacetyltransferase IV in Escherichia coli and Salmonella typhimurium isolated from animals in France. Antimicrob Agents Chemother 29: 239–243PubMedGoogle Scholar
  12. Chaslus-Dancla E, Gerbaud G, Lagorce M et al. (1987) Persistence of an antibiotic resistance plasmid in intestinal Escherichia coli of chickens in the absence of selective pressure. Antimicrob Agents Chemother 31: 784–788PubMedGoogle Scholar
  13. Christie PJ, Dunny GM (1984) Antibiotic selection pressure resulting in multiple antibiotic resistance and localization of resistance determinants to conjugative plasmids in streptococci. J Infect Dis 149: 74–82PubMedCrossRefGoogle Scholar
  14. Col NF, O’Connor RW (1987) Estimating worldwide current antibiotic useage: report of task force 1. Rev Infect Dis 9 [Suppl 3]: S232 - S243PubMedCrossRefGoogle Scholar
  15. Courtney MA, Miler JR, Summersgill J, Melo J, Raff MJ, Streips UN (1980) R-factor responsible for outbreak of multiple resistant Klebsiella pneumoniae. Antimicrob Agents Chemother 18: 926–929PubMedGoogle Scholar
  16. Datta N, Hughes VM, Nugent ME, Richards H (1979) Plasmids and transposons and their stability and mutability in bacteria isolated during an outbreak of hospital infection. Plasmid 2: 182–196PubMedCrossRefGoogle Scholar
  17. DuPont HL, Steele JH (1987) Use of antimicrobial agents in animal feeds: implications for human health. Rev Infect Dis 9: 447–460PubMedCrossRefGoogle Scholar
  18. Echols RM, Palmer DL, King RM, Long GW (1984) Multidrug resistant Serratia mar cescens bacteriuria related to urologic instrumentation. South Med J 77: 173–177PubMedCrossRefGoogle Scholar
  19. Elwell LP, Inamine JM, Minshew BH (1978) Common plasmid specifying tobramycin resistance found in two bacteria isolated from burn patients. Antimicrob Agents Chemother 13: 312–317PubMedGoogle Scholar
  20. Farmer JJ, Weinstein RA, Zierdt CH, Brokopp CD (1982) Hospital outbreaks caused by Pseudomonas aeruginosa: importance of serogroup p11. J Clin Microbiol 16: 226–270Google Scholar
  21. Frost JA, Willshaw GA, Barclay EA, Rowe B (1985) Plasmid characterization of drug-resistant Shigella dysenteriae I from an epidemic in Central Africa. J Hyg (Camb) 94: 163–172CrossRefGoogle Scholar
  22. Griffin HG, Foster TJ, Falkiner FR, Carre ME, Coleman DC (1985) Molecular analysis of multiple resistance plasmids transferred from gram negative bacteria isolated in a urological unit. Antimicrob Agents Chemother 28: 413–418PubMedGoogle Scholar
  23. Grunstein M, Hogness DS (1975) Colony hybridization: a method for the isolation of cloned DNAs that contain a specific gene. Proc Natl Acad Sci USA 72: 3961–3965PubMedCrossRefGoogle Scholar
  24. Gustafon TL, Band JD, Hutcheson RH, Schaffner W (1983) Pseudomonas folliculitis: an outbreak and review. Rev Infect Dis 5: 1–8CrossRefGoogle Scholar
  25. Hardy DJ, Legeai RJ, O’Callaghan RJ (1980) Klebsiella neonatal infections: mechanism of broadening aminoglycoside resistance. Antimicrob Agents Chemother 18: 542–548PubMedGoogle Scholar
  26. Hartely CL, Richmond MH (1975) Antibiotic resistance and the survival of E. coli in the alimentary tract. Br Med J [Clin Res] IV: 71–74CrossRefGoogle Scholar
  27. Holmberg SD, Wachsmuth KI, Hickman-Brenner FW, Cohen ML (1984) Comparison of plasmid profile analysis, phage typing and antimicrobial susceptibility testing in characterizing Salmonella typhimurium isolates from outbreaks. J Clin Microbiol 19: 100–104PubMedGoogle Scholar
  28. Holmes DS, Quigley M (1981) A rapid boiling method for the preparation of bacterial plasmids. Anal Biochem 114: 193–197PubMedCrossRefGoogle Scholar
  29. Jacoby GA (1984) Resistance plasmids of Pseudomonas aeruginosa. In: Bryan LE (ed) Antimicrobial drug resistance. Academic, Orlando, pp 497–514Google Scholar
