BACKGROUND: Since the incidence of vancomycin-resistant enterococci (VRE) is increasing and treatment options remain limited, we aimed to investigate the epidemiology of vancomycin- and tigecycline-resistant enterococci in a university hospital using whole genome sequencing (WGS). METHODS: Between April and December 2021, 102 VRE isolates were collected from a single tertiary care hospital in the Czech Republic. Forty selected isolates underwent antimicrobial susceptibility testing and WGS (Illumina short reads and long reads with MinION in selected isolates). RESULTS: All Enterococcus faecium isolates were resistant to ampicillin, carrying the PBP5_Met485Ala, PBP5_Glu629Val, and fluoroquinolones carrying the GyrA_Ser83Ile and ParC_Ser80Ile substitutions. The vanA operon was found on pELF2-like plasmids and plasmids carrying rep17 and/or rep18b genes. The novel Tn1546 structural variants were identified in vanA-carrying isolates. The vanB operon was located on the chromosome within a Tn1549 structural variant. Linezolid resistance was detected in one isolate carrying the 23S rDNA_G2576T substitution. Twenty-two isolates were resistant to tigecycline (tet(L), tet(M) and rpsJ_del 155-166 or RpsJ_Lys57Arg). Discrepancies between phenotypic and genotypic resistance profiles were observed for daptomycin (RpoB_Ser491Phe), trimethoprim/sulfamethoxazole (dfrG gene), nitrofurantoin (NmrA_Gln48Lys substitution without the EF0404 and EF0648 genes) and tetracycline (truncated TetM). The two multilocus sequence typing (MLST) schemes identified different numbers of STs: 5 STs, with ST117 as the predominant one (n = 32, 80%), versus 10 STs, with ST138 (27.5%), ST136 (25%), and ST1067 (20%) being the most frequent, respectively. The whole genome MLST revealed clonal clustering (0-7 allele differences) among isolates of the same ST. When comparing ST117 isolates from our study with 2,204 ST117 isolates from 15 countries, only one Czech isolate clustered closely with strains from Germany and the Netherlands, differing by just 16 alleles. CONCLUSIONS: The spread of E. faecium isolates ST117 resistant to vancomycin and tigecycline was identified. The discrepancies between resistance genotypes and phenotypes highlight the importance of combining molecular and phenotypic surveillance in antimicrobial resistance monitoring.

• MeSH
• Anti-Bacterial Agents * pharmacology   MeSH
• Bacterial Proteins genetics   MeSH
• Enterococcus faecium * genetics   drug effects   isolation & purification   classification   MeSH
• Vancomycin-Resistant Enterococci * genetics   drug effects   isolation & purification   MeSH
• Genome, Bacterial MeSH
• Gram-Positive Bacterial Infections * microbiology   epidemiology   MeSH
• Humans MeSH
• Microbial Sensitivity Tests MeSH
• Drug Resistance, Multiple, Bacterial genetics   MeSH
• Multilocus Sequence Typing MeSH
• Vancomycin Resistance genetics   MeSH
• Whole Genome Sequencing MeSH
• Tigecycline * pharmacology   MeSH
• Vancomycin * pharmacology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

