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1.
Emerg Infect Dis ; 30(10): 2079-2089, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39320160

RESUMEN

Campylobacteriosis and antimicrobial resistance (AMR) are global public health concerns. Africa is estimated to have the world's highest incidence of campylobacteriosis and a relatively high prevalence of AMR in Campylobacter spp. from humans and animals. Few studies have compared Campylobacter spp. isolated from humans and poultry in Africa using whole-genome sequencing and antimicrobial susceptibility testing. We explored the population structure and AMR of 178 Campylobacter isolates from East Africa, 81 from patients with diarrhea in Kenya and 97 from 56 poultry samples in Tanzania, collected during 2006-2017. Sequence type diversity was high in both poultry and human isolates, with some sequence types in common. The estimated prevalence of multidrug resistance, defined as resistance to >3 antimicrobial classes, was higher in poultry isolates (40.9%, 95% credible interval 23.6%-59.4%) than in human isolates (2.5%, 95% credible interval 0.3%-6.8%), underlining the importance of antimicrobial stewardship in livestock systems.


Asunto(s)
Antibacterianos , Infecciones por Campylobacter , Campylobacter coli , Campylobacter jejuni , Diarrea , Pruebas de Sensibilidad Microbiana , Aves de Corral , Humanos , Campylobacter jejuni/efectos de los fármacos , Campylobacter jejuni/genética , Campylobacter jejuni/aislamiento & purificación , Animales , Diarrea/microbiología , Diarrea/epidemiología , Diarrea/tratamiento farmacológico , Infecciones por Campylobacter/microbiología , Infecciones por Campylobacter/epidemiología , Infecciones por Campylobacter/tratamiento farmacológico , Infecciones por Campylobacter/veterinaria , Aves de Corral/microbiología , Antibacterianos/farmacología , Campylobacter coli/efectos de los fármacos , Campylobacter coli/genética , Campylobacter coli/aislamiento & purificación , Farmacorresistencia Bacteriana , Enfermedades de las Aves de Corral/microbiología , Enfermedades de las Aves de Corral/epidemiología , Enfermedades de las Aves de Corral/tratamiento farmacológico , Secuenciación Completa del Genoma , África Oriental/epidemiología , Farmacorresistencia Bacteriana Múltiple , Filogenia
2.
PLoS One ; 19(9): e0308030, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39316598

RESUMEN

Thermotolerant Campylobacter is an important zoonotic pathogen known for causing gastroenteritis in humans, with poultry as its primary reservoir. A total of 468 samples were collected, of which 335 were chicken carcass samples (representing the food component), and 133 were chicken caeca samples (representing the animal component). These samples underwent culture, with colonies examined under a microscope. Species identification was achieved through multiplex PCR. Additionally, antimicrobial susceptibility profiles were determined using the Kirby-Bauer method, testing for sensitivity to gentamicin, ciprofloxacin, tetracycline, and erythromycin. Additionally, 55 C. jejuni (62.5%) and 33 C. coli (37.5%) isolates were selected for whole genome sequencing (WGS). A High prevalence of Campylobacter was observed, with rates of 95.5% (n = 127, CI95%: 92.5% - 98.5%) in the animal component and 72.5% (n = 243, CI95%: 69.9% - 75.1%) in the food component. Specifically, C. jejuni was detected in 33.1% (n = 42) of poultry farms and 38.3% (n = 93) of chicken carcasses, while C. coli was found in 64.6% (n = 82) of poultry farms and 60.5% (n = 147) of chicken carcasses. Antimicrobials with the highest rates of resistance (67%-100%) were ciprofloxacin and tetracycline, in both animal and food component isolates. Erythromycin resistance was notable, ranging from 22% to 33%, with only two C. jejuni isolates from retail were resistant to gentamicin. Furthermore, multidrug resistance was identified in 23% (20 isolates) of the Campylobacter isolates. Genetic analysis revealed the presence of fourteen resistance genes in both C. jejuni and C. coli isolates, including tet(O), blaOXA-460, blaOXA-184, blaOXA-489, blaOXA-193, blaOXA-784, blaOXA-603, aph(3')-IIIa, aad9, aph(2'')-If, aadE-Cc, sat4, and ant(6)-Ia. Additionally, twenty-five plasmids were detected in the 88 Campylobacter isolates examined. Interestingly, most isolates also harbored genes encoding putative virulence factors associated with pathogenicity, invasion, adherence, and production of cytolethal distending toxin (cdt): cheV, cheA, cheW, cheY, flaA, flgR, flaC, flaD, flgB, flgC, ciaB, ciaC. The WGS analysis showed the presence of several cgSTs in both animal and food components, with nine of them widely disseminated between components. Moreover, C. coli and C. jejuni isolates from different sources presented less than 11 single nucleotide polymorphisms (SNPs), suggesting clonality (16 isolates). Further analysis using SNP tree demonstrated widespread distribution of certain C. jejuni and C. coli clones across multiple farms and retail stores. This study presents, for the first-time, insights into the clonality, plasmid diversity, virulence, and antimicrobial resistance (AMR) of thermotolerant Campylobacter strains originating from the Ecuadorian poultry industry. The identification of AMR genes associated with the main antibiotics used in the treatment of campylobacteriosis in humans, highlights the importance of the prudent use of antimicrobials in the poultry industry. Additionally, this research remarks the need for regional studies to understand the epidemiology of this pathogen.


