scholarly journals Antimicrobial resistance in non-typhi Salmonella enterica isolated from humans and poultry in Palestine

2011 ◽  
Vol 6 (02) ◽  
pp. 132-136 ◽  
Author(s):  
Rula AL-Dawodi ◽  
Mohammad A Farraj ◽  
Tamer Essawi
Keyword(s):  
Drug Resistance ◽  
Antimicrobial Resistance ◽  
Nalidixic Acid ◽  
Gene Mutation ◽  
Direct Sequencing ◽  
Resistance Mechanism ◽  
Fluoroquinolone Resistance ◽  
Mutation Pattern ◽  
Resistance Rates ◽  
Prevalent Mutation

Introduction: The efficacy of chemotherapy can be compromised by drug resistance.  This study was undertaken to describe the resistance profiles and fluoroquinolone resistance mechanism of non-typhoidal Salmonella (NTS) isolated from humans and poultry in West Bank, Palestine. Methodology: One hundred and fifty-one isolates of NTS, obtained from humans (71) and poultry (80), collected between September 2005 and January 2007, were tested for susceptibility to ampicillin, gentamicin, tetracycline ceftriaxone, nalidixic acid and ciprofloxacin. Mutation patterns within gyrA were determined by direct sequencing or by digestion of PCR-amplified DNA fragments with the restriction enzyme HinfI. Results: Resistance rates among human and poultry isolates were respectively 59% and 51% for ampicillin, 31% and 10% for gentamicin, 59% and 80% for tetracycline, 59% and 45% for nalidixic acid, and 30% and 15% for ciprofloxacin. All the isolates were susceptible to ceftriaxone. Mutations at positions 83 and/or 87 were detected in gyrA of isolates with resistance to nalidixic acid. Isolates which were resistant to nalidixic acid but susceptible to ciprofloxacin had a single gyr A gene mutation at point 87.  This gene mutation was sufficient to induce a new phenotype (6 isolates) with decreased susceptibility to ciprofloxacin. Conclusion: Mutations in gyrA at positions 83 or 87 were the most prevalent mutation pattern of fluoroquinolone resistant NTS isolates but other unknown mechanisms are also present. Continued surveillance of antimicrobial resistance among NTS isolates is needed to mitigate the increasing prevalence of quinolone resistance.

scholarly journals The Role of Aquatic Ecosystems (River Tua, Portugal) as Reservoirs of Multidrug-Resistant Aeromonas spp.

Water ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 698
Author(s):  
Sónia Gomes ◽  
Conceição Fernandes ◽  
Sandra Monteiro ◽  
Edna Cabecinha ◽  
Amílcar Teixeira ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antimicrobial Resistance ◽  
Nalidixic Acid ◽  
Water Samples ◽  
Aquatic Ecosystems ◽  
Anthropogenic Activities ◽  
Aquatic Organisms ◽  
Resistant Bacteria ◽  
Anthropogenic Pressures ◽  
Resistance Rates

The inappropriate use of antibiotics, one of the causes of the high incidence of antimicrobial-resistant bacteria isolated from aquatic ecosystems, represents a risk for aquatic organisms and the welfare of humans. This study aimed to determine the antimicrobial resistance rates among riverine Aeromonas spp., taken as representative of the autochthonous microbiota, to evaluate the level of antibacterial resistance in the Tua River (Douro basin). The prevalence and degree of antibiotic resistance was examined using motile aeromonads as a potential indicator of antimicrobial susceptibility for the aquatic environment. Water samples were collected from the middle sector of the river, which is most impacted area by several anthropogenic pressures. Water samples were plated on an Aeromonas-selective agar, with and without antibiotics. The activity of 19 antibiotics was studied against 30 isolates of Aeromonas spp. using the standard agar dilution susceptibility test. Antibiotic resistance rates were fosfomycin (FOS) 83.33%, nalidixic acid (NA) 60%, cefotaxime (CTX) 40%, gentamicin (CN) 26.67%, tobramycin (TOB) 26.67%, cotrimoxazole (SXT) 26.67%, chloramphenicol (C) 16.67%, and tetracycline (TE) 13.33%. Some of the nalidixic acid-resistant strains were susceptible to fluoroquinolones. Multiple resistance was also observed (83.33%). The environmental ubiquity, the natural susceptibility to antimicrobials and the zoonotic potential of Aeromonas spp. make them optimal candidates for studying antimicrobial resistance (AMR) in aquatic ecosystems. Aquatic environments may provide an ideal setting for the acquisition and dissemination of antibiotic resistance because anthropogenic activities frequently impact them. The potential risk of multi- and pan-resistant bacteria transmission between animals and humans should be considered in a “One Health—One World” concept.

