<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0123-9392</journal-id>
<journal-title><![CDATA[Infectio]]></journal-title>
<abbrev-journal-title><![CDATA[Infect.]]></abbrev-journal-title>
<issn>0123-9392</issn>
<publisher>
<publisher-name><![CDATA[Asociación Colombiana de Infectología.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0123-93922023000200078</article-id>
<article-id pub-id-type="doi">10.22354/24223794.1126</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Alta frecuencia de bacilos Gram negativos de importancia clínica resistentes a betalactámicos en efluentes de aguas residuales hospitalarias]]></article-title>
<article-title xml:lang="en"><![CDATA[High frequency of clinically important Gram-negative bacilli resistant to beta-lactams in hospital wastewater effluents.]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Tellez-Carrasquilla]]></surname>
<given-names><![CDATA[Sara]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez]]></surname>
<given-names><![CDATA[Erika A.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Jiménez]]></surname>
<given-names><![CDATA[J. Natalia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Antioquia  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,aff2  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,aff3  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,aff4  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2023</year>
</pub-date>
<volume>27</volume>
<numero>2</numero>
<fpage>78</fpage>
<lpage>85</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S0123-93922023000200078&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S0123-93922023000200078&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S0123-93922023000200078&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción: La resistencia bacteriana es una problemática multifactorial, donde otros escenarios diferentes al hospitalario han cobrado gran importancia.  Objetivo: Determinar la presencia de bacilos Gram negativos resistentes a betalactámicos de importancia clínica en aguas residuales de un hospital de alta complejidad de la ciudad de Medellín, Antioquia.  Materialesy métodos: Estudio descriptivo de corte transversal. Entre noviembre y diciembre de 2018 se realizaron dos muestreos en dos efluentes de agua residual de un hospital de alta complejidad. Las bacterias fueron aisladas empleando medios cromogénicos y posteriormente se realizó caracterización molecular de betalactamasas empleando PCR. La identificación bacteriana y la susceptibilidad se llevaron a cabo por métodos automatizados.  Resultados: Noventa aislados fueron obtenidos, de los cuales el 78,90% (n=71) portaban al menos un gen que codificaba para BLEE ó penicilinasas; y el 78,90% (n=71) al menos un gen para carbapenemasas. Citrobacter freundii fue la bacteria predominante (30% n=12), seguida de Klebsiella pneumoniae (25% n=10). En todos los aislados seleccionados se encontró Multidrogorresistencia (MDR) (100% n=40).  Conclusión: La alta presencia de bacterias resistentes a betalactámicos en aguas residuales hospitalarias evidencia la necesidad de implementar estrategias de manejo de estos desechos, dado el riesgo potencial para la transmisión y diseminación de bacterias resistentes.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction: Bacterial resistance is a multifactorial phenomenon, where scenarios other than the hospital setting have gained significant importance.  Objective: To determine the presence of beta-lactam-resistant Gramnegative bacilli of clinical importance in wastewater from a highly complex hospital in Medellín, Antioquia.  Materials and methods: A descriptive cross-sectional study was carried out. Two wastewater samples were taken from two effluents from a highly complex hospital between November and December 2018. Bacteria were isolated from chromogenic agar, and subsequently, molecular PCR characterization of beta-lactamases of clinical importance was performed. Bacterial identification and susceptibility were determinate by automatized method.  Results: Ninety isolates from hospital effluents were obtained, of which 78.90% (n=71) had at least one gene that encoded for ESBL or penicillinase; and 78.90% (n=71) at least one gene coding for carbapenemases. Citrobacter freundii was the predominant bacteria in the evaluated isolates (30% n=12), followed by Klebsiella pneumoniae (25% n = 10). In the isolates selected for susceptibility determination, all (100% n=40) were found to have multidrug resistance (MDR).  Conclusion: The high presence of bacteria resistant to beta-lactams in wastewater from hospital, evidences the need to implement management strategies for these wastes, given the potential risk for the transmission and spread of resistant bacteria.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Resistencia bacteriana]]></kwd>
<kwd lng="es"><![CDATA[bacilos Gram negativos]]></kwd>
<kwd lng="es"><![CDATA[aguas residuales hospitalarias]]></kwd>
<kwd lng="es"><![CDATA[betalactamasas]]></kwd>
<kwd lng="en"><![CDATA[Bacterial resistance]]></kwd>
<kwd lng="en"><![CDATA[Gram negative bacilli]]></kwd>
<kwd lng="en"><![CDATA[hospital wastewater]]></kwd>
<kwd lng="en"><![CDATA[betalactamases]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Muto]]></surname>
<given-names><![CDATA[CA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Why Are Antibiotic-Resistant Nosocomial Infections Spiraling Out of Control]]></article-title>