Asunto(s)
Antibacterianos , Infecciones por Campylobacter , Campylobacter coli , Campylobacter jejuni , Pollos , Granjas , Variación Genética , Campylobacter coli/genética , Campylobacter coli/efectos de los fármacos , Campylobacter coli/aislamiento & purificación , Animales , Campylobacter jejuni/genética , Campylobacter jejuni/efectos de los fármacos , Campylobacter jejuni/aislamiento & purificación , Pollos/microbiología , Antibacterianos/farmacología , Infecciones por Campylobacter/microbiología , Infecciones por Campylobacter/epidemiología , Infecciones por Campylobacter/veterinaria , Farmacorresistencia Bacteriana/genética , Ecuador/epidemiología , Pruebas de Sensibilidad Microbiana , Humanos , Microbiología de Alimentos , Secuenciación Completa del Genoma , Tetraciclina/farmacología
3.
PLoS One ; 19(8): e0305581, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39159178

RESUMEN

Campylobacteriosis outbreaks have previously been linked to dairy foods. While the genetic diversity of Campylobacter is well understood in high-income countries, it is largely unknown in low-income countries, such as Ethiopia. This study therefore aimed to conduct the first genomic characterization of Campylobacter isolates from the Ethiopian dairy supply chain to aid in future epidemiological studies. Fourteen C. jejuni and four C. coli isolates were whole genome sequenced using an Illumina platform. Sequences were analyzed using the bioinformatics tools in the GalaxyTrakr platform to identify MLST types, and single nucleotide polymorphisms, and infer phylogenetic relationships among the studied isolates. Assembled genomes were further screened to detect antimicrobial resistance and virulence gene sequences. Among 14 C. jejuni, ST 2084 and ST 51, which belong to the clonal complexes ST-353 and ST-443, respectively, were identified. Among the 4 sequenced C. coli isolates, two isolates belonged to ST 1628 and two to ST 830 from the clonal complex ST-828. The isolates of C. jejuni ST 2084 and ST 51 carried ß-lactam resistance gene blaOXA-605, a fluoroquinolone resistance-associated mutation T86I in the gryA gene, and a macrolide resistance-associated mutation A103V in 50S L22. Only ST 2084 isolates carried the tetracycline resistance gene tetO. Conversely, all four C. coli ST 830 and ST 1628 isolates carried tetO, but only ST 1628 isolates also carried blaOXA-605. Lastly, C. jejuni ST 2084 isolates carried a total of 89 virulence genes, and ST 51 isolates carried up to 88 virulence genes. Among C. coli, ST 830 isolates carried 71 genes involved in virulence, whereas two ST 1628 isolates carried up to 82 genes involved in virulence. Isolates from all identified STs have previously been isolated from human clinical cases, demonstrating a potential food safety concern. This finding warrants further monitoring of Campylobacter in dairy foods in Ethiopia to better understand and manage the risks associated with Campylobacter contamination and transmission.


Asunto(s)
Campylobacter coli , Campylobacter jejuni , Variación Genética , Filogenia , Campylobacter coli/genética , Campylobacter coli/aislamiento & purificación , Campylobacter coli/efectos de los fármacos , Campylobacter coli/patogenicidad , Campylobacter jejuni/genética , Campylobacter jejuni/aislamiento & purificación , Campylobacter jejuni/patogenicidad , Etiopía/epidemiología , Infecciones por Campylobacter/microbiología , Infecciones por Campylobacter/epidemiología , Productos Lácteos/microbiología , Genoma Bacteriano/genética , Secuenciación Completa del Genoma , Polimorfismo de Nucleótido Simple , Microbiología de Alimentos , Antibacterianos/farmacología , Humanos , Tipificación de Secuencias Multilocus , Virulencia/genética , Farmacorresistencia Bacteriana/genética , Animales
4.
Arch Razi Inst ; 79(1): 41-54, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-39192957

RESUMEN

Campylobacter spp. genera is one of the most common causes of microbial enteritis worldwide. This study aimed to find out how common Campylobacter organisms were in raw meat from large livestock in Iran, as well as to determine their antibiotic susceptibility profiles. Several 550 fresh, ready-to-eat meat samples were collected from slaughterhouses, butcher shops, and restaurants in the study region. The samples were collected from cattle (n=138), goats (n=102), camels (n=56), and sheep (n=254). Campylobacter spp. were isolated and identified using normal bacteriological methods and polymerase chain reaction (PCR). Genotyping was performed using PCR to identify virulence genes. The disc diffusion technique was used to determine antibiotic susceptibility. The two Campylobacter spp. were found in 84 (15.27%) of the 550 meat samples tested. Cattle and camel samples accounted for the highest (52.38%) and lowest (3.57%) frequencies of Campylobacter spp., respectively. There were significant differences in the prevalence of Campylobacter spp. in cattle (2=43.04 or OR=7.68, CI=3.40-17.30, P<0.01). Campylobacter jejuni and Campylobacter coli accounted for 82.14% (n=69) of Campylobacter spp. isolated from raw meat. While C. jejuni was found in 39.28% of the samples (n=33), C. coli was observed in 42.85% (n=36). Other Campylobacter spp. formed 17.85 % (n=15) of the samples. The most common genotypes observed in C. jejuni bacteria collected from different types of large animal samples were ciaB (100%) and flaA (100%). On the other hand, virbll (7.69%) was the C. jejuni strain found with the lowest incidence in different large animal samples. The most frequent genotypes found in C. coli bacteria were ciaB (100%) and flaA (100%). C. coli isolates dnaJ (0%), wlaN (0%), virbll (0%), and ceuE (0%) were detected with the lowest frequency in several samples from large livestock. Campylobacter spp. isolated from different sample types and sources were 100% sensitive to aphA-3-1 and GM10. The isolates were reported to be resistant to E15 (76.93%), cmeB (69.24%), aadE1 (69.24%), CIP5 (69.24%), and AM10 (69.24%). According to this study, Campylobacter was found in food from factory farming. Consequently, the disease can be transmitted by eating raw or undercooked meat. Therefore, proper handling and preparation of meat meals, as well as hygiene measures from the slaughterhouse to the retailer, are critical in preventing Campylobacter infections.


