Displaying publications 181 - 200 of 277 in total

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  1. Fulltext Prevalence and antimicrobial resistance of Listeria, Salmonella, and Yersinia species isolates in ducks and geese
    Jamali H, Radmehr B, Ismail S
    Poult Sci, 2014 Apr;93(4):1023-30.
    PMID: 24706981 DOI: 10.3382/ps.2013-03699
    The aims of this study were to determine the prevalence and antimicrobial resistance of Listeria, Salmonella, and Yersinia spp. isolated from duck and goose intestinal contents. A total of 471 samples, including 291 duck and 180 goose intestinal contents, were purchased from wet markets between November 2008 and July 2010. Listeria, Salmonella, and Yersinia spp. were isolated from 58 (12.3%), 107 (22.7%), and 80 (17%) of the samples, respectively. It was concluded that Listeria ivanovii, Salmonella Thompson, and Yersinia enterocolitica were the predominant serovars among Listeria, Salmonella, and Yersinia spp., respectively. Moreover, resistance to tetracycline was common in Listeria (48.3%) and Salmonella spp. (63.6%), whereas 51.3% of the Yersinia spp. isolates were resistant to cephalothin. Therefore, continued surveillance of the prevalence of the pathogens and also of emerging antibiotic resistance is needed to render possible the recognition of foods that may represent risks and also ensure the effective treatment of listeriosis, salmonellosis, and yersiniosis.
    Matched MeSH terms: Gram-Positive Bacterial Infections/microbiology; Gram-Positive Bacterial Infections/epidemiology; Gram-Positive Bacterial Infections/veterinary
  2. Continuous infusion vs. bolus dosing: implications for beta-lactam antibiotics
    Mohd Hafiz AA, Staatz CE, Kirkpatrick CM, Lipman J, Roberts JA
    Minerva Anestesiol, 2012 Jan;78(1):94-104.
    PMID: 21730935
    Beta-lactam antibiotics display time-dependant pharmacodynamics whereby constant antibiotic concentrations rather than high peak concentrations are most likely to result in effective treatment of infections caused by susceptible bacteria. Continuous administration has been suggested as an alternative strategy, to conventional intermittent dosing, to optimise beta-lactam pharmacokinetic/pharmacodynamic (PK/PD) properties. With the availability of emerging data, we elected to systematically investigate the published literature describing the comparative PK/PD and clinical outcomes of beta-lactam antibiotics administered by continuous or intermittent infusion. We found that the studies have been performed in various patient populations including critically ill, cancer and cystic fibrosis patients. Available in vitro PK/PD data conclusively support the administration of beta-lactams via continuous infusion for maximizing bacterial killing from consistent attainment of pharmacodynamic end-points. In addition, clinical outcome data supports equivalence, even with the use of a lower dose by continuous infusion. However, the present clinical data is limited with small sample sizes common with insufficient power to detect advantages in favour of either dosing strategy. With abundant positive pre-clinical data as well as document in vivo PK/PD advantages, large multi-centre trials are needed to describe whether continuous administration of beta-lactams is truly more effective than intermittent dosing.
    Matched MeSH terms: Bacterial Infections/drug therapy*; Bacterial Infections/etiology; Bacterial Infections/mortality
  3. Complications after tenckhoff catheter insertion: a single-centre experience using multiple operators over four years
    Liu WJ, Hooi LS
    Perit Dial Int, 2010 03 12;30(5):509-12.
    PMID: 20228175 DOI: 10.3747/pdi.2009.00083
    OBJECTIVE: To analyze the complications after Tenckhoff catheter insertion among patients with renal failure needing dialysis. ♢

    PATIENTS AND METHODS: The open, paramedian approach is the commonest technique to insert the 62-cm coiled double-cuffed Tenckhoff peritoneal catheter. All patients with catheters inserted between January 2004 and November 2007 were retrospectively analyzed for demographics and followed for up to 1 month for complications. We excluded patients whose catheters had been anchored to the bladder wall and who underwent concurrent omentectomy or readjustment without removal of a malfunctioning catheter (n = 7). Intravenous cloxacillin was the standard preoperative antibiotic prophylaxis. ♢

    RESULTS: Over the 4-year study period, 384 catheters were inserted under local anesthetic into 319 patients [201 women (62.8%); mean age: 49.4 ± 16.7 years (range: 13 - 89 years); 167 (52.2%) with diabetes; 303 (95%) with end-stage renal disease] by 22 different operators. All Tenckhoff catheters were inserted by the general surgical (n = 223) or urology (n = 161) team. There were 29 cases (7.6%) of catheter migration, 22 (5.7%) of catheter obstruction without migration, 24 (6.3%) of exit-site infection, 12 (3.1%) of leak from the main incision, 14 (3.6%) of culture-proven wound infection, 11 (2.9%) post-insertion peritonitis, and 1 (0.3%) hemoperitoneum. No deaths were attributed to surgical mishap. ♢

    CONCLUSIONS: The most common complication was catheter migration. The paramedian insertion technique was safe, with low complication rates.