<source><![CDATA[Infect Control Hosp Epidemiol]]></source>
<year>2005</year>
<volume>26</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>10-2</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[De Angelis]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Giacomo Del]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Posteraro]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Sanguinetti]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Tumbarello]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Molecular mechanisms, epidemiology, and clinical importance of ß-lactam resistance in enterobacteriaceae]]></article-title>
<source><![CDATA[Int J Mol Sci]]></source>
<year>2020</year>
<volume>21</volume>
<numero>14</numero>
<issue>14</issue>
<page-range>1-22</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Stuart]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Lapworth]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Crane]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Hart]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Review of risk from potential emerging contaminants in UK groundwater]]></article-title>
<source><![CDATA[Sci Total Environ [Internet]]]></source>
<year>2012</year>
<volume>416</volume>
<page-range>1-21</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hassoun-Kheir]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Stabholz]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Kreft]]></surname>
<given-names><![CDATA[JU]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Comparison of antibiotic-resistant bacteria and antibiotic resistance genes abundance in hospital and community wastewater: A systematic review]]></article-title>
<source><![CDATA[Sci Total Environ]]></source>
<year>2020</year>
<numero>743</numero>
<issue>743</issue>
</nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lépesová]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Olejníková]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Mackuíak]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Cverenkárová]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Krahulcová]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Bírosová]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hospital Wastewater-Important Source of Multidrug Resistant Coliform Bacteria with ESBL-Production]]></article-title>
<source><![CDATA[Int J Environ Res Public Health [Internet]. 26 de octubre de]]></source>
<year>2020</year>
<volume>17</volume>
<numero>21</numero>
<issue>21</issue>
<page-range>7827</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Marti]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Variatza]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Balcazar]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
<name>
<surname><![CDATA[Balcázar]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The role of aquatic ecosystems as reservoirs of antibiotic resistance]]></article-title>
<source><![CDATA[Trends Microbiol. enero de]]></source>
<year>2014</year>
<volume>22</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>36-41</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Aristizábal-Hoyos]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Rodríguez]]></surname>
<given-names><![CDATA[EA]]></given-names>
</name>
<name>
<surname><![CDATA[Arias]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Jiménez]]></surname>
<given-names><![CDATA[JN]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[High clonal diversity of multidrug-resistant and extended spectrum beta-lactamase-producing Escherichia coli in a wastewater treatment plant]]></article-title>
<source><![CDATA[J Environ Manage [Internet]]]></source>
<year>2019</year>
<volume>245</volume>
<numero>May</numero>
<issue>May</issue>
<page-range>37-47</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dallenne]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[da Costa]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Decré]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Favier]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Arlet]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Development of a set of multiplex PCR assays for the detection of genes encoding important ß-lactamases in Enterobacteriaceae]]></article-title>
<source><![CDATA[J Antimicrob Chemother]]></source>
<year>2010</year>
<volume>65</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>490-5</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Poirel]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Walsh]]></surname>
<given-names><![CDATA[TR]]></given-names>
</name>
<name>
<surname><![CDATA[Cuvillier]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Nordmann]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Multiplex PCR for detection of acquired carbapenemase genes]]></article-title>
<source><![CDATA[Diagn Microbiol Infect Dis [Internet]]]></source>
<year>2011</year>
<volume>70</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>119-23</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Woodford]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Ellington]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
<name>
<surname><![CDATA[Coelho]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Multiplex PCR for genes encoding prevalent OXA carbapenemases in Acinetobacter spp]]></article-title>
