Spread of extensively resistant VIM-2-positive ST235 Pseudomonas aeruginosa in Belarus, Kazakhstan, and Russia: a longitudinal epidemiological and clinical.

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Spread of extensively resistant VIM-2-positive ST235 Pseudomonas aeruginosa in Belarus, Kazakhstan, and Russia: a longitudinal epidemiological and clinical study Mikhail V Edelstein, PhD, Elena N Skleenova, MD, Oksana V Shevchenko, PhD, Jimson W D'souza, MD, Dmitry V Tapalski, DSc, Ilya S Azizov, DSc, Marina V Sukhorukova, PhD, Roman A Pavlukov, MSc, Roman S Kozlov, PhD, Mark A Toleman, PhD, Prof Timothy R Walsh, PhD The Lancet Infectious Diseases Volume 13, Issue 10, Pages 867-876 (October 2013) DOI: 10.1016/S1473-3099(13)70168-3 Copyright © 2013 Elsevier Ltd Terms and Conditions

Figure 1 Study map Cities where Pseudomonas aeruginosa was isolated are colour-coded on the basis of if and when MBL-producing species were detected. MBL=metallo-β-lactamase. The Lancet Infectious Diseases 2013 13, 867-876DOI: (10.1016/S1473-3099(13)70168-3) Copyright © 2013 Elsevier Ltd Terms and Conditions

Figure 2 Genetic context and distribution of MBL-encoding integrons Gene bank accession numbers given in parentheses. Variable region is between the integrase gene (intI1) and the 3′ conserved sequences. 5′ and 3′ conserved sequences of class 1 integrons are green and MBL gene cassettes are blue. MBL=metallo-β-lactamase. The Lancet Infectious Diseases 2013 13, 867-876DOI: (10.1016/S1473-3099(13)70168-3) Copyright © 2013 Elsevier Ltd Terms and Conditions

Figure 3 Minimum spanning MLVA trees of MBL-producing Pseudomonas aeruginosa isolates by city (A) and type of integron (B) Nodes (circles) of the dendrogram correspond to MLVA types (profiles). Size of each node is proportional to the number of isolates. Solid lines link MLVA types differing at one VNTR loci and dashed lines those differing at two loci. Corresponding sequence types are shown near each cluster. MLVA=multiple loci VNTR analysis. VNTR=variable number of tandem repeats. The Lancet Infectious Diseases 2013 13, 867-876DOI: (10.1016/S1473-3099(13)70168-3) Copyright © 2013 Elsevier Ltd Terms and Conditions