  30. John JF, McNeill WF (1980) Plasmid diversity in multi-resistant Serratia marscens isolates from hospitals. In: Nelson JD, Grassi C (eds) Current chemotherapy and infectious disease. Proceeding of the 11th International Congress of Chemotherapy and the 19th Interscience Conference on Antimicrobial Agents and Chemotherapy, vol 1. American Society for Microbiology, Washington DC, pp 28–30Google Scholar
  31. John JF, McNeill WF (1981) Characteristics of Serratia marcescens containing a plasmid coding for gentamicin resistance in nosocomial infections. J Infect Dis 143: 810–817PubMedCrossRefGoogle Scholar
  32. John JF Jr, Twitty JA (1986) Plasmids as epidemiologic markers in nosocomial gram-negative bacilli: experience at a university and review of the literature. Rev Infect Dis 8: 693–704PubMedCrossRefGoogle Scholar
  33. John JF, McKee KT, Twitty JA, Schaffner W (1983) Molecular epidemiology of sequential nursery epidemics caused by multiresistant Klebsiella pneumoniae. J Pediatr 102: 825–830PubMedCrossRefGoogle Scholar
  34. Kado CI, Liu ST (1981) Rapid procedure for detection and isolation of large and small plasmids. J Bacteriol 145: 1365–1373PubMedGoogle Scholar
  35. Larson TA, Garrett CR, Gerding DN (1986) Frequency of aminoglycoside 6’-N-acetyltransferase among Serratia species during increased use of amikacin in the hospital. Antimicrob Agents Chemother 30: 176–178PubMedGoogle Scholar
  36. Lee SC, Gerding DN, Cleary PP (1984) Plasmid macroevolution in a nosocomial environment: demonstration of a persistent molecular polymorphism and construction of a cladistic phylogeny on the basis of restriction data. Mol Gen Genet 194: 173–178PubMedCrossRefGoogle Scholar
  37. Lee SC, Gerding DN, Cleary PP (1986) Hospital distribution, persistence, and reintroduc tion of related gentamicin R plasmids. Antimicrob Agents Chemother 29: 654–659PubMedGoogle Scholar
  38. Levin MH, Weinstein RA, Nathan C et al. (1984) Association of infection caused by Pseudomonas aeruginosa serotype 011 with intravenous abuse of pentazocine mixed with tripelennamine. J Clin Microbiol 20: 758–762PubMedGoogle Scholar
  39. Levine JF, Maslow MJ, Leibowitz RE et al. (1985) Amikacin-resistant gram negative bacilli: correlation of occurrence with amikacin use. J Infect Dis 151: 295–300PubMedCrossRefGoogle Scholar
  40. Levy SB (1986) Ecology of antibiotic resistance determinants. Banbury report 24: antibiotic resistance genes: ecology, transfer and expression. Cold Spring Harbor Laboratory, pp 17–30Google Scholar
  41. Levy SB, Fitzgerald GB, Macone AB (1976) Spread of antibiotic resistant plasmids from chicken to chicken and from chicken to man. Nature 260: 40–42PubMedCrossRefGoogle Scholar
  42. Levy SB, Burke JP, Wallace CK (eds) (1987) Antibiotic use and antibiotic resistance worldwide. Rev Infect Dis 9 [Suppl 3]: S231 - S316CrossRefGoogle Scholar
  43. Locksley RM, Cohen ML, Quinn TC, Tompkins LS, Coyle MB, Kirihara JM, Counts GW (1982) Multiply antibiotic resistant Staphylococcus aureus: introduction, transmission and evolution of nosocomial infection. Ann Intern Med 97: 317–324PubMedGoogle Scholar
  44. Maas R (1983) An improved colony hybridization method with significantly increased sensitivity for detection of single genes. Plasmid 10: 296–298PubMedCrossRefGoogle Scholar
  45. MacArthur RD, Lehman MH, Currie-McCumber CA, Shlaes DM (1988) The epidemiology of resistant Pseudomonas aeruginosa on an Intermediate Care Ward. Am J Epidemiol 128: 821–827PubMedGoogle Scholar
  46. Markowitz SM, Smith SM, Williams DS (1983) Retrospective analysis of plasmid patterns in a study of burn unit outbreaks of infection due to Enterobacter cloacae. J Infect Dis 148: 18–23PubMedCrossRefGoogle Scholar
  47. Markowitz SM, Veazey JM, Macrina FL, Mayhall CG, Lamb VA (1980) Sequential outbreak of infection due to Klebsiella pneumoniae in a neonatal intensive care unit: implication of conjugative R plasmid. J Infect Dis 142: 106–112PubMedCrossRefGoogle Scholar
