Genotypic and antimicrobial characterisation of Propionibacterium acnes isolates from surgically excised lumbar disc herniations

The anaerobic skin commensal Propionibacterium acnes is an underestimated cause of human infections and clinical conditions. Previous studies have suggested a role for the bacterium in lumbar disc herniation and infection. To further investigate this, five biopsy samples were surgically excised from each of 64 patients with lumbar disc herniation. P. acnes and other bacteria were detected by anaerobic culture, followed by biochemical and PCR-based identification. In total, 24/64 (38%) patients had evidence of P. acnes in their excised herniated disc tissue. Using recA and mAb typing methods, 52% of the isolates were type II (50% of culture-positive patients), while type IA strains accounted for 28% of isolates (42% patients). Type III (11% isolates; 21% patients) and type IB strains (9% isolates; 17% patients) were detected less frequently. The MIC values for all isolates were lowest for amoxicillin, ciprofloxacin, erythromycin, rifampicin, tetracycline, and vancomycin (≤1mg/L). The MIC for fusidic acid was 1-2 mg/L. The MIC for trimethoprim and gentamicin was 2 to ≥4 mg/L. The demonstration that type II and III strains, which are not frequently recovered from skin, predominated within our isolate collection (63%) suggests that the role of P. acnes in lumbar disc herniation should not be readily dismissed. © 2013 Jess Rollason et al.

Writing online:a guide to effective digital communication at work

Online writing plays a complex and increasingly prominent role in the life of organizations. From newsletters to press releases, social media marketing and advertising, to virtual presentations and interactions via e-mail and instant messaging, digital writing intertwines and affects the day-to-day running of the company - yet we rarely pay enough attention to it. Typing on the screen can become particularly problematic because digital text-based communication increases the opportunities for misunderstanding: it lacks the direct audio-visual contact and the norms and conventions that would normally help people to understand each other. Providing a clear, convincing and approachable discussion, this book addresses arenas of online writing: virtual teamwork, instant messaging, emails, corporate communication channels, and social media. Instead of offering do and don’t lists, however, it teaches the reader to develop a practice that is observant, reflective, and grounded in the understanding of the basic principles of language and communication. Through real-life examples and case studies, it helps the reader to notice previously unnoticed small details, question previously unchallenged assumptions and practices, and become a competent digital communicator in a wide range of professional contexts.

Practical secure information flow in programming languages

If we classify variables in a program into various security levels, then a secure information flow analysis aims to verify statically that information in a program can flow only in ways consistent with the specified security levels. One well-studied approach is to formulate the rules of the secure information flow analysis as a type system. A major trend of recent research focuses on how to accommodate various sophisticated modern language features. However, this approach often leads to overly complicated and restrictive type systems, making them unfit for practical use. Also, problems essential to practical use, such as type inference and error reporting, have received little attention. This dissertation identified and solved major theoretical and practical hurdles to the application of secure information flow. ^ We adopted a minimalist approach to designing our language to ensure a simple lenient type system. We started out with a small simple imperative language and only added features that we deemed most important for practical use. One language feature we addressed is arrays. Due to the various leaking channels associated with array operations, arrays have received complicated and restrictive typing rules in other secure languages. We presented a novel approach for lenient array operations, which lead to simple and lenient typing of arrays. ^ Type inference is necessary because usually a user is only concerned with the security types for input/output variables of a program and would like to have all types for auxiliary variables inferred automatically. We presented a type inference algorithm B and proved its soundness and completeness. Moreover, algorithm B stays close to the program and the type system and therefore facilitates informative error reporting that is generated in a cascading fashion. Algorithm B and error reporting have been implemented and tested. ^ Lastly, we presented a novel framework for developing applications that ensure user information privacy. In this framework, core computations are defined as code modules that involve input/output data from multiple parties. Incrementally, secure flow policies are refined based on feedback from the type checking/inference. Core computations only interact with code modules from involved parties through well-defined interfaces. All code modules are digitally signed to ensure their authenticity and integrity. ^

The use of a computer graphic organizer for persuasive composition writing by Hispanic students with specific learning disabilities