scholarly journals Impact of an Intervention to Control Imipenem-Resistant Acinetobacter baumannii and Its Resistance Mechanisms: An 8-Year Survey

2021 ◽  
Vol 11 ◽  
Author(s):  
Lida Chen ◽  
Pinghai Tan ◽  
Jianming Zeng ◽  
Xuegao Yu ◽  
Yimei Cai ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Acinetobacter Baumannii ◽  
Bacterial Resistance ◽  
Efflux Pump ◽  
Resistance Mechanism ◽  
Resistance Mechanisms ◽  
Multi Drug Resistance ◽  
Minimal Inhibitory Concentrations ◽  
Resistance Rates ◽  
The Impact

BackgroundThis study aimed to examine the impact of an intervention carried out in 2011 to combat multi-drug resistance and outbreaks of imipenem-resistant Acinetobacter baumannii (IRAB), and to explore its resistance mechanism.MethodsA total of 2572 isolates of A. baumannii, including 1673 IRAB isolates, were collected between 2007 and 2014. An intervention was implemented to control A. baumannii resistance and outbreaks. Antimicrobial susceptibility was tested by calculating minimal inhibitory concentrations (MICs), and outbreaks were typed using pulsed-field gel electrophoresis (PFGE). Resistance mechanisms were explored by polymerase chain reaction (PCR) and whole genome sequencing (WGS).ResultsFollowing the intervention in 2011, the resistance rates of A. baumannii to almost all tested antibiotics decreased, from 85.3 to 72.6% for imipenem, 100 to 80.8% for ceftriaxone, and 45.0 to 6.9% for tigecycline. The intervention resulted in a decrease in the number (seven to five), duration (8–3 months), and departments (five to three) affected by outbreaks; no outbreaks occurred in 2011. After the intervention, only blaAMPC (76.47 to 100%) and blaTEM–1 (75.74 to 96.92%) increased (P < 0.0001); whereas blaGES–1 (32.35 to 3.07%), blaPER–1 (21.32 to 1.54%), blaOXA–58 (60.29 to 1.54%), carO (37.50 to 7.69%), and adeB (9.56 to 3.08%) decreased (P < 0.0001). Interestingly, the frequency of class B β-lactamase genes decreased from 91.18% (blaSPM–1) and 61.03% (blaIMP–1) to 0%, while that of class D blaOXA–23 increased to 96.92% (P < 0.0001). WGS showed that the major PFGE types causing outbreaks each year (type 01, 11, 18, 23, 26, and 31) carried the same resistance genes (blaKPC–1, blaADC–25, blaOXA–66, and adeABC), AdeR-S mutations (G186V and A136V), and a partially blocked porin channel CarO. Meanwhile, plasmids harboring blaOXA–23 were found after the intervention.ConclusionThe intervention was highly effective in reducing multi-drug resistance of A. baumannii and IRAB outbreaks in the long term. The resistance mechanisms of IRAB may involve genes encoding β-lactamases, efflux pump overexpression, outer membrane porin blockade, and plasmids; in particular, clonal spread of blaOXA–23 was the major cause of outbreaks. Similar interventions may also help reduce bacterial resistance rates and outbreaks in other hospitals.

scholarly journals Antimicrobial resistance in Salmonella enterica serovar Enteritidis in Morocco

2010 ◽  
Vol 4 (12) ◽  
pp. 804-809 ◽  
Author(s):  
Farida Ohmani ◽  
Khadija Khedid ◽  
Saad Britel ◽  
Aicha Qasmaoui ◽  
Reda Charof ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Nalidixic Acid ◽  
Salmonella Enterica ◽  
Inhibitory Concentration ◽  
Diffusion Method ◽  
Salmonella Enterica Serovar Enteritidis ◽  
Gastrointestinal Infections ◽  
Disk Diffusion Method ◽  
Resistance Patterns ◽  
Resistance Rates