Public transport represents a potential site for the transmission of resistant pathogens due to the rapid movement of large numbers of people. This study aimed to investigate the bacterial contamination of frequently touched surfaces in the public transport system operating in the proximity of the biggest Czech hospital during the coronavirus pandemic despite extensive cleaning and disinfection efforts. In June and September 2020, samples from the metro trains, ground transport and stationary objects were collected, enriched and cultured. The antimicrobial susceptibility was tested by broth microdilution. Staphylococcus aureus isolates exhibiting inconclusive results of vancomycin susceptibility testing were retested by broth macrodilution and subjected to whole genome sequencing. All S. aureus isolates were tested for vancomycin heteroresistance (hVISA). A total of 513/542 (94.6 %) samples were culture-positive with higher frequency in September (p = 0.004). S. aureus was the most frequent opportunistic bacterial pathogen found (3.7 %, 20/542) followed by Enterobacterales spp. (1.8 %, 10/542). No methicillin-resistant S. aureus (MRSA), extended-spectrum beta-lactamase producers (ESBL) or carbapenemase-producing bacteria were detected. Resistance to clinically relevant drugs was rare except for resistance to ampicillin (67 %, 8/12), cefuroxime (42 %, 5/12) in Enterobacterales and chloramphenicol (90 %, 18/20), penicillin (45 %, 9/20), and erythromycin (20 %, 4/20) in S. aureus. One S. aureus isolate was shown to be resistant to vancomycin (8 mg/L) by forming large visible cell aggregates. Population analysis profile-area under the curve ratio (PAP-AUC) testing did not confirm the hVISA phenotype, but mutations in the hVISA phenotype-related gene vraR and other genes related to cell wall synthesis (fmtB) and intercellular adhesion (sasC) were found. Our study shows that in the COVID-19 pandemic, despite the intensive use of disinfectants, public transport was a source of opportunistic bacterial pathogens including S. aureus with unusual vancomycin resistance phenotype that could be easily missed by standard susceptibility testing.

• MeSH
• Anti-Bacterial Agents * pharmacology   MeSH
• COVID-19 * MeSH
• Transportation MeSH
• Humans MeSH
• Microbial Sensitivity Tests * MeSH
• Pandemics MeSH
• Vancomycin Resistance MeSH
• SARS-CoV-2 * MeSH
• Staphylococcus aureus * drug effects   genetics   MeSH
• Vancomycin * pharmacology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

Vankomycin-rezistentní enterokoky (VRE) představují významný medicínský problém, s jejich výskytem se ale setkáváme také u některých domácích zvířat (zejména kur domácí). Podle našich recentních poznatků se tyto enterokoky dostávají také do přírodního prostředí a kolonizují synantropní volně žijící ptáky. Rozsah kolonizace, zdroje a cesty šíření VRE budou studovány v rámci tohoto projektu v definované oblasti střední Moravy v minimálně tříleté časové perspektivě. Jednotlivé izoláty z lidí, potravin, zvířat a prostředí budou charakterizovány fenotypovými vlastnostmi a analýzami DNA. Budou navržena opatření k zamezení šíření VRE v humánní populaci, potravinách, u zvířat a v prostředí. Projekt také zahrnuje analýzu výskytu reziduí antibiotik a těžkých kovů v odpadních a povrchových vodách.; Vancomycin-resistant enterococci (VRE) pose a serious problem in medicine but are also encountered in some domestic animals (especially the chicken). Our recent findings have shown that these enterococci get into the environment and colonize synanthropic wild birds. The extent of colonization, sources and ways of the spread of VRE will be studied by this project in a defined area of Central Moravia over at least three years. Isolates obtained from humans, foods, animals and the environment will be characterized by phenotypic properties and DNA analyses. The measure will be proposed to prevent the spread of VRE in humans, foods, animals and the environment. The project also includes the analysis of the occurrence of antibiotics and heavy metals in wastewater and surface water.

• MeSH
• Chain of Infection MeSH
• Vancomycin-Resistant Enterococci MeSH
• Epidemiological Monitoring MeSH
• Phenotype MeSH
• Environmental Monitoring MeSH
• One Health MeSH
• Vancomycin Resistance MeSH
• Sequence Analysis, DNA MeSH
• Environmental Exposure MeSH
• Environmental Pollution MeSH
• Geographicals
• Czech Republic MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• epidemiologie
• environmentální vědy
• bakteriologie
• NML Publication type
• závěrečné zprávy o řešení grantu AZV MZ ČR

