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Applied and Environmental Microbiology, April 2009, p. 1908-1915, Vol. 75, No. 7
0099-2240/09/$08.00+0 doi:10.1128/AEM.02228-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
Inc A/C Plasmids Are Prevalent in Multidrug-Resistant Salmonella enterica Isolates
,
Rebecca L. Lindsey,
Paula J. Fedorka-Cray,
Jonathan G. Frye, and
Richard J. Meinersmann*
U.S. Department of Agriculture, Agricultural Research Service, Bacterial Epidemiology and Antimicrobial Resistance Research Unit, Richard B. Russell Agricultural Research Center, 950 College Station Road, Athens, Georgia 30605-2720
Received 26 September 2008/
Accepted 12 January 2009

ABSTRACT
Bacterial plasmids are fragments of extrachromosomal double-stranded
DNA that can contain a variety of genes that are beneficial
to the host organism, like those responsible for antimicrobial
resistance. The objective of this study was to characterize
a collection of 437
Salmonella enterica isolates from different
animal sources for their antimicrobial resistance phenotypes
and plasmid replicon types and, in some cases, by pulsed-field
gel electrophoresis (PFGE) in an effort to learn more about
the distribution of multidrug resistance in relation to replicon
types. A PCR-based replicon typing assay consisting of three
multiplex PCRs was used to detect 18 of the 26 known plasmid
types in the
Enterobacteriaceae based on their incompatibility
(Inc) replicon types. Linkage analysis was completed with antibiograms,
replicon types, serovars, and Inc A/C. Inc A/C plasmids were
prevalent in multidrug-resistant isolates with the notable exception
of
Salmonella enterica serovar Typhimurium. Cluster analysis
based on PFGE of a subset of 216 isolates showed 155 unique
types, suggesting a variable population, but distinct clusters
of isolates with Inc A/C plasmids were apparent. Significant
linkage of serovar was also seen with Inc replicon types B/O,
I1, Frep, and HI1. The present study showed that the combination
of
Salmonella, the Inc A/C plasmids, and multiple-drug-resistant
genes is very old. Our results suggest that some strains, notably
serovar Typhimurium and closely related types, may have once
carried the plasmid but that the resistance genes were transferred
to the chromosome with the subsequent loss of the plasmid.

INTRODUCTION
Bacterial plasmids are self-replicating extrachromosomal fragments
of double-stranded DNA. They range in size from a few to several
hundred kilobase pairs. Plasmids can contain a variety of genes
that are beneficial to the survival of the host bacteria. These
sequences can encode antimicrobial and heavy metal resistance,
toxin production, or virulence factors that allow their bacterial
host to adapt to changing environments (
2,
12,
35). The classification
and tracking of plasmids is beneficial because they are potentially
a medium of horizontal gene transfer of drug resistance (
5,
12,
24). Horizontal transfer of DNA in prokaryotes occurs in
three forms: transformation, conjugation, or transduction (
12,
30). Plasmids contain a replicon that consists of sequences
that are necessary for self-replication in a host cell, which
includes the origin of replication, control of initiation, and
replication functions (
5,
10). Plasmids can be classified according
to incompatibility (Inc) types that are based on the inability
of plasmids with the same replication mechanism to exist in
the same cell (
10,
22). Different plasmids of the same Inc type
cannot coexist in one bacterial strain. In the
Enterobacteriaceae,
there are 26 known Inc types or replicon types. A PCR-based
replicon typing assay has been developed to distinguish 18 replicon
types (
6,
18,
19).
