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1.0137 -1.1116 TD
[(The)-403.1(inducible)-410(AmpC)-405(activity)-403.3(was)-408.3(tested)-406.4(phenotypically)]TJ
-1.0137 -1.1174 TD
[(using)-333.7(disk)-338.4(approximation)-340.8(technique.)-333.9(Imipenem)-342(\(10)]TJ
/F6 1 Tf
21.092 0 TD
(m)Tj
/F5 1 Tf
.5529 0 TD
[(g\),)-333.9(ce-)]TJ
-21.645 -1.1116 TD
[(foxitin)-261.5(\(30)]TJ
/F6 1 Tf
4.4407 0 TD
(m)Tj
/F5 1 Tf
.5529 0 TD
[(g\),)-259(and)-263.6(amoxicillin-clavulanate)-271.9(\(20/10)]TJ
/F6 1 Tf
15.5973 0 TD
(m)Tj
/F5 1 Tf
.5529 0 TD
[(g\))-261.4(disks)]TJ
-21.1439 -1.1116 TD
[(are)-276.3(used)-276.1(as)-273.9(the)-275.3(inducing)-275.2(antibiotics,)-277.5(and)-269.4(ceftazidime)-284.5(\(30)]TJ
/F6 1 Tf
22.9064 0 TD
(m)Tj
/F5 1 Tf
.5529 0 TD
(g\))Tj
-23.4593 -1.1174 TD
[(disks)-425.7(\(Bio-Rad\))-427.9(as)-423.6(the)-425(reporter)-425.9(antibiotic.)-426.4(Disks)-420.8(were)-428(ap-)]TJ
0 -1.1116 TD
[(plied)-248.8(by)-249.9(use)-246.2(of)-249.8(an)-245.3(applicator)-251(at)-251.2(a)-249.9(distance)-248.5(of)-249.8(20)-163.5(mm,)-250(and)-246.4(any)]TJ
T*
[(obvious)-353.2(blunting)-354.8(or)-353.5(attening)-358.1(of)-353.5(the)-350.2(zone)-358.1(of)-353.5(inhibition)-351.5(be-)]TJ
0 -1.1174 TD
[(tween)-348.7(the)-344.4(ceftazidime)-353.6(disk)-344.2(and)-344.3(the)-350.2(inducing)-344.3(antibiotic)-348.1(was)]TJ
0 -1.1116 TD
[(interpreted)-338.5(as)-337.2(a)-330.6(positive)-338.5(result)-336.1(for)-331.5(AmpC.)]TJ
/F2 1 Tf
8.9663 0 0 8.9663 313.0582 725.7825 Tm
[(Inhibitory)-336.5(effects)-334.6(of)-336.7(CCCP)-335.1(against)-333.8(efux)-333.9(pumps)]TJ
/F5 1 Tf
9.843 0 0 9.843 323.0361 709.3416 Tm
[(Efux)-300.3(pump)-293.6(overexpression)-300.8(was)-298.9(initially)-299.8(screened)-295.5(for)-297(by)]TJ
-1.0137 -1.1116 TD
[(testin)-8(g)-461.9(susceptibility)-473.2(to)-463.1(imipenem)-468.9(and)-465.2(meropenem)-470.8(in)-468.9(the)]TJ
0 -1.1174 TD
[(presence)-324.3(and)-321.2(absence)-317.4(of)-319(an)-320.1(efux)-317.5(pump)-316.7(inhibitor,)-319.1(carbonyl)]TJ
0 -1.1116 TD
[(cyani)-8(de-)]TJ
/F4 1 Tf
3.4616 0 TD
(m)Tj
/F5 1 Tf
.72 0 TD
[(-chlorophenylhydrazone)-456.5(\(CCCP\).)-450.7(AST)-448.7(was)-448.6(per-)]TJ
-4.1815 -1.1116 TD
[(forme)-7.8(d)-456.1(b)0(y)-463(agar)-461.7(dilution)-464.3(method)-458.4(with)-466.3(and)-459.5(without)-464(CCCP)]TJ
0 -1.1174 TD
[(added)-295.8(in)-296.1(MH)-297.7(agar)-294.7(at)-291.5(concentrations)-302.5(of)-295.9(12.5)-168(mM.)-290(Drugs)-299.9(and)]TJ
0 -1.1116 TD
[(CCCP)-324.1(were)-318.6(obtained)-322.4(from)-316.6(Sigma-Aldri)-9.8(ch)-314.4(Corp.)-319.9(\(St.)-317.7(Louis,)]TJ
T*
(MO\).)Tj
/F2 1 Tf
8.9663 0 0 8.9663 313.0582 607.6345 Tm
[(Detection)-340.2(of)-330.4(MBLs)]TJ
/F5 1 Tf
9.843 0 0 9.843 323.0361 591.1935 Tm
[(Screening)-295.6(for)-291.2(MBL)-288.7(production)-294.6(was)-293.1(done)-287.8(by)-290.2(Etest)]TJ
/F10 1 Tf
7.3823 0 0 6.5614 522.1416 595.5589 Tm
()Tj
/F5 1 Tf
9.843 0 0 9.843 530.8723 591.1935 Tm
(MBL)Tj
-22.1288 -1.1174 TD
[(commercial)-387(strips)-380.8(according)-382.1(to)-376.7(the)-379(manufacturers)-384(instruc-)]TJ
0 -1.1116 TD
[(tions)-287.8(\(AB)-287.4(Biodisk\).)-284(The)-282.1(Etest)-290.2(MBL)-282.9(strip)-282(conta)-8(ins)-279.7(a)-284.5(double-)]TJ
T*
[(sided)-369.5(dilution)-360.7(range)-364.9(of)-365(imipenem)-365.2(and)-361.6(imipenem)-371(combined)]TJ
T*
[(with)-305(EDTA.)-305.7(The)-299.4(test)-305.1(was)-298.9(considered)-308.2(positive)-303.9(if)-301.8(a)-301.8(reduction)]TJ
0 -1.1174 TD
[(of)-428.4(imipenem)-428.6(MIC)-425.7(by)-428.4(threefold)-427.1(or)-428.4(more)-427.2(twofold)-423.5(dilutions)]TJ
0 -1.1116 TD
[(was)-339.2(observed)-333.5(in)-336.4(the)-332.9(presence)-335.8(of)-336.2(EDTA.)]TJ
1.0137 -1.1116 TD
[(Polymerase)-401.4(chain)-399.6(reaction)-404.2(\(PCR\))-399(analyses)-397.9(for)-400.7(detection)]TJ
-1.0137 -1.1174 TD
[(of)-388.1(MBLs)-387.5(and)-384.6(KPC)-390.9(carbapenemase)-392.1(genes)-387.8(were)-387.7(carried)-385.6(out)]TJ
0 -1.1116 TD
[(for)-550.4(all)-551.9(strains.)-547.8(Template)-556.4(DNA)-547.3(was)-552.3(prepared)-547.9(by)-549.4(boiling)]TJ
T*
[(method.)-358.2(Specic)-356.6(primers)-361.3(to)-353.7(detect)-355.9(the)-355.9(presence)-358.8(of:)]TJ
/F4 1 Tf
21.4319 0 TD
(bla)Tj
/F5 1 Tf
7.3823 0 0 6.5614 536.655 479.9621 Tm
(IMP)Tj
9.843 0 0 9.843 549.751 481.6062 Tm
(,)Tj
/F4 1 Tf
-24.0468 -1.1174 TD
(bla)Tj