<source><![CDATA[Int J Antimicrob Agents]]></source>
<year>2006</year>
<volume>27</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>351-3</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wayne]]></surname>
<given-names><![CDATA[PA]]></given-names>
</name>
</person-group>
<source><![CDATA[Performance Standards for Antimicrobial Susceptibility Testing,]]></source>
<year>2020</year>
<edition>30</edition>
<publisher-loc><![CDATA[CLSI ]]></publisher-loc>
<publisher-name><![CDATA[Clinical and Laboratory Standards Institute]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wayne]]></surname>
<given-names><![CDATA[PA]]></given-names>
</name>
</person-group>
<source><![CDATA[Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria]]></source>
<year>2016</year>
<edition>3</edition>
<publisher-loc><![CDATA[CLSI ]]></publisher-loc>
<publisher-name><![CDATA[Clinical and Laboratory Standards Institute]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="">
<collab>EUCAST</collab>
<source><![CDATA[Antimicrobial Susceptibility Testing Breakpoint tables for interpretation of MICs and zone diameters]]></source>
<year>2020</year>
</nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Magiorakos]]></surname>
<given-names><![CDATA[AP]]></given-names>
</name>
<name>
<surname><![CDATA[Srinivasan]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Carey]]></surname>
<given-names><![CDATA[RB]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria An international expert proposal for interim standard definitions for acquired resistance]]></article-title>
<source><![CDATA[Clin Microbiol Infect [Internet]]]></source>
<year>2012</year>
<volume>18</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>268-81</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="">
<collab>Ministerio de Ambiente y Desarrollo sostenible</collab>
<source><![CDATA[Resolución 0631 de 2015]]></source>
<year>2015</year>
</nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hocquet]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Muller]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Bertrand]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[What happens in hospitals does not stay in hospitals antibiotic-resistant bacteria in hospital wastewater systems]]></article-title>
<source><![CDATA[J Hosp Infect [Internet]]]></source>
<year>2016</year>
<volume>93</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>395-402</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Aristizabal-Hoyos]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Rodríguez]]></surname>
<given-names><![CDATA[EA]]></given-names>
</name>
<name>
<surname><![CDATA[Torres-Palma]]></surname>
<given-names><![CDATA[RA]]></given-names>
</name>
<name>
<surname><![CDATA[Jiménez]]></surname>
<given-names><![CDATA[JN]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Concern levels of beta-lactamase-producing Gram-negative bacilli in hospital wastewater: hotspot of antimicrobial resistance in Latin-America]]></article-title>
<source><![CDATA[Diagn Microbiol Infect Dis]]></source>
<year>2022</year>
<numero>115819</numero>
<issue>115819</issue>
</nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hernández-Gómez]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Blanco]]></surname>
<given-names><![CDATA[VM]]></given-names>
</name>
<name>
<surname><![CDATA[Motoa]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Correa]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Maya]]></surname>
<given-names><![CDATA[JJ]]></given-names>
</name>
<name>
<surname><![CDATA[de la Cadena]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evolución de la resistencia antimicrobiana de bacilos Gram negativos en unidades de cuidados intensivos en Colombia]]></article-title>
<source><![CDATA[Biomedica]]></source>
<year>2014</year>
<volume>34</volume>
<numero>^s1</numero>
<issue>^s1</issue>
<supplement>1</supplement>
<page-range>91-100</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ocampo]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Cienfuegos]]></surname>
<given-names><![CDATA[AV]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A Two-Year Surveillance in Five Colombian Tertiary Care Hospitals Reveals High Frequency of Non-CG258 Clones of Carbapenem-Resistant Klebsiella pneumoniae with Distinct Clinical Characteristics]]></article-title>
<source><![CDATA[Am Soc Microbiol]]></source>
<year>2016</year>
<volume>60</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>332-42</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nadimpalli]]></surname>
<given-names><![CDATA[ML]]></given-names>
</name>
<name>
<surname><![CDATA[Marks]]></surname>
<given-names><![CDATA[SJ]]></given-names>
</name>
<name>
<surname><![CDATA[Montealegre]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Urban informal settlements as hotspots of antimicrobial resistance and the need to curb environmental transmission]]></article-title>
<source><![CDATA[Nat Microbiol]]></source>
<year>2020</year>
<volume>5</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>787-95</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Picão]]></surname>
<given-names><![CDATA[RC]]></given-names>
</name>
<name>
<surname><![CDATA[Cardoso]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
<name>
<surname><![CDATA[Campana]]></surname>