    Matched MeSH terms: Bacterial Infections/etiology; Bacterial Infections/microbiology; Bacterial Infections/epidemiology
  4. Applying the Multinational Association for Supportive Care in Cancer risk scoring in predicting outcome of febrile neutropenia patients in a cohort of patients
    Baskaran ND, Gan GG, Adeeba K
    Ann Hematol, 2008 Jul;87(7):563-9.
    PMID: 18437382 DOI: 10.1007/s00277-008-0487-7
    The purpose of this study was to determine if the Multinational Association for Supportive Care in Cancer (MASCC) risk-index score is able to predict the outcome of febrile neutropenia in patients with underlying hematological malignancy and to look at the other possible predictors of outcome. A retrospective study of 116 episodes of febrile neutropenia in patients who were admitted to the hematology ward of a local medical center in Malaysia between January 1st 2004 and January 31st 2005. Patient characteristics and the MASCC score were compared with outcome. The MASCC score predicted the outcome of febrile neutropenic episodes with a positive predictive value of 82.9%, a sensitivity of 93%, and specificity of 67%. Other predictors of a favorable outcome were those patients who had lymphomas versus leukemias, duration of neutropenia of less than 7 days, low burden of illness characterized by the absence of an infective focus and absence of lower respiratory tract infection, a serum albumin of >25 g/l, and the absence of gram-negative bacteremia on univariate analysis but only serum albumin level, low burden of illness, and presence of respiratory infection were significantly associated with unfavorable outcome after multivariate analysis. The MASCC score is a useful predictor of outcome in patients with febrile neutropenia with underlying hematological malignancies. This scoring system may be adapted for use in local settings to guide the clinical management of patients with this condition.
    Matched MeSH terms: Bacterial Infections/complications; Bacterial Infections/drug therapy; Bacterial Infections/prevention & control
  5. Fulltext Hospital-acquired vancomycin-resistant enterococci: now appearing in Kuala Lumpur Hospital
    Zubaidah AW, Ariza A, Azmi S
    Med J Malaysia, 2006 Oct;61(4):487-9.
    PMID: 17243529 MyJurnal
    Hospital-acquired vancomycin-resistant enterococci (VRE) were first reported in the late 1980s and have since been an increasing problem worldwide. Kuala Lumpur Hospital thus far, to the best of our knowledge has been spared from this pathogen. We describe the first confirmed case of Enterococcus faecium exhibiting the van A phenotype in our hospital, in a patient with chronic renal failure who was successfully treated with linezolid. The microbiology laboratory plays an important role in the identification and detection of VRE.
    Matched MeSH terms: Gram-Positive Bacterial Infections/drug therapy*; Gram-Positive Bacterial Infections/etiology; Gram-Positive Bacterial Infections/microbiology
  6. Causative Pathogens of Febrile Neutropaenia in Children Treated for Acute Lymphoblastic Leukaemia
    Lam JC, Chai JY, Wong YL, Tan NW, Ha CT, Chan MY, et al.
    Ann Acad Med Singap, 2015 Nov;44(11):530-4.
    PMID: 27089960
    INTRODUCTION: Treatment of acute lymphoblastic leukaemia (ALL) using intensive chemotherapy has resulted in high cure rates but also substantial morbidity. Infective complications represent a significant proportion of treatment-related toxicity. The objective of this study was to describe the microbiological aetiology and clinical outcome of episodes of chemotherapy-induced febrile neutropaenia in a cohort of children treated for ALL at our institution.

    MATERIALS AND METHODS: Patients with ALL were treated with either the HKSGALL93 or the Malaysia-Singapore (Ma-Spore) 2003 chemotherapy protocols. The records of 197 patients who completed the intensive phase of treatment, defined as the period of treatment from induction, central nervous system (CNS)-directed therapy to reinduction from June 2000 to January 2010 were retrospectively reviewed.

