Antibacterial resistance, Wayampis Amerindians, French Guyana.Drug resistance in fecal bacteria was high in Wayampis Amerindians who did not take antibacterial agents and were not hospitalized for 1 year. In the Wayampis Amerindians, an isolated traditional community in French Guyana, antibacterial use was 0.64 treatments per person per year. Hospitalization rate was 6.1% per year. Antibacterial drug-resistant bacteria can spread in persons who are not taking antibacterial agents. ********** Antibacterial-resistant bacteria can spread in persons not taking antibacterial agents. This resistance results from contaminated food, antibacterial drug exposure, and cross-contamination from humans or animals. Antibacterial resistance is high in developing countries (1) because of self-medication, the suboptimal Suboptimal A solution is called suboptimal if a part of the solution has been optimized without regards to the overall objective. quality of antibacterial drugs, and poor community and patient hygiene (2). To analyze the role of cross-transmission on the resistance of focal commensal commensal /com·men·sal/ (kom-men´sil) 1. living on or within another organism, and deriving benefit without harming or benefiting the host. 2. a parasite that causes no harm to the host. enterobacteria en·ter·o·bac·te·ri·um n. pl. en·ter·o·bac·te·ri·a Any of various gram-negative rod-shaped bacteria of the family Enterobacteriaceae that includes some pathogens of plants and animals, such as the colon bacillus and salmonella. , we conducted a study from October 1 through 15, 2001, among Wayampis Amerindians who lived in the most southern part of French Guyana, in an isolated, ethnically homogeneous, traditional community. The community was made up of 184 males and 204 females (193 children <15 years and 195 adults), who were evenly distributed in three villages (Z, n = 248; TS, n = 85; and YP, n = 55). Access to the villages was restricted to residents, and the sites were isolated, 100 km south of the closest village. Villagers shared large huts (13.9 + 8.6 inhabitants
The game is based loosely on the concepts from SameGame. per hut [range 4-38]) with no latrines or hygienic facilities, and used a single spot on the river for drinking, bathing, and disposal of human waste. They ate only local food (crops grown in a traditional manner and meat from fishing or hunting). They did not raise farm animals except a few free-running chickens. A paramedic par·a·med·ic n. A person who is trained to give emergency medical treatment or assist medical professionals. paramedic officer permanently residing in Z provided the only antibacterial agents in the vicinity and recorded their dispensation. When necessary, the villagers were hospitalized in Cayenne, the capital of French Guyana. Medical care was free. The Study Rates of antibacterial exposure were calculated as the ratio of the number of treatments prescribed divided by the number of villagers and compared by using analysis of variance. Chi-square-tests or Fisher exact tests were used for binary variables. During the year preceding the study, 24 (6.1%) of 388 villagers had been hospitalized; 235 (60.6%) had received no treatment with antibacterial agents. One hundred fifty-three (39.4%) of the villagers had received 250 courses of antibacterial treatment. Of the therapeutic agents used, 72 (28.8%) were amino-penicillins, 111 (44.4%) were metronidazole metronidazole /met·ro·ni·da·zole/ (-ni´dah-zol) an antiprotozoal and antibacterial effective against obligate anaerobes; used as the base or the hydrochloride salt. It is also used as a topical treatment for rosacea. , 36 (14.4%) were macrolides, and 31 (12.4%) were different antibacterial agents (17 penicillin M, 2 penicillin G penicillin G n. The most commonly used penicillin compound, used primarily in the form of its stable salts. Also called benzylpenicillin. , 7 cotrimoxazole, 3 cyclines, and 2 first-generation cephalosporins Cephalosporins Definition Cephalosporins are medicines that kill bacteria or prevent their growth. Purpose Cephalosporins are used to treat infections in different parts of the body—the ears, nose, throat, lungs, sinuses, and ). Ninety-eight (25.3%) villagers had received one course of treatment, 30 (7.7%) received 2 courses of treatment, 13 (3.4%) received 3 courses of treatment, and 12 (2.1%) received [greater than or equal to] 4 courses of treatment. Overall antibacterial and aminopenicillin exposures were significantly higher in village Z, where the paramedical par·a·med·i·cal adj. 1. Of, relating to, or being a person trained to give emergency medical treatment or assist medical professionals. 