INTRODUCTION — The genus Aeromonas consists of gram-negative rods widely distributed in freshwater, estuarine, and marine environments [1,2]. Aeromonas species grow at a range of temperatures, although they are isolated with increasing frequency during warmer months (May through October in the Northern hemisphere). Aeromonas species cause a wide spectrum of disease syndromes among warm- and cold-blooded animals, including fish, reptiles, amphibians, mammals, and humans [3,4].
MICROBIOLOGY — The genus Aeromonas was re-categorized from the family Vibrionaceae to the family Aeromonadaceae in the mid-1980s, when phylogenetic evidence from molecular studies became available to support this distinction [2,5,6].
The genus Aeromonas has been divided into two major groups [7]:
●Motile, mesophilic species, including eight that can cause disease in humans (table 1).
●Non-motile, psychrophilic species that generally cause disease only in fish.
Aeromonas species are oxidase positive and ferment glucose. The organisms grow at a range of temperatures from 0 to 42ºC.
PATHOGENICITY AND PATHOGENESIS — The role of Aeromonas as a gastrointestinal pathogen is uncertain. Stool isolation rates among individuals with diarrhea are variable, ranging from <1 to >60 percent. In addition, Aeromonas is a common isolate from asymptomatic individuals [8,9]. There has been only one major outbreak in which Aeromonas has been implicated as the etiologic agent of disease [10]. Efforts to induce illness in volunteers with selected Aeromonas strains were unsuccessful in one trial, although selection of strains may not have been optimal [11].
Nonetheless, it is likely that certain strains of Aeromonas cause diarrheal disease [8,12-17]. One large study identified Aeromonas spp as a cause of traveler's diarrhea in 18 (2 percent) of 863 patients in Spain [15]. In the Global Enteric Multicenter Study (GEMS), which compared stool cultures among 12,110 children with diarrhea and 17,291 matched control children at seven global sites, Aeromonas was associated with diarrhea only in Pakistan and Bangladesh, where Aeromonas-positive culture rates ranged from 19 percent in the 0- to 11-month age group to 29 percent in the 24- to 59-month age group. However, Aeromonas was isolated as the sole pathogen in less than 5 percent of cases at those sites, with Shigella as the most common co-isolate [17]. In contrast, in Africa and India, rates of isolation never exceeded 1 percent. Factors responsible for these regional differences in incidence remain to be determined, and the potential role of coinfecting pathogens, such as Shigella, in disease occurrence warrants further study.
At a patient level, it is not possible to predict whether a specific Aeromonas strain is responsible for diarrheal illness. Possible virulence factors of Aeromonas species include toxins (cytotoxic and cytotonic), proteases, hemolysins, lipases, adhesins, agglutinins, pili, enterotoxins, various enzymes, and outer membrane arrays, such as an S-layer and capsule. Other factors that may contribute to virulence include VacB [18], enolase [19], and the presence of a Type VI secretion system [20-27]. In one study, whole genome sequencing and comparative genomics were used to characterize a virulent subtype of Aeromonas hydrophila isolated from aquatic wounds that has genes for toxin production, toxin secretion, and bacterial motility [28]. It is uncertain how many aeromonads contain these putative virulence factors and how these factors contribute to risk of illness.
EPIDEMIOLOGY — Mesophilic aeromonads have a global distribution [1,2] and have been isolated from a variety of aquatic environments, including [29-32]:
●Fresh water
●Estuarine (brackish) water
●Surface water, especially recreational
●Drinking water, including treated, well, and bottled
●Polluted waters
●Waste water effluent sludge [33].
Aeromonads are not generally considered marine organisms, but can be found in marine systems that interface with fresh waters and can survive at all but the most extreme salt concentrations [29]. Usually they are not part of the groundwater bacterial population, which is generally poor in nutrients.
In nutrient-rich waters, Aeromonas species can grow to large numbers and generally peak in the warmer temperatures of the summer months in temperate freshwater lakes and chlorinated drinking water [34,35]. Aeromonas species appear to tolerate polluted environments, including chemical pollution, although they are not considered to be of fecal origin [30]. The organism has also been isolated from retail produce sources and meat products [36].
Contact with any fresh or brackish water body is the most common source of human infection. The risk of infection can be reduced by caution in the setting of natural water sources (lakes, rivers, streams, ponds, bays), including minimizing the risk of traumatic wounds and avoiding oral ingestion, particularly during warmer summer months.
Underlying host factors may also influence the likelihood of infection [14]. In the Global Enteric Multicenter Study (GEMS) study, breastfeeding was associated with a lower likelihood of Aeromonas infection, but only in patients 24 months of age or younger [17]. In a study from Bangladesh, detection of Aeromonas in diarrheal samples was associated with severe acute malnutrition (odds ratio = 25.7) [37]. Hematologic malignancies and cirrhosis are associated with increased risk for infection [38,39].
ASSOCIATED DISEASES — Diarrheal disease is the most common manifestation of Aeromonas infection. The organism has also been associated with a variety of extraintestinal presentations [4,8,12,40-42].