Asunto(s)
Antibacterianos , Camelus , Campylobacter coli , Campylobacter jejuni , Farmacorresistencia Bacteriana , Cabras , Carne , Animales , Campylobacter jejuni/efectos de los fármacos , Campylobacter jejuni/aislamiento & purificación , Campylobacter jejuni/genética , Irán/epidemiología , Campylobacter coli/efectos de los fármacos , Campylobacter coli/aislamiento & purificación , Bovinos , Ovinos , Camelus/microbiología , Carne/microbiología , Antibacterianos/farmacología , Microbiología de Alimentos , Ganado/microbiología
5.
PLoS One ; 19(7): e0304409, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38959220

RESUMEN

BACKGROUND: Children with under-five year age disproportionally affected with foodborne illness. Campylobacteriosis is the most common foodborne disease next to Norovirus infection. Macrolides are commonly prescribed as the first line of treatment for Campylobacter gastroenteritis, with fluoroquinolone and tetracycline as secondary options. However, resistance to these alternatives has been reported in various regions worldwide. OBJECTIVE: To determine the prevalence, associated risk-factors and antimicrobial resistance of Campylobacter jejuni and C. coli among under-five children with diarrhea. METHODS: Institution-based cross-sectional study was conducted from November, 2022 to April 2023. The study sites were selected using a random sampling technique, while the study subjects were included using a convenient sampling technique. The data were collected using a structured questionnaire. Stool samples were inoculated onto modified charcoal cefoperazone deoxycholate agar and incubated for 48 hours. The suspected colonies were analyzed using matrix-assisted laser desorption ionization-time of flight mass spectrometry to confirm the species. Antimicrobial susceptibility testing was performed using a disc diffusion technique. All potential covariates (independent variables) were analyzed one by one using bivariate logistic regression model to identify candidate variables with P value < 0.25. Multivariable logistic analysis was used to identify potential associated factors using the candidate variables. A p value ≤ 0.05 at a 95% confidence interval was statistically significant. RESULT: Among the 428 samples, 7.0% (CI: 4.5-9.3) were confirmed Campylobacter species. The prevalence of C. jejuni and C. coli among under-five children was 5.1% (CI: 3.0-7.0) and 1.9% (CI: 0.7-3.3), respectively. C. jejuni (73.3%) was dominant over C. coli (26.7%). The resident, contact with domestic animals, and parents/guardians education level were significantly associated with campylobacteriosis among under-five children. One-third of the Campylobacter isolates (33.3%, 10/30) were resistant to ciprofloxacin and tetracycline whereas 10.0% (3/30) were resistant to erythromycin. Furthermore, 3.3% (1/30) of the Campylobacter were found to be multidrug-resistant. CONCLUSION: The prevalence of Campylobacter species was 7.0%. The resistance rate of Campylobacter species of ciprofloxacin and tetracycline-resistance strains was 33.3%. Peri-urban residence, contact with domestic animals, and low parental educational statuses were significantly associated factors with increased risk of Campylobacter infection. Continuous surveillance on antimicrobial resistance and health education of personal and environmental hygiene should be implemented in the community.


Asunto(s)
Antibacterianos , Infecciones por Campylobacter , Campylobacter coli , Campylobacter jejuni , Diarrea , Humanos , Campylobacter jejuni/efectos de los fármacos , Campylobacter jejuni/aislamiento & purificación , Campylobacter coli/efectos de los fármacos , Campylobacter coli/aislamiento & purificación , Infecciones por Campylobacter/epidemiología , Infecciones por Campylobacter/tratamiento farmacológico , Infecciones por Campylobacter/microbiología , Preescolar , Lactante , Femenino , Masculino , Diarrea/epidemiología , Diarrea/microbiología , Diarrea/tratamiento farmacológico , Etiopía/epidemiología , Estudios Transversales , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana , Prevalencia , Pruebas de Sensibilidad Microbiana , Recién Nacido , Factores de Riesgo
6.
J Food Prot ; 87(7): 100308, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38815809

RESUMEN

Human gastrointestinal infections caused by Campylobacter species is the second most important foodborne illness after salmonellosis worldwide. Poultry represent one of the main sources of Campylobacter organisms. In the present study, the short variable region of flagellin gene (SVR-flaA) typing was carried out to determine the variation among the circulating strains of Campylobacter jejuni and Campylobacter coli. The C. jejuni and C. coli isolated from poultry and poultry meat were screened for the presence of virulence determinants like cadF, flaA, cdtB, and wlaN gene. The screening for wlaN gene is crucial in view of the fact that most patients with Guillian Barre's (GB) syndrome with a preceding history of diarrheal illness have been found to harbor wlaN gene-positive C jejuni strains. Out of the 200 samples comprising poultry meat and cloacal swabs, 21.5% of samples were found to harbor Campylobacter spp. of which 2.5% were Campylobacter jejuni, and 19% were confirmed as Campylobacter coli. The cadF, flaA, cdtB virulence genes were detected in all the Campylobacter spp. isolated in the present study. The presence of the wlaN gene in the Campylobacter jejuni isolated in the present study may pose a public health threat with long-term human health implications. The SVR-flaA typing of twelve Campylobacter isolates obtained in the present study revealed that Campylobacter coli flaA sequence OL471375 is a new strain with a novel allele type 1,675 and peptide sequence 5 which stands deposited in pubMLST database for Campylobacter. The other flaA-SVR gene sequences identified in this study were OL471369, OL471370, OL471371, OL471372, OL471373, and OL471374. Among twelve Campylobacter spp., three distinct DdeI-RFLP patterns were observed, each varying in size from 100 to 1,000 base pairs. Antimicrobial profiling of the Campylobacter spp. isolated in the present study revealed that 50% of the strains were multidrug resistant. All the Campylobacter spp. were resistant to ciprofloxacin (CIP), ampicillin (AMP), penicillin (PEN), and nalidixic acid (NAL) whereas 57.1% of strains were resistant to tetracycline (TET) and erythromycin (ERY) 28% to amoxicillin (AMX) and enrofloxacin (ENO), 85% to amikacin (AMK). The high degree of resistance to fluoroquinolones observed in the present study is crucial in view of fluoroquinolones being drugs of choice for the treatment of human Campylobacter infections.