Many culturally and linguistically diverse (CLD) students with specific learning disabilities (SLD) struggle with the writing process. Particularly, they have difficulties developing and expanding ideas, organizing and elaborating sentences, and revising and editing their compositions (Graham, Harris, & Larsen, 2001; Myles, 2002). Computer graphic organizers offer a possible solution to assist them in their writing. This study investigated the effects of a computer graphic organizer on the persuasive writing compositions of Hispanic middle school students with SLD. A multiple baseline design across subjects was used to examine its effects on six dependent variables: number of arguments and supporting details, number and percentage of transferred arguments and supporting details, planning time, writing fluency, syntactical maturity (measured by T-units, the shortest grammatical sentence without fragments), and overall organization. Data were collected and analyzed throughout baseline and intervention. Participants were taught persuasive writing and the writing process prior to baseline. During baseline, participants were given a prompt and asked to use paper and pencil to plan their compositions. A computer was used for typing and editing. Intervention required participants to use a computer graphic organizer for planning and then a computer for typing and editing. The planning sheets and written composition were printed and analyzed daily along with the time each participant spent on planning. The use of computer graphic organizers had a positive effect on the planning and persuasive writing compositions. Increases were noted in the number of supporting details planned, percentage of supporting details transferred, planning time, writing fluency, syntactical maturity in number of T-units, and overall organization of the composition. Minimal to negligible increases were noted in the mean number of arguments planned and written. Varying effects were noted in the percent of transferred arguments and there was a decrease in the T-unit mean length. This study extends the limited literature on the effects of computer graphic organizers as a prewriting strategy for Hispanic students with SLD. In order to fully gauge the potential of this intervention, future research should investigate the use of different features of computer graphic organizer programs, its effects with other writing genres, and different populations.

The Effect of Sample and Sample Matrix on DNA Processing: Mechanisms for the Detection and Management of Inhibition in Forensic Samples

The presence of inhibitory substances in biological forensic samples has, and continues to affect the quality of the data generated following DNA typing processes. Although the chemistries used during the procedures have been enhanced to mitigate the effects of these deleterious compounds, some challenges remain. Inhibitors can be components of the samples, the substrate where samples were deposited or chemical(s) associated to the DNA purification step. Therefore, a thorough understanding of the extraction processes and their ability to handle the various types of inhibitory substances can help define the best analytical processing for any given sample. A series of experiments were conducted to establish the inhibition tolerance of quantification and amplification kits using common inhibitory substances in order to determine if current laboratory practices are optimal for identifying potential problems associated with inhibition. DART mass spectrometry was used to determine the amount of inhibitor carryover after sample purification, its correlation to the initial inhibitor input in the sample and the overall effect in the results. Finally, a novel alternative at gathering investigative leads from samples that would otherwise be ineffective for DNA typing due to the large amounts of inhibitory substances and/or environmental degradation was tested. This included generating data associated with microbial peak signatures to identify locations of clandestine human graves. Results demonstrate that the current methods for assessing inhibition are not necessarily accurate, as samples that appear inhibited in the quantification process can yield full DNA profiles, while those that do not indicate inhibition may suffer from lowered amplification efficiency or PCR artifacts. The extraction methods tested were able to remove >90% of the inhibitors from all samples with the exception of phenol, which was present in variable amounts whenever the organic extraction approach was utilized. Although the results attained suggested that most inhibitors produce minimal effect on downstream applications, analysts should practice caution when selecting the best extraction method for particular samples, as casework DNA samples are often present in small quantities and can contain an overwhelming amount of inhibitory substances.

The Use of a Computer Graphic Organizer for Persuasive Composition Writing by Hispanic Students with Specific Learning Disabilities

Many culturally and linguistically diverse (CLD) students with specific learning disabilities (SLD) struggle with the writing process. Particularly, they have difficulties developing and expanding ideas, organizing and elaborating sentences, and revising and editing their compositions (Graham, Harris, & Larsen, 2001; Myles, 2002). Computer graphic organizers offer a possible solution to assist them in their writing. This study investigated the effects of a computer graphic organizer on the persuasive writing compositions of Hispanic middle school students with SLD. A multiple baseline design across subjects was used to examine its effects on six dependent variables: number of arguments and supporting details, number and percentage of transferred arguments and supporting details, planning time, writing fluency, syntactical maturity (measured by T-units, the shortest grammatical sentence without fragments), and overall organization. Data were collected and analyzed throughout baseline and intervention. Participants were taught persuasive writing and the writing process prior to baseline. During baseline, participants were given a prompt and asked to use paper and pencil to plan their compositions. A computer was used for typing and editing. Intervention required participants to use a computer graphic organizer for planning and then a computer for typing and editing. The planning sheets and written composition were printed and analyzed daily along with the time each participant spent on planning. The use of computer graphic organizers had a positive effect on the planning and persuasive writing compositions. Increases were noted in the number of supporting details planned, percentage of supporting details transferred, planning time, writing fluency, syntactical maturity in number of T-units, and overall organization of the composition. Minimal to negligible increases were noted in the mean number of arguments planned and written. Varying effects were noted in the percent of transferred arguments and there was a decrease in the T-unit mean length. This study extends the limited literature on the effects of computer graphic organizers as a prewriting strategy for Hispanic students with SLD. In order to fully gauge the potential of this intervention, future research should investigate the use of different features of computer graphic organizer programs, its effects with other writing genres, and different populations.