/F5 1 Tf
7.3823 0 0 6.5614 325.7007 469.0203 Tm
(VIM)Tj
9.843 0 0 9.843 340.044 470.6078 Tm
(,)Tj
/F4 1 Tf
.5414 0 TD
(bla)Tj
/F5 1 Tf
7.3823 0 0 6.5614 358.0156 469.0203 Tm
(GIM)Tj
9.843 0 0 9.843 375.1936 470.6078 Tm
(and)Tj
/F4 1 Tf
1.7452 0 TD
(bla)Tj
/F5 1 Tf
7.3823 0 0 6.5614 404.9574 469.0203 Tm
(SPM-1,)Tj
/F4 1 Tf
9.843 0 0 9.843 430.5826 470.6078 Tm
(bla)Tj
/F5 1 Tf
7.3823 0 0 6.5614 443.1684 469.0203 Tm
(NDM,)Tj
9.843 0 0 9.843 465.1085 470.6078 Tm
(and)Tj
/F4 1 Tf
1.7394 0 TD
(bla)Tj
/F5 1 Tf
7.3823 0 0 6.5614 494.8723 469.0203 Tm
(KPC)Tj
9.843 0 0 9.843 512.1069 470.6078 Tm
[(were)-295.6(used)]TJ
-20.2223 -1.1116 TD
[(in)-399.7(PCR)-402.6(mixtures)-402.9(\(50)]TJ
/F6 1 Tf
8.8815 0 TD
(m)Tj
/F5 1 Tf
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[(l)-404.4(nal)-397.2(volumes\))-402.8(containing)-405.4(25)]TJ
/F6 1 Tf
12.7981 0 TD
(m)Tj
/F5 1 Tf
.5529 0 TD
.3986 Tc
[(lo)398.6(f)]TJ
-22.7796 -1.1116 TD
0 Tc
[(PCR)-339.3(master)-338.4(mix,)-336.4(20)]TJ
/F6 1 Tf
8.5532 0 TD
(m)Tj
/F5 1 Tf
.5472 0 TD
[(l)-335.3(o)0(f)-336.2(ultrapure)-340.7(water,)-340.5(1)]TJ
/F6 1 Tf
9.2271 0 TD
(m)Tj
/F5 1 Tf
.5529 0 TD
[(l)-335.3(o)0(f)-336.2(each)-342(pri-)]TJ
-18.8803 -1.1116 TD
[(mer)-339.7(\(Sigma-Aldrich\),)-341.3(and)-338.5(3)]TJ
/F6 1 Tf
11.5655 0 TD
(m)Tj
/F5 1 Tf
.5472 0 TD
[(l)-341.1(o)0(f)-330.5(template)-342.2(DNA.)-337.7(All)-338.5(prim-)]TJ
-12.1127 -1.1174 TD
[(ers)-338.3(are)-333.9(listed)-336.3(in)-330.6(Table)-337.5(1.)]TJ
/F2 1 Tf
8.9663 0 0 8.9663 313.0582 401.7826 Tm
[(Pulsed-eld)-337.6(gel)-334.6(electrophoresis)]TJ
/F4 1 Tf
9.843 0 0 9.843 323.0361 385.3416 Tm
[(P.)-316.8(aeruginosa)]TJ
/F5 1 Tf
6.0016 0 TD
[(strains)-314(were)-324.4(genotyped)-317.6(by)-313.2(pulsed-eld)-325.3(gel)]TJ
-7.0153 -1.1116 TD
[(elect)-9.3(rophoresis)-345.9(\(PFGE\))-342.4(of)]TJ
/F4 1 Tf
11.0414 0 TD
(Spe)Tj
/F5 1 Tf
1.4514 0 TD
[(I)-340.9(restricted)-348.7(fragments.)-350.8(PFGE)]TJ
-12.4928 -1.1116 TD
[(was)-373.8(performed)-376.2(as)-371.8(previously)-369.3(described,)]TJ
7.3823 0 0 6.5614 474.1794 367.8235 Tm
(16)Tj
9.843 0 0 9.843 485.2345 363.4582 Tm
[(with)-368.4(our)-371.9(modi-)]TJ
-17.4922 -1.1174 TD
[(cations.)-595.3(Briey,)-593.9(bacteria)-595.4(were)-595.1(grown)-588.1(overnight)-593(in)-595.6(BHI)]TJ
0 -1.1116 TD
[(medium,)-359.4(washed,)-358.6(resuspended)-355(in)-353.7(saline)-360.3(EDTA)-354.1(\(SE\))-356.7(buffer)]TJ
T*
[(\(75)-170.3(mM)-280.8(NaCl,)-287.5(25)-169.2(mM)-280.8(EDTA\),)-283.8(and)-286.7(embedded)-284.2(in)-284.5(agarose)-281.7(by)]TJ
0 -1.1174 TD
[(mixing)-296.1(150)]TJ
/F6 1 Tf
4.8094 0 TD
(m)Tj
/F5 1 Tf
.5529 0 TD
[(l)-289.2(o)0(f)-295.9(bacterial)-297.2(suspension)-299.7(and)-292.4(150)]TJ
/F6 1 Tf
13.5526 0 TD
(m)Tj
/F5 1 Tf
.5529 0 TD
[(l)-289.2(o)0(f)-295.9(2)0(%)-297(low)]TJ
-19.4678 -1.1116 TD
[(melting)-344.6(point)-339.8(agarose)-345(solution)-337.3(in)-342.1(SE)-343.1(buffer.)-339.4(Agarose)-344.7(plugs)]TJ
T*
[(were)-416.5(incubated)-416.8(overnight)-414.5(in)-417(Lysis)-409.6(solution)-417.9(1)-410(\()0(6)-169.2(m)0(M)-413.3(Tris-)]TJ
0 -1.1174 TD
[(HCl)-368.2(pH)-360.2(7.5,)-366.2(100)-164.6(mM)-361.4(EDTA)-365.6(pH)-365.9(7.5,)-360.4(1)-168.1(M)-364.9(NaCl,)-362.4(0.5%)-364.9(Brij)]TJ
0 -1.1116 TD
[(58,)-437.6(0.2%)-439.8(sodium)-434(dodecyl)-442.2(sulfate)-436.3([SDS],)-435.6(0.5%)-439.8(lauryl)-440(sar-)]TJ
T*
[(cosine,)-467.3(and)-459.5(0.5)-166.9(mg/ml)-457.5(lysosim\),)-462.6(washed)-464.6(twice)-464(for)-458.3(15)-169.2(min)]TJ
T*
[(with)-293.5(50)-163.5(mM)-286.6(EDTA)-290.8(pH)-291.1(9.5,)-285.5(and)-286.7(then)-287.9(incubated)-290.1(overnight)-287.8(in)]TJ
0 -1.1174 TD
[(Lysis)-403.9(solution)-400.7(2)-398.5(\(1%)-396(lauryl)-399.7(sarcosine,)-402.4(500)-170.3(mM)-396(EDTA)-400.2(pH)]TJ
0 -1.1116 TD
[(9.5,)-366.2(and)-367.3(0.5)-166.9(mg/ml)-371.1(proteinase)-365.9(K\).)-369.3(Agarose)-367.8(plugs)-368.3(were)-370.4(wa-)]TJ
T*
[(shed)-281.8(with)-282(TE)-275.3(buffer)-284.1(\(10)-164.5(mM)-280.8(Tris)-276.2(pH)-279.5(7.5,)-279.8(10)-163.5(mM)-280.8(EDTA)-279.2(pH)]TJ
0 -1.1174 TD
[(7.5\))-473.2(thrice)-475.7(for)-475.5(30)-163.5(min)-471.2(at)-475.8(4)]TJ
/F10 1 Tf
11.3639 0 TD
()Tj
/F5 1 Tf
.3917 0 TD
[(C.)-472.1(After)-474.1(this,)-474.4(the)-476.9(wash)-472.8(plugs)]TJ
-11.7556 -1.1116 TD
[(were)-497.1(sliced)-492.8(in)]TJ
/F6 1 Tf
6.5488 0 TD
(*)Tj
/F5 1 Tf
.9964 0 TD