Asunto(s)
Campylobacter coli , Campylobacter jejuni , Farmacorresistencia Bacteriana Múltiple , Flagelina , Aves de Corral , Animales , Flagelina/genética , Humanos , Campylobacter jejuni/efectos de los fármacos , Campylobacter jejuni/genética , India , Campylobacter coli/efectos de los fármacos , Campylobacter coli/genética , Virulencia , Contaminación de Alimentos/análisis , Microbiología de Alimentos , Factores de Virulencia/genética , Campylobacter/efectos de los fármacos , Campylobacter/genética , Carne/microbiología , Variación Genética , Antibacterianos/farmacología , Pruebas de Sensibilidad Microbiana
7.
J Glob Antimicrob Resist ; 38: 27-34, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38821444

RESUMEN

OBJECTIVES: Campylobacter is a significant zoonotic pathogen primarily transmitted through poultry. Our study aimed to assess antimicrobial resistance and genetic relationships among Campylobacter isolates from retail chicken meat and humans in Taiwan. METHODS: Campylobacter isolates were analysed using whole-genome sequencing to investigate their antimicrobial resistance, genetic determinants of resistance, and genotypes. RESULTS: Campylobacter coli and Campylobacter jejuni accounted for 44.9% and 55.1% of chicken meat isolates, and 11.4% and 88.6% of human isolates, respectively. C. coli displayed significantly higher resistance levels. Furthermore, isolates from chicken meat exhibited higher levels of resistance to most tested antimicrobials compared to isolates from humans. Multidrug resistance was observed in 96.3% of C. coli and 43.3% of C. jejuni isolates from chicken meat and 80.6% of C. coli and 15.8% of C. jejuni isolates from humans. Macrolide resistance was observed in 85.5% of C. coli isolates, primarily attributed to the erm(B) rather than the A2075G mutation in 23S rRNA. Among the 511 genomes, we identified 133 conventional MLST sequence types, indicating significant diversity among Campylobacter strains. Notably, hierarchical Core-genome multilocus sequence typing clustering, including HC0, HC5, and HC10, revealed a significant proportion of closely related isolates from chicken meat and humans. CONCLUSIONS: Our research highlights significant associations in antimicrobial resistance and genetic relatedness between Campylobacter isolates from chicken meat and humans in Taiwan. The genetic analysis data suggest that campylobacteriosis outbreaks may occur more frequently in Taiwan than previously assumed. Our study emphasizes the need for strategies to control multidrug-resistant strains and enhance outbreak prevention.


Asunto(s)
Antibacterianos , Infecciones por Campylobacter , Campylobacter coli , Campylobacter jejuni , Pollos , Farmacorresistencia Bacteriana Múltiple , Carne , Pruebas de Sensibilidad Microbiana , Tipificación de Secuencias Multilocus , Secuenciación Completa del Genoma , Campylobacter jejuni/genética , Campylobacter jejuni/efectos de los fármacos , Campylobacter jejuni/aislamiento & purificación , Campylobacter coli/efectos de los fármacos , Campylobacter coli/genética , Campylobacter coli/aislamiento & purificación , Pollos/microbiología , Animales , Humanos , Taiwán , Antibacterianos/farmacología , Infecciones por Campylobacter/microbiología , Infecciones por Campylobacter/epidemiología , Carne/microbiología , Farmacorresistencia Bacteriana Múltiple/genética , Genotipo , Farmacorresistencia Bacteriana/genética , Microbiología de Alimentos
8.
Vet Microbiol ; 293: 110083, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38593623

RESUMEN

Campylobacter spp., such as Campylobacter jejuni and Campylobacter coli, are important zoonotic Gram-negative pathogens that cause acute intestinal diseases in humans. In this study, a retrospective analysis was conducted on previously collected Campylobacter isolates from antimicrobial resistance surveillance. A total of 29 optrA-positive C. coli strains were identified and subjected to second-generation sequencing. Multilocus sequence typing and single nucleotide polymorphism analyses demonstrated that the 29 optrA-positive isolates were genetically homogeneous. Notably, among the 29 isolated strains, the ΔoptrA variants exhibit a nonsense mutation at position 979 where the base C is substituted by T, leading to the formation of a premature termination codon. The alignment of sequences and genetic environmental characteristics suggested that ΔoptrA located on a chromosomally carried multidrug-resistant genomic island. There are other resistant genes on the multidrug resistance genomic island, such as aph(2'')-If, aph(3')-III, aadE, tet(O), tet(L), cat, erm(A), optrA and blaOXA-61. As a result, the 29 ΔoptrA-positive strains displayed susceptibility to both florfenicol and linezolid. The ΔoptrA gene is linked to the erm(A) gene, resulting in the formation of translocatable unit (TU) that are encompassed by two copies of IS1216 mobile elements. Multiple occurrences of similar TUs have been documented in numerous C. coli and provided evidence for the significance of TUs in facilitating the transfer of drug resistance genes in C. coli.


Asunto(s)
Antibacterianos , Infecciones por Campylobacter , Campylobacter coli , Pollos , Farmacorresistencia Bacteriana Múltiple , Islas Genómicas , Campylobacter coli/genética , Campylobacter coli/efectos de los fármacos , Islas Genómicas/genética , Pollos/microbiología , Animales , Farmacorresistencia Bacteriana Múltiple/genética , Antibacterianos/farmacología , Infecciones por Campylobacter/microbiología , Infecciones por Campylobacter/veterinaria , Estudios Retrospectivos , Proteínas Bacterianas/genética , Pruebas de Sensibilidad Microbiana , Tipificación de Secuencias Multilocus , Enfermedades de las Aves de Corral/microbiología , Polimorfismo de Nucleótido Simple
9.
Arch Razi Inst ; 77(1): 249-255, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-35891742

RESUMEN

Antimicrobial resistance is a critical public health issue that affects people all over the world. Since bacteria have a proclivity for rapidly acquiring and propagating the resistance gene, antimicrobial-resistant Campylobacter has a negative impact on public health. As a result, the creation of new and highly pathogenic clones is facilitated, making antimicrobial treatment more challenging. This study aimed to determine the antimicrobial resistance pattern (ARP) models, multiple drug resistance (MDR) models, and multiple antibiotic resistance (MAR) index of Campylobacter species isolated from poultry meat sold in Baghdad markets, Iraq. By employing the disc diffusion test, 30 Campylobacter strains from chicken meat, including C. jejuni (n=10) and C. coli (n=20), were exposed to tetracycline (TET), erythromycin, Gentamicin, nalidixic acid, ciprofloxacin, and norfloxacin (NOR). The ARP of the Campylobacter isolates revealed up to five antibiotypes for two species, which revealed resistance to one or more antimicrobials, and 67% of them had MDR resistance to two or more experienced antimicrobials. The NOR-TET model is the most common MDR, having a prevalence of 30% among experienced isolates. In addition, the MAR index, equal to and lower than one, was found in 87% of the isolates. Antibiotic resistance in Campylobacter raises the probability of treatment failure in humans and animals, as well as the propagation of antimicrobial resistance genes. As a result, the presence of Campylobacter in meat could pose a risk of human infection and pollution of the environment.