Excessive use of antibiotics contributes to the selection of resistant bacteria and intestinal colonization with multiresistant pathogens poses a risk factor for subsequent infections. The present study assessed vancomycin-resistant enterococci (VRE) carriage rates in patients admitted to our tertiary care hospital. Stool samples sent for routine culturing were screened with vancomycin containing solid or broth enrichment media. VRE isolates were identified with matrix-assisted laser desorption/ionization-time of flight mass spectrometry and antibiotic susceptibilities were tested by E-test. Vancomycin resistance genes were detected by polymerase chain reaction. Medical records of carriers were examined for suspected risk factors for colonization. Altogether 3025 stool specimens were analyzed. Solid media identified a VRE carriage rate of 2.2% while broth enrichment detected 5.8%. Seventy percent of the isolates were Enterococcus faecium. VanB genotype was detected in 38.2%, VanA in 37.3%, VanC1 in 22.6%, and VanC2 in 1.9%. All VRE were sensitive to linezolid, daptomycin, and tigecycline. Collective risk factors for carriage were diabetes, normal flora absence, Clostridioides difficile positivity, longer hospital stay, and advanced age. 78.5% of the carriers received antibiotic therapy which was metronidazole in most cases (47.3%). We recommend regular screening of risk groups such as patients with diabetes, history of recent hospitalization, or former C. difficile infection as an imperative step for preventing VRE dissemination.

• MeSH
• Anti-Bacterial Agents pharmacology   therapeutic use   MeSH
• Tertiary Care Centers MeSH
• Child MeSH
• Adult MeSH
• Vancomycin-Resistant Enterococci isolation & purification   MeSH
• Feces microbiology   MeSH
• Genotype MeSH
• Gram-Positive Bacterial Infections drug therapy   epidemiology   microbiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Microbial Sensitivity Tests MeSH
• Adolescent MeSH
• Young Adult MeSH
• Child, Preschool MeSH
• Carrier State epidemiology   microbiology   MeSH
• Retrospective Studies MeSH
• Vancomycin Resistance genetics   MeSH
• Risk Factors MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Intestines microbiology   MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Child, Preschool MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Hungary MeSH

Vancomycin-resistant enterococci (VRE) are nosocomial pathogens of increasing medical importance. This study involved 121 VRE selectively obtained from a representative set of 1464 samples collected from various sources in the north-eastern part of the Czech Republic. In total, 119 VRE belonged to Enterococcus faecium and two to Enterococcus faecalis. All isolates of E. faecium were resistant to at least three antibiotic classes. The resistance genes vanA, erm(B), tet(M), tet(L), aac(3)-IIIa and aac(6')-aph(2'') were detected. We assigned the E. faecium to sequence types ST5, ST18, ST38, ST64, ST92, ST273, ST549 and ST640. In E. faecium isolates, we identified the presence of replicases rep20pLG1 , rep2pRE25 , rep17pRUM , rep21pVEF1/2 and rep14pRI1 , as well as relaxases relpEF1 , relpLG1 , relpCIZ2 , relpRE25 and relpRUM . The presence of the toxin-antitoxin system axe-txe was detected mainly among isolates of hospital origin. The A and D types of transposon Tn1546 were those occurring most frequently. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first extensive study of vancomycin-resistant enterococci of diverse origin in a single well-defined area of the Czech Republic. The isolates were investigated for their antibiotic resistance, epidemiological characteristics and plasmid characteristics. Based on the results obtained, we can make assumptions as to the ways that vancomycin resistance is disseminated throughout the environment including humans and animals.

• MeSH
• Anti-Bacterial Agents pharmacology   MeSH
• Bacterial Proteins genetics   MeSH
• Enterococcus faecalis drug effects   genetics   isolation & purification   MeSH
• Enterococcus faecium drug effects   genetics   isolation & purification   MeSH
• Vancomycin-Resistant Enterococci classification   genetics   isolation & purification   MeSH
• Gram-Positive Bacterial Infections epidemiology   microbiology   MeSH
• Humans MeSH
• Plasmids genetics   MeSH
• Vancomycin Resistance genetics   MeSH
• Toxin-Antitoxin Systems genetics   MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

We investigated the genetic basis of glycopeptide resistance in laboratory-derived strains of S. haemolyticus with emphasis on differences between vancomycin and teicoplanin. The genomes of two stable teicoplanin-resistant laboratory mutants selected on vancomycin or teicoplanin were sequenced and compared to parental S. haemolyticus strain W2/124. Only the two non-synonymous mutations, VraS Q289K and WalK V550L were identified. No other mutations or genome rearrangements were detected. Increased cell wall thickness, resistance to lysostaphin-induced lysis and adaptation of cell growth rates specifically to teicoplanin were phenotypes observed in a sequenced strain with the VraS Q289K mutation. Neither of the VraS Q289K and WalK V550L mutations was present in the genomes of 121S. haemolyticus clinical isolates. However, all but two of the teicoplanin resistant strains carried non-synonymous SNPs in vraSRTU and walKR-YycHIJ operons pointing to their importance for the glycopeptide resistance.