Certain replicon types are associated with multidrug resistance as well as bacteria implicated in disease outbreaks or found in food-producing animals. Multidrug-resistant (MDR) Salmonella strains are responsible for human outbreaks and may be acquired through food animals, which are a major source of zoonotic pathogens (3, 16, 23, 25, 35, 36). Twenty-two MDR Salmonella enterica serovar Heidelberg isolates from turkey-associated sources were found to have XbaI pulsed-field gel electrophoresis (PFGE) profiles that were indistinguishable from the most common profile associated with human infection. Conjugation experiments confirmed that the one tested representative isolate was able to transfer a large plasmid of approximately 120 kb (20). The Inc A/C plasmid backbone from MDR Salmonella enterica serovar Newport was found to have a backbone similar to that of plasmid pIP1202 from Yersinia pestis, the causative agent of the plague, as well as that of plasmid pYR71 from Yersinia ruckeri, a fish pathogen (34). MDR Salmonella enterica serovar Newport with plasmid-mediated extended-spectrum cephalosporin resistance was isolated from animals during a salmonellosis outbreak that led to the closure of the large animal hospital at the University of Pennsylvania's New Bolton Center (26). In clinical human isolates of the Enterobacteriaceae, Inc A/C or Inc N plasmids have been shown to be associated with extended-spectrum cephalosporin and carbapenem resistance determinants emerging in Greece, Italy, and the United States (7). Inc I1 and A/C replicon types are associated with plasmids carrying and disseminating extended-spectrum β-lactamase genes in animals and humans (9, 13, 18). The Inc HI1 replicon type is associated with an MDR plasmid, plasmid pHCM1, found in Salmonella enterica serovar Typhi, recovered during an MDR typhoid fever outbreak in Vietnam from 1993 to 1996 (33). Salmonella enterica serovar Paratyphi A was found to contain an MDR IncHI1 plasmid, plasmid pAKU_1, and, in some regions, can be the causative agent of enteric fever (17). To further study the Inc A/C plasmid, we characterized the antimicrobial resistance profiles and the presence of replicon types in 437 ampicillin- and tetracycline-resistant Salmonella enterica isolates recovered from ill animals in 2005. Amp- or Tet-resistant isolates were selected because they are more likely to have a plasmid.

MATERIALS AND METHODS
Bacterial strains and plasmids.
Salmonella enterica strains in this study were collected from
samples submitted to veterinary diagnostic laboratories in 2005
in which
Salmonella was identified as being either the primary
or secondary etiological agent associated with the illness,
as previously described (
http://www.ars.usda.gov/Main/docs.htm?docid=6750&page=1).
Veterinary diagnostic laboratories obtained isolates from the
state in which they are located; the isolates were sent to the
National Veterinary Services Laboratory (NVSL), Ames, IA (
www.aphis.usda.gov/animal_health/lab_info_services/about_nvsl.shtml);
and we obtained the isolates from the NVSL. All strains tested
for plasmid Inc types were resistant to ampicillin and/or tetracycline.
The 437 isolates in this study (see Table S1 in the supplemental
material) represent 55 serovars (including nonmotile and untypeable)
from 17 different sources including canine (dog), cattle, chicken,
dairy cattle, equine, environment, feline (domestic cat), parrot,
reptile (turtle and lizard), swine, turkey, wild avian (pheasant
and unknown spp.), wild mammal (alpaca, mongoose, and unknown
spp.), and wild rodent (unknown spp.). Strains were obtained
from 28 states in all five regions in the United States as defined
for the NARMS program (
http://www.ars.usda.gov/Main/docs.htm?docid=6750)
and included region 1, the Northeast (Connecticut, Delaware,
Indiana, Massachusetts, Maryland, Maine, Michigan, New Hampshire,
New Jersey, New York, Ohio, Pennsylvania, Rhode Island, and
Vermont); region 2, the Southeast (Alabama, Florida, Georgia,
Kentucky, North Carolina, Puerto Rico, South Carolina, Tennessee,
Virginia, and West Virginia); region 3, the Midwest (Iowa, Illinois,
Kansas, Minnesota, Missouri, North Dakota, Nebraska, South Dakota,
and Wisconsin); region 4, the Southwest (Arkansas, Louisiana,
Mississippi, Oklahoma, and Texas); and region 5, the West (Arizona,
California, Colorado, Idaho, Montana, New Mexico, Nevada, Oregon,
Utah, Washington, and Wyoming).
Positive controls used in the replicon typing procedure were originally created in the laboratory of Werner K. Maas (6, 10) and generously provided by Alessandra Carattoli (Istituto Superiore di Sanita, Rome, Italy). All bacterial strains were stored at –80°C in LB lennox (Hardy Diagnostics, Santa Maria, CA) with 15% glycerol or stored at room temperature in tryptic soy agar (Hardy Diagnostics, Santa Maria, CA) slants until use.
Antimicrobial susceptibility testing.