Asunto(s)
Campylobacter coli , Campylobacter jejuni , Farmacorresistencia Bacteriana Múltiple , Carne , Aves de Corral , Animales , Antibacterianos/farmacología , Campylobacter coli/efectos de los fármacos , Campylobacter coli/genética , Campylobacter jejuni/efectos de los fármacos , Campylobacter jejuni/genética , Pollos , Farmacorresistencia Bacteriana Múltiple/genética , Irak , Carne/microbiología , Pruebas de Sensibilidad Microbiana/veterinaria , Aves de Corral/microbiología , Tetraciclina
10.
Vet Microbiol ; 264: 109308, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34922150

RESUMEN

Although Campylobacter, an obligate microaerophilic foodborne pathogen, is susceptible to oxygen, aerotolerant/hyper-aerotolerant (HAT) Campylobacter can survive under aerobic conditions. Here, we aimed to reveal what affects the enhanced aerotolerance in HAT Campylobacter coli at genome and gene expression levels. We compared the whole genomes between HAT and oxygen-sensitive (OS) C. coli isolates from swine and analyzed the relative expressions of oxidative stress-related (sodB, ahpC, katA, and trxB) and iron transport/uptake-related (cfbpA, ceuE, feuB, and feoB) genes. The comparative genomics showed no relation between the clustering of the strains and aerotolerance levels. The reactive oxygen species-related factors involved in respiration, stress response, and iron acquisition/uptake were similar among the strains, regardless of their aerotolerance levels. However, the expressions of the oxidative stress-related genes under aerobic conditions compared to that of microaerobic conditions increased in the HAT strains, while decreased in the OS strains. Our findings suggest that what influences differences in aerotolerance between HAT and OS C. coli may be due to the differential expressions of oxidative stress-related genes despite the similarities in genomic structure. This study provides insights into the genetic basis of aerotolerance in C. coli. Therefore, it could assist in managing HAT C. coli that has the potential to be easily transmitted to humans through the food chain.


Asunto(s)
Campylobacter coli , Estrés Oxidativo , Animales , Campylobacter coli/efectos de los fármacos , Campylobacter coli/genética , Enfermedades Transmitidas por los Alimentos/microbiología , Regulación de la Expresión Génica/efectos de los fármacos , Estrés Oxidativo/genética , Oxígeno/farmacología , Porcinos , Transcriptoma
11.
Food Microbiol ; 100: 103853, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34416958

RESUMEN

The combined effects of ethylenediaminetetraacetic acid (EDTA) and bacteriophage (phage) treatment of foodborne pathogens were investigated. Although viable counts for Campylobacter jejuni decreased by 1.5 log after incubation for 8 h in the presence of phage PC10, re-growth was observed thereafter. The combination of phage PC10 and 1 mM EDTA significantly inhibited the re-growth of C. jejuni. The viable counts for C. jejuni decreased by 2.6 log (P < 0.05) compared with that of the initial count after 24 h. Moreover, EDTA at 0.67 or 1.3 mM, combined with the specific lytic phages, also effectively inhibited the re-growth of phage-resistant cells of Campylobacter coli, Salmonella enterica serovar Enteritidis, and Salmonella enterica serovar Typhimurium. In addition, the combined effects of lytic phages and EDTA were investigated on the viability of Campylobacter in BHI broth at low temperatures followed by the optimum growth temperature. The re-growth of C. coli was significantly inhibited by the coexistence of 1.3 mM EDTA, and the viable counts of surviving bacteria was about the same as the initial viable count after the incubation. This is the first study demonstrating the combined use of lytic phages and EDTA is effective in inhibiting the re-growth of phage-resistant bacteria in Gram-negative bacteria.


Asunto(s)
Bacteriófagos/fisiología , Campylobacter coli/crecimiento & desarrollo , Campylobacter jejuni/crecimiento & desarrollo , Ácido Edético/farmacología , Salmonella enteritidis/crecimiento & desarrollo , Salmonella typhimurium/crecimiento & desarrollo , Campylobacter coli/efectos de los fármacos , Campylobacter coli/virología , Campylobacter jejuni/efectos de los fármacos , Campylobacter jejuni/virología , Viabilidad Microbiana , Salmonella enteritidis/efectos de los fármacos , Salmonella enteritidis/virología , Salmonella typhimurium/efectos de los fármacos , Salmonella typhimurium/virología
12.
mSphere ; 6(3)2021 05 12.
Artículo en Inglés | MEDLINE | ID: mdl-33980673

RESUMEN

Previous studies indicated that Campylobacter has developed several mechanisms that confer resistance to florfenicol, which is used in food animal production. This study describes the coexistence of optrA and fexA in Campylobacter jejuni and Campylobacter coli isolates from pigs and poultry. Moreover, whole-genome sequencing data showed that the two genes are located in various multidrug resistance genomic islands within different regions of the Campylobacter genomes. The emergence of optrA and fexA may support the spread of florfenicol-resistant Campylobacter strains of animal origin.IMPORTANCE Florfenicol is widely used for the treatment of respiratory infections and as a feed additive in food animal production. As a foodborne pathogen, Campylobacter is constantly exposed to florfenicol, and resistance to this antimicrobial agent has increased in recent years. Previous studies indicated that Campylobacter has developed several mechanisms that confer resistance to florfenicol. This study describes for the first time the coexistence of the florfenicol exporter FexA and the ribosomal protective protein OptrA in Campylobacter jejuni isolated from pigs. The two genes were located in various multidrug resistance genomic islands within different regions of the Campylobacter genomes. Although phenicols are not commonly used for the treatment of Campylobacter infections, the extensive use of florfenicol in food animals may play a role in the coselection of multidrug resistance genomic island (MDRGI)-carrying Campylobacter isolates which also exhibited resistance to critically important antimicrobial agents (macrolides, aminoglycosides, and tetracyclines) commonly used for the treatment of human campylobacteriosis.