• MeSH
• Anti-Bacterial Agents pharmacology   MeSH
• Drug Resistance, Bacterial genetics   MeSH
• DNA, Bacterial genetics   MeSH
• Phenotype MeSH
• Genome, Bacterial genetics   MeSH
• Histidine Kinase genetics   MeSH
• Polymorphism, Single Nucleotide genetics   MeSH
• Humans MeSH
• Vancomycin Resistance genetics   MeSH
• Base Sequence MeSH
• Sequence Analysis, DNA MeSH
• Staphylococcal Infections microbiology   MeSH
• Staphylococcus haemolyticus drug effects   genetics   isolation & purification   MeSH
• Teicoplanin pharmacology   MeSH
• Vancomycin pharmacology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Poland MeSH

The most prevalent type of acquired vancomycin resistance in Enterococcus faecium (VREfm) is encoded by the vanA transposon Tn1546, mainly located on transferable plasmids. vanA plasmids have been characterized in VREfm from a variety of sources but not wild birds. The aim of this study was to analyse the genetic context of VREfm strains recovered from wild corvid birds and to compare their plasmid and strain characteristics with human strains. To achieve that, 75 VREfm isolates, including strains from wild birds recovered during wide surveillance studies performed in Europe, Canada and the United States (2010-2013), and clinical and wastewater strains from Czech Republic, a region lacking data about vanA plasmids, were analysed. Their population structure, presence of major putative virulence markers and characterization of vanA transposons and plasmids were established. VREfm from wild birds were mainly associated with major human lineages (ST18 and ST78) circulating in hospitals worldwide and were enriched in putative virulence markers that are highly associated with clinical E. faecium from human infections. They also carried plasmids of the same families usually found in the clinical setting [RCR, small theta plasmids, RepA_N (pRUM/pLG1) and Inc18]. The clinically widespread IS1251-carrying Tn1546 type "F" was predominant and Tn1546-vanA was mainly located on pRUM/Axe-Txe (USA) and Inc18- or pLG1-like (Europe) plasmids. VREfm from hospitals and wastewaters carried Tn1546-vanA in different plasmid types including mosaic pRUM-Inc18 plasmids, not identified in wild birds. This is the first characterization of vanA plasmids obtained from wild birds. A similar plasmid pool seems to exist in different clonal E. faecium backgrounds of humans and wild birds. The isolation of VREfm strains from wild birds that belong to human E. faecium adapted lineages and carry virulence genes, Tn1546 and plasmid variants widespread in the clinical setting is of concern and highlight their role as potential drivers of the global dissemination of vancomycin resistance.

• MeSH
• Enterococcus faecium * drug effects   genetics   MeSH
• Vancomycin-Resistant Enterococci * drug effects   genetics   MeSH
• Gram-Positive Bacterial Infections microbiology   transmission   veterinary   MeSH
• Humans MeSH
• Passeriformes microbiology   MeSH
• Plasmids genetics   MeSH
• Vancomycin Resistance genetics   MeSH
• Zoonoses microbiology   transmission   MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Bakteriální rezistence patří k nejzávažnějším fenoménům moderní medicíny. Staphylococcus aureus je jednou z bakterií, u kterých výskyt rezistence na antibiotika představuje závažnou komplikaci při účinné léčbě infekčních onemocnění. Meticilin‑rezistentní S. aureus (MRSA) je typickým původcem infekcí u pacientů s anamnézou pobytu v nemocničním prostředí. Vyvolává obdobné spektrum onemocnění jako meticilin‑senzitivní kmeny, nevyznačuje se vyšší virulencí. Pochopení patogeneze stafylokokových infekcí a mechanismů vzniku antibiotické rezistence je základní podmínkou pro vývoj nových účinných léků. Tento přehledový článek popisuje rozdělení MRSA dle genetických a epidemiologických charakteristik na komunitní, nemocniční a zvířecí kmeny. Informuje o jejich charakteristice, odlišnostech a rozšíření, což má praktický dopad při volbě optimální terapie a preventivních opatření. Čtenáři je podán ucelený přehled možností terapie infekcí způsobených MRSA a nastíněn genetický podklad i základní mechanismy stafylokokové antibiotické rezistence.