  48. Mayer KH, Fling ME, Hopkins JD, O’Brien TF (1985) Trimethoprim resistance in multiple genera of Enterobacteriaceae at a U.S. hospital: spread of the type II dihydrofolate reductase gene by a single plasmid. J Infect Dis 151: 783–789PubMedCrossRefGoogle Scholar
  49. Mayer KH, Hopkins JD, Gilleece ES, Chao L, O’Brien TF (1986) Molecular evolution, species distribution, and clinical consequences of an endemic aminoglycoside resistance plasmid. Antimicrob Agents Chemother 29: 628–633PubMedGoogle Scholar
  50. Mayo MS, Cook WL, Schlitzer RL, Ward MA, Wilson LA, Ahearn DG (1986) Antibiograms, serotypes and plasmid profiles of Pseudomonas aeruginosa associated with corneal ulcers and contact lens wear. J Clin Microbiol 24: 372–376PubMedGoogle Scholar
  51. McGowan JE (1983) Antimicrobial resistance in hospital organisms and its relation to antibiotic use. Rev Infect Dis 5: 1033–1048PubMedCrossRefGoogle Scholar
  52. McGowan JE, Terry PM, Huang T-SR, Houk CL, Davies J (1979) Nosocomial infections with gentamicin-resistant Staphylococcus aureus: plasmid analysis as an epidemiologic tool. J Infect Dis 140: 864–872PubMedCrossRefGoogle Scholar
  53. McKee KT, Cotton RB, Stratton CW, Lavely GB, Wright PF, Shenai JP, Evans ME, Melly MA, Farmer JJ, Karzon DT, Schaffner W (1982) Nursery epidemic due to multiply resistant Klebsiella pneumoniae: epidemiologic setting and impact on perinatal health care delivery. Infect Control 3: 150–156PubMedGoogle Scholar
  54. Meyers JA, Sanchez D, Elwell LP, Falkow S (1976) Simple agarose gel electrophoretic method for the identification and characterization of plasmid deoxyribonucleic acid. J Bacteriol 127: 1529–1537PubMedGoogle Scholar
  55. Murray BE, Rensimer ER (1983) Transfer of trimethoprim resistance from fecal Escherichia coli isolated during a prophylaxis study in Mexico. J Infect Dis 147: 724–728PubMedCrossRefGoogle Scholar
  56. Murray BE, Levine MM, Cordano AM et al. (1985) Survey of plasmids in Salmonella typhi from Chile and Thailand. J Infect Dis 151: 551–555PubMedCrossRefGoogle Scholar
  57. Nagano Y, Takahashi S (1985) Stored urine as a reservoir of gentamicin-resistant bacteria and as a site of conjugative R plasmid transfer. J Hosp Infect 6: 245–251PubMedGoogle Scholar
  58. Nakamura M, Sato S, Ohya T, Suzuki S, Ikeda S (1986) Plasmid profile analysis in epidemiological studies of animal Salmonella typhimurium infection in Japan. J Clin Microbiol 23: 3605Google Scholar
  59. Newport MT, John JF, Michel YM, Levkoff AH (1985) Endemic Serratia marcescens infection in a neonatal intensive care nursery associated with gastrointestinal colonization. Pediatr Infect Dis 4: 160–167PubMedCrossRefGoogle Scholar
  60. O’Brien TF, Ross DG, Guzman MA, Medeiros AA, Hedges RW, Botstein D (1980) Dissemination of an antibiotic resistance plasmid in hospital patient flora. Antimicrob Agents Chemother 17: 537–543PubMedGoogle Scholar
  61. O’Brien TF, Pla MdP, Mayer KH et al. (1985) Intercontinental spread of a new antibiotic resistance gene on an epidemic plasmid. Science 230: 87–88PubMedCrossRefGoogle Scholar
  62. O’Brien TF and members of task force 2 (1987) Resistance of bacteria to antibacterial agents: report of task force 2. Rev Infect Dis 9 [Suppl 3]: S244 - S260PubMedCrossRefGoogle Scholar
  63. O’Callagahan RJ, Rousset KM, Harkess NK, Murray ML, Lewis AC, Williams WL (1978) Analysis of increasing antibiotic resistance of Klebsiella pneumoniae relative to changes in chemotherapy. J Infect Dis 138: 293–298CrossRefGoogle Scholar
  64. Ogle JW, Janda JM, Woods DE, Vasil ML (1987) Characterization and use of a DNA probe as an epidemiological marker for Pseudomonas aeruginosa. J Infect Dis 155: 119–126PubMedCrossRefGoogle Scholar