<given-names><![CDATA[EH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The route of antimicrobial resistance from the hospital effluent to the environment Focus on the occurrence of KPC-producing Aeromonas spp. and Enterobacteriaceae in sewage]]></article-title>
<source><![CDATA[Diagn Microbiol Infect Dis [Internet]]]></source>
<year>2013</year>
<volume>76</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>80-5</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vanegas]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Cienfuegos]]></surname>
<given-names><![CDATA[AV]]></given-names>
</name>
<name>
<surname><![CDATA[Ocampo]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Similar frequencies of Pseudomonas aeruginosa isolates producing KPC and VIM carbapenemases in diverse genetic clones at tertiary-care hospitals in Medellín, Colombia]]></article-title>
<source><![CDATA[J Clin Microbiol]]></source>
<year>2014</year>
<volume>52</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>3978-86</page-range></nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="book">
<collab>Instituto Nacional de Salud</collab>
<source><![CDATA[Informe de resultados de la vigilancia por laboratorio de resistencia antimicrobiana en infecciones asociadas a la atención en salud (IAAS) 2018]]></source>
<year>2020</year>
<volume>5</volume>
<page-range>48</page-range><publisher-name><![CDATA[Instituto Nacional de Salud]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[lach]]></surname>
<given-names><![CDATA[CF]]></given-names>
</name>
<name>
<surname><![CDATA[Hutinel]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Razavi]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Âhrén]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Larsson]]></surname>
<given-names><![CDATA[DGJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Monitoring of hospital sewage shows both promise and limitations as an early-warning system for carbapenemase-producing Enterobacterales in a low-prevalence setting]]></article-title>
<source><![CDATA[Water Res]]></source>
<year>2021</year>
<numero>200</numero>
<issue>200</issue>
</nlm-citation>
</ref>
<ref id="B25">
<label>25</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Makowska]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Philips]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Dabert]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Nowis]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Metagenomic analysis of ß-lactamase and carbapenemase genes in the wastewater resistome]]></article-title>
<source><![CDATA[Water Res]]></source>
<year>2020</year>
<numero>170</numero>
<issue>170</issue>
</nlm-citation>
</ref>
<ref id="B26">
<label>26</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rozman]]></surname>
<given-names><![CDATA[U]]></given-names>
</name>
<name>
<surname><![CDATA[Duh]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Cimerman]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Turk]]></surname>
<given-names><![CDATA[SS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hospital wastewater effluent Hot spot for antibiotic resistant bacteria]]></article-title>
<source><![CDATA[J Water Sanit Hyg Dev]]></source>
<year>2020</year>
<volume>10</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>171-8</page-range></nlm-citation>
</ref>
<ref id="B27">
<label>27</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[GERMEN]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<source><![CDATA[Vigilancia de la Resistencia a los Antibióticos en instituciones hospitalarias y sus laboratorios clínicos en el Valle de Aburrá, año 2019]]></source>
<year>2020</year>
<page-range>1-25</page-range></nlm-citation>
</ref>
<ref id="B28">
<label>28</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gómez-González]]></surname>
<given-names><![CDATA[JF]]></given-names>
</name>
<name>
<surname><![CDATA[Sánchez-Duque]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Perfil microbiológico y resistencia bacteriana en una unidad de cuidados intensivos de Pereira, Colombia, 2015]]></article-title>
<source><![CDATA[Rev Médicas UIS]]></source>
<year>2018</year>
<volume>31</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>9-15</page-range></nlm-citation>
</ref>
<ref id="B29">
<label>29</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Leonor]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Barrios]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Alberto]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Sierra]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Del]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Jaimes]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Bacterias resistentes a antibióticos en ecosistemas acuáticos]]></article-title>
<source><![CDATA[Prod + Limpia]]></source>
<year>2015</year>
<volume>10</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>160-72</page-range></nlm-citation>
</ref>
<ref id="B30">
<label>30</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Abbott]]></surname>
<given-names><![CDATA[IJ]]></given-names>
</name>
<name>
<surname><![CDATA[Jenney]]></surname>
<given-names><![CDATA[AWJ]]></given-names>
</name>
<name>
<surname><![CDATA[Spelman]]></surname>
<given-names><![CDATA[DW]]></given-names>
</name>
<name>
<surname><![CDATA[Pilcher D]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Sidjabat]]></surname>
<given-names><![CDATA[HE]]></given-names>