    RESULTS: There were a total of 587 episodes of febrile neutropaenia in 197 patients, translating to an overall rate of 2.98 episodes per patient. A causative pathogen was isolated in 22.7% of episodes. An equal proportion of Gram-positive bacteria (36.4%) and Gram-negative bacteria (36.4%) were most frequently isolated followed by viral pathogens (17.4%), fungal pathogens (8.4%) and other bacteria (1.2%). Fungal organisms accounted for a higher proportion of clinically severe episodes of febrile neutropaenia requiring admission to the high-dependency or intensive care unit (23.1%). The overall mortality rate from all episodes was 1.5%.

    CONCLUSION: Febrile neutropaenia continues to be of concern in ALL patients undergoing intensive chemotherapy. The majority of episodes will not have an identifiable causative organism. Gram-positive bacteria and Gram-negative bacteria were the most common causative pathogens identified. With appropriate antimicrobial therapy and supportive management, the overall risk of mortality from febrile neutropaenia is extremely low.

    Matched MeSH terms: Gram-Negative Bacterial Infections/epidemiology*; Gram-Positive Bacterial Infections/epidemiology*
  7. Fulltext Lesson learnt: first reported case of complicated cutaneous pythiosis in a dog in Malaysia
    Omar, S., Mohd Zainudin, N.A.I., Azman, N., Jessie-Bay, J.X.
    Jurnal Veterinar Malaysia, 2019;31(1):34-37.
    MyJurnal
    This report documents a case of 5-month old intact male German Shepherd dog diagnosed with pythiosis on its left forelimb. This is the first ever reported case of pythiosis presented at the University Veterinary Teaching Hospital (UVH), Universiti Putra Malaysia and may be the first ever reported incidence in Malaysia with a complaint of a chronic non-healing wound. The case became complicated as the dog was concurrently infected with a mixed bacterial infection and the identified bacteria were resistant towards a number of antibiotics tested. The antibiotic that was determined to be sensitive was only able to act on certain bacteria and not to the others. The journey of getting to the final diagnosis was almost impossible if we had not tried different media preparation: with and without Dermasel supplement; and through molecular approach using amplification at ITS region followed by DNA sequence analysis. The unwarranted lack during the diagnosis process of this incidence has made us more aware of the presence of Pythium insidiosum in Malaysia and plan for a more strategize ways of diagnosing the suspected fungus at laboratory setting in future. The objective of this paper is to share our experience and reflection on the diagnosis of the rare incidence of pythiosis present in Malaysia.
    Matched MeSH terms: Bacterial Infections
  8. Fulltext Identification of salmonella and other pathogenic bacteria in pet red-eared sliders, trachemys scripta elegans, from pet shops in the Klang valley
    Selvarajah, G.T., Khairani-Bejo, S.
    Jurnal Veterinar Malaysia, 2019;31(2):23-27.
    MyJurnal
    Bacteriological isolation and identification were performed on 60 cloacal swabs and 15 aquarium water samples of pet red-eared sliders (Trachemys scripta elegans) obtained from aquarium shops in the Klang Valley, Central Peninsula Malaysia. The most common bacteria isolated was Aeromonas spp., which was present in both cloacal swabs (70%) and aquarium water (86.7%). Klebsiella spp. (50%), Escherichia coli (33.3%), Yersinia spp. (16.7%) and Salmonella spp. (15%) obtained form cloacal swabs were identified as pathogenic to both humans and animals. Salmonella spp. were isolated from both cloacal swabs and aquarium water. The Salmonella serotypes identified were S. tennessee, S. typhimurium, S. brezany, S. pomona, S. corvallis and S. schwarzengrund. Bacterial infections in humans associated with handling exotic pets directly or indirectly in contact with aquarium water have been described regularly, hence the zoonotic significance of owning a turtle infected with Salmonella spp. or any pathogenic bacteria therefore cannot be ignored.
    Matched MeSH terms: Bacterial Infections
  9. Fulltext Determining Soil Microbial Communities and Their Influence on Ganoderma Disease Incidences in Oil Palm (Elaeis guineensis) via High-Throughput Sequencing
    Goh YK, Zoqratt MZHM, Goh YK, Ayub Q, Ting ASY
    Biology (Basel), 2020 Nov 27;9(12).