Bacterial resistance counts to the most serious problems of modern medicine. Staphylococcus aureus is one of the bacteria in which the incidence of antibiotic resistance is a problem complicating the effective treatment of infectious diseases. Methicillin‑resistant S. aureus (MRSA) is a typical pathogen in patients with a history of medical hospitalization. It induces a similar spectrum of diseases like methicillin‑sensitive S. aureus strains, there is no higher virulence in MRSA strains. Understanding the pathogenesis of staphylococcal infections and mechanisms of antibiotic resistance is essential for the development of new effective drugs. This article provides comprehensive information on the division of MRSA strains according to genetic and epidemiological characteristics to community, hospital and animal strains, their characteristics, differences and distribution. This has a practical impact on the choice of optimal therapy and preventive measures. This review also summarizes MRSA treatment possibilities, the genetic background, and basic mechanisms of staphylococcal antibiotic resistance.

• Keywords
• telavancin,
• MeSH
• Aminoglycosides therapeutic use   MeSH
• Anti-Bacterial Agents adverse effects   therapeutic use   MeSH
• Drug Resistance, Bacterial MeSH
• Bacteremia drug therapy   microbiology   MeSH
• beta-Lactam Resistance MeSH
• Daptomycin therapeutic use   MeSH
• Cross Infection * drug therapy   microbiology   MeSH
• Community-Acquired Infections drug therapy   microbiology   MeSH
• Humans MeSH
• Methicillin-Resistant Staphylococcus aureus * genetics   isolation & purification   pathogenicity   drug effects   MeSH
• Minocycline therapeutic use   MeSH
• Vancomycin Resistance MeSH
• Staphylococcal Infections * drug therapy   microbiology   transmission   MeSH
• Staphylococcus aureus genetics   MeSH
• Teicoplanin administration & dosage   therapeutic use   MeSH
• Tigecycline MeSH
• Vancomycin * administration & dosage   therapeutic use   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

The present study was performed to evaluate the antibacterial activities of an antimicrobial peptide (CSpK14) and the synergies thereof with β-lactams against vancomycin-resistant Staphylococcus aureus (VRSA) and Enterococci (VRE). Our strain was isolated from fermented food (kimchi), which is 99.79 % homologous with Bacillus amyloliquefaciens subsp. plantarum FZB42(T). CSpK14 was purified to homogeneity by diammonium sulfate precipitation, concentration, dialysis, and followed by two-stage chromatographic separation, i.e., Sepharose Cl-6B and Sephadex G-25 chromatography, and had a molar mass of ~4.6 kDa via Tricine SDS-PAGE and in situ examination. It was stable at pH 6.0-11.5 and temperature up to 80 °C. In addition, it was also stable with various metal ions, solvents, and proteases. The N-terminal amino acid sequence was H-Y-D-P-G-D-D-S-G-N-T-G and did not show any significant homology with reported peptides. However, it shows some degrees of identity with alpha-2-macroglobulin and ligand-gated channel protein from different microorganisms. CSpK14 significantly reduced the minimum inhibitory concentrations (MICs) of β-lactams and had no effect on non-β-lactams against VRSA and VRE. MICs of CSpK14/oxacillin and CSpK14/ampicillin were reduced by 8- to 64-fold and 2- to 16-fold, respectively. The time killing assay between CSpK14/oxacillin (2.29-2.37 Δlog10CFU/mL at 24 h) and CSpK14/ampicillin (2.30-2.38 Δlog10CFU/mL at 24 h) being >2-fold and fractional inhibitory concentration index ˂0.5 revealed synergy. Furthermore, the biofilms formed by VRSA and VRE were reduced completely. CSpK14 was simple to purify, had low molecular mass, was stable over a wide pH range or tested chemicals, had broad inhibitory spectrum, and possessed potent synergistic antimicrobial-antibiofilm properties. CSpK14 synergistically enhanced the efficacy of β-lactams and is therefore suitable for combination therapy.