2. officer resided (Table 1), and in children. In October 1999, one of the investigators (V.J. or A.A.) asked each adult to participate in the study. Children were recruited with the help of the teachers at school. Exclusion criteria exclusion criteria AIDS Donor exclusion criteria, see there were fever, diarrhea, or acute infection, and a stay outside the study zone, a history of hospitalization (verified by Cayenne's hospital records), or treatment with an antibacterial agent (verified by records of the paramedical officer) during the preceding year. We chose this period for surveillance because it was the longest period for which information was available. Information was verified by one of the investigators. The study was approved by the Comite Consultatif de Protection des Personnes se pretant a des Recherches Biomedicales (CCPPRB CCPPRB Comité Consultatifs de Protection des Personnes se prêtant à des Recherches Biomédicales ) of Cayenne and by the administrative authorities of French Guyana and was authorized by the French Ministry of Health. Before participants were included, the study was presented to the villagers, with the aid of the chief of the village who explained that some of them would be asked to participate. Consent was obtained before participants were included in the study. Study participants were asked to bring fresh stool samples (unformed samples were excluded) to the paramedic officers. The samples were then mixed into brain-heart infusion broth with 10% glycerol glycerol, glycerin, glycerine, or 1,2,3-propanetriol (prō`pāntrī'ŏl), CH2OHCHOHCH2OH, colorless, odorless, sweet-tasting, syrupy liquid. and frozen in liquid nitrogen. Upon harvesting, 25 [micro]L of broth was added to 2 mL of brain-heart infusion broth, incubated for 4 h, and plated on cetrimide Noun 1. cetrimide - a cationic detergent that is a powerful disinfectant antimicrobial, antimicrobic, disinfectant, germicide - an agent (as heat or radiation or a chemical) that destroys microorganisms that might carry disease , Chapman, and bile-esculin-acid agar containing 10 mg/L of vancomycin (after an enrichment step of 18 h in broth containing 1 mg/L of vancomycin) to detect Pseudomonas aeruginosa Pseudomonas aeruginosa A normal soil inhabitant and human saprophyte that may contaminate various solutions in a hospital, causing opportunistic infection in weakened Pts Clinical Infective endocarditis in IVDAs, RTIs, UTIs, bacteremia, meningitis, 'malignant' , Staphylococcus aureus Staphylococcus au·re·us n. A bacterium that causes furunculosis, pyemia, osteomyelitis, suppuration of wounds, and food poisoning. Staphylococcus aureus Staphylococcus pyogenes , and vancomycin-resistant enterococci enterococci bacteria in the genus Enterococcus. , respectively. Antibacterial-resistant gram-negative bacteria were detected by using two separate methods. The first method explored the predominant flora. Drigalski agar plates were plated with the fecal dilutions; after 48 h growth, five colonies were randomly selected, identified, and tested for antibacterial susceptibility as described (http://www.sfm. asso.fr). A participant was defined as colonized Colonized This occurs when a microorganism is found on or in a person without causing a disease. Mentioned in: Isolation in the predominant flora with gram-negative bacteria resistant to a given antibacterial agent when at least one strain resistant to this antibacterial agent was isolated. The second method explored the subdominant sub·dom·i·nant n. Music The fourth tone of a diatonic scale, next below the dominant. adj. 1. Zoology Less than dominant; ranking below one that is dominant: flora. Drigalski agar plates were supplemented with either ampicillin ampicillin (ăm'pĭsĭl`ĭn), a penicillin-type antibiotic that is effective against both gram-negative microorganisms and gram-positive microorganisms such as Escherichia coli. (10 mg/L), ceftazidime (2 mg/L), streptomycin streptomycin (strĕp'tōmī`sĭn), antibiotic produced by soil bacteria of the genus Streptomyces and active against both gram-positive and gram-negative bacteria (see Gram's stain), including species resistant to other (20 mg/L), kanamycin kanamycin /kan·a·my·cin/ (kan?ah-mi´sin) an aminoglycoside antibiotic derived from Streptomyces kanamyceticus, effective against aerobic gram-negative bacilli and some gram-positive bacteria, including mycobacteria; used as the (20 mg/L), chloramphenicol chloramphenicol (klōr'ămfĕn`əkŏl'), antibiotic