    PMID: 33260913 DOI: 10.3390/biology9120424
    Basal stem rot (BSR), caused by Ganoderma boninense, is the most devastating oil palm disease in South East Asia, costing US$500 million annually. Various soil physicochemical parameters have been associated with an increase in BSR incidences. However, very little attention has been directed to understanding the relationship between soil microbiome and BSR incidence in oil palm fields. The prokaryotic and eukaryotic microbial diversities of two coastal soils, Blenheim soil (Typic Quartzipsamment-calcareous shell deposits, light texture) with low disease incidence (1.9%) and Bernam soil (Typic Endoaquept-non-acid sulfate) with high disease incidence (33.1%), were determined using the 16S (V3-V4 region) and 18S (V9 region) rRNA amplicon sequencing. Soil physicochemical properties (pH, electrical conductivity, soil organic matter, nitrogen, phosphorus, cation exchange capacity, exchangeable cations, micronutrients, and soil physical parameters) were also analyzed for the two coastal soils. Results revealed that Blenheim soil comprises higher prokaryotic and eukaryotic diversities, accompanied by higher pH and calcium content. Blenheim soil was observed to have a higher relative abundance of bacterial taxa associated with disease suppression such as Calditrichaeota, Zixibacteria, GAL15, Omnitrophicaeota, Rokubacteria, AKYG587 (Planctomycetes), JdFR-76 (Calditrichaeota), and Rubrobacter (Actinobacteria). In contrast, Bernam soil had a higher proportion of other bacterial taxa, Chloroflexi and Acidothermus (Actinobacteria). Cercomonas (Cercozoa) and Calcarisporiella (Ascomycota) were eukaryotes that are abundant in Blenheim soil, while Uronema (Ciliophora) and mammals were present in higher abundance in Bernam soil. Some of the bacterial taxa have been reported previously in disease-suppressive and -conducive soils as potential disease-suppressive or disease-inducible bacteria. Furthermore, Cercomonas was reported previously as potential bacterivorous flagellates involved in the selection of highly toxic biocontrol bacteria, which might contribute to disease suppression indirectly. The results from this study may provide valuable information related to soil microbial community structures and their association with soil characteristics and soil susceptibility to Ganoderma.
    Matched MeSH terms: Bacterial Infections
  10. Seeds, fermented foods, and agricultural by-products as sources of plant-derived antibacterial peptides
    Chai TT, Tan YN, Ee KY, Xiao J, Wong FC
    Crit Rev Food Sci Nutr, 2019;59(sup1):S162-S177.
    PMID: 30663883 DOI: 10.1080/10408398.2018.1561418
    The emergence of bacterial resistance against conventional antibiotics and the growing interest in developing alternative, natural antibacterial agents have prompted the search for plant-derived antibacterial peptides in recent decades. Different classes of endogenous antibacterial peptides have been identified from various plant species. Moreover, protein hydrolysates and hydrolysate-derived peptides with potent antibacterial effects have also been identified from numerous plant sources. Antibacterial peptides are often cationic and amphipathic, consisting of fewer than 100 amino acids. They are able to disrupt bacterial membrane integrity via pore formation and/or compromise bacterial metabolic processes. In this review, we summarize current knowledge on the characteristics and modes of action of antibacterial peptides, as well as salient points concerning the production of antibacterial protein hydrolysates from plant proteins. Examples of plant-derived antibacterial hydrolysates and peptides will be highlighted, with particular attention to less explored seeds, fermented plant foods and agricultural by-products. Promising future research directions with regards to the application of plant-derived antibacterial hydrolysates and peptides in food preservation, farm animal disease management, and nutraceutical/functional food development will be proposed.
    Matched MeSH terms: Bacterial Infections
  11. Fulltext Structural, Optical and Antibacterial Efficacy of Pure and Zinc-Doped Copper Oxide against Pathogenic Bacteria
    Khalid A, Ahmad P, Alharthi AI, Muhammad S, Khandaker MU, Rehman M, et al.
    Nanomaterials (Basel), 2021 Feb 10;11(2).