Asunto(s)
Proteínas Bacterianas/genética , Infecciones por Campylobacter/veterinaria , Campylobacter coli/genética , Campylobacter jejuni/genética , Farmacorresistencia Bacteriana Múltiple/genética , Animales , Antibacterianos/farmacología , Infecciones por Campylobacter/microbiología , Campylobacter coli/efectos de los fármacos , Campylobacter jejuni/efectos de los fármacos , Islas Genómicas , Aves de Corral/microbiología , Porcinos/microbiología , Tianfenicol/análogos & derivados , Tianfenicol/farmacología
13.
Ann Clin Microbiol Antimicrob ; 20(1): 36, 2021 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-34016127

RESUMEN

BACKGROUND: Campylobacter resistance to antimicrobial agents is regarded as a major concern worldwide. The aim of this study was to investigate the expression of the CmeABC efflux pump and the RAPD-PCR pattern in drug-resistant Campylobacter isolates. METHODS: A total of 283 stool specimens were collected from children under the age of five with diarrhea. The minimum inhibitory concentration (MIC) of tetracycline and ciprofloxacin was determined by broth microdilution method and E-test, respectively. Detection of tetracycline and ciprofloxacin determinants was done by amplification of tetO gene and PCR-sequencing of the gyrA gene. The cmeABC transcriptional expression was analyzed by Real-time (RT)-PCR. Clonal correlation of resistant strains was determined by RAPD-PCR genotyping. RESULTS: Out of 283 fecal samples, 20 (7.02%) samples were positive for Campylobacter spp. Analysis of duplex PCR assay of the cadF gene showed that 737 and 461 bp amplicons were corresponding to Campylobacter jejuni and Campylobacter coli, respectively. All of the 17 phenotypically tetracycline-resistant Campylobacter isolates harbored the tetO gene. Also, four phenotypically ciprofloxacin-resistant Campylobacter isolates had a point mutation at codon 257 of the gyrA gene (ACA to ATA; Thr > Ile). High-level expression of the cmeA gene was observed in ciprofloxacin-resistant and high-level tetracycline-resistant Campylobacter isolates, suggesting a positive correlation between the cmeA gene expression level and tetracycline resistance level. Moreover, a statistically significant difference was observed in the cmeA gene expression between ciprofloxacin-resistant and ciprofloxacin-susceptible strains, which signifies the crucial contribution of the efflux pump in conferring multiple drug resistance phenotype among Campylobacter spp. RAPD analysis of Campylobacter isolates exhibited 16 different patterns. Simpsone`s diversity index of RAPD-PCR was calculated as 0.85, showing a high level of homogeneity among the population; however, no clear correlation was detected among tetracycline and/or ciprofloxacin resistant isolates. CONCLUSION: Significant contribution of the CmeABC efflux pump in conferring high-level resistance to tetracycline and ciprofloxacin was observed in C. jejuni and C. coli clinical isolates. The resistant phenotype is suggested to be mediated by CmeABC efflux pumps, the tetO gene, and point mutation of the gyrA gene. Genotyping revealed no clonal correlation among resistant strains, indicating distinct evolution of tetracycline and ciprofloxacin resistant genotypes among the isolates.


Asunto(s)
Antibacterianos/farmacología , Campylobacter coli/efectos de los fármacos , Campylobacter coli/fisiología , Campylobacter jejuni/efectos de los fármacos , Campylobacter jejuni/fisiología , Farmacorresistencia Bacteriana , Proteínas de Transporte de Membrana/fisiología , Proteínas Bacterianas/fisiología , Ciprofloxacina/farmacología , ADN Bacteriano , Diarrea/microbiología , Heces/microbiología , Humanos , Pruebas de Sensibilidad Microbiana , Técnica del ADN Polimorfo Amplificado Aleatorio , Tetraciclina/farmacología
14.
Foodborne Pathog Dis ; 18(7): 462-468, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33887151

RESUMEN

Campylobacter is one of the most common causes of foodborne bacterial infections worldwide. Why poultry has been shown to be one of the most significant sources of these bacteria, ruminants, especially cattle, are also responsible for a high number of human Campylobacter jejuni, and to a lesser extent Campylobacter coli, infections. In this study, bovine and pig carcasses in Poland were investigated for the presence of Campylobacter and for their antimicrobial resistance. A total of 204 swabs from bovine carcasses and 355 swab samples from pig carcasses were tested during 2014-2018. Campylobacter was identified in 129 (36.3%) of the pig and in 11 (5.4%) of the bovine carcasses, respectively. The pig isolates were classified as C. coli (121; 34.1%) or C. jejuni (8; 2.3%), whereas the bovine Campylobacter were identified either as C. jejuni (8; 3.9% isolates) or C. coli (3; 1.5% strains). Resistance of the isolates (n = 140) to erythromycin, ciprofloxacin, nalidixic acid, streptomycin, and tetracycline revealed that the vast majority of C. coli was resistant to streptomycin (106 isolates; 85.5%), tetracycline (97; 78.2%), nalidixic acid (90; 72.6%), and ciprofloxacin (88; 71.0%). Among C. jejuni isolates (n = 16) the resistance rates to all antibiotics were lower than in C. coli, irrespective of the origin. A total of 74 of 121 (61.2%) C. coli isolates from the pig carcasses and one of three such isolates from the bovine samples were multiresistant. Most of the C. coli (64 isolates; 85.3%) had the ciprofloxacin+nalidixic acid+streptomycin+tetracycline resistance profile. The results suggest that pig and bovine carcasses may be an underestimated reservoir of Campylobacter, especially for C. coli in pigs. The high antimicrobial resistance rates of such strains to streptomycin, quinolones, and tetracyclines highlight the need for monitoring of these bacteria in such food and food products.


Asunto(s)
Antibacterianos/farmacología , Campylobacter/efectos de los fármacos , Bovinos/microbiología , Farmacorresistencia Bacteriana , Porcinos/microbiología , Animales , Campylobacter/patogenicidad , Campylobacter coli/efectos de los fármacos , Campylobacter coli/patogenicidad , Polonia , Quinolonas/farmacología , Estreptomicina/farmacología , Tetraciclinas/farmacología
15.
Pediatr Infect Dis J ; 40(4): 356-358, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33710980

RESUMEN

Metagenomic next-generation sequencing is a promising tool for detecting pathogens that are difficult to isolate by traditional modalities, particularly in the diagnosis of complex infections in immunocompromised children. We describe a child with X-linked agammaglobulinemia and chronic abdominal pain diagnosed with a multiorganism infection (Helicobacter cinaedi, Campylobacter coli and Parainfluenza) identified by various diagnostic tools, including plasma metagenomic next-generation sequencing.