effective against a wide range of gram-negative and gram-positive bacteria (see Gram's stain). It was originally isolated from a species of Streptomyces bacteria. (20 mg/L), tetracycline tetracycline (tĕ'trəsī`klēn), any of a group of antibiotics produced by bacteria of the genus Streptomyces. They are effective against a wide range of Gram positive and Gram negative bacteria, interfering with protein (10 rag/L), or nalidixic acid nalidixic acid /nal·i·dix·ic ac·id/ (nal-i-dik´sik) a synthetic antibacterial agent used in the treatment of genitourinary infections caused by gram-negative organisms. na·li·dix·ic acid n. (50 rag/L) (3), used within 24 h after preparation, and kept at 4[degrees]C until used. The plates were plated with the fecal dilutions, incubated for 48 h, and inspected for lactose-positive and lactose-negative colonies. A participant was defined as colonized in the subdominant flora with gram-negative bacteria resistant to a given antibacterial agent when at least one colony grew on agar containing the corresponding antibacterial agent. No further identification was performed; for quality control purposes, some positive plates were randomly selected for confirmation of antibacterial susceptibility of the isolates. Because the number were few and unexpected, colonies that grew on agar containing ceftazidime were all identified by conventional methods or 16S RNA RNA: see nucleic acid. RNA in full ribonucleic acid One of the two main types of nucleic acid (the other being DNA), which functions in cellular protein synthesis in all living cells and replaces DNA as the carrier of genetic gene sequencing (4), when needed; their antibacterial susceptibility was tested; and genes encoding for extended spectrum [beta]-lactamase were characterized, when needed, by polymerase chain reaction polymerase chain reaction (pŏl`ĭmərās') (PCR), laboratory process in which a particular DNA segment from a mixture of DNA chains is rapidly replicated, producing a large, readily analyzed sample of a piece of DNA; the process is and sequencing (5). When needed, the clonality of isolates was determined by using pulsed-field gel electrophoresis (PFGE PFGE Pulsed-Field Gel Electrophoresis ) (6). The fecal flora was thus analyzed in a subgroup of 93 volunteers (39 men and 54 women; 41.2% from village TS, 18.1% from village Z, and 23.6% village YP [p < 0.001]) who met the inclusion criteria cited above, representing 93 (23.9%) of 388 villagers and 93 (39.6%) of 235 who had not received antibacterial agents for 1 year. Carriage of resistant gram-negative bacteria in subdominant flora of these 93 volunteers ranged from [greater than or equal to] 90% for those resistant to ampicillin, streptomycin, and tetracycline to 7% for those resistant to nalidixic acid (Table 2), with no significant difference for sex or age. We found no association between the rate of resistance in the study participants and the number persons who used antibacterial agents or of children in the hut. Fourteen participants (all living in village Z but not in the same hut) were colonized by gram-negative bacteria resistant to ceftazidime, including three Escherichia coli Escherichia coli (ĕsh'ərĭk`ēə kō`lī), common bacterium that normally inhabits the intestinal tracts of humans and animals, but can cause infection in other parts of the body, especially the urinary tract. strains with a similar pattern by PFGE that produced [Bla.sub.TEM TEM 1. transmission electron microscope. 2. triethylenemelamine. 3. transmissible encephalopathy of mink. .52] extended spectrum [beta]-lactamase. Nine participants (three, one, and five living in villages TS, YP and Z, respectively, and only two in the same hut) were colonized by strains of Acinetobacter baumannii sharing the same susceptibility pattern. Two participants (one in village TS and one in village Z) were colonized by strains of Ochrobactrum spp. Neither S. aureus The aureus (pl. aurei) was a gold coin of ancient Rome valued at 25 silver denarii. The aureus was regularly issued from the 1st century BC to the beginning of the 4th century AD, when it was replaced by the solidus. or P. aeruginosa were isolated. One participant from village Z was colonized by a vancomycin-resistant strain of Enterococcus enterococcus /en·tero·coc·cus/ (en?ter-o-kok´us) pl. enterococ´ci an organism belonging to the genus Enterococcus. Enterococcus /En·tero·coc·cus/ ( gallinarum. Resistance rates in the predominant flora were from 95% to tetracycline to 0% to ceftazidime and nalidixic acid, with no significant