    PMID: 33578945 DOI: 10.3390/nano11020451
    Copper oxide and Zinc (Zn)-doped Copper oxide nanostructures (CuO-NSs) are successfully synthesized by using a hydrothermal technique. The as-obtained pure and Zn-doped CuO-NSs were tested to study the effect of doping in CuO on structural, optical, and antibacterial properties. The band gap of the nanostructures is calculated by using the Tauc plot. Our results have shown that the band gap of CuO reduces with the addition of Zinc. Optimization of processing conditions and concentration of precursors leads to the formation of pine needles and sea urchin-like nanostructures. The antibacterial properties of obtained Zn-doped CuO-NSs are observed against Gram-negative (Pseudomonasaeruginosa,Klebsiellapneumonia,Escherichiacoli) and Gram-positive (Staphylococcusaureus) bacteria via the agar well diffusion method. Zn doped s are found to have more effective bacterial resistance than pure CuO. The improved antibacterial activity is attributed to the reactive oxygen species (ROS) generation.
    Matched MeSH terms: Bacterial Infections
  12. Fulltext Assessment of polymyxin B associated nephrotoxicity in ICU patients in a Malaysian tertiary teaching hospital
    Lim, M. Y., Nusaibah Abdul Rahim, Periyasamy, P., Lau, C. L.
    Malaysian Journal of Medicine and Health Sciences, 2019;15(102):4-4.
    MyJurnal
    Introduction: Polymyxins are used as the “last-line therapy” for multi drug resistant (MDR) Gram-negative bacterial infections. However, the development of nephrotoxicity is a major concern. The objectives of this study were to determine the incidence and severity of acute kidney injury (AKI) and to identify risk factors associated with AKI and mortality rate in Malaysian patients on polymyxin B (PMB) for MDR Gram-negative bacterial infections. Methods: A retrospective study was conducted in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Medical and
    medication charts were reviewed for all intensive care unit (ICU) patients who received intravenous (IV) PMB from 1st May 2008 to 1st May 2018. Simple and multiple logistic regression were performed to identify risk factors of PMB induced nephrotoxicity. Results: Among the total 572 patients identified, only 31 patients were eligible to be included. The incidence rate of AKI was 45.2% (14 of 31 patients). Univariate analysis showed that age was a significant risk factor of PMB associated nephrotoxicity [OR 1.074; 95% CI 1.002-1.151; P=0.045]. Other four variables (P
    Matched MeSH terms: Gram-Negative Bacterial Infections
  13. Some observations on vitamin A starvation among immigrant Indians in Malaysia
    Field JW
    Malayan Medical Journal, 1931;6:46-53.
    Matched MeSH terms: Bacterial Infections
  14. Chemotherapy in tropical diseases
    Nocht PB
    Malayan Medical Journal, 1931;6:38-42.
    Matched MeSH terms: Bacterial Infections
  15. Fulltext Recurrent Submandibular Sialolithiasis in a Child
    Thong HK, Mohamad Mahbob H, Sabir Husin Athar PP, Tengku Kamalden TMI
    Cureus, 2020 Dec 19;12(12):e12163.
    PMID: 33489575 DOI: 10.7759/cureus.12163
    Sialolithiasis is a commonly encountered disease of the salivary glands, reported to represent up to 30% of all salivary gland diseases. However, the condition is rarely encountered in the pediatric population. The formation of a salivary stone is believed to be secondary to the deposition of calcium salts around a nidus. The formation of a nidus is commonly associated with desquamated epithelial or sloughing from a recent bacterial infection. Patients with submandibular sialolithiasis usually present with acute swelling over the neck associated with pain, fever, and purulent intraoral discharge. Neglected and poorly treated acute infection may progress to life-threatening abscess formation. Here we are describing our encounter with a 10-year-old boy with recurrent submandibular sialolithiasis. He was initially treated with conservative measures and antibiotics regimen. Failure of medical treatment and recurring symptoms led to submandibular gland excision followed by a full recovery.
    Matched MeSH terms: Bacterial Infections
  16. Fulltext Pathology Associated with White Spot Virus (WSV) Infection in Wild Broodstock of Tiger Prawns (Penaeus monodon)
    Kua BC, Rashid NM
    Trop Life Sci Res, 2012 May;23(1):87-92.
    PMID: 24575228 MyJurnal
    A total of six wild broodstocks of tiger prawns, Penaeus monodon, were found positive for White Spot Virus (WSV) with an IQ2000 detection kit. Using histopathology, the intranuclear inclusion of haemocyte due to WSV infection was observed in the epithelium cells of the antennal gland, stomach and gills. This result confirmed that the wild broodstocks were positive with WSV without showing any white spot. Additionally, histopathological examination also revealed an accumulation of haemocytes around the hepatopancreatic tubules resulting from bacterial infection. Encapsulation and nodule formation, as well as related necrosis, were also observed around the hepatopancreatic tubules infected with a metazoan parasite. Encysted tylocephalum larval cestodes were observed in the hepatopancreas, with haemocytic aggregation being observed around the infected tubules. These findings showed some bacterial and parasitic infections which, in addition to the viral infection itself, could contribute to the 80% mortality rate in wild broodstocks infected with WSV.