[(12)-170.3(mm)-488.5(slices,)-496.1(that)-489.6(were)-497.1(digested)-495(with)]TJ
-7.5452 -1.1116 TD
[(20)-169.2(U)-393.6(o)0(f)]TJ
/F4 1 Tf
3.5077 0 TD
(Spe)Tj
/F5 1 Tf
1.4457 0 TD
[(I)-392.7(restriction)-394.8(endonuclease)-399.1(\(Fermentas,)-399(Vilnius,)]TJ
-4.9533 -1.1174 TD
[(Lithu)-7(ania\))-704.8(at)-700.4(37)]TJ
/F10 1 Tf
7.3263 0 TD
()Tj
/F5 1 Tf
.3917 0 TD
[(C)-704.8(overnight,)-705.9(and)-701.4(then)-702.6(transferred)-706.6(to)]TJ
-7.718 -1.1116 TD
(0.5)Tj
/F10 1 Tf
1.4169 0 TD
()Tj
/F5 1 Tf
.72 0 TD
[(TBE)-507.8(buffer,)-506.4(loaded)-504.4(on)-503.3(the)-505.7(comb,)-505.6(and)-499.8(run)-504.4(in)-503.4(1.2%)]TJ
-2.1369 -1.1116 TD
[(agarose)-431.4(gel)-425.1(in)-428.5(CHEF-DR)]TJ
/F10 1 Tf
7.3823 0 0 6.5614 417.5999 159.5905 Tm
()Tj
/F5 1 Tf
9.843 0 0 9.843 427.6345 155.2252 Tm
[(III)-429.4(pulsed-eld)-423.3(electrophor)-10(esis)]TJ
-11.6404 -1.1174 TD
[(system)-250.6(\(Bio-Rad,)-245.9(Hercules,)-246.9(CA\))-247.1(at)-245.4(6)-243(V/cm,)-247.4(120)]TJ
/F10 1 Tf
19.2144 0 TD
()Tj
/F5 1 Tf
.6393 0 TD
[(eld)-241.7(angle,)]TJ
-19.8537 -1.1116 TD
(14)Tj
/F10 1 Tf
.9964 0 TD
()Tj
/F5 1 Tf
.3974 0 TD
[(C,)-506.7(with)-506.6(initial)-504.9(and)-505.6(nal)-506.6(switch)-504(times)-503.3(between)-507.5(3)-507.9(and)]TJ
-1.3939 -1.1116 TD
[(36)-163.5(sec)-500.8(for)-498.6(26)-163.5(hr.)-500.9(Gels)-496(were)-502.9(anal)10.4(yzed)-502.1(with)-495.1(GelComp)10.9(ar)-504.4(II)]TJ
T*
[(software)-605.1(\(Appl)10.8(ied)-609.4(Maths)-606.5(NV,)-612.1(Sint-)11.7(Martens-)11.1(Latem,)-607.1(Bel-)]TJ
0 -1.1174 TD
[(gium\).)-494.1(A)-503.1(dendrogr)13.1(am)-499.9(showing)-492.3(clonal)-493(relation)11.6(ship)-499.7(of)-497.5(the)]TJ
0 -1.1116 TD
[(isolates)-506.5(was)-506.2(constr)9.6(ucted)-503.3(using)-506.5(the)-505.7(unweight)11.9(ed-pair-)11.9(group)]TJ
T*
[(method)-395(of)-405.3(the)-396.3(arithmet)10.3(ic)-400.9(average)-398.2(clust)10.5(ering)-398.4(with)-397.2(the)-402(Dice)]TJ
0 -1.1174 TD
[(similari)11.5(ty)-428.5(coef)9.6(cient)-422.8(\(optimi)13.7(zation)-423.9(1%,)-421.4(toleran)12.8(ce)-430.7(1%,)-421.4(and)]TJ
0 -1.1116 TD
[(toleranc)10.5(e)-336.3(chan)10.6(ge)-331.7(0.5%\).)]TJ
/F7 1 Tf
8.9663 0 0 8.9663 62.022 749.6502 Tm
(262)Tj
42.4584 0 TD
[(BUBONJA-SONJE)-339.6(ET)-338.7(AL.)]TJ
ET
endstream
endobj
62 0 obj
<>stream
/GS1 gs
BT
/F2 1 Tf
8.9663 0 0 8.9663 59.7543 412.7243 Tm
0 0 0 1 k
0 Tc
0 Tw
[(Real-time)-339.8(RT-PCR)]TJ
/F5 1 Tf
9.843 0 0 9.843 69.7323 396.3401 Tm
[(The)-334(expression)-329.8(of)-330.5(the)-332.9(genes)-330.2(coding)-330.4(for)-331.5(the)-332.9(efux)-329(pumps)]TJ
-1.0137 -1.1174 TD
[(pr)20.9(ot)20.7(ei)19.5(ns)-422.5(M)15.3(e)0(x)19.7(A)0(B)18.9(,)-429.6(Me)18.8(xC)19.8(D)15.3(,)-435.4(M)15.3(e)0(x)19.7(E)0(F)19.8(,)-429.6(as)-423.6(we)24.6(ll)-422.9(as)-417.9(ou)20.8(te)19.6(r)-433(m)15(em)18.5(-)]TJ
0 -1.1116 TD
[(br)20.9(an)19.7(e)-273(p)0(r)20.9(o)16.2(te)19.6(in)-261.5(Op)20(rD)25.8(,)-274.1(w)0(a)24.6(s)-271.6(an)19.7(al)19.5(yz)19.7(e)15(d)-271.8(us)21(in)20.7(g)-266(r)0(e)19.7(v)0(e)19.7(r)0(s)21.1(e)0(-)19.7(t)0(r)20.7(a)0(n)19.7(s)0(c)25.6(r)0(i)20.7(p)0(t)20.7(i)0(o)20.7(n)]TJ
T*
[(quantitative)-553(PCR)-546.6(\(RT-qPCR\).)-547.3(Total)-549.5(RNA)-547.5(was)-546.6(extracted)]TJ
0 -1.1174 TD
[(from)-535.5(all)-540.4(strains)-532.8(using)-535.3(the)-540.2(High)-535.3(Pure)-535.3(RNA)-536(Isolation)-535.4(kit)]TJ
0 -1.1116 TD
[(\(Roche,)-318.6(Mannheim,)-316.3(Germany\),)-316.1(and)-309.7(reverse)-316.2(transcribed)-320.9(into)]TJ
T*
[(cDNA)-440.2(using)-431.7(the)-430.8(rst-strand)-439.1(cDNA)-434.4(Synthesis)-431.2(Kit)-436.4(for)-435.2(RT-)]TJ
0 -1.1174 TD
[(PCR)-581.2(\(Roche\).)-578.9(The)-575.9(latter)-585.3(was)-575.4(subjected)-583.7(to)-572.5(qPCR)-582.3(using)]TJ
0 -1.1116 TD
[(LightCycler)-339.6(FastStart)-334.6(DNA)-334.2(Master)-332.3(SYBR)-335.5(Green)-337(I)-329.4(\(Roche\))]TJ
T*
[(in)-370.9(the)-367.5(LightCycler)-374.1(2.0)-368.5(LC)-367.3(\(Roche\).)-377.3(Relative)-370.8(expression)-370.2(of)]TJ
0 -1.1174 TD
[(the)-407.8(efux)-409.7(pumps,)-407.4(and)]TJ
/F4 1 Tf
9.5611 0 TD
(oprD)Tj
/F5 1 Tf
2.5112 0 TD
[(genes)-405.1(in)-411.3(clinical)-410.2(isolates)-408.6(was)]TJ
-12.0723 -1.1116 TD
[(determined)-327(by)-324.7(comparing)-324.6(mRNA)-325.2(levels)-320(of)-324.7(the)-321.4(genes)-324.4(in)-319.1(the)]TJ
T*
[(clinical)-502.4(isolates)-506.5(and)-494(control)]TJ
/F4 1 Tf
12.2682 0 TD