Each Salmonella enterica isolate was tested for susceptibility to a panel of 15 antimicrobial drugs using the Sensititer system (Trek Diagnostic Systems Inc., Westlake, OH) that included amikacin, amoxicillin-clavulanic acid, ampicillin, cefoxitin, ceftiofur, ceftriaxone, chloramphenicol, ciprofloxacin, gentamicin, kanamycin, nalidixic acid, streptomycin, sulfamethoxazole, tetracycline, and trimethoprim-sulfamethoxazole as defined by the NARMS program (http://www.ars.usda.gov/Main/docs.htm?docid=6750). Each isolate was classified as being susceptible, intermediate, or resistant using Clinical and Laboratory Standards Institute (CLSI; formerly National Committee for Clinical Laboratory Standards) breakpoints when available; otherwise, breakpoint interpretations from the National Antimicrobial Resistance Monitoring System were used (21). For linkage analyses described below, intermediate sensitivity was not distinguished from the susceptible trait.
Multiplex PCR for plasmid replicon typing.
Salmonella isolates were examined by PCR using three multiplex primer panels for the presence of 18 plasmid replicons as described previously by Johnson et al. (19). This replicon typing procedure is a modified version of eight PCR multiplex and simplex reactions described previously by Carattoli et al. (6). Primers were obtained from a Eurofins MWG operon (Huntsville, AL). Inc-type reference plasmid DNA was extracted from 2 ml LB broth cultures grown overnight with appropriate antibiotics and processed with a Qiaprep spin miniprep kit (Qiagen, Valencia, CA). Template DNA for PCR from the 437 Salmonella isolates was prepared by suspending a single colony in 200 µl sterile water and treating in a boiling water bath for 10 min. PCRs were performed according to the polymerase manufacturer's instructions, with a final volume of 25 µl: 5 µl of boiled lysate or 10 ng of each reference plasmid, 1x AmpliTaq buffer 1, 0.50 µM of each primer, 4 mM MgCl2, 0.2 mM of each deoxynucleoside triphosphate, and 1.25 units of AmpliTaq polymerase (Applied Biosystems, Foster City, CA). Positive controls as well as a negative control without DNA were run with each multiplex primer panel. PCR cycle conditions were as follows: 5 min at 94°C; 30 cycles of 30 s at 94°C, 30 s at 60°C, and 90 s at 72°C; and a final extension step of 5 min at 72°C. Amplicons were visualized on 1x Tris-borate-EDTA 2% agarose gels run for 2 h at 80 V alongside a TrackIt 1-kb Plus DNA ladder (Invitrogen Corporation, Carlsbad, CA). An isolate was considered to be positive for a particular gene if an amplicon of the expected size was observed.
PFGE.
A total of 223 isolates of the original 437 strains were analyzed by a 24-h Salmonella PFGE protocol as described by PulseNet (8) at the USDA VetNet Laboratory (Athens, GA). Briefly, genomic DNA was digested with 10 U of XbaI (Roche Molecular Biochemicals, Indianapolis, IN) and separated with the CHEF-Mapper XA PFGE system (Bio-Rad, Hercules, CA) in 0.5x Tris-borate-EDTA buffer at 14°C at 6 V for 18 h with a ramped pulse time of 2.16 to 63.8 s. The BioNumerics software program (Applied Maths Scientific Software Development, Sint-Martens-Latem, Belgium) was applied for cluster analysis using the Dice-based coefficients with a 1.5% band tolerance and 1.5% optimization with coefficient and the unweighted pair-group method.
DT104 analysis.
Pentaresistant (ampicillin, chloramphenicol, streptomycin, sulfonamides, and tetracycline [ACSSuT] resistance) Salmonella enterica serovar Typhimurium isolates were phage typed at the National Veterinary Services Laboratory, Ames, IA (www.aphis.usda.gov/animal_health/lab_info_services/about_nvsl.shtml).
Statistical analysis.
Linkage disequilibrium (LD) was calculated as an extension of Fisher's exact probability test on contingency tables (27) as instituted by the program Arlequin (11). Standard settings were used, 10,000 steps in the Markov chain and 1,000 dememorization steps; and calculations of D, D', and r2 coefficients were made with a significance level of 0.05.

RESULTS
Characterization of Salmonella enterica isolates.