Development of microsatellite markers in Cannabis Sativa for fingerprinting and genetic relatedness analyses

Microsatellite markers were developed for Cannabis sativa L. (marijuana) to estimate the level of polymorphism, usefulness for DNA typing (genotype identification), and to measure the genetic relationships between the different plants. Twelve different oligonucleotide probes were used to screen an enriched microsatellite library of Cannabis sativa in which 49% of the clones contained microsatellite sequences. Characterization of microsatellite loci in Cannabis revealed that GA/CT was the most abundant class of isolated microsatellites representing 50% overall. Eleven polymorphic SSR markers were developed, derived from dinucleotide motifs and eight from trinucleotide motifs. A total of 52 alleles were detected averaging 4.7 alleles/locus. The expected heterozygosity of the eleven loci ranged between 0.368 and 0.710 and the common probability of identical genotypes was 1.8 x 107. The loci identified 27 unique profiles of the 41 Cannabis samples. The eleven microsatellite markers developed in this study were found to be useful for DNA fingerprinting and for assessing genetic relationships in Cannabis.

Epidemiologia e caracterização molecular dos vírus Dengue circulantes no Rio Grande do Norte, 2013-2014

Dengue is an acute infectious disease, usually transmitted by Aedes aegypti mosquitoes. The etiologic agents belong to the family Flaviviridae, genus Flavivirus, and occur as four antigenically related but distinct serotypes designated DENV-1, 2, 3, and 4. In Brazil, the disease represents a national public health problem. The purpose of the present study was to describe epidemiological aspects of dengue in the State of Rio Grande do Norte, from 2013 to 2014. A total of 483 blood or serum samples, collected from January 2013 to December 2014, were studied by RT-PCR for viral detection and typing. The infection was confirmed in 36.44% (176/483) of the cases studied. This study detected the circulation of three serotypes of dengue virus in Rio Grande do Norte, DENV-1, 2, and 4. The predominant serotype in 2013-2014 was the DENV-4, representing 83.51% (81/97) and 68.35% (54/79) of the positive cases, respectively. Regarding the spatial distribution, most of the cases occurred in Natal and Caicó, with 9.28% (9/97) and 18.99% (15/79), respectively. The months with the biggest viral circulation in RN were March 2013 and May 2014. The female gender was the most affected, representing 69.07% (67/97) in 2013 and 54.43% (43/79) in 2014. The most affected age groups were 21-30 years (2013) and 11-20 years (2014) with 25.77% (25/97) and 20.25% (16/79) positive cases, respectively. Phylogenetic analysis indicated that genotype V (DENV-1) and genotype II (DENV-4) circulated in the State. Our results provide information about the dynamics of DENV in the Rio Grande do Norte, important for the development of disease control strategies.

Infecções por enterobacteriaceae resistente aos carbapenêmicos em hospital de ensino: epidemiologia e caracterização molecular