differences between adults and children, men and women, or villages. Although they were not chosen randomly, approximately 40% of the untreated villagers were included, which suggests that the group was representative of the whole community. Recently, high resistance rates were also reported in remote populations from Bolivia (7) and Nepal (2). Here, however, we have provided additional information on exposure to antibacterial drugs and hospitalizations of the study participants. In the villages studied, the global antibacterial exposure (0.64 treatments/person/year) was roughly half that of France (8), thus close to the mean rate of European Union European Union (EU), name given since the ratification (Nov., 1993) of the Treaty of European Union, or Maastricht Treaty, to the European Community countries (9), which stresses the indirect impact of antibacterial use on persons who do not use them. Unrecorded antibacterial drug use in the participants was unlikely because no alternate sources of antibacterial agents existed, and free antibacterial agents were provided when needed, decreasing the likelihood of nonprescribed use or sharing of antibacterial agents by family members. Our results can be compared only to those of studies performed with similar methods and in persons who also had not taken antibacterial drugs. For instance, resistance rates of predominant E. coli E. coli: see Escherichia coli. E. coli in full Escherichia coli Species of bacterium that inhabits the stomach and intestines. E. coli can be transmitted by water, milk, food, or flies and other insects. in the Wayampis population to ampicillin, tetracycline, and streptomycin were higher than that observed in French bank workers (10) or Bostonian children (1), but close to that reported in children from Venezuela and China (1). That the resistance rate was higher in the Wayampis Amerindians than in the French workers was unexpected, considering the higher levels of antibacterial drug use in the French community. These data suggested frequent cross-transmission likely attributable to poor hygiene (1,2). Cross-transmission is common among households, even in industrialized in·dus·tri·al·ize v. in·dus·tri·al·ized, in·dus·tri·al·iz·ing, in·dus·tri·al·iz·es v.tr. 1. To develop industry in (a country or society, for example). 2. countries (11). Its role in the spread of drug-resistant bacteria among the Wayampis Amerindians, even in adults, was further indicated by the lack of difference in resistance rates according to age. Resistance to quinolones, which were not used in this community, was lower than in Europe (12), which illustrates the specificity of selective pressure. Third-generation cephalosporins were also not used. Thus, how samples from three participants were colonized by an E. coli carrying [Bla.sub.TEM.52] (13), an extended-spectrum [beta]-lactamase-gene found only in hospitals, is difficult to explain. However, enterobacteria that produced an extended spectrum [beta]-lactamase were prevalent at the time in the Cayenne hospital (B.M., unpub, data). Since the three persons with the [Bla.sub.TEM-52]-colonized samples had not been hospitalized during the previous year, possibly this strain, or a different one, carrying [Bla.sub.TEM-52] was acquired and spread in the community by one of the 24 villagers hospitalized during the year preceding the study. Extended-spectrum [beta]-lactamase can disseminate in the community (14). We cannot exclude that the three [Bla.sub.TEM-52] carriers had been hospitalized earlier. If they were hospitalized and colonized during hospitalization, this colonization would not have been likely to have persisted for so long; indeed, carriage of resistant nasal staphylococci can last for months, but resistance in intestinal enterobacteria decreases within 10-20 days after selective pressure ends (15). Conclusions Antibacterial agents in the food chain are a source of resistance in industrialized countries (16). In our study, food was strictly local but may have been the source of the wild-type naturally resistant A. baumannii and Ochrobactrum spp. strains that we isolated. Environmental species have also been isolated in Amerindians living in nearby (formerly Dutch) Guyana (17). Because data confirmed the lack of direct antibacterial drug exposure in our study participants, the results demonstrate that, once resistance elements are introduced into a population, moderate use of antibacterial drugs in the environment is enough to maintain them in intestinal bacteria when sanitary conditions are poor.