</name>
<name>
<surname><![CDATA[Richardson]]></surname>
<given-names><![CDATA[LJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Active surveillance for multidrug-resistant Gram-negative bacteria in the intensive care unit]]></article-title>
<source><![CDATA[Pathology]]></source>
<year>2015</year>
<volume>47</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>575-9</page-range></nlm-citation>
</ref>
<ref id="B31">
<label>31</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Magira]]></surname>
<given-names><![CDATA[EE]]></given-names>
</name>
<name>
<surname><![CDATA[Islam]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Niederman]]></surname>
<given-names><![CDATA[MS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Multi-drug resistant organism infections in a medical ICU Association to clinical features and impact upon outcome]]></article-title>
<source><![CDATA[Med Intensiva [Internet]]]></source>
<year>2018</year>
<volume>42</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>225-34</page-range></nlm-citation>
</ref>
<ref id="B32">
<label>32</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mustapha]]></surname>
</name>
<name>
<surname><![CDATA[Adam]]></surname>
</name>
<name>
<surname><![CDATA[Tijani]]></surname>
</name>
<name>
<surname><![CDATA[Isa]]></surname>
</name>
<name>
<surname><![CDATA[Bello]]></surname>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Resistance Profiles of Bacteria Isolated from Wastewater in the University of Maiduguri Teaching Hospital]]></article-title>
<collab>S H</collab>
<source><![CDATA[J Biotechnol Res]]></source>
<year>2016</year>
<volume>2</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>49-54</page-range></nlm-citation>
</ref>
<ref id="B33">
<label>33</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Czekalski]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Gascón Díez]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Bürgmann]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Wastewater as a point source of antibiotic-resistance genes in the sediment of a freshwater lake]]></article-title>
<source><![CDATA[ISME J]]></source>
<year>2014</year>
<volume>8</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>1381-90</page-range></nlm-citation>
</ref>
<ref id="B34">
<label>34</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nnadozie]]></surname>
<given-names><![CDATA[CF]]></given-names>
</name>
<name>
<surname><![CDATA[Odume]]></surname>
<given-names><![CDATA[ON]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Freshwater environments as reservoirs of antibiotic resistant bacteria and their role in the dissemination of antibiotic resistance genes]]></article-title>
<source><![CDATA[Environ Pollut [Internet]]]></source>
<year>2019</year>
<volume>254</volume>
<page-range>113067</page-range></nlm-citation>
</ref>
<ref id="B35">
<label>35</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dorado-García]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Smid]]></surname>
<given-names><![CDATA[JH]]></given-names>
</name>
<name>
<surname><![CDATA[van Pelt]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Molecular relatedness of ESBL/AmpC-producing Escherichia coli from humans, animals, food and the environment a pooled analysis]]></article-title>
<source><![CDATA[J Antimicrob Chemother [Internet]. 1 de febrero de]]></source>
<year>2018</year>
<volume>73</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>339-47</page-range></nlm-citation>
</ref>
<ref id="B36">
<label>36</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mills]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<source><![CDATA[The threat of carbapenem-resistant bacteria in the environment: Evidence of widespread contamination of reservoirs at a global scale]]></source>
<year>2019</year>
<volume>255</volume>
<page-range>113143</page-range><publisher-name><![CDATA[Environmental Pollution. Elsevier Ltd]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B37">
<label>37</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Walsh]]></surname>
<given-names><![CDATA[TR]]></given-names>
</name>
<name>
<surname><![CDATA[Weeks]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Livermore]]></surname>
<given-names><![CDATA[DM]]></given-names>
</name>
<name>
<surname><![CDATA[Toleman]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study]]></article-title>
<source><![CDATA[Lancet Infect Dis]]></source>
<year>2011</year>
<volume>11</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>355-62</page-range></nlm-citation>
</ref>
<ref id="B38">
<label>38</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Majlander]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Anttila V-J]]></surname>
</name>
<name>
<surname><![CDATA[Nurmi]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Seppälä]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Tiedje]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Muziasari]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Routine wastewater-based monitoring of antibiotic resistance in two Finnish hospitals focus on carbapenem resistance genes and genes associated with bacteria causing hospital-acquired infections]]></article-title>
<source><![CDATA[J Hosp Infect [Internet]. noviembre de]]></source>
<year>2021</year>
<volume>117</volume>
<page-range>157-64</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