Introduction: The production of KPC (Klebsiella pneumoniae carbapenemase) has become an important mechanism of carbapenem-resistance among Enterobacteriaceae strains. In Brazil, KPC is already widespread and its incidence has increased significantly, reducing treatment options. The “perfect storm” combination of the absence of new drug developmentand the emergence of multidrug-resistant strains resulted in the need for the use of older drugs, with greater toxicity, such as polymyxins. Aims: To determine the occurrence of carbapenemase-producing strains in carbapenem-resistant Enterobacteriaceae isolated from patients with nosocomial infection/colonization during September/2014 to August/2015, to determine the risk factors associated with 30-day- mortality and the impact of inappropriate therapy. Materials and Methods: We performed a case control study to assess the risk factors (comorbidities, invasive procedures and inappropriate antimicrobial therapy) associated with 30-day-mortality, considering the first episode of infection in 111 patients. The resistance genes blaKPC, blaIMP, blaVIM and blaNDM-1 were detected by polymerase chain reaction technique. Molecular typing of the strains involved in the outbreak was performed by pulsed field gel electrophoresis technique. The polymyxin resistance was confirmed by the microdilution broth method. Results: 188 episodes of carbapenem-resistant Enterobacteriaceae infections/colonizations were detected; of these, 122 strains were recovered from the hospital laboratory. The presence of blaKPC gene were confirmed in the majority (74.59%) of these isolates. It was not found the presence of blaIMP , blaVIM and blaNDM-1 genes. K. pneumoniae was the most frequent microorganism (77,13%), primarily responsible for urinary tract infections (21,38%) and infections from patients of the Intensive Care Unit (ICU) (61,38%). Multivariate statistical analysis showed as predictors independently associated with mortality: dialysis and bloodstream infection. The Kaplan-Meier curve showed a lower probability of survival in the group of patients receiving antibiotic therapy inappropriately. Antimicrobial use in adult ICU varied during the study period, but positive correlation between increased incidence of strains and the consumption was not observed. In May and July 2015, the occurrence rates of carbapenem-resistant Enterobacteriaceae KPC-producing per 1000 patient-days were higher than the control limit established, confirming two outbreaks, the first caused by colistin-susceptible KPC-producing K. pneumoniae isolates, with a polyclonal profile and the second by a dominant clone of colistin-resistant (≥ 32 μg/mL) KPC-producing K. pneumoniae. The cross transmission between patients became clear by the temporal and spatial relationships observed in the second outbreak, since some patients occupied the same bed, showing problems in hand hygiene adherence among healthcare workers and inadequate terminal disinfection of environment. The outbreak was contained when the ICU was closed to new admissions. Conclusions: The study showed an endemicity of K. pneumoniae KPC-producing in adult ICU, progressing to an epidemic monoclonal expansion, resulted by a very high antibiotic consumption of carbapenems and polymyxins and facilitated by failures in control measures the unit.

Estudio genético HLA en poblaciones iraníes: epidemiología, antropología y farmacogenética

The HLA system is the most polymorphic genetic system described in humans. It consists of several closely linked loci encoding cell surface glycoproteins whose best known function is activating immune system response through antigenic presentation. New loci and new alleles have been described since the discovery of this genetic system and the presently available DNA typing and sequencing of these new alleles have increased the variety of HLA allelism. Due to the fact that HLA gene frequencies have a large degree of variability and a remarkable geographical correlation, HLA genes are an important and useful tool to infer genetic background and ethnical composition of modern human populations and also for tracing migration of ancient ones. In addition, certain combinations of contiguous alleles due to the strong linkage disequilibrium between HLA neighbouring loci show a characteristic frequency or are distinctive in many present day populations. Thus, HLA genetic system is a unique tool for studying the origin of relatively isolated groups, like Turkmen, Azeri and Kurd people, the populations under study, living in North Iran, in the surrounding area of Caspian Sea. Finally, HLA polymorphism is crucial for the compatibility between donor and receptor in organ transplantation and several HLA alleles have been linked to diseases and to response to drug treatments, which accomplishes relationships of certain variants with different pathologies treatment including AIDS. This is important in personalized treatments design. Turkmen could be descendants of Oghuz tribes from Seljuq branch coming from Transoxiana region (Central Asia) contemporarily to the foundation of the Seljuk Empire in 10th century AD. Conversely, this people could belong to another group within the Oghuz, arriving to Iran five centuries later. Migrations of this people were initially developed peacefully, being vassals of the Safavid Empire, and later by violent raids. They speak a language belonging to the Turkish-Oghuz group. In Iran, Turkmen live in Golestan province, mainly in Türkmensähra (“Turkmen plain”) area and amount 1.5 million people (2% of Iranian population). Most of this people are Sunni Muslims...