Introduction: Salmonella enterica is recognised worldwide as one of the major agents of human gastrointestinal infections. The aim of the present work is to ascertain the antimicrobial susceptibilities of 150 Salmonella enterica serovar Enteritidis isolates from humans in Morocco during the period from 2000 to 2008. Methodology: Antimicrobial resistance determination was performed by disk diffusion method using seven antibiotics. The minimal inhibitory concentration (MIC) of ciprofloxacin was determined for nalidixic acid-resistant (NAR) isolates using E-test strips. Results: Sixty-one (42%) isolates were resistant to at least one class of antimicrobial agent. The largest numbers of resistant isolates were observed for nalidixic acid with 53 isolates (36%) followed by ampicillin with 7 isolates (5%), tetracycline with 6 isolates (4%), and trimethoprim/sulfamethoxazole with 2 isolates (1%).The resistant isolates were grouped in seven different resistance patterns of which two isolates were resistant to three antibiotics. Among the 53 (36%) NAR isolates, 37 (76%) had a reduced susceptibility to ciprofloxacin. Conclusion: Resistance rates of Salmonella enterica serovar Enteritidis from Morocco are generally low but the resistance to nalidixic acid is worryingly common. Continual surveillance of antibiotic resistance is of primary importance.

scholarly journals Salmonella Heidelberg Isolated from Poultry Shows a Novel Resistance Profile

2018 ◽  
Vol 44 (1) ◽  
pp. 6 ◽  
Author(s):  
Gabriella Bassi das Neves ◽  
Lenita Moura Stefani ◽  
Eduarda Pick ◽  
Denise Nunes Araujo ◽  
Jéssica Giuriatti ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Antimicrobial Resistance ◽  
Nalidixic Acid ◽  
Multiple Drug Resistance ◽  
Horizontal Transmission ◽  
Multi Drug Resistance ◽  
Disk Diffusion Test ◽  
Resistance Profile ◽  
Drug Resistance Pattern ◽  
Field Samples

Background: The development of antimicrobial resistance in bacteria is a serious public health issue worldwide. Salmonella spp. is considered a leader cause of gastrointestinal disease in animals and humans, and poultry products have been reported as an important reservoir of the bacterium. S. Heidelberg became lately one of the most prevalent serovars found in several countries. However, hardly any information is available about the epidemiology and the resistance profile of it. Therefore, the objective of this study was to determine the antibiotic resistance profile of S. Heidelberg (SH) and to compare to S. Enteritidis (SE) and S. Typhimurium (ST) isolated from the Southern part of Brazil.Materials, Methods & Results: A total of 162 Salmonella isolates of poultry origin serotyped as SH (54), SE (54), and ST (54) were submitted to the disk-diffusion test with disks containing 10 antibiotics of 7 different classes, routinely used in veterinary and human medicine such as: enrofloxacin, ciprofloxacin, norfloxacin, gentamicin, ceftiofur, ceftriaxone, nalidixic acid, tetracycline, sulfamethoxazole-trimethoprim, and chloramphenicol. In addition, the Multi-drug Resistance Pattern (MDRP) and the Multiple-Drug Resistance Index (MDRI) were determined. The Chi-square (χ2) test with 1% of significance level was used to statistically evaluate the results. All isolates were susceptible to norfloxacin, enrofloxacin, and ciprofloxacin. The majority of the isolates were resistant to the quinolone class (68%), more specifically to nalidixic acid, which is considered a synthetic quinolone, followed by penicillin (47%) and cephalosporin (16%). Overall, SH isolates showed higher resistance compared to ST and SE (18, 16.5, and 9.6%, respectively). SH isolated from field samples, mainly drag swabs, showed higher resistance levels (24.2%) than those isolated from slaughterhouses (5.6%). SH showed the highest percentage of resistance to ceftiofur (31.5%), ceftriaxone (9.3%), and tetracycline (64.8%) in comparison to the other two serotypes. Most of the SH isolates were resistant to at least two (66.7%), three or more antibiotics (33.3%). A different scenario was observed for ST and SE, where 25.9 and 9.3% were susceptible to at least one drug, respectively. The most common pattern of resistance (MDRP) was C (gentamicin - nalidixic acid - tetracycline) for 14 SH isolates, and A (ceftiofur - nalidixic acid - tetracycline) for 12 SH isolates. MDRI indicated that 22.8% of all isolates were multidrug resistant. SH was the isolate with the largest variety of resistance patterns compared to ST and SE, where 11.7% of the isolates were resistant to more than three antibiotics. In addition, SH showed the greatest MDRI (0.25) ranging from 0.2 to 0.5.Discussion: SH was resistant to almost all antibiotics tested and showed multi-drug resistant profile, therefores, it showed a potential for horizontal transmission of resistance genes. Additionally, SH showed a higher resistance profile for ceftiofur, an important antibiotic used in poultry, which can cross-resist to ceftriaxone, commonly used to treat salmonellosis in children. Our results showed that SH is a real challenge regarding antimicrobial resistance. This scenario leads to the need for rational and judicious use of antimicrobials in poultry and, as an alert to the medical community.