Table 1. Antibacterial exposure in 388 Wayampi Amerindians from three
villages in southern French Guyana during the year preceding the study
(a)
Frequency of antibacterial exposure in (%)
Antibacterial agents TS (n = 85) YP (n = 55) Z (n = 248)
Aminopenicillins 5.9 14.6 23.8
Metronidazole 16.5 30.9 32.3
Macrolides 8.2 1.8 11.3
Other 5.8 7.3 8.9
Overall 36.5 54.6 76.2
Frequency of antibacterial
exposure in (%)
Antibacterial agents Total (N = 388) p value (b)
Aminopenicillins 18.6 0.007
Metronidazole 28.6 0.15
Macrolides 9.3 0.2
Other 8.0 0.7
Overall 64.4 0.007
(a) Frequency of antibacterial exposure was calculated by dividing the
number of all antibacterial courses during the year preceding the study
by the number of persons in each village.
(b) Analysis of variance (ANOVA).
Table 2. Prevalence of carriage of gram-negative bacteria resistant to
various antibacterial agents in the predominant and the subdominant
fecal flora of the 93 study participants (a)
Predominant flora (b)
Escherichia Klebsiella Enterobacter
Antibacterial agent coli (%) sp. (%) sp. (%)
Ampicillin 51 (55) 19 (21) 5 (5)
Ceftazidime 0 0 0
Nalidixic acid 0 0 0
Pefloxacine 0 0 0
Streptomycin 42 (45) 2 (2) 0
Kanamycin 5 (5) 0 0
Tetracycline 59 (63) 14 (15) 0
Cotrimoxazole 27 (29) 0 0
Chloramphenicol 22 (24) 0 0
Subdominant
flora
Predominant flora (b)
Lactose
Antibacterial agent Other (%) Any (%) positive (%)
Ampicillin 2 (2) 77 (33) 89 (96)
Ceftazidime 0 0 3 (c) (4)
Nalidixic acid 0 0 7 (e) (8)
Pefloxacine 0 0 ND
Streptomycin 0 44 (47) 83 (90)
Kanamycin 0 5 (5) 45 (49)
Tetracycline 2 (2) 75 (81) 86 993)
Cotrimoxazole 0 27 (29) ND
Chloramphenicol 0 22 (24) 48 (52)
Subdominant flora
Lactose
Antibacterial agent negative (%) Any (%)
Ampicillin 31 (33) 93 (100)
Ceftazidime 11 (d) (12) 14 (15)
Nalidixic acid 0 7 (8)
Pefloxacine ND ND
Streptomycin 19 (21) 86 (93)
Kanamycin 4 (5) 47 (51)
Tetracycline 25 (27) 86 (93)
Cotrimoxazole ND ND
Chloramphenicol 27 (29) 60 (67)
(a) Accounting for 23.9% (93 of 388) of the glooal population of the
villages studied and not significantly different from it for male/
female ratio or age distribution.