Prevalence and control of Clostridium difficile in patients with cystic fibrosis

The aim of this thesis was to investigate the high prevalence of Clostridium difficile in patients with cystic fibrosis (CF), and to control its dissemination. To determine the carriage rate of C. difficile in CF patients, 60 patients were tested for C. difficile and its toxin. In total, 50% of patients were found to be asymptomatic carriers of C. difficile despite toxin being detected in 31.66% of patients. Ribotyping of the C. difficile isolates revealed 16 distinct ribotypes, including the hyper virulent RT078. All isolates were sensitive to both Vancomycin and Metronidazole. The effect of CF and its treatment on the gut microbiota of CF patients was assessed by 16s sequencing of the gut microbiota of 68 CF patients. When compared to a healthy control group, CF patient gut microbiota was found to be less diverse and had an increased Firmicutes to Bacteriodetes ratio. Interestingly, CF patients who were carriers of C. difficile had a less diverse gut microbiota than C. difficile negative CF patients. Multilocus sequence typing was found to be comparable to PCR-ribotyping for typing C. difficile isolates from high risk patient groups. The sequence type ST 26 is potentially associated with CF patients as all seven isolates were found in this group and this sequence type has been previously reported in CF patients in a geographically distinct study. The bacteriophage ФCD6356 was assessed as a targeted antimicrobial against C. difficile in an ex-vivo model of the human distal colon. Despite reducing viable C. difficile by 1.75 logs over 24 hours, this bacteriophage was not suitable due to its lysogenic nature. Following treatment, all surviving C. difficile were immune to reinfection due to prophage integration. However, the ФCD6356 encoded endolysin was capable of reducing viable C. difficile by 2.9 over 2 hours in vitro after being cloned and expressed in Escherichia coli.

Genomic diversity of Lactobacillus salivarius

Lactobacillus salivarius is unusual among the lactobacilli due to its multireplicon genome architecture. The circular megaplasmids harboured by L. salivarius strains encode strain-specific traits for intestinal survival and probiotic activity. L. salivarius strains are increasingly being exploited for their probiotic properties in humans and animals. In terms of probiotic strain selection, it is important to have an understanding of the level of genomic diversity present in this species. Comparative genomic hybridization (CGH) and multilocus sequence typing (MLST) were employed to assess the level of genomic diversity in L. salivarius. The wellcharacterised probiotic strains L. salivarius UCC118 was employed as a genetic reference strain. The group of test strains were chosen to reflect the range of habitats from which L. salivarius strains are frequently recovered, including human, animal, and environmental sources. Strains of L. salivarius were found to be genetically diverse when compared to the UCC118 genome. The most conserved strains were human GIT isolates, while the greatest level of divergence were identified in animal associated isolates. MLST produced a better separation of the test strains according to their isolation origins, than that produced by CGHbased strain clustering. The exopolysaccharide (EPS) associated genes of L. salivarius strains were found to be highly divergent. The EPS-producing phenotype was found to be carbonsource dependent and inversely related to a strain's ability to produce a biofilm. The genome of the porcine isolate L. salivarius JCM1046 was shown by sequencing to harbour four extrachromosomal replicons, a circular megaplasmid (pMP1046A), a putative chromid (pMP1046B), a linear megaplasmid (pLMP1046) and a smaller circular plasmid (pCTN1046) which contains an integrated Tn916-like element (Tn6224), which carries the tetracycline resistance gene tetM. pLMP1046 represents the first sequence of a linear plasmid in a Lactobacillus species. Dissemination of antibiotic resistance genes among species with food or probiotic-association is undesirable, and the identification of Tn6224-like elements in this species has implications for strain selection for probiotic applications. In summary, this thesis used a comparative genomics approach to examine the level of genotypic diversity in L. salivarius, a species which contains probiotic strains. The genome sequence of strain JCM1046 provides additional insight into the spectrum of extrachromosomal replicons present in this species.

On the fly type specialization without type analysis

Les langages de programmation typés dynamiquement tels que JavaScript et Python repoussent la vérification de typage jusqu’au moment de l’exécution. Afin d’optimiser la performance de ces langages, les implémentations de machines virtuelles pour langages dynamiques doivent tenter d’éliminer les tests de typage dynamiques redondants. Cela se fait habituellement en utilisant une analyse d’inférence de types. Cependant, les analyses de ce genre sont souvent coûteuses et impliquent des compromis entre le temps de compilation et la précision des résultats obtenus. Ceci a conduit à la conception d’architectures de VM de plus en plus complexes. Nous proposons le versionnement paresseux de blocs de base, une technique de compilation à la volée simple qui élimine efficacement les tests de typage dynamiques redondants sur les chemins d’exécution critiques. Cette nouvelle approche génère paresseusement des versions spécialisées des blocs de base tout en propageant de l’information de typage contextualisée. Notre technique ne nécessite pas l’utilisation d’analyses de programme coûteuses, n’est pas contrainte par les limitations de précision des analyses d’inférence de types traditionnelles et évite la complexité des techniques d’optimisation spéculatives. Trois extensions sont apportées au versionnement de blocs de base afin de lui donner des capacités d’optimisation interprocédurale. Une première extension lui donne la possibilité de joindre des informations de typage aux propriétés des objets et aux variables globales. Puis, la spécialisation de points d’entrée lui permet de passer de l’information de typage des fonctions appellantes aux fonctions appellées. Finalement, la spécialisation des continuations d’appels permet de transmettre le type des valeurs de retour des fonctions appellées aux appellants sans coût dynamique. Nous démontrons empiriquement que ces extensions permettent au versionnement de blocs de base d’éliminer plus de tests de typage dynamiques que toute analyse d’inférence de typage statique.