scholarly journals Prevalence of fluoroquinolone resistance and mutations in the gyrA, parC and parE genes of Riemerella anatipestifer isolated from ducks in China

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Dekang Zhu ◽  
Mingyu Zheng ◽  
Jinge Xu ◽  
Mingshu Wang ◽  
Renyong Jia ◽  
...  
Keyword(s):  
Amino Acid ◽  
Nalidixic Acid ◽  
High Frequency ◽  
Resistance Mechanism ◽  
Fold Increase ◽  
Fluoroquinolone Resistance ◽  
Mutation Site ◽  
Riemerella Anatipestifer ◽  
Substitution Mutations

Abstract Background Riemerella anatipestifer is one of the most serious infectious disease-causing pathogens in the duck industry. Drug administration is an important method for prevention and treatment of infection in duck production, leading to widespread drug resistance in R. anatipestifer. Methods For a total of 162 isolates of R. anatipestifer, the MICs were determined for a quinolone antimicrobial agent, namely, nalidixic acid, and three fluoroquinolones, namely, ciprofloxacin, enrofloxacin and ofloxacin. The gyrA, parC, and parE gene fragments were amplified by PCR to identify the mutation sites in these strains. Site-directed mutants with mutations that were detected at a high frequency in vivo were constructed (hereafter referred to as site-directed in vivo mutants), and the MICs of these four drugs for these strains were determined. Results In total, 100, 97.8, 99.3 and 97.8% of the 137 R. anatipestifer strains isolated between 2013 and 2018 showed resistance to nalidixic acid, ciprofloxacin, enrofloxacin, and ofloxacin, respectively. The high-frequency mutation sites were detected in a total of 162 R. anatipestifer strains, such as Ser83Ile and Ser83Arg, which are two types of substitution mutations of amino acid 83 in GyrA; Val799Ala and Ile811Val in ParC; and Val357Ile, His358Tyr, and Arg541Lys in ParE. MIC analysis results for the site-directed in vivo mutants showed that the strains with only the Ser83Ile mutation in GyrA exhibited an 8–16-fold increase in MIC values, and all mutants showed resistance to ampicillin and ceftiofur. Conclusions The resistance of R. anatipestifer to quinolone agents is a serious problem. Amino acid 83 in GyrA is the major target mutation site for the fluoroquinolone resistance mechanism of R. anatipestifer.

scholarly journals Prevalence and antimicrobial resistance of Campylobacter isolates from poultry offals

2017 ◽  
Vol 73 (9) ◽  
pp. 561-566
Author(s):  
Beata Wysok ◽  
Joanna Wojtacka ◽  
Agnieszka Wiszniewska – Łaszczych ◽  
Joanna Szteyn ◽  
Małgorzata Gomółka–Pawlicka
Keyword(s):  
Drug Resistance ◽  
Antimicrobial Resistance ◽  
Nalidixic Acid ◽  
Acid Resistance ◽  
Coli Strain ◽  
Multi Drug Resistance ◽  
Species Analysis ◽  
By Products ◽  
Nalidixic Acid Resistance