[(P.)-495.3(aeruginosa)]TJ
/F5 1 Tf
6.3587 0 TD
[(ATCC)-503.9(27853)]TJ
-18.6269 -1.1116 TD
[(strain,)-356.8(which)-353.3(is)-347.7(sensitive)-357.8(to)-347.9(all)-350.3(tested)-354.6(antibiotics.)-358.2(The)-351.2(gene)]TJ
0 -1.1174 TD
[(coding)-393.8(for)-394.9(the)-396.3(ribosomal)-392.5(protein)-395(S12)-394.8(\(rpsl\))-392.3(was)-396.8(used)-391.3(as)-394.8(a)]TJ
0 -1.1116 TD
[(reference)-459.1(gene)-450.2(for)-452.5(normalizing)-453.8(the)-453.8(transcription)-454.6(levels)-452.5(of)]TJ
T*
[(target)-395.1(genes.)-397(Relative)-399.6(quantication)-392.6(was)-396.8(done)-391.5(by)-393.9(compar-)]TJ
0 -1.1174 TD
[(ative)-405.5(C)]TJ
7.3823 0 0 6.5614 89.5748 208.3464 Tm
(t)Tj
9.843 0 0 9.843 95.6409 209.9905 Tm
[(method)-406.6(\(2)]TJ
/F10 1 Tf
7.3823 0 0 6.5614 138.6708 214.3559 Tm
(-)Tj
/F6 1 Tf
.7219 0 TD
(DD)Tj
/F5 1 Tf
1.3363 0 TD
(Ct)Tj
9.843 0 0 9.843 160.8377 209.9905 Tm
(\).)Tj
7.3823 0 0 6.5614 166.6204 214.3559 Tm
(23)Tj
9.843 0 0 9.843 177.959 209.9905 Tm
[(According)-410.6(to)-399.7(previously)-409.6(pub-)]TJ
-12.009 -1.1116 TD
[(lished)-393.7(criteria,)-390.4(isolates)-385.5(were)-393.5(considered)-388.8(as)-389.1(having)-388(MexAB)]TJ
T*
[(efux)-484.5(pump)-483.7(overexpression)-490.9(if)-480.4(the)-488.4(mRNA)-480.7(level)-486.1(of)]TJ
/F4 1 Tf
22.0654 0 TD
(mexB)Tj
/F5 1 Tf
-22.0654 -1.1174 TD
[(gene)-496.3(was)-494.7(at)-498.8(least)-497.5(threefold)-496.2(higher)-491.7(in)-497.7(the)-494.2(isolate)-494(than)-495.3(in)]TJ
0 -1.1116 TD
[(reference)-390(ATCC)-382.9(27853)-379.9(strain,)-379.9(negative)-386.9(if)-376.7(lower)-382(than)-385.8(two-)]TJ
T*
[(fo)15.1(ld)20.7(,)-366.3(a)0(n)13.9(d)-369.7(bo)20.8(rd)20.9(er)19.7(li)20.6(ne)-360.5(if)-365.2(be)19.7(tw)19.8(ee)18.5(n)-369.7(t)0(w)19.8(o)0(f)20.9(o)0(l)15(d)-364(an)13.9(d)-369.7(t)0(h)20.7(r)0(e)19.7(e)0(f)19.7(o)0(l)20.7(d)0(.)]TJ
7.3823 0 0 6.5614 276.5479 159.5905 Tm
(4)Tj
9.843 0 0 9.843 283.918 155.2252 Tm
[(Is)21.1(o-)]TJ
-22.7739 -1.1174 TD
[(la)13.8(te)19.5(s)-640.2(w)0(e)18.8(r)0(e)-631.1(c)0(o)13.9(n)0(s)21(i)0(d)20.7(e)0(r)19.7(e)0(d)-636.9(p)0(o)20.8(s)0(i)20.9(t)0(i)20.6(v)0(e)-636.9(f)0(o)20.9(r)-640.4(Me)18.8(xC)19.8(D)-641.3(a)0(n)13.9(d)-640.4(Me)18.8(xE)19.6(F)]TJ
0 -1.1116 TD
[(ov)15.1(er)19.7(ex)19.7(pr)20.9(es)19.9(si)15.1(on)-244.1(if)-244.2(th)20.7(e)-261.4(l)0(e)19.6(v)0(e)19.7(l)-254.7(of)-244.1(mR)18.6(NA)-251.6(fo)20.9(r)]TJ
/F4 1 Tf
16.2827 0 TD
[(me)18.8(xD)]TJ
/F5 1 Tf
2.5573 0 TD
(or)Tj
/F4 1 Tf
1.0828 0 TD
[(me)18.8(xF)]TJ
/F5 1 Tf
2.4536 0 TD
[(we)18.8(re)]TJ
-22.3765 -1.1116 TD
[(at)-326(le)19.6(as)19.9(t)-335.3(1)0(0)20.8(-)0(f)20.9(o)0(l)20.7(d)-335.2(hi)20.7(gh)20.8(er)-325.9(th)20.7(an)-325.9(in)-319.1(re)19.7(fe)14(re)19.7(nc)19.7(e)-330.6(A)0(T)13(C)0(C)-321(s)0(t)20.9(r)0(a)19.7(i)0(n)15(,)-331.7(ne)19.7(ga)19.7(-)]TJ
T*
[(ti)14.8(ve)-389.3(if)-394(lo)20.7(we)18.8(r)-404.2(t)0(h)20.7(a)0(n)-395(5)0(-)20.9(f)0(o)20.9(l)0(d)15(,)-400.8(an)19.7(d)-404.3(b)0(o)20.8(r)0(d)20.9(e)0(r)19.7(l)0(i)14.8(n)0(e)-389.3(i)0(f)-394(b)0(e)19.7(t)0(w)19.8(e)0(e)18.5(n)-404.3(5-)-393.8(an)19.7(d)]TJ
0 -1.1174 TD
[(10)15.1(-f)20.9(ol)20.7(d.)]TJ
7.3823 0 0 6.5614 90.4819 104.7685 Tm
(4)Tj
9.843 0 0 9.843 97.6819 100.4031 Tm
[(Is)21.1(ol)15(at)19.5(es)-348.7(we)18.8(re)-348.9(co)19.7(ns)21(id)20.7(er)19.7(ed)-348.9(ha)19.7(vi)14.9(ng)-342(re)14(du)20.8(ce)18.5(d)]TJ
/F4 1 Tf
16.7492 0 TD
[(op)20.8(rD)]TJ
/F5 1 Tf
2.4306 0 TD
[(ex)19.7(-)]TJ
-23.0331 -1.1116 TD
[(pr)15.1(es)19.9(si)20.9(on)-336.3(if)-336.4(th)20.7(e)-347.8(m)0(R)18.6(N)0(A)-338(l)0(e)19.6(v)0(e)13.9(l)0(s)-336.2(w)0(e)18.8(r)0(e)-337.4(m)0(o)19.6(r)0(e)-337.4(t)0(h)20.7(a)0(n)-337.4(t)0(w)19.8(o)0(f)15.1(o)0(l)20.7(d)-346.7(lo)20.7(we)18.8(r)]TJ
T*
[(th)15(an)-268.3(in)-267.3(th)20.7(e)-284.5(r)0(e)19.7(f)0(e)19.7(r)0(e)19.7(n)0(c)19.7(e)-284.5(AT)18.8(CC)-269.2(st)20.9(ra)19.7(in)-273(27)20.8(85)20.8(3.)]TJ
7.3823 0 0 6.5614 222.4062 82.885 Tm
-.0162 Tc
(29)Tj
9.843 0 0 9.843 232.4409 78.5197 Tm
0 Tc
[(We)-270.6(us)21(ed)-274.1(pr)20.9(im)19.5(er)19.7(s)]TJ
-17.5441 -1.1174 TD
[(fo)15.1(r)-358.2(R)0(T)18.6(-)0(q)15.1(P)0(C)20(R)-365(th)20.7(at)-354.8(am)18.5(pl)20.7(i)20.9(ed)-354.7(th)20.7(e)-365.1(r)0(e)19.7(g)0(i)20.7(o)0(n)-353.5(o)0(f)]TJ
/F4 1 Tf
17.377 0 TD
[(op)20.8(rD)]TJ
/F5 1 Tf
2.4364 0 TD
[(mR)18.6(NA)-355.3(be)19.7(-)]TJ
-19.8134 -1.1116 TD