(b) Bacteria with intermediate susceptibility were categorized as
resistant.
(c) Extended spectrum [beta]-lactamase E. coli.
(d) Acinetobacter baumanni: 9 (all with the same susceptibility pattern
including susceptibility to ureidopenicillins, third -generation
cephalosporins, aminoglycosides, and quinolones) and Ochrobactrum spp.
(identified by 16s RNA genes sequencing): 2.
(e) E. coli.
Acknowledgments We thank the villagers for their help during the study, Patricia Vienne for her help in Cayenne; P. Lavoine, M.J. Julliard, and S. Couriol for secretarial assistance; and Gerald Pier and Philippe Bougnoux for critical reading of the manuscript. This project was supported in part by the Institut National de la Sante et de la Recherche Medicale (INSERM INSERM Institut National de la Santé et de la Recherche Médicale (French Institute of Health and Medical Research) ). References (1.) Lester S, Del Pilar Pilar strong-minded female leader of a group of guerrillas in the Spanish Civil War. [Am. Lit.: Hemingway For Whom the Bell Tolls] See : Female Power Pilar Pla M, Wang F, Perez Schaeli I, O'Brien T. The carriage of Escherichia colt resistant to antibiotic agents by healthy children in Boston, Caracas, Venezuela, and in Qin Pu, China. N Engl J Med. 1990;323:285-9. (2.) Watson JL, Marshall B, Pokhrel BM, Katie KK, Levy SB. Carriage of antibiotic-resistant fecal bacteria in Nepal reflects proximity to Kathmandu. J Infect Dis. 2001;184:1163-9. (3.) Chachaty E, Youssef MT. Bourneix C, Andremont A. Shedding of antibiotic-resistant members of the family Enterobacteriaceae in healthy residents of France and Jordan. Res Microbiol. 1995;146:175-82 (4.) Ruimy R, Breittmayer V, Elbaze P, Lafay B, Boussemart O, Gauthier M, et al. Phylogenetic phy·lo·ge·net·ic adj. 1. Of or relating to phylogeny or phylogenetics. 2. Relating to or based on evolutionary development or history. analysis and assessment of the genera Vibrio vibrio Any of a group of aquatic, comma-shaped bacteria in the family Vibrionaceae. Some species cause serious diseases in humans and other animals. They are gram-negative (see , Photobacterium, Aeromonas, and Plesiomonas deduced from small-subunit rRNA sequences. Int J Syst Bacteriol. 1994;44:416-26. (5) Arlet G, Brami G, Decre D, Flippo A, Galliot gal·li·ot n. Variant of galiot. O, Lagrange PH, et al. Molecular characterisation by PCR-restriction fragment length polymorphism of TEM beta-lactamases. FEMS Microbiol Lett. 1995;134:203-8. (6.) Bohm H. Karch H. DNA fingerprinting of Escherichia coil O157:H7 strains by pulsed field gel electrophoresis Historical Background Standard gel electrophoresis techniques for separation of DNA molecules provided huge advantages for molecular biology research. However, many limitations existed with the standard protocol in that it was unable to separate very large molecules of DNA . J Clin Microbiol. 1992;30:2169-72 (7.) Bartoloni A, Cutts F, Leoni S, Austin CC, Mantella A, Guglielmetti P, et al. Patterns of antibiotic use and antibiotic resistance among healthy children in Bolivia. Trop Med Int Health. 1998;3:116-23. (8.) Guillemot guillemot (gĭl`əmŏt'), northern sea bird, genus Cephas, of the auk family. The black guillemot, or trystie, Cephus grylle, is about 13 in. D. Antibiotic use in humans and bacterial resistance. Curt Opin Microbiol. 1999;2;494-8. (9.) Cars O, Molstad S, Melander A. Variation in antibiotic use in the European Union. Lancet. 