The aim of the study was to determine the presence of Campylobacter strains in poultry by-products and define antimicrobial resistance of isolates. In total, 400 samples were tested among which 300 included the liver, heart and stomach, and 100 samples represented the contents of the cecum. The samples were taken from chickens and turkeys in the slaughterhouse after evisceration. The prevalence of Campylobacter in chicken samples was 100% with regards to the contents of cecum and offal. The turkey origin Campylobacter strains were noted in 76% of the livers, 78% hearts and 82% gizzards. The samples of cecum contents were positive in 60%. Species analysis of the strains isolated showed C. jejuni as dominant. The estimation of sensitivity to antibiotics showed that Campylobacter strains were most frequently resistant to quinolones and tetracyclines. Resistance to ciprofloxacin was detected among 52.7% and 52.5% chicken and turkey origin strains. The same was noted regarding nalidixic acid, resistance to which was shown in 56% and 58.5% isolates, respectively. Regarding tetracyclines, the highest resistance of the strains from chicken and turkey was detected to doxycyclinum in 61.3% and 53.3% of isolates, respectively. However the highest sensitivity was showed to erythromycin, gentamicin and chloramphenicol. Only one C. coli strain from turkey offal was resistant to gentamicin. Simultaneously multi drug resistance was defined. The aimed studies showed that 62% of C. jejuni and 53.8% of C. coli strains from chicken offal were resistant to two or more agents. In turkey origin isolates MDR was detected in 54.7% of C. jejuni and 53.3% of C. coli strains.

scholarly journals A Study on Molecular Detection of Mutations Associated with Second Line Anti-tuberculosis Drug Resistance

2019 ◽  
pp. 1-7
Author(s):  
Akansha Goyal ◽  
Hiral Gadhavi ◽  
Binita Aring ◽  
Summaiya Mullan
Keyword(s):  
Drug Resistance ◽  
Gene Mutation ◽  
Geographical Area ◽  
Rapid Identification ◽  
Drug Resistant ◽  
Second Line ◽  
Gyra Gene ◽  
Tb Control ◽  
Mutation Pattern ◽  
Resistant Strains

Background: Efficient tuberculosis (TB) control is based on an early diagnosis followed by the rapid identification of drug resistance, in order to treat patients adequately, break the chain of transmission, and avoid the spread of resistant strains. Multidrug-resistant (MDR) Mycobacterium tuberculosis have emerged worldwide and seriously threaten TB control and prevention programs. At the same time, the emergence of extensively drug-resistant tuberculosis (XDR TB) has also become an important global health problem. Objectives: To detect common gene mutation pattern associated with drug resistance against second line anti-tuberculosis drugs in TB patients by SL-LPA as a rapid and early diagnostic test. Materials and Methods:total 652 sputum samples were received from 30 districts at culture district laboratory, Jamnagar from October 2018 to December 2018, and were included in the study. Second line Second line- line probe assay (SL-LPA) was used to detect mutations associated with resistance for anti-tuberculosis drugs. Results: Out of the 652 samples analyzed for mutations associated with second line anti-tuberculosisdrug resistance, 43% of the samples exhibited various forms of mutations. Out of these samples, mutations associated with gyrA gene were detected in 36.6% samples, gyrB gene mutation in 0.7% samples, rrs gene mutation in 4.4% samples and eis gene mutation in 1.2% samples. Conclusion: The present study provide information on the mutation pattern of drug resistant strains present in the geographical area and help to provide the basis for effective strategies for control of drug resistant TB in this region. It also re-emphasizes the importance of second line LPA which can diagnose TB and drug resistance in a single day and allows earlier administration of appropriate treatment as compared to culture result which take 1-2 months.

Serovars and antimicrobial resistance of non-typhoidal Salmonella from human patients in Shanghai, China, 2006–2010

2013 ◽  
Vol 142 (4) ◽  
pp. 826-832 ◽  
Author(s):  
J. ZHANG ◽  
H. JIN ◽  
J. HU ◽  
Z. YUAN ◽  
W. SHI ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Antimicrobial Resistance ◽  
Nalidixic Acid ◽  
Fourth Generation ◽  
The Third ◽  
Stool Specimens ◽  
Resistance Rates