[(tw)14.1(ee)18.5(n)-369.7(n)0(t)15(.)-372.1(51)20.8(6)-375.5(a)0(n)19.7(d)-375.5(71)20.8(8)-375.5(o)0(f)]TJ
/F4 1 Tf
10.8282 0 TD
[(op)20.8(rD)]TJ
/F5 1 Tf
2.4479 0 TD
[(se)19.9(qu)15.1(en)19.7(ce)-361.6(fr)15.1(om)-360.5(PA)14.4(O1)-365.9(\(c)19.7(or)20.9(-)]TJ
12.2336 36.1191 TD
[(re)19.7(sp)21(on)20.8(ds)-290(to)-290.3(th)15(e)-296(r)0(e)14(g)0(i)20.7(o)0(n)-290.2(b)0(e)19.7(t)0(w)19.8(e)0(e)18.5(n)-300.6(aa)18.5(.)-297.2(1)0(7)15.1(2)-294.8(an)19.7(d)-300.6(2)0(3)20.8(8)-300.6(in)-290.3(th)20.7(e)-301.8(O)0(p)20(r)0(D)]TJ
0 -1.1116 TD
[(pr)20.9(ot)20.7(ei)19.5(n\))15.1(.)-320.2(P)0(r)21(i)0(m)19.5(e)0(r)14(s)-323.4(us)21(ed)-314.4(fo)20.9(r)-323.6(q)0(P)21(C)0(R)-315.3(a)0(r)19.7(e)-324.8(li)20.6(st)15.1(ed)-314.4(in)-313.3(Ta)18.5(bl)20.7(e)-324.8(1)0(.)]TJ
/F7 1 Tf
8.9663 0 0 8.9663 310.8472 379.2188 Tm
(Results)Tj
/F2 1 Tf
0 -1.8336 TD
[(Clinical)-334.2(characteristics)-336.6(and)-335.7(antimicrobial)]TJ
0 -1.2203 TD
[(susceptibility)-333.2(of)-336.7(isolates)]TJ
/F5 1 Tf
9.843 0 0 9.843 320.8251 335.3952 Tm
[(Most)-396.9(of)-405.3(the)-402(isolates)-402.8(were)-405(obtained)-403.1(from)-403(patients)-403(of)-405.3(the)]TJ
-1.0137 -1.1116 TD
-.0158 Tc
[(ICUs)-333.5(\(70)-15.8(%)9.7(\)).4(,)-330.2(a)-.8(nd)-333.7(mostl)-15.8(y)-317.6(is)-15.8(o)11(l).3(ate)-15.8(d)-318.7(fr)-15.8(o)10.8(m)-329.1(end)-15.8(o)10.8(trac)-15.8(h)9.6(eal)-333.8(aspi)-15.8(r)10.7(a)-.8(tes)]TJ
T*
-.0159 Tc
[(\(87)-15.9(%)9.6(\)).3(.)-301.6(S)-15.9(e)9.7(rot)-15.9(y)10.6(p).3(e)-306.1(O)-.6(:)-15.9(1)10.6(1)-305(w)-.6(as)-304.8(t)-15.9(h)10.6(e)-306.1(m)-.9(ost)-305.1(p)-15.9(r)10.7(e)-.9(val)-15.9(e)9.4(nt,)-307.3(acc)-15.9(o)9.5(unti)-15.9(n)10.6(g)-305(for)]TJ
/F6 1 Tf
0 -1.1174 TD
0 Tc
(*)Tj
/F5 1 Tf
.9849 0 TD
[(4)16.2(7)16.2(%)-353.5(o)16.2(f)-352.4(t)16(h)16.2(e)-353.6(i)16.1(so)26.8(l)16.1(a)15(te)25.3(s)16.4(,)-349(fo)26.6(l)16.1(l)16(ow)25.7(e)15(d)-352.4(b)16.2(y)-352.4(s)16.4(e)15(ro)26.6(t)16(y)16.2(pe)-337.4(O)15.3(:)0(1)-336.4(\()0(2)26.6(9)16.2(%)15.1(\))0(.)-338.6(S)16.3(i)16(x)]TJ
-.9849 -1.1116 TD
[(i)16.1(s)16.4(ol)26.5(a)15(t)16(e)15(s)-352.2(w)15.3(e)15(re)-337.4(t)16(h)16.2(e)-353.6(r)16.2(a)15(r)0(e)-337.4(s)16.4(e)15(r)0(o)26.6(t)16(y)16.2(p)0(e)25.4(s)-346.5(O:)25.6(6)16.2(,)-349(O)15.3(:)16.1(7/)26.5(8)16.2(,)-349(O)15.3(:)0(1)26.5(5)16.2(,)-349(a)15(nd)-336.3(O)15.3(:)16(16)26.6(,)]TJ
T*
-.016 Tc
[(whil)-16(e)-342(t).1(w)-16(o)-341.6(is)-16(o)10.8(l)0(at)-16(e)9.3(s)-351(w)-16(e)8.6(re)-358.1(unty)-16(p)10.6(eabl)-16(e)-342(or)-356.9(pol)-16(y)10.5(a)-1(gg)-16(l)10.5(u).2(tin)-16(a)9.4(ble)-358.1(\().2(Fi)-16(g)10.5(.)]TJ
0 -1.1174 TD
-.0157 Tc
[(1\).)-387.7(A)-15.7(l)9.9(l)-385.6(o).5(f)-391.1(3).5(8)-391.2(i).4(sol)-15.7(a)9.6(tes)-391(w)-.4(ere)-392.3(r).5(es)-15.7(i)11(s).7(ta)-15.7(n)9.7(t)-385.5(t)-15.7(o)-375.1(mer)-15.7(o)10.9(p).5(ene)-15.7(m)-377.4(and)-391.2(dor-)]TJ
0 -1.1116 TD
-.0159 Tc
[(ipen)-15.9(e)9.5(m)-.9(,)-445.5(a)-.9(nd)-449(in)-443.2(ge)-15.9(n)9.5(e)-.9(ral)-15.9(,)-435.3(inte)-15.9(r)9.6(media)-15.9(r)9.6(y)-443.2(r)-15.9(e)9.6(sis)-15.9(t)10.8(ant)-449.1(t).2(o)-443.2(i)-15.9(m)9.3(i).2(pene)-15.9(m)]TJ
T*
-.0158 Tc
[(\(Tab)-15.8(l)10.7(e)-357.9(2\))-15.8(.)-348.6(N)-.5(ine)-363.6(i).3(sol)-15.8(a)9.5(tes)-362.3(w)-.5(ere)-363.6(i).3(mip)-15.8(e)9.6(nem)-357.9(r)-15.8(e)9.7(s).6(is)-15.8(t)10.9(a)-.8(nt)-15.8(.)-348.8(A)-.5(lmos)-15.8(t)-346.2(a)-.8(ll)]TJ
0 -1.1174 TD
-.0159 Tc
[(iso)-15.9(l)10.6(ates)-598.5(disp)-15.9(l)10.6(a)-.9(yed)-598.7(r).3(esi)-15.9(s)10.8(tan)-15.9(c)9.5(e)-594.1(t).1(o)-593(t).2(h)-15.9(e)-583.7(othe)-15.9(r)-583.7(grou)-15.9(p)10.7(s)-592.8(of)-592.9(a)-15.9(n)9.5(ti-)]TJ
0 -1.1116 TD
[(pse)-16(u)9.4(domon)-16(a)9.4(s)-281.8(an)-16(t)10.5(i).1(bi)-16(o)10.5(t).1(ic)-16(s)9.6(,)-284.4(with)-287.8(79%)-283.1(b)-16(e)9.4(ing)-282(M)-16(D)8.8(R)-283.1(\(3)-16(0)-271.6(out)-287.9(of)-282(38)]TJ
T*
0 Tc
[(i)16.1(s)16.4(ol)26.5(a)15(t)16(e)15(s)0(\))26.8(.)-446.9(A)15.3(l)16(l)-444.7(i)16.1(so)26.8(l)16.1(a)15(te)25.3(s)-444.4(b)16.2(e)15(l)16.1(on)26.6(g)16.2(i)16.1(ng)-434.2(t)16.1(o)-444.6(d)16.2(i)16(ff)26.7(e)15(r)16.2(en)25.4(t)-444.7(s)16.4(e)15(r)0(o)26.6(t)16(y)16.2(p)0(e)25.4(s)-444.4(w)15.3(e)15(r)16.2(e)]TJ
T*
-.0153 Tc
(MDR)Tj
/F4 1 Tf
2.6149 0 TD
-.0158 Tc
[(P.)-393.6(aer)-15.8(u)11(gin)-15.8(o)10.8(sa)]TJ
/F5 1 Tf
5.5754 0 TD
0 Tc