  65. Olson B, Weinstein RA, Nathan C et al. (1984) Epidemiology of endemic Pseudomonas aeruginosa: why infection control efforts have failed. J Infect Dis 150: 808–816PubMedCrossRefGoogle Scholar
  66. Olson B, Weinstein RA, Nathan C et al. (1985) Occult aminoglycoside resistance in Pseudomonas aeruginosa: epidemiology and implications for therapy and control. J Infect Dis 152: 769–774PubMedCrossRefGoogle Scholar
  67. Olsvik O, Sorum H, Birkness K, Wachsmuth K, Fjolstad M, Lassen J, Fossum K, Feeley JC (1985) Plasmid characterization of Salmonella typhimurium transmitted from animals to humans. J Clin Microbiol 22: 336–338PubMedGoogle Scholar
  68. Parisi JT, Hecht DW (1980) Plasmid profiles in epidemiological studies of infections by Staphylococcus epidermidis. J Infect Dis 141: 637–643PubMedCrossRefGoogle Scholar
  69. Pederson SS, Koch C, Hoiby N, Rosendal K (1986) An epidemic spread of multiresistant Pseudomonas aeruginosa in a cystic fibrosis centre. J Antimicrob Chemother 17: 505–516CrossRefGoogle Scholar
  70. Petrocheilou V, Grinsted J, Richmond MH (1976) R-plasmid transfer in vivo in the absence of antibiotic selection pressure. Antimicrob Agents Chemother 10: 753–761PubMedGoogle Scholar
  71. Prado D, Murray BE, Cleary TG, Pickering LK (1987) Limitations of using the plasmid pattern as an epidemiological tool for clinical isolates of Shigella sonnei. J Infect Dis 155: 314–316PubMedCrossRefGoogle Scholar
  72. Price KE, Kresel PA, Farchione LA et al. (1981) Epidemiological studies of aminoglycoside resistance in the USA. J Antimicrob Chemother 8 [Suppl A]: 89–105PubMedGoogle Scholar
  73. Ratnam S, Hogan K, March SB, Butler RW (1986) Whirlpool-associated folliculitis: report of an outbreak and review. J Clin Microbiol 23: 655–659PubMedGoogle Scholar
  74. Rhinehart E, Shlaes DM, Keys TF, Serkey J, Kirkley B, Kim C, Currie-McCumber CA, Hall G (1987) Nosocomial clonal dissemination of methicillin-resistant Staphylococcus aureus. Arch Intern Med 147: 521–524PubMedCrossRefGoogle Scholar
  75. Rubens CE, McNeill WF, Farrar WE (1979) Evolution of multiple antibiotic resistance plasmids mediated by transposable plasmid deoxyribonucleic acid sequences. J Bacteriol 140: 713–719PubMedGoogle Scholar
  76. Rubens CE, Farrar WE, McGee ZA, Schaffner W (1981) Evolution of a plasmid mediating resistance to multiple antimicrobial agents during a prolonged epidemic of nosocomial infections. J Infect Dis 143: 170–181PubMedCrossRefGoogle Scholar
  77. Rudy RP, Murray BE (1984) Evidence for an epidemic trimethoprim-resistance plasmid in fecal isolates of Escherichia coli from citizens of the United States studying in Mexico. J Infect Dis 150: 25–29PubMedCrossRefGoogle Scholar
  78. Sadowski PL, Peterson BC, Gerding DN, Clearly PP (1979) Physical characterization of ten R plasmids obtained from an outbreak of nosocomial Klebsiella pneumoniae infections. Antimicrob Agents Chemother 15: 616–624PubMedGoogle Scholar
  79. Saravolatz LD, Markowitz N, Arking L, Pohlod D, Fisher E (1982) Methicillin-resistant Staphylococcus aureus: epidemiologic observations during a community acquired outbreak. Ann Intern Med 96: 11–16PubMedGoogle Scholar
  80. Schaberg DR, Zervos M (1986) Plasmid analysis in the study of the epidemiology of nosocomial gram positive cocci. Rev Infect Dis 8: 705–712PubMedCrossRefGoogle Scholar
  81. Schaberg DR, Highsmith AK, Wachsmuth IK (1977) Resistance plasmid transfer by Serrada marcescens in urine. Antimicrob Agents Chemother 11: 449–450PubMedGoogle Scholar
  82. Schaefler S, Jones D, Perry W et al. (1981) Emergence of gentamicin and methicillin resistant Staphylococcus aureus strains in New York City hospitals. J Clin Microbiol 13: 754–759PubMedGoogle Scholar
  83. Shlaes DM, Currie CA (1983) Endemic gentamicin resistant R factors on a spinal cord injury unit. J Clin Microbiol 18: 236–241PubMedGoogle Scholar