Assisting End-users in Filling Out Web Services

With the quick advance of web service technologies, end-users can conduct various on-line tasks, such as shopping on-line. Usually, end-users compose a set of services to accomplish a task, and need to enter values to services to invoke the composite services. Quite often, users re-visit websites and use services to perform re-occurring tasks. The users are required to enter the same information into various web services to accomplish such re-occurring tasks. However, repetitively typing the same information into services is a tedious job for end-users. It can negatively impact user experience when an end-user needs to type the re-occurring information repetitively into web services. Recent studies have proposed several approaches to help users fill in values to services automatically. However, prior studies mainly suffer the following drawbacks: (1) limited support of collecting and analyzing user inputs; (2) poor accuracy of filling values to services; (3) not designed for service composition. To overcome the aforementioned drawbacks, we need maximize the reuse of previous user inputs across services and end-users. In this thesis, we introduce our approaches that prevent end-users from entering the same information into repetitive on-line tasks. More specifically, we improve the process of filling out services in the following 4 aspects: First, we investigate the characteristics of input parameters. We propose an ontology-based approach to automatically categorize parameters and fill values to the categorized input parameters. Second, we propose a comprehensive framework that leverages user contexts and usage patterns into the process of filling values to services. Third, we propose an approach for maximizing the value propagation among services and end-users by linking a set of semantically related parameters together and similar end-users. Last, we propose a ranking-based framework that ranks a list of previous user inputs for an input parameter to save a user from unnecessary data entries. Our framework learns and analyzes interactions of user inputs and input parameters to rank user inputs for input parameters under different contexts.

Antimicrobial susceptibility of Pseudomonas aeruginosa isolated from cystic fibrosis patients through Northern Europe

Pseudomonas aeruginosa is a major cause of morbidity and mortality in cystic fibrosis patients. This study compares the antimicrobial susceptibility of 153 P. aeruginosa isolates from the United Kingdom (UK) (n=58), Belgium (n=44), and Germany (n=51) collected from 120 patients during routine visits over the 2006-2012 period. MICs were measured by broth microdilution. Genes encoding extended spectrum β-lactamases (ESBL), metallo-β-lactamases and carbapenemases were detected by PCR. Pulsed Field Gel Electrophoresis and Multi-Locus Sequence Typing were performed on isolates resistant to ≥ 3 antibiotic classes among penicillins/cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, polymyxins. Based on EUCAST/CLSI breakpoints, susceptibility was ≤ 30%/≤ 40% (penicillins, ceftazidime, amikacin, ciprofloxacin), 44-48%/48-63% (carbapenems), 72%/72% (tobramycin), and 92%/78% (colistin) independently of patient's age. Sixty percent of strains were multidrug resistant (MDR; European Centre for Disease prevention and Control criteria). Genes encoding ESBL (most prevalent BEL, PER, GES, VEB, CTX-M, TEM, SHV, and OXA), metallo β-lactamases (VIM, IMP, NDM), or carbapenemases (OXA-48, KPC) were not detected. The Liverpool Epidemic Strain (LES) was prevalent in UK isolates only (75% of MDR isolates). Four MDR ST958 isolates were found spread over the three countries. The other MDR clones were evidenced in ≤ 3 isolates and localized in a single country. A new sequence type (ST2254) was discovered in one MDR isolate in Germany. Clonal and non-clonal isolates with different susceptibility profiles were found in 21 patients. Thus, resistance and MDR are highly prevalent in routine isolates from 3 countries, with carbapenem (meropenem), tobramycin and colistin remaining the most active drugs.