SUMMARYWe conducted a retrospective study on non-typhoidal Salmonella isolates from patients with diarrhoea in Shanghai, China, 2006–2010. A total of 1484 isolates of 70 Salmonella serovars were recovered from about 18 000 stool specimens. Serovars Enteritidis and Typhimurium were the most prevalent with isolation rates of 27·6% and 25·5%, respectively. The majority (1151, 77·6%) of the isolates were resistant to at least one antimicrobial, and 598 (40·3%) to more than three antimicrobials. Approximately half (50·9%) of the isolates were resistant to nalidixic acid and other resistance rates were sulfisoxazole (47·9%), streptomycin (37·6%), ampicillin (31·3%) and tetracycline (30·5%). Co-resistance to fluoroquinolones and the third- and fourth-generation cephalosporins was also identified.

scholarly journals Species Distribution, Antimicrobial Resistance, and Enterotoxigenicity of Non-aureus Staphylococci in Retail Chicken Meat

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 809
Author(s):  
Soo In Lee ◽  
Sun Do Kim ◽  
Ji Heon Park ◽  
Soo-Jin Yang
Keyword(s):  
Antimicrobial Resistance ◽  
Opportunistic Infections ◽  
Food Poisoning ◽  
Tetracycline Resistance ◽  
Chicken Meat ◽  
Fluoroquinolone Resistance ◽  
Coagulase Negative Staphylococci ◽  
Meat Samples ◽  
Resistance Rates ◽  
Retail Chicken Meat

Non-aureus staphylococci (NAS), including coagulase-negative staphylococci, have emerged as important causes of opportunistic infections in humans and animals and a potential cause of staphylococcal food poisoning. In this study, we investigated (i) the staphylococcal species profiles of NAS in in retail chicken meat, (ii) the phenotypic and genotypic factors associated with antimicrobial resistance in the NAS isolates, and (iii) the prevalence of classical and newer staphylococcal enterotoxin (SE) genes. A total of 58 NAS of nine different species were isolated from retail raw chicken meat samples. The occurrence of multidrug resistance in the NAS, particularly S. agnetis and S. chromogenes, with high resistance rates against tetracycline or fluoroquinolones were confirmed. The tetracycline resistance was associated with the presence of tet(L) in S. chromogenes and S. hyicus or tet(K) in S. saprophyticus. The occurrence of fluoroquinolone resistance in S. agnetis and S. chromogenes was usually associated with mutations in the quinolone resistance determining regions (QRDR) of gyrA and parC. In addition, the frequent presence of SE genes, especially seh, sej, and sep, was detected in S. agnetis and S. chromogenes. Our findings suggest that NAS in raw chicken meat can have potential roles as reservoirs for antimicrobial resistance and enterotoxin genes.

scholarly journals Association between Antimicrobial Consumption and Resistance in Escherichia coli

2008 ◽  
Vol 53 (3) ◽  
pp. 912-917 ◽  
Author(s):  
Miika Bergman ◽  
Solja T. Nyberg ◽  
Pentti Huovinen ◽  
Pirkko Paakkari ◽  
Antti J. Hakanen
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Resistance ◽  
Clinical Microbiology ◽  
Urine Samples ◽  
Fluoroquinolone Resistance ◽  
Antimicrobial Consumption ◽  
Ampicillin Resistance ◽  
E Coli ◽  
Amoxicillin Clavulanate ◽  
Resistance Rates

ABSTRACT During a 9-year study period from 1997 through 2005, the association between antimicrobial resistance rates in Escherichia coli and outpatient antimicrobial consumption was investigated in 20 hospital districts in Finland. A total of 754,293 E. coli isolates, mainly from urine samples, were tested for antimicrobial resistance in 26 clinical microbiology laboratories. The following antimicrobials were studied: ampicillin, amoxicillin-clavulanate, cephalosporins, fluoroquinolones, trimethoprim, trimethoprim-sulfamethoxazole, pivmecillinam, and nitrofurantoin. We applied a protocol used in earlier studies in which the level of antimicrobial consumption over 1 year was compared with the level of resistance in the next year. Statistically significant associations were found for nitrofurantoin use versus nitrofurantoin resistance (P < 0.0001), cephalosporin use versus nitrofurantoin resistance (P = 0.0293), amoxicillin use versus fluoroquinolone resistance (P = 0.0031), and fluoroquinolone use versus ampicillin resistance (P = 0.0046). Interestingly, we found only a few associations between resistance and antimicrobial consumption. The majority of the associations studied were not significant, including the association between fluoroquinolone use and fluoroquinolone resistance.

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