The total number of
Salmonella enterica diagnostic isolates
in the collection was 1,548; 842 (54%) of these were Amp or
Tet resistant. Strains that were identical in all of three traits,
serovar, state/region, and host animal, were removed from the
set to decrease redundancy. We characterized the remaining 437
Salmonella enterica isolates for their antimicrobial resistances
and replicon types. These isolates represent 55 serovars from
17 different host sources and were obtained from 28 states in
five regions of the United States (see Table S1 in the supplemental
material). When the original parameters of Amp or Tet resistance
were examined in the characterized strains, 224 (51%) were both
Amp and Tet resistant, 47 (11%) were only Amp resistant, and
166 (38%) were only Tet resistant. The top four prevalent antimicrobial
resistances by percent in the population are tetracycline (89.2%),
streptomycin (74.8%), sulfamethoxazole (73.2%), and ampicillin
(62.0%) (Table
1). Ciprofloxacin is the only tested drug that
did not show resistance in any of the strains, and it was not
included in further analyses. Sixty-five percent of the strains
analyzed show resistance to four or more of the antimicrobials
on our panel.
Replicon typing, a PCR-based assay consisting of three multiplex
primer panels, was conducted on all
Salmonella isolates for
the presence of 18 different plasmid based Inc types (
19). The
most prevalent replicon types by percent in the population that
we characterized were Inc A/C (26.3%), I1 (23.6%), HI1 (6.4%),
and FIIA (2.5%) (Table
2). Forty-seven percent of our strains
did not show a positive reaction for any replicon type, but
our assay detects only 18 of the 26 known replicon types in
the
Enterobacteriaceae. We did not identify any isolates that
carried the FIC, K/B, T, or W Inc replicon type.
Inc A/C was present in 115 strains and 21 out of 53 serovars
(not including nonmotile and untypeable) (Table
3). Inc A/C
was not found in isolates from two states in separate regions,
and each of these consisted of only one isolate. Inc A/C was
found in all source species except for wild rodent, parrot,
pheasant, and unknown avian spp.; each of these groups consisted
of only one isolate (Table
3). Recognizing the selection for
the study of isolates that are Amp or Tet resistant, in the
93 Inc A/C-positive strains, 88 (95%) were both Amp and Tet
resistant, none were only Amp resistant, and 5 (5%) were only
Tet resistant. When the Amp or Tet resistance was examined in
the 81 Inc I1-positive strains, 21 (26%) were Amp and Tet resistant,
11 (14%) were only Amp resistant, and 49 (60%) were only Tet
resistant. In the 22 isolates that were both Inc A/C and Inc
I1 positive, 21 (95%) were both Amp and Tet resistant, 0 (0%)
were only Amp resistant, and 1 (5%) was only Tet resistant.
In the remaining 241 isolates that were not Inc A/C or Inc I1
positive, 94 (39%) were both Amp and Tet resistant, 36 (15%)
were only Amp resistant, and 111 (46%) were only Tet resistant.
Pairwise LD between the antimicrobial resistance profile and
Salmonella enterica isolate serovar showed a linkage (
P value
of <0.05) with all the antimicrobials tested except amikacin
and nalidixic acid (data not shown). Resistance to these two
antimicrobials showed low representation in our population,
with nalidixic acid at 1.4% and amikacin at 0.5% (Table
1).
Pairwise LD between antimicrobial resistance profiles and Inc
A/C replicon type of
Salmonella enterica isolates shows linkage
(
P value of <0.05) with all antimicrobials tested except
amikacin, ceftriaxone, ciprofloxacin, nalidixic acid, streptomycin,
and sulfamethoxazole (data not shown). Pairwise LD between 14
replicon types and
Salmonella enterica serovars show linkage
(
P value < 0.05) of serovar and Inc A/C, B/O, Frep, HI1,
and I1 (Fig.
1). A nonrandom association is seen between strain
serovar and the Inc A/C, B/O, Frep, HI1, I1, and A/C subsets
(Fig.
1).
PFGE analysis was conducted on 216 of the 437 total isolates
including 98 of 104 Inc A/C-positive isolates (Fig.