    Matched MeSH terms: Bacterial Infections
  17. Fulltext Cat's curse: a case of misdiagnosed kerion
    Mazlim M, Muthupalaniappen L
    Malays Fam Physician, 2012;7(2-3):35-8.
    PMID: 25606254 MyJurnal
    Kerion is an inflammatory type of tinea capitis which can be mistaken for bacterial infection or folliculitis as both conditions display similar clinical features. It occurs most frequently in prepubescent children and rarely in adults. We report a 26-year-old woman who presented with multiple tender inflammed nodules on her scalp. Her condition was misdiagnosed as bacterial abscess and treated with multiple courses of antibiotics without improvement. Later, her condition was re-diagnosed as kerion based on clinical appearance, history of contact with infected animal and Wood's lamp examination. symptoms and lesions resolved completely with systemic antifungal treatment leaving residual scarring alopecia. The delay in the diagnosis and treatment of this patient resulted in permanent scarring alopecia.
    Matched MeSH terms: Bacterial Infections
  18. Purulent meningitis in childhood
    Lee EI, Khoo BH, Puthucheary SD, Thong ML
    Med J Malaysia, 1977 Dec;32(2):114-9.
    PMID: 26858
    Matched MeSH terms: Bacterial Infections
  19. Fulltext Management of rhinosinusitis in adults in primary care
    Husain S, Amilia HH, Rosli MN, Zahedi FD, Sachlin IS, Development Group Clinical Practice Guidelines Management of Rhinosinusitis in Adolescents & Adults
    Malays Fam Physician, 2018;13(1):28-33.
    PMID: 29796207 MyJurnal
    Rhinosinusitis is a common health problem encountered in primary care. It is due to mucosal inflammation of the nose and paranasal sinuses. Less than 2% of the cases are associated with bacterial infections. Diagnosis is based on clinical symptoms and supported by nasal endoscopy and imaging studies. Intranasal corticosteroids and normal saline irrigation are important treatments. Antibiotics are seldom indicated.
    Matched MeSH terms: Bacterial Infections
  20. Comparative genome analysis of multiple vancomycin-resistant Enterococcus faecium isolated from two fatal cases
    Lim SY, Yap KP, Teh CS, Jabar KA, Thong KL
    Infect Genet Evol, 2017 04;49:55-65.
    PMID: 28039075 DOI: 10.1016/j.meegid.2016.12.029
    Enterococcus faecium is both a commensal of the human intestinal tract and an opportunistic pathogen. The increasing incidence of enterococcal infections is mainly due to the ability of this organism to develop resistance to multiple antibiotics, including vancomycin. The aim of this study was to perform comparative genome analyses on four vancomycin-resistant Enterococcus faecium (VREfm) strains isolated from two fatal cases in a tertiary hospital in Malaysia. Two sequence types, ST80 and ST203, were identified which belong to the clinically important clonal complex (CC) 17. This is the first report on the emergence of ST80 strains in Malaysia. Three of the studied strains (VREr5, VREr6, VREr7) were each isolated from different body sites of a single patient (patient Y) and had different PFGE patterns. While VREr6 and VREr7 were phenotypically and genotypically similar, the initial isolate, VREr5, was found to be more similar to VRE2 isolated from another patient (patient X), in terms of the genome contents, sequence types and phylogenomic relationship. Both the clinical records and genome sequence data suggested that patient Y was infected by multiple strains from different clones and the strain that infected patient Y could have derived from the same clone from patient X. These multidrug resistant strains harbored a number of virulence genes such as the epa locus and pilus-associated genes which could enhance their persistence. Apart from that, a homolog of E. faecalis bee locus was identified in VREr5 which might be involved in biofilm formation. Overall, our comparative genomic analyses had provided insight into the genetic relatedness, as well as the virulence potential, of the four clinical strains.
    Matched MeSH terms: Gram-Positive Bacterial Infections/drug therapy; Gram-Positive Bacterial Infections/microbiology*; Gram-Positive Bacterial Infections/pathology
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