[(,)-377.8(e)15(x)16.2(c)0(e)24.3(p)16.2(t)-375.6(s)16.4(ev)25.4(e)15(n)-375.5(O)15.3(:)0(1)-365.2(i)16.1(s)16.4(o)16.2(la)25.3(t)16(e)15(s)-381(t)16.1(h)16.2(a)15(t)-375.6(s)0(h)26.8(o)16.2(w)15.3(e)15(d)]TJ
-8.1903 -1.1174 TD
[(s)16.4(e)15(ns)26.8(i)16(t)16.1(iv)26.5(i)16(t)16.1(y)-300.6(t)16.1(o)-294.8(t)16(he)-285.6(m)15(o)16.2(st)-284.4(o)16.2(f)-294.8(th)26.5(e)-296(t)16(es)25.6(t)16.1(e)15(d)-300.6(a)15(n)16.2(t)16(ib)26.5(i)16.1(o)16.2(ti)26.3(c)15(s)16.4(.)]TJ
/F4 1 Tf
18.7766 0 TD
-.016 Tc
[(P.)-313.2(ae)-16(r)9.6(ugi)-16(n)10.5(o).2(sa)]TJ
/F5 1 Tf
-18.7766 -1.1116 TD
[(str)-15.9(a)9.6(ins)-748.3(d).3(e)-15.9(m)8.3(ons)-15.9(t)10.8(r).3(ate)-15.9(d)-739.2(high-)-15.9(l)10.6(e)-.9(ve)-15.9(l)-733.6(r)-15.9(e)9.6(s).5(i)-15.9(s)10.8(tanc)-15.9(e)-740.4(t).2(o)-748.5(g).3(ent)-15.9(a)9.4(micin)]TJ
T*
-.0157 Tc
[(\(79)-15.7(%)9.8(\)).5(,)-295.6(a)-15.7(m)8.5(i).4(kaci)-15.7(n)-288.7(\(66%\))-15.7(,)-285.1(t)-15.7(o)10.8(bramy)-15.7(c)9.7(i).3(n)-299(\().5(7)-15.7(9)10.9(%\),)-301.4(a)-.7(nd)-299(cip)-15.7(r)10.9(oo)-15.7(x)10.9(acin)]TJ
0 -1.1174 TD
-.0161 Tc
[(\(71)-16.1(%)9.4(\)).1(.)-284.5(T)-1.1(e)-16.1(n)-272.9(s)-16.1(t)10.6(ra)-16.1(i)9.2(n).1(s)-287.7(\(26)-16.1(%)9.4(\))-287.9(show)-16.1(e)8.5(d)-287.9(AmpC)]TJ
/F6 1 Tf
16.3979 0 TD
0 Tc
(b)Tj
/F5 1 Tf
.5357 0 TD
-.0155 Tc
[(-)-15.5(l)11(acta)-15.5(m)8.7(ase)-288.5(act)-15.5(i)10.8(v).7(ity)]TJ
-16.9335 -1.1116 TD
0 Tc
[(b)16.2(y)-323.6(p)16.2(h)16.2(e)15(no)26.6(t)16.1(y)16.2(pi)26.5(c)-324.8(t)16.1(e)15(s)16.4(t)16.1(i)0(n)26.5(g)16.2(.)-326(T)15(a)15(b)16.2(l)16(e)-324.8(3)-323.6(d)16.2(e)15(p)16.2(ic)25.3(t)16(s)-323.4(t)16(h)16.2(e)-324.8(M)15.3(IC)]TJ
7.3823 0 0 6.5614 497.0266 147.4582 Tm
-.0239 Tc
(50)Tj
9.843 0 0 9.843 507.4581 149.1023 Tm
-.0159 Tc
[(and)-339.5(M)-.6(IC)]TJ
7.3823 0 0 6.5614 542.6644 147.4582 Tm
-.0162 Tc
(90)Tj
9.843 0 0 9.843 310.8472 138.1606 Tm
0 Tc
[(v)16.2(a)15(l)16(u)0(e)25.4(s)-242.8(o)16.2(f)-243(cl)25.3(i)16(n)16.2(ic)25.3(a)15(l)-243.1(i)16(s)0(o)26.8(l)16.1(a)15(t)16.1(es)25.6(.)-245.3(A)15.3(c)15(c)15(o)16.2(rd)26.6(i)16.1(n)16.2(g)-248.8(t)16.1(o)-243(M)15.3(I)16.2(C)]TJ
7.3823 0 0 6.5614 483.0235 136.5165 Tm
-.0239 Tc
(90)Tj
9.843 0 0 9.843 492.6613 138.1606 Tm
-.016 Tc
[(valu)-16(e)9.4(s).4(,)-261.3(c)-1(oli)-16(s)10.7(tin)]TJ
-18.4714 -1.1174 TD
-.0158 Tc
[(was)-322(foun)-15.8(d)-306(t).3(o)-316.4(b)-15.8(e)-307.1(t).3(he)-323.3(most)-322.3(activ)-15.8(e)-307.1(a)-.8(gen)-15.8(t)-306.1(\(0.3)-15.8(8)]TJ
/F6 1 Tf
17.642 0 TD
0 Tc
(m)Tj
/F5 1 Tf
.5357 0 TD
-.0157 Tc
[(g/ml)-15.7(\))10.8(,)-318.6(fol)-15.7(l)10.6(o).5(wed)]TJ
-18.1776 -1.1116 TD
-.0159 Tc
[(by)-356.8(ce)-15.9(f)9.6(e)-.9(pi)-15.9(m)9.3(e)-358(\(8)]TJ
/F6 1 Tf
6.2205 0 TD
0 Tc
(m)Tj
/F5 1 Tf
.5414 0 TD
-.0158 Tc
[(g/ml\))-362.4(a)-.8(nd)-356.7(c)-15.8(e)8.5(ftaz)-15.8(i)9.5(d).4(ime)-363.6(\(12)]TJ
/F6 1 Tf
10.5633 0 TD
0 Tc
(m)Tj
/F5 1 Tf
.5414 0 TD
[(g)16.2(/)16.1(m)15(l)16(\).)-327(Th)25.4(e)-342.1(M)15.3(IC)]TJ
-17.8666 -1.1116 TD
-.0159 Tc
[(valu)-15.9(e)9.5(s)-333.6(of)-333.7(co)-15.9(l)10.6(i).2(st)-15.9(i)10.4(n)-333.8(wer)-15.9(e)-324.5(belo)-15.9(w)-324.2(t).1(he)-334.9(res)-15.9(i)10.8(st)-15.9(a)9.4(n).3(ce)-334.9(br)-15.9(e)9.6(a)-.9(kp)-15.9(o)10.7(i).1(nts)-15.9(.)]TJ
/F2 1 Tf
8.9663 0 0 8.9663 310.8472 84.0189 Tm
0 Tc
[(Detection)-333.9(of)-330.4(MBLs)]TJ
/F5 1 Tf
9.843 0 0 9.843 320.8251 67.6346 Tm
[(Although)-338.3(eight)-346.8(isolates)-345.2(were)-347.4(suspected)-341.4(to)-342.1(be)-343.2(MBL)-346.3(posi-)]TJ
-1.0137 -1.1174 TD
[(tive)-334.1(by)-330.5(the)-332.9(MBL)-334.7(Etest,)-333.9(PCR)-333.5(analyses)-334.6(did)-337.5(not)-331.7(detect)-332.9(MBLs)]TJ
ET
59.754 719.49 490.167 .22668 re
f
59.754 472.479 490.167 .28348 re
f
59.754 700.497 490.167 .22681 re
f
BT
/F11 1 Tf
9.845 0 0 9.845 75.9685 725.1588 Tm
(Table)Tj
/F5 1 Tf
3.0002 0 TD
(1.)Tj
/F11 1 Tf
1.2496 0 TD
[(Primers)-336(Used)-332.7(for)-332.2(Polymerase)-338.2(Chain)-336.5(Reaction)-332.4(and)-332(Reverse-Transcription)-336.9(Quantitative)]TJ
/F5 1 Tf
40.3616 0 TD
(PCR)Tj
/F4 1 Tf
-46.2584 -1.8658 TD
[(Gene)-12059.8(Primer)-7322.3(Oligonucleotide)-336.8(sequence)-8915.1(Reference)]TJ
0 -1.9061 TD
(VIM-1)Tj
7.3837 0 0 6.5625 85.4929 692.3904 Tm
(a)Tj
/F5 1 Tf
9.845 0 0 9.845 194.6834 688.025 Tm
[(VIM-1-F)-4407.9(CAGATTGCCGATGGTGGTTGG)-5591.8(Lauretti)]TJ
/F4 1 Tf
31.4704 0 TD
[(et)-331.6(al.)]TJ
/F5 1 Tf
7.3837 0 0 6.5625 525.1463 692.3904 Tm