2). Six
strains were not included in the cluster analysis because their
PFGE patterns were inconsistent with serovar results (E. McGlinchey,
personal communication). PFGE analysis was conducted on 118
Inc A/C-negative isolates that were randomly selected, including
49 Inc I1-positive strains (51 additional isolates containing
Inc I1 were identified but were not included in PFGE analysis)
as well as 69 other strains that were picked as a reference
set. Cluster analysis based on PFGE showed 155 unique types,
suggesting a variable population. The source animal of the isolate
did not appear to have a correlation to cluster analysis. Inc
A/C-positive strains have a high degree of multidrug resistance
compared to strains without any detected replicon type, which
have a reduced antimicrobial profile. However, Inc A/C-positive
strains of
Salmonella enterica serovar Choleraesuis variant
Kunzendorf were resistant to sulfamethoxazole and tetracycline
only. Inc A/C-positive strains form clusters, whereas Inc I1
appears random, and not enough information was available to
detect linkage patterns among the B/O, Frep, and HI1 Inc types
(Fig.
2).
This study included 38 isolates of serovar Typhimurium and 55
isolates of serovar Typhimurium variant 5–. Fifty percent
of the population of
Salmonella enterica serovar Typhimurium
or serovar Typhimurium variant 5– isolates were pentaresistant
(ACSSuT) (or more) and phage typed. Thirty-four percent of the
isolates of these serovars were DT104 positive (Table
4). Ten
percent were Inc A/C-positive and pentaresistant (or more),
and only 1% were Inc A/C and DT104 positive (Table
4).

DISCUSSION
The objective of this study was to characterize a large population
of
Salmonella enterica isolates from different animal sources
for their antimicrobial resistance phenotypes and plasmid replicon
type and, in some cases, by PFGE in an effort to learn more
about the distribution of multidrug resistance in relation to
Inc A/C as well as the other replicon types which we examined.
PFGE was conducted on approximately one-half of the study population
and was used for cluster analysis. Linkage analysis was completed
with antibiograms, replicon types, serovars, and Inc A/C groups.
Cluster analysis based on PFGE of 216 isolates showed 155 unique types. Cluster analysis showed that Inc A/C-positive strains form groups based on multidrug resistance and serovar, whereas Inc I1-positive isolates did not appear to be clonally distributed. This indicated that Inc A/C plasmids have been stably associated with clones for a very long time (however, molecular clocks cannot be accurately constructed with a phylogenetic analysis of PFGE) (29), while Inc I1 plasmids are much more mobile. Inc A/C plasmids are large, >150 kb, while Inc I1 plasmids are frequently approximately 100 kb (9, 34). Larger plasmids usually transfer at lower frequencies than smaller plasmids and can be expected to be more stable (14). It can also be inferred from the stable association with clones with similar resistance phenotypes that the plasmid itself is very old and that the linkage of the resistance genes does not represent a recent accretion.
The cluster analysis shows seven groups that may be considered to be epidemic clones, highly successful clones, which, for the sake of this discussion, were considered to be PFGE types (28) with three or more identical individuals (labeled clones A to G) (Fig. 2). There is some replicon type diversity in these clones; two have diversity with regard to Inc A/C (clones A and B), three have diversity with regard to Inc I1 (clones C, D, and E), two have diversity with regard to Inc F1B (clones B and C), and one does not have any detected replicon types associated with it (clone G). We also found diversity in the antimicrobial resistance profiles associated with these seven clones; one clone has no diversity with regard to antimicrobials (clone G), two clones have diversity with regard to one antimicrobial (clone A and F), three clones have diversity with regard to two antimicrobials (clone B, C, and E), and one clone has diversity with regard to three antimicrobials (clone D).
Most of the Salmonella enterica isolates in this study that carried the Inc A/C plasmids were multidrug resistant, which is consistent with the findings described previously by Welch et al. (34). We observed that Inc A/C-positive strains carry more antimicrobial resistance than isolates with other replicon types, so it was of interest to note a clone with three Inc A/C-positive individuals of serovar Choleraesuis variant Kunzendorf, which were resistant to sulfamethoxazole and tetracycline only. It is possible that these three isolates carry other resistance genes that are not expressed. All of the Salmonella enterica serovar Choleraesuis variant Kunzendorf strains in this study originated from swine in region 3, and they had antimicrobial resistance profiles of two to five drugs. We infer from the PFGE analysis that the serovar Choleraesuis variant Kunzendorf clone is a stable clone that is being amplified and is undergoing little change despite the lack of important antimicrobial resistance genes.