• MeSH
• Ampicillin pharmacology   MeSH
• Anti-Bacterial Agents biosynthesis   isolation & purification   pharmacology   MeSH
• Bacillus amyloliquefaciens classification   immunology   metabolism   MeSH
• Biofilms drug effects   growth & development   MeSH
• Chromatography, Ion Exchange MeSH
• Vancomycin-Resistant Enterococci drug effects   growth & development   MeSH
• Phylogeny MeSH
• Antimicrobial Cationic Peptides biosynthesis   isolation & purification   pharmacology   MeSH
• Drug Therapy, Combination MeSH
• Microbial Sensitivity Tests MeSH
• Oxacillin pharmacology   MeSH
• Vancomycin Resistance drug effects   MeSH
• Amino Acid Sequence MeSH
• Protein Stability MeSH
• Staphylococcus aureus drug effects   growth & development   MeSH
• Drug Synergism MeSH
• Publication type
• Journal Article MeSH

OBJECTIVES: An Enterococcus faecium isolate (Efa-125) carrying both the vanA and vanB genes was recovered from a patient with bacteraemia treated in a Greek hospital. Since this is the first description in Europe of E. faecium carrying both vanA and vanB genes, the isolate was further studied. METHODS: Susceptibility to several antibiotics was determined using the VITEK®2 automated system. The isolate was typed by multilocus sequence typing (MLST). To define the genetic units of the vanA and vanB genes, the plasmid content of Efa-125 was analysed by pulsed-field gel electrophoresis (PFGE) of total DNA digested with S1 nuclease followed by hybridisation with digoxigenin-labelled vanA and vanB probes. In addition, plasmids and chromosomes were sequenced using the Illumina MiSeq platform. RESULTS: E. faecium Efa-125 belonged to ST117 and expressed resistance both to vancomycin and teicoplanin, with minimum inhibitory concentrations (MICs) for both of 256mg/L. The vanA gene was carried on a 29 320-bp plasmid exhibiting high similarity to pA6981 previously characterised from Enterococcus gallinarum A6981, whereas vanB was part of a Tn1549-like transposon integrated into the chromosome. Expression of the VanA phenotype was correlated with the presence of intact vanZ and vanS genes. CONCLUSIONS: This is the first detection in Greece of vanA-vanB genotype/VanA phenotype E. faecium and indicates an evolving epidemiology of vancomycin-resistant enterococci.

• MeSH
• Anti-Bacterial Agents pharmacology   MeSH
• Genes, Bacterial genetics   MeSH
• Bacterial Proteins genetics   MeSH
• Bacteremia microbiology   MeSH
• Enterococcus faecium drug effects   genetics   isolation & purification   pathogenicity   MeSH
• Vancomycin-Resistant Enterococci genetics   MeSH
• Phenotype MeSH
• Genotype MeSH
• Gram-Positive Bacterial Infections microbiology   MeSH
• Humans MeSH
• Carbon-Oxygen Ligases genetics   MeSH
• Microbial Sensitivity Tests MeSH
• Molecular Epidemiology * MeSH
• Multilocus Sequence Typing MeSH
• Hospitals MeSH
• Plasmids genetics   MeSH
• Protein Kinases genetics   MeSH
• Electrophoresis, Gel, Pulsed-Field MeSH
• Gene Expression Regulation, Bacterial MeSH
• Vancomycin Resistance MeSH
• Teicoplanin pharmacology   MeSH
• Transcription Factors genetics   MeSH
• DNA Transposable Elements MeSH
• Vancomycin pharmacology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Europe MeSH
• Greece MeSH