(20)Tj
9.845 0 0 9.845 194.6834 678.0471 Tm
[(VIM-1-R)-4293.9(AGGTGGGCCATTCAGCCAGA)]TJ
/F4 1 Tf
-13.7053 -1.0078 TD
(IMP)Tj
7.3837 0 0 6.5625 77.3291 672.4911 Tm
(a)Tj
/F5 1 Tf
9.845 0 0 9.845 194.6834 668.1258 Tm
[(IMP-A)-5240.9(GAAGGYGTTTATGTTCATAC)-6361.9(Watanabe)]TJ
/F4 1 Tf
32.3054 0 TD
[(et)-331.6(al.)]TJ
/F5 1 Tf
7.3837 0 0 6.5625 533.3101 672.4911 Tm
(42)Tj
9.845 0 0 9.845 194.6834 658.1479 Tm
[(IMP-B)-5292.9(GTAMGTTTCAAGAGTGATGC)]TJ
/F4 1 Tf
-13.7053 -1.0135 TD
(SPM)Tj
7.3837 0 0 6.5625 78.9732 652.5353 Tm
(a)Tj
/F5 1 Tf
9.845 0 0 9.845 194.6834 648.1699 Tm
[(SPM-F)-5187.9(CCTACAATCTAACGGCGACC)-6257.9(Toleman)]TJ
/F4 1 Tf
31.8563 0 TD
[(et)-331.6(al.)]TJ
/F5 1 Tf
7.3837 0 0 6.5625 528.8881 652.5353 Tm
(40)Tj
9.845 0 0 9.845 194.6834 638.2487 Tm
[(SPM-R)-5073.9(TCGCCGTGTCCAGGTATAAC)]TJ
/F4 1 Tf
-13.7053 -1.0135 TD
(GIM)Tj
7.3837 0 0 6.5625 78.3496 632.636 Tm
(a)Tj
/F5 1 Tf
9.845 0 0 9.845 194.6834 628.2707 Tm
[(GIM-F)-5240.9(AGAACCTTGACCGAACGCAG)-6049.9(Castanheira)]TJ
/F4 1 Tf
33.0195 0 TD
[(et)-337.3(al.)]TJ
/F5 1 Tf
7.3837 0 0 6.5625 540.3967 632.636 Tm
(5)Tj
9.845 0 0 9.845 194.6834 618.2927 Tm
[(GIM-R)-5126.9(ACTCATGACTCCTCACGAGG)]TJ
/F4 1 Tf
-13.7053 -1.0135 TD
(NDM-1)Tj
7.3837 0 0 6.5625 89.8015 612.6802 Tm
(a)Tj
/F5 1 Tf
9.845 0 0 9.845 194.6834 608.3148 Tm
[(NDM-F)-4855.9(AATGGAATTGCCCAATATTATGC)-4311.8(Yong)]TJ
/F4 1 Tf
30.503 0 TD
[(et)-331.6(al.)]TJ
/F5 1 Tf
7.3837 0 0 6.5625 515.5652 612.6802 Tm
(44)Tj
9.845 0 0 9.845 194.6834 598.3936 Tm
[(NDM-R)-4741.9(CGAAAGTCAGGCTGTGTTGC)]TJ
/F4 1 Tf
-13.7053 -1.0135 TD
(KPC)Tj
7.3837 0 0 6.5625 78.9732 592.7809 Tm
(a)Tj
/F5 1 Tf
9.845 0 0 9.845 194.6834 588.4156 Tm
[(KPC-F)-5240.9(TGTCACTGTATCGCCGTC)-7901.9(Yigit)]TJ
/F4 1 Tf
30.3475 0 TD
[(et)-331.6(al.)]TJ
/F5 1 Tf
7.3837 0 0 6.5625 514.0345 592.7809 Tm
(43)Tj
9.845 0 0 9.845 194.6834 578.4376 Tm
[(KPC-R)-5126.9(CTCAGTGCTCTACAGAAAACC)]TJ
-13.7053 -1.0135 TD
[(Ribosomal)-340.6(protein)-330.9(S12)]TJ
.9156 -1.0077 TD
[(reference)-337.3(gene)]TJ
7.3837 0 0 6.5625 127.5023 562.9038 Tm
(b)Tj
9.845 0 0 9.845 194.6834 568.4597 Tm
[(rpsL-1)-5396.9(GCTGCAAAACTGCCCGCAACG)-5435.8(Islam)]TJ
/F4 1 Tf
30.5145 0 TD
[(et)-331.6(al.)]TJ
/F5 1 Tf
7.3837 0 0 6.5625 515.6786 572.8817 Tm
(12)Tj
9.845 0 0 9.845 194.6834 558.5385 Tm
[(rpsL-2)-5396.9(ACCCGAGGTGTCCAGCGAACC)]TJ
/F4 1 Tf
-13.7053 -1.0135 TD
(oprD)Tj
7.3837 0 0 6.5625 80.5039 552.9258 Tm
(b)Tj
/F5 1 Tf
9.845 0 0 9.845 194.6834 548.5605 Tm
[(oprD-F)-5125.9(GCTCGACCTCGAGGCAGGCCA)-5435.8(Rodriguez-Martinez)]TJ
/F4 1 Tf
28.8618 -1.0135 TD
[(et)-331.6(al.)]TJ
/F5 1 Tf
7.3837 0 0 6.5625 499.4077 542.9479 Tm
(34)Tj
9.845 0 0 9.845 194.6834 538.5825 Tm
[(oprD-R)-5011.9(CCAGCGATTGGTCGGATGCCA)]TJ
/F4 1 Tf
-13.7053 -1.0135 TD
(mexAB)Tj
7.3837 0 0 6.5625 87.7606 533.0266 Tm
(b)Tj
/F5 1 Tf
9.845 0 0 9.845 194.6834 528.6046 Tm
[(mexB-1)-4834.9(CAAGGGCGTCGGTGACTTCCAG)-4821.8(Islam)]TJ
/F4 1 Tf
30.5145 0 TD
[(et)-331.6(al.)]TJ
/F5 1 Tf
7.3837 0 0 6.5625 515.6786 533.0266 Tm
(12)Tj
9.845 0 0 9.845 194.6834 518.6833 Tm
[(mexB-2)-4834.9(ACCTGGGAACCGTCGGGATTGA)]TJ
/F4 1 Tf
-13.7053 -1.0135 TD
(mexCD)Tj
7.3837 0 0 6.5625 89.2913 513.0707 Tm
(b)Tj
/F5 1 Tf
9.845 0 0 9.845 194.6834 508.7054 Tm
[(MxD-F)-5073.9(GGACGGCTCGCTGGTCCGGCT)-5591.8(Rodriguez-Martinez)]TJ
/F4 1 Tf
28.8618 -1.0135 TD
[(et)-331.6(al.)]TJ
/F5 1 Tf
7.3837 0 0 6.5625 499.4077 503.0928 Tm
(34)Tj
9.845 0 0 9.845 194.6834 498.7274 Tm
[(MxD-R)-4959.9(CGACGAAGCGCGAGGTGTCGT)]TJ
/F4 1 Tf
-13.7053 -1.0077 TD
(mexEF)Tj
7.3837 0 0 6.5625 87.7606 493.1715 Tm
(b)Tj
/F5 1 Tf
9.845 0 0 9.845 194.6834 488.8062 Tm
[(mexF-F)-4896.9(CGCCTGGTCACCGAGGAAGAGT)-4717.8(El)-331.6(Amin)]TJ
/F4 1 Tf
31.7929 0 TD
[(et)-337.3(al.)]TJ
/F5 1 Tf
7.3837 0 0 6.5625 528.3211 493.1715 Tm
(8)Tj
9.845 0 0 9.845 194.6834 478.8282 Tm
[(mexF-R)-4782.9(TAGTCCATGCCTTGCGGGAAGC)]TJ
6.5633 0 0 5.8334 67.748 464.5983 Tm
(a)Tj
8.7511 0 0 8.7511 70.696 460.6865 Tm
[(Primers)-334.5(used)-331.8(for)-330.5(PCR.)]TJ
6.5633 0 0 5.8334 67.748 455.5841 Tm
(b)Tj
8.7511 0 0 8.7511 71.0362 451.729 Tm
[(Primers)-334.5(used)-331.8(for)-330.5(RT-qPCR.)]TJ
-.3757 -1.0236 TD
[(RT-qPCR,)-333.2(reverse-transcription)-335.2(quantitative)-333.1(polymerase)-335(chain)-332.1(reaction.)]TJ
/F7 1 Tf
8.9663 0 0 8.9663 59.7543 749.7069 Tm
(CARBAPENEM-RESISTANT)Tj
/F12 1 Tf
13.4804 0 TD
[(P.)-330.2(AERUGINOSA)]TJ
/F7 1 Tf