It is interesting to compare the clades that include serovars Typhimurium and Heidelberg with the clade that includes serovar Newport or the clade that includes serovar Derby. Pentaresistance (ACSSuT resistance) was seen to be common among Salmonella enterica serovar Typhimurium isolates, although Inc A/C plasmids were not prevalent in the clade, and other plasmid types were scattered throughout the clade. Pentaresistance in serovar Typhimurium is often associated with phage type DT104, which has multiple resistance genes located in an island on the chromosome (4, 15, 31, 32). In this study, serovar Typhimurium and serovar Typhimurium variant 5– ACSSuT (or more) resistance was more frequently associated with carrying the DT104 phenotype than having the Inc A/C plasmid (Table 4): 34% of the isolates of these serovars were DT104 positive and pentaresistant, while 10% were Inc A/C positive and pentaresistant (or more). In contrast, the clade that includes serovar Newport isolates has a high prevalence of Inc A/C-type plasmids associated with resistance to eight or more antimicrobials, and the clade that includes serovar Derby has Inc A/C plasmids infrequently and little resistance to beta-lactam antimicrobials. From these considerations, we hypothesize that the serovar Newport clade had an Inc A/C plasmid at its origin, while the serovar Derby isolates with Inc A/C plasmids may represent recent acquisitions. The serovar Typhimurium clade may have had an Inc A/C plasmid early in its genesis, but it was largely lost, perhaps after transferring genes that helped to stabilize the plasmid, including antimicrobial resistance genes, to the chromosome. Welch et al. (34) previously compared the DNA sequences of three Inc A/C plasmid backbones: pSN254 from an MDR Salmonella enterica serovar Newport isolate; pIP1202 from Yersinia pestis, the causative agent of the plague; as well as plasmid pYR71 from an isolate of the fish pathogen Yersinia ruckeri that was found to be resistant to a large number of antimicrobials. When the sequence of the DT104 resistance island (GenBank accession number AF071555) (4) was compared to these plasmids by BLAST (1), there was a very high degree of similarity of resistance genes, supporting the hypothesis that the genes have a common origin. An alternative hypothesis is that the MDR genes originated in serovar Typhimurium and were transferred to an Inc A/C plasmid that was not amplified with serovar Typhimurium. With PFGE data, it is difficult to distinguish between the two hypotheses because proper rooting of the tree cannot be established (29). However, when PFGE data were reanalyzed, including 15 isolates of serovar Typhimurium that were pansusceptible and Inc A/C negative, they fell into separate clades that appear more ancient than the clades representing the MDR strains in several alternative rootings (data not shown).
In conclusion, the present study showed that the combination of Salmonella species, the Inc A/C plasmids, and MDR genes is very old. Our results suggest that some strains, notably serovar Typhimurium and closely related types, used to carry the plasmid and had a transfer of resistance genes to the chromosome with a subsequent loss of the plasmid. This means that MDR Salmonella strains have been around in numbers too low to be found for much longer than humans had any influence, that there has not been substantial new accretion of resistance by a recent acquisition of existing genes into new strains, and that any increase in levels of these types of strains represents clonal expansion that may or may not be driven by modern practices.

ACKNOWLEDGMENTS
We acknowledge Alessandra Carattoli for replicon typing control
strains and Shayla Hunter, Sandra House, Takiyah Ball, Cheryl
Gresham, Carolina Hall, Beth McGlinchey, Jovita Haro, and Tyler
Wilcher for technical assistance.
The mention of trade names or commercial products in the manuscript is solely for the purpose of providing specific information and does not imply recommendation or endorsement by the U.S. Department of Agriculture.

FOOTNOTES
* Corresponding author. Mailing address: USDA-ARS-BEAR, Richard B. Russell Research Center, P.O. Box 5677, Athens, GA 30604-5677. Phone: (706) 546-3236. Fax: (706) 546-3018. E-mail:
rmeiners{at}saa.ars.usda.gov 
Published ahead of print on 30 January 2009. 
Supplemental material for this article may be found at http://aem.asm.org/. 

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Applied and Environmental Microbiology, April 2009, p. 1908-1915, Vol. 75, No. 7
0099-2240/09/$08.00+0 doi:10.1128/AEM.02228-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
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