Asunto(s)
Dolor Abdominal/microbiología , Agammaglobulinemia/complicaciones , Campylobacter coli/genética , Coinfección/diagnóstico , Enfermedades Genéticas Ligadas al Cromosoma X/complicaciones , Helicobacter/genética , Huésped Inmunocomprometido , Paramyxoviridae/genética , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/microbiología , Campylobacter coli/efectos de los fármacos , Campylobacter coli/patogenicidad , Niño , Coinfección/tratamiento farmacológico , Coinfección/microbiología , Coinfección/virología , Helicobacter/efectos de los fármacos , Helicobacter/patogenicidad , Humanos , Masculino , Metagenómica/métodos , Infecciones por Paramyxoviridae/diagnóstico , Infecciones por Paramyxoviridae/virología
16.
PLoS One ; 16(2): e0246755, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33566816

RESUMEN

Campylobacter jejuni and Campylobacter coli are globally recognized as a major cause of bacterial foodborne gastroenteritis. A cross-sectional study was conducted from October 2015 to May 2016 in Mekelle city to isolate, identify, and estimate the prevalence of C. jejuni and C. coli in raw meat samples and to determine their antibiotic susceptibility pattern. A total of 384 raw meat samples were randomly collected from bovine (n = 210), goat (n = 108), and chicken (n = 66), and isolation and identification of Campylobacter spp. were performed using standard bacteriological techniques and PCR. Antibiotic susceptibility test was performed using disc diffusion method. Of the total 384 raw meat samples, 64 (16.67%) were found positive for Campylobacter spp. The highest prevalence of Campylobacter spp. was found in chicken meat (43.93%) followed by bovine meat (11.90%) and goat meat (9.25%). The most prevalent Campylobacter spp. isolated from meat samples was C. jejuni (81.25%). The overall prevalence of Campylobacter in restaurants, butcher shops, and abattoir was 43.93%, 18.30%, and 9.30%, respectively. 96.8%, 81.25%, 75%, and 71% of the Campylobacter spp. isolates were sensitive to norfloxacin, erythromycin, chloramphenicol, and sulphamethoxazole-trimethoprim, respectively. However, 96.9%, 85.9%, and 50% of the isolates were resistant to ampicillin, amoxicillin, and streptomycin, respectively. Strains that developed multi-drug resistant were 68.7%. The result of this study revealed the occurrence of Campylobacter in bovine, goat, and chicken meats. Hence, there is a chance of acquiring infection via consumption of raw or undercooked meat. Thus, implementation of hygienic practices from a slaughterhouse to the retailers, proper handling and cooking of foods of meat are very important in preventing Campylobacter infection.


Asunto(s)
Infecciones por Campylobacter/microbiología , Campylobacter coli/efectos de los fármacos , Campylobacter jejuni/efectos de los fármacos , Pollos/microbiología , Farmacorresistencia Bacteriana Múltiple , Cabras/microbiología , Carne/microbiología , Amoxicilina/farmacología , Ampicilina/farmacología , Animales , Antibacterianos/farmacología , Campylobacter coli/aislamiento & purificación , Campylobacter jejuni/aislamiento & purificación , Bovinos , Cloranfenicol/farmacología , Estudios Transversales , Eritromicina/farmacología , Etiopía , Pruebas de Sensibilidad Microbiana , Norfloxacino/farmacología , Prevalencia , Estreptomicina/farmacología , Sulfametoxazol/farmacología , Trimetoprim/farmacología
17.
PLoS One ; 16(2): e0246571, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33571292

RESUMEN

The Center for Disease Control and Prevention identifies antimicrobial resistant (AMR) Campylobacter as a serious threat to U.S. public health due to high community burden, increased transmissibility, and limited treatability. The National Antimicrobial Resistance Monitoring System (NARMS) plays an important role in surveillance of AMR bacterial pathogens in humans, food animals and retail meats. This study investigated C. coli and C. jejuni from live food animals, poultry carcasses at production, and retail meat in North Carolina between January 2018-December 2019. Whole genome sequencing and bioinformatics were used for phenotypic and genotypic characterization to compare AMR profiles, virulence factors associated with Guillain-Barré Syndrome (GBS) (neuABC and cst-II or cst-III), and phylogenic linkage between 541 Campylobacter isolates (C. coli n = 343, C. jejuni n = 198). Overall, 90.4% (489/541) Campylobacter isolates tested positive for AMR genes, while 43% (233/541) carried resistance genes for three or more antibiotic classes and were classified molecularly multidrug resistant. AMR gene frequencies were highest against tetracyclines (64.3%), beta-lactams (63.6%), aminoglycosides (38.6%), macrolides (34.8%), quinolones (24.4%), lincosamides (13.5%), and streptothricins (5%). A total of 57.6% (114/198) C. jejuni carried GBS virulence factors, while three C. coli carried the C. jejuni-like lipooligosaccharide locus, neuABC and cst-II. Further evidence of C. coli and C. jejuni interspecies genomic exchange was observed in identical multilocus sequence typing, shared sequence type (ST) 7818 clonal complex 828, and identical species-indicator genes mapA, ceuE, and hipO. There was a significant increase in novel STs from 2018 to 2019 (2 in 2018 and 21 in 2019, p<0.002), illustrating variable Campylobacter genomes within food animal production. Introgression between C. coli and C. jejuni may aid pathogen adaption, lead to higher AMR and increase Campylobacter persistence in food processing. Future studies should further characterize interspecies gene transfer and evolutionary trends in food animal production to track evolving risks to public health.