8.1629 0 TD
[(OUTBREAK)-25717(263)]TJ
ET
endstream
endobj
68 0 obj
<>stream
/GS1 gs
BT
/F5 1 Tf
9.843 0 0 9.843 62.022 149.7826 Tm
0 0 0 1 k
0 Tc
0 Tw
[(of)-347.7(either)-349(IMP,)-347.3(VIM,)-342.5(GIM,)-348.3(SPM,)-347.1(or)-347.7(NDM)-345.8(family)-349(\(data)-347.7(not)]TJ
0 -1.1116 TD
[(shown\).)-333.2(PCR)-339.3(for)-331.5(KPC)-333.3(genes)-335.9(was)-339.2(also)-333.8(negative.)]TJ
/F2 1 Tf
8.9663 0 0 8.9663 62.022 116.9008 Tm
[(Synergy)-334.8(between)-331.9(CCCP)-335.1(and)-335.7(carbapenems)]TJ
/F5 1 Tf
9.843 0 0 9.843 72 100.4598 Tm
[(A)-387.9(d)0(e)19.7(g)0(r)20.9(e)0(e)-378.9(o)0(f)-376.5(s)0(y)15.3(n)0(e)19.7(r)0(g)20.9(y)-387(wa)18.8(s)-386.8(o)0(b)20.8(s)0(e)14.1(r)0(v)20.9(e)0(d)-377.7(b)0(e)19.7(t)0(w)19.8(e)0(e)18.5(n)-387(ef)19.7(u)15.2(x)-387(p)0(u)20.8(m)0(p)]TJ
-1.0137 -1.1116 TD
[(in)20.7(hi)20.7(bi)15(to)20.7(r)-427.3(a)0(n)19.7(d)-427.3(te)19.5(st)20.9(ed)-423.8(ca)18.5(rb)20.9(ap)19.7(en)19.7(em)18.5(s.)-419(Th)19.6(e)-428.5(M)0(I)20(C)-428.3(le)19.6(ve)19.7(ls)-416.8(of)-422.6(me)18.4(r-)]TJ
0 -1.1174 TD
[(op)20.8(en)19.7(em)-200.4(sh)21(ow)20(ed)-199.2(tw)19.8(of)15.1(ol)20.7(d)-208.4(t)0(o)-198.2(e)0(i)19.5(g)0(h)20.8(t)0(f)20.7(o)0(l)20.7(d)-208.4(re)19.7(du)20.8(ct)19.5(io)15(n)-202.7(i)0(n)-198.2(t)0(h)15(e)-203.8(pr)15.1(es)19.9(en)19.7(ce)]TJ
0 -1.1116 TD
[(of)-336.2(CC)18.8(CP)-337.1(in)-342.1(32)-336.3(\(8)20.9(4%)19.8(\))-346.6(o)0(u)20.8(t)-346.8(of)-336.2(38)-342(is)20.9(ol)20.7(at)19.5(es)19.9(,)-349(b)0(u)20.8(t)-346.8(CC)18.8(CP)-337.1(di)15(d)-346.7(n)0(o)20.8(t)]TJ
T*
[(al)19.5(lo)20.7(w)-174.8(c)0(o)19.7(m)0(p)19.6(l)0(e)19.6(t)0(e)-164.8(r)0(e)19.7(s)0(t)15.1(o)0(r)20.9(a)0(t)19.5(i)0(o)20.7(n)-173.9(of)-163.4(me)18.4(ro)20.9(pe)19.7(ne)19.7(m)-175.1(a)0(c)18.5(t)0(i)20.6(v)0(i)20.7(t)0(y)-163.6(a)0(c)18.5(c)0(o)19.7(r)0(d)15.1(i)0(n)20.7(g)-173.9(to)]TJ
25.504 9.4632 TD
[(re)14(la)19.6(ti)20.6(ve)19.7(ly)-215.4(hi)20.7(gh)-215.3(me)18.4(ro)20.9(pe)19.7(ne)13.9(m)-221.2(M)0(I)20(C)0(s)-216.2(\()0(8)15.1()0(6)20.8(4)]TJ
/F6 1 Tf
15.7182 0 TD
(m)Tj
/F5 1 Tf
.5414 0 TD
[(g/)20.7(ml)19.5(\).)-217.6(MI)20(C)-226.7(l)0(e)19.5(v)0(e)19.7(l)0(s)-215.2(o)0(f)]TJ
-16.2596 -1.1116 TD
[(im)19.5(ip)15(en)19.7(em)-235(sh)21(ow)20(ed)-239.5(ma)18.4(in)20.7(ly)-232.7(a)-249.9(t)0(w)19.8(o)0(f)20.9(o)0(l)20.7(d)-248.8(re)19.7(du)20.8(ct)19.5(io)20.7(n)-248.8(i)0(n)-232.7(t)0(h)20.7(e)-249.9(pr)20.9(es)19.9(en)19.7(ce)]TJ
0 -1.1174 TD
[(of)-261.4(CC)18.8(CP)-262.3(in)-261.5(22)-261.4(\(5)20.9(8%)19.8(\))-271.8(o)0(u)20.8(t)-266.2(of)-261.4(38)-261.4(is)20.9(ol)20.7(at)19.5(es)-262.4(\(d)20.9(at)13.8(a)-267.2(n)0(o)20.8(t)-271.9(sh)21(ow)20(n\))15.1(.)]TJ
/F2 1 Tf
8.9663 0 0 8.9663 313.0582 105.959 Tm
[(Pulsed-eld)-337.6(gel)-334.6(electrophoresis)]TJ
/F5 1 Tf
9.843 0 0 9.843 323.0361 89.5181 Tm
[(Among)-238(38)-238.3(isolates,)-239.2(obtained)-241.8(mainly)-233.9(from)-241.7(patients)-236(of)-238.3(ICU,)]TJ
-1.0137 -1.1174 TD
[(and)-643.8(mostly)-635.7(isolat)-8(ed)-636.9(from)-639.1(respiratory)-642.2(specimens,)-645.6(PFGE)]TJ
0 -1.1116 TD
[(analy)-8(sis)-331.3(revea)-9(led)-332.9(35)-336.3(distinct)-338.6(proles)-336.9(\(Fig.)-336.1(1\).)-339.7(Isolates)-339.3(were)]TJ
T*
[(grouped)-273.8(in)-267.3(ve)-275(clusters)-270.2(based)-272.6(on)]TJ
/F10 1 Tf
13.6908 0 TD
(>)Tj
/F5 1 Tf
.72 0 TD
[(80%)-269.3(similarity)-273(criterion,)]TJ
ET
q
490.48 0 0 520.611 62.022 211.635 cm
/Im1 Do
Q
BT
/F13 1 Tf
9.845 0 0 9.845 62.022 194.0598 Tm
[(FIG.)-411.6(1.)]TJ
/F5 1 Tf
4.1922 0 TD
[(Dendrogram)-411.6(showing)-410.8(the)-413.2(clonal)-411.7(relationship)-412.1(of)]TJ
/F4 1 Tf
20.1664 0 TD
[(Pseudomonas)-416.8(aeruginosa)]TJ
/F5 1 Tf
10.8721 0 TD
[(clinical)-415.2(strains,)-414.6(generated)-411.1(from)-414(the)]TJ
-35.2308 -1.0135 TD
[(PFGE)-408.7(proles.)-408.6(C,)-402.7(cardiology;)-411.1(GE,)-404.7(gastroenterology;)-406.7(ICU,)-411.3(intensive)-408.9(care)-404.8(unit;)-408.6(N,)-402.5(neurology;)-408.8(NS,)-409.1(neurosurgery;)-406.8(P,)-407.3(pul-)]TJ
T*
[(monology;)-332.9(PED,)-336.4(pediatric;)-336.6(PFGE,)-337.2(pulsed-eld)-335.7(gel)-332.6(electrophoresis;)-337.6(SUR,)-336.2(surgery;)-337.3(U,)-333.4(untypeable.)]TJ
/F7 1 Tf
8.9663 0 0 8.9663 62.022 749.6502 Tm
(264)Tj
42.4584 0 TD
[(BUBONJA-SONJE)-339.6(ET)-338.7(AL.)]TJ
ET
endstream
endobj
70 0 obj
<>stream
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