  84. Shlaes DM, Currie-McCumber CA (1986) Dissemination of a plasmid determining multiple antibiotic resistance between two Veterans Administration Medical Centers. Infect Control 7: 362–364PubMedGoogle Scholar
  85. Shlaes DM, Vartian C, Currie CA (1983) Variability in DNA sequence of closely related nosocomial gentamicin-resistance plasmids. J Infect Dis 148: 1013–1018PubMedCrossRefGoogle Scholar
  86. Shlaes DM, Currie-McCumber CA, Eanes M et al. (1986a) Gentamicin-resistance plasmids in an intensive care unit. Infect Control 7: 355–361Google Scholar
  87. Shlaes DM, Lehman MH, Currie-McCumber CA et al. (1986b) Prevalence of colonization with antibiotic resistant gram negative bacilli in a nursing home care unit. The importance of cross-colonization as documented by plasmid analysis. Infect Control 7: 538–545Google Scholar
  88. Shlaes DM, Currie-McCumber CA, Yessayan A (1987) The VA ANT(2+) plasmid in Dallas. Letter. Antimicrob Agents Chemother 31: 1155PubMedGoogle Scholar
  89. Shlaes DM, Currie-McCumber C, Lehman MH (1988) Introduction of a plasmid encoding the Ohio-I ß-lactamase to an intermediate care ward by patient transfer. Infect Control Hosp Epidemiol 9: 317–319PubMedCrossRefGoogle Scholar
  90. Shooter RA, Cooke EM, Gaya H et al. (1969) Food and medicaments as possible sources of hospital strains of Pseudomonas aeruginosa. Lancet 1: 227–229Google Scholar
  91. Southern EM (1975) Detection of specific sequences among DNA fragments separated by gel electrophoresis. J Mol Biol 98: 503–517PubMedCrossRefGoogle Scholar
  92. Spika JS, Waterman SH, Soo Hoo GW et al. (1987) Chloramphenicol-resistant Salmonella newport traced through hamburger to dairy farms. A major persisting source of human salmonellosis in California. N Engl J Med 316: 565–570PubMedCrossRefGoogle Scholar
  93. Steen R, Skold O (1985) Plasmid-borne or chromosomally mediated resistance by Tn7 is the most common response to ubiquitous use of trimethoprim. Antimicrob Agents Chemother 27: 933–937PubMedGoogle Scholar
  94. Tacket CO, Shahid N, Huq MI, Alim ARMA, Cohen ML (1984) Usefulness of plasmid profiles for differentiation of Shigella isolates in Bangladesh. J Clin Microbiol 20: 300–301PubMedGoogle Scholar
  95. Taylor DN, Wachsmuth IK, Shangkuan YH et al. (1982) Salmonellosis associated with marijuana: a multistate outbreak traced by plasmid fingerprinting. N Engl J Med 306: 1249–1253PubMedCrossRefGoogle Scholar
  96. Taylor DE, Chumpitaz JC, Goldstein F (1985) Variability of Inc HII plasmids from Salmonella typhi with special reference to Peruvian plasmids encoding resistance to trimethoprim and other antibiotics. Antimicrob Agents Chemother 28: 452–455PubMedGoogle Scholar
  97. Tompkins LS, Plorde JJ, Falkow S (1980) Molecular analysis of R factors from multiresistant nosocomial isolates. J Infect Dis 141: 625–636PubMedCrossRefGoogle Scholar
  98. Wachsmuth K (1986) Molecular epidemiology of bacterial infections: examples of methodology and of investigations of outbreaks. Rev Infect Dis 8: 682–692PubMedCrossRefGoogle Scholar
  99. Zervos MJ, Dembinski S, Mikesell T, Schaberg DR (1986a) High level resistance to gentamicin in Streptococcus faecalis: risk factors and evidence for exogenous acquisition of infection. J Infect Dis 153: 1075–1083CrossRefGoogle Scholar
  100. Zervos MJ, Mikesell TS, Schaberg DR (1986b) Heterogeneity of plasmids determining high level resistance to gentamicin in clinical isolates of Streptococcus faecalis. Antimicrob Agents Chemother 30: 78–81Google Scholar
  101. Zervos MJ, Kauffman CA, Therasse PM, Bergman AG, Mikesell TS, Schaberg DR (1987) Nosocomial infection by gentamicin-resistant Streptococcus faecalis. Ann Intern Med 106: 687–691PubMedGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • D. M. Shlaes
  • C. A. Currie-McCumber

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