Asunto(s)
Campylobacter coli/genética , Campylobacter jejuni/genética , Farmacorresistencia Bacteriana , Transferencia de Gen Horizontal , Animales , Antibacterianos/farmacología , Proteínas Bacterianas/genética , Campylobacter coli/efectos de los fármacos , Campylobacter coli/aislamiento & purificación , Campylobacter jejuni/efectos de los fármacos , Campylobacter jejuni/aislamiento & purificación , Carne/microbiología , North Carolina , Aves de Corral/microbiología
18.
J Appl Microbiol ; 130(4): 1368-1379, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32886839

RESUMEN

AIM: To analyse the prevalence, genetic diversity and antimicrobial susceptibility of Campylobacter spp. in northern Spain. METHODS AND RESULTS: Campylobacter was isolated from 139 samples of broiler meat and faecal dropping of broiler and swine with a prevalence of 35·4, 62 and 42·8%, respectively. Campylobacter jejuni (n = 55) and Campylobacter coli (n = 31) were identified by multiplex-PCR in meat, faeces and human clinical samples while Campylobacter fetus (n = 3) was exclusively detected in the latter. Fingerprinting by flaA-RFLP and PFGE revealed 68 different genotypes from the 89 isolates with a Biodiversity Simpson's index of 0·98. The 86·5% of the isolates were resistant to ciprofloxacin, 85·4% to tetracycline and 49·4% to erythromycin; only three genotypes were susceptible to the three antimicrobial drugs. Multidrug resistance was detected in the 40·7% of the isolates. CONCLUSIONS: Campylobacter remains prevalent in northern Spain with a high biodiversity degree. About 93·3% of the isolates were resistant to one or more drugs. SIGNIFICANCE AND IMPACT OF THE STUDY: Although different measures are taken to control Campylobacter, the detection of isolates resistant to the drugs used in the treatment of campylobacteriosis is still high, including different species and genotypes. This evidences the need of additional strategies against this pathogen.


Asunto(s)
Antibacterianos/farmacología , Infecciones por Campylobacter/veterinaria , Campylobacter coli/efectos de los fármacos , Campylobacter jejuni/efectos de los fármacos , Enfermedades de las Aves de Corral/microbiología , Enfermedades de los Porcinos/microbiología , Animales , Infecciones por Campylobacter/epidemiología , Infecciones por Campylobacter/microbiología , Campylobacter coli/clasificación , Campylobacter coli/genética , Campylobacter coli/aislamiento & purificación , Campylobacter jejuni/clasificación , Campylobacter jejuni/genética , Pollos , Ciprofloxacina/farmacología , Farmacorresistencia Bacteriana , Eritromicina/farmacología , Carne/microbiología , Pruebas de Sensibilidad Microbiana , Tipificación Molecular , Filogenia , Enfermedades de las Aves de Corral/epidemiología , Prevalencia , España/epidemiología , Porcinos , Enfermedades de los Porcinos/epidemiología , Tetraciclina/farmacología
19.
Int J Food Microbiol ; 338: 108998, 2021 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-33279789

RESUMEN

Reducing the Campylobacter load on poultry carcasses represents a major tasks for the industry as its ability to reduce their presence is of major interest aiming to increase consumer safety. This study investigated the ability of a mixture of natural antimicrobials (A3001) to reduce the adherence of the T6SS+/-C. coli isolates (NC1hcp-, NC2 hcp- and NC3 hcp+) to chicken neck skin and whole carcasses. Overall, the antimicrobial mixture induced a significant reduction in the capability of our C. coli isolates to colonise the chicken skin (p < 0.05) and carcasses (p < 0.0001) but with a greater effect (≈3 log reduction) on the NC3 isolate. Using the HCT-8 in vitro infection model we also show that at a concentration of 0.5% A3001, the impact on the NC3 isolate is accompanied by the downregulation of the hcp gene (p = 0.0001), and indicator of the T6SS presence. The results described herein also indicated that these isolates are highly resistant to H2O2, up to 20 mM, suggesting a high resilience to environmental stresses. In summary our study shows that natural antimicrobials can reduce the ability of T6SS positive chicken C. coli isolates to adhere to chicken skin or to the whole carcass and to infect epithelial cells in vitro and could be considered a potential intervention at processor level.


Asunto(s)
Campylobacter coli/efectos de los fármacos , Pollos/microbiología , Microbiología de Alimentos , Piel/microbiología , Animales , Antibacterianos/farmacología , Peróxido de Hidrógeno/farmacología
20.
Indian J Med Microbiol ; 38(2): 157-161, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32883928

RESUMEN

Purpose: Campylobacter is one of the most common pathogens that cause food-borne infections worldwide. The aim of this study was to determine the antimicrobial resistance rates and the presence of multiple virulence genes in Campylobacter isolates obtained from humans. Materials and Methods: In this study, 71 Campylobacter isolates obtained from human faecal samples were used. Antimicrobial susceptibility tests were performed through the gradient strip method. The presence of virulence genes was investigated by monoplex and multiplex polymerase chain reaction. Results: The rate of resistance of the 66 Campylobacter jejuni isolates was 12.1% for erythromycin, 40.9% for tetracycline and 68.2% for ciprofloxacin. Only one of five Campylobacter coli isolates was resistant to these three antimicrobial agents. The flaB, pldA, cdtA, cadF, cdtC and ceuE genes were found in all 66 of the C. jejuni isolates. In the C. jejuni isolates, positivity rates of 92.4% for flaA, 96.7% for cdtB, 98.5% for ciaB, 90.9% for dnaJ and 96.7% for racR were observed. The flaA, flaB, ciaB, cdtA and cdtC genes were present in all C. coli isolates. Conclusions: It was detected that there is an increase in antimicrobial resistance of Campylobacter strains in our region, and most of the isolates harbour virulence genes.


Asunto(s)
Antibacterianos/farmacología , Infecciones por Campylobacter/microbiología , Campylobacter coli/genética , Campylobacter jejuni/genética , Genes Bacterianos , Campylobacter coli/efectos de los fármacos , Campylobacter coli/aislamiento & purificación , Campylobacter coli/patogenicidad , Campylobacter jejuni/efectos de los fármacos , Campylobacter jejuni/aislamiento & purificación , Campylobacter jejuni/patogenicidad , Ciprofloxacina/farmacología , Farmacorresistencia Bacteriana/genética , Farmacorresistencia Bacteriana Múltiple/genética , Eritromicina/farmacología , Heces/microbiología , Humanos , Centros de Atención Terciaria , Tetraciclina/farmacología , Resistencia a la Tetraciclina/genética , Turquía , Virulencia/genética
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