2001 ;357:1851. (10.) Aubry-Damon H, Grenet K, Ndiaye-Sall P, Che D, Corderio E, Bougnoux M, et al. Antimicrobial resistance in commensal flora of pig farmers. Emerg Infect Dis. 2004;10:873-9. (11.) Fornasini M, Roves RR, Murray BE, Morrow AL, Picketing LK. Trimethoprim-resistant Escherichia colt in households of children attending day care centers. J Infect Dis. 1992;166:326-30. (12.) Garau J, Xercavins M, Rodriguez Carballeira M, Gomez-Vera JR, Coil I, Vidal D, et al. Emergence and dissemination of quinolone-resistant Escherichia colt in the community. Antimicrob Agents Chemother. 1999;43:2736-41. (13.) Poyart C, Mugnier P, Quesne G, Berche P, Trieu-Cuot P. A novel extended-spectrum TEM-type beta-lactamase (TEM-52) associated with decreased susceptibility to moxalactam in Klebsiella pneumoniae. Antimicrob Agents Chemother. 1998;42:108-13. (14.) Colodner R, Keness Y, Chazan cha·zan or haz·zan also chaz·zan n. A cantor in a synagogue. [Mishnaic Hebrew and Jewish Aramaic B, Raz R. Antimicrobial susceptibility of community-acquired uropathogens in northern Israel. Int J Antimicrob Agents. 2001; 18:189-92. (15.) Murray BE. Rensimer ER, DuPont HL. Emergence of high-level trimethoprim trimethoprim /tri·meth·o·prim/ (-meth´o-prim) an antibacterial closely related to pyrimethamine; almost always used in combination with a sulfonamide, primarily for the treatment of urinary tract infections. resistance in fecal Escherichia colt during oral administration of trimethoprim or trimethoprim-sulfamethoxazole. N Engl J Med. 1982;306:130-5. (16.) Corpet DE. Antibiotic resistance from food N Engl J Med 1988;318:1206-7. (17.) Silverman MS, Scolnik D, Willey BM, Daneman N, Davis I, Aronson L, et al. Antibiotic resistance in healthy adults and children in Guyana. Abstract C2-2094, 43rd International Conference on Antimicrobial Agents and Chemotherapy Antimicrobial Agents and Chemotherapy (print-ISSN 0066-4804, CODEN AMACCQ; canceled ISSN 0074-9923, canceled CODEN AACHAX) is an academic journal published by the American Society for Microbiology. . Chicago, IL, USA, 2003 (14-17 September). Karine Grenet, * Didier Guillemot, ([dagger]) Vincent Jarlier, ([double dagger]) Brigitte Moreau, ([section]) Stephane Dubourdieu, * Raymond Ruimy, * Laurence Armand-Lefevre, * Pierre Bau, * and Antoine Andremont * * Assistance Publique-Hopitaux de Paris, Paris, France; ([dagger]) Pharmaco-Epidemiologie Institut Pasteur, Paris, France; ([double dagger]) Groupe Hospitalier Pitie-Salpetriere, Paris, France; and ([section]) Centre Hospitalier de Cayenne, French Guyana Dr. Grenet is a pharmacist and clinical biologist. She is currently working in the Laboratory of Bacteriology bacteriology Study of bacteria. Modern understanding of bacterial forms dates from Ferdinand Cohn's classifications. Other researchers, such as Louis Pasteur, established the connection between bacteria and fermentation and disease. , Groupe Hospitalier Pitie-Salpetriere, Paris, France. Her main research insterest is bacterial resistance in humans. Address for correspondence: Antoine Andremont, Laboratoire de Bacteriologic bac·te·ri·ol·o·gy n. The study of bacteria, especially in relation to medicine and agriculture. bac·te , Hopital Bichat Claude Bernard, 46 rue Henri-Huchard, 75018 Paris, France; fax: 331-40-25-85-81; email: antoine.andrrmont@bch.ap-hop-paris.fr |
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