Diarrhea — Aeromonas spp are associated with a range of diarrheal presentations including:
●Acute, secretory diarrhea, often accompanied by vomiting
●Acute, dysenteric diarrhea with blood and mucus
●Chronic diarrhea, lasting more than 10 days
●Choleric diarrhea with "rice-water" stools
●Traveler's diarrhea (probably the most commonly recognized presentation in the United States)
There have been two reports of A. hydrophila enterocolitis associated with the hemolytic uremic syndrome (HUS) [43-45]. (See "Diagnosis of immune TTP".)
Wound infections — Aeromonas can cause mild to severe wound infections. Infection typically occurs on the extremities following traumatic aquatic injury. Such wound infections affect men three times more commonly than women. The most typical presentation is cellulitis [46], although myonecrosis (with and without gas production), rhabdomyolysis, and lesions mimicking ecthyma gangrenosum have been reported [47-50]. A case of nearly fatal necrotizing fasciitis from a traumatic leg wound incurred from contact with a fresh water river highlights the virulence potential of aeromonads to cause serious disease [51].
A. hydrophila, Aeromonas veronii, and Aeromonas schubertii are the species most commonly isolated from wound infections [4,8,21,52]. Aeromonas was a common wound isolate among tsunami victims in southeast Asia in 2004, and elevated numbers of Aeromonas spp were recorded in floodwater samples in New Orleans following Hurricane Katrina in 2005 [53,54]. Additionally, several reports have documented aeromonad necrotizing fasciitis associated with species other than A. hydrophila, such as A. veronii biovar sobria, A. schubertii, and Aeromonas caviae [55,56]. A former arabinose-negative biovar of A. hydrophila is now known as Aeromonas dhakensis and has a high association with more serious human infections, especially in Taiwan, Malaysia, and Australia [57].
Serious wound infections and sepsis have also been reported following the medicinal use of leeches [58-60]. Aeromonads reside in the gut of the leech Hirudo medicinalis, where they assist in the enzymatic digestion of the blood ingested by the leech [58,59,61,62]. Patients undergoing leech therapy often receive systemic chemoprophylaxis with ciprofloxacin to prevent such infection. Emerging reports of ciprofloxacin-resistant strains of Aeromonas isolated from leeches may limit the utility of this practice [60,63-65].
Bacteremia — Sepsis with Aeromonas species is strongly associated with infection with A. veronii biovar sobria. These patients present with the classic signs and symptoms of gram-negative sepsis and may have gastrointestinal symptoms, including abdominal pain, nausea, vomiting, and diarrhea [4,66].
Sepsis tends to occur in older patients with hematologic malignancy [38], serious hepatobiliary disease, other immunocompromising conditions, or traumatic injuries. One case report described recurrent Aeromonas bacteremia over two years in an elderly man who had repeated exposure through contaminated well water [67]. Pediatric case reports of sepsis due to A. hydrophila have been reported, including one case of a patient with diarrhea and pneumonia and one case of acute renal failure [68,69]. Cases have also been rarely reported among pregnant women; in 2011, three cases of bacteremia with Aeromonas spp were identified in pregnant women at the Thailand-Myanmar Border [70].
It is not always possible to identify the source of the organism in cases of sepsis; in such cases, it is reasonable to surmise that it was acquired from the gastrointestinal tract.
Miscellaneous extraintestinal sites — Aeromonas spp have been implicated in cases of ocular infections, osteomyelitis, meningitis, respiratory infections following "near drowning," pelvic abscesses, otitis, cystitis, endocarditis, peritonitis, cholecystitis, and joint infections [4,8,21,71-73]. Necrotizing fasciitis and folliculitis due to A. hydrophila strain have also been reported [74-76].
DIAGNOSIS — Aeromonads are not routinely identified in most microbiology laboratories as part of the normal protocol for isolating stool pathogens. For cases in which Aeromonas is suspected clinically, the laboratory should be advised to look for the organism. It is readily identified in routine wound or blood cultures. Automated genetic identification systems can identify most true Aeromonas isolates to the level of A. hydrophila group or A. hydrophila/A. caviae. However, these identifications are often incomplete or erroneous due to insufficient discriminatory markers to detect interspecies differences [77-79]. A study evaluating the ability of six commercial systems to identify clinical Aeromonas isolates noted that accuracy of these systems was limited by outdated databases and taxonomy, weak algorithms, and the need for impractical tests [80]. Certain algorithms, however, performed well, such as the Aerokey II [81], which correctly identified 95.5 percent of 87 isolates to the species level. This dichotomous algorithm can differentiate the emerging virulent species known as A. dhakensis, which has been linked with severe infection, including septicemia [82].
Hemolysis is variable on blood agar media; most species display beta hemolysis. Although aeromonads grow on nearly all enteric media, they often are overlooked on MacConkey agar because A. caviae is lactose-positive just like Escherichia coli. Ampicillin-containing medium should not be used to suppress normal enteric flora, since a substantial portion of A. caviae isolates and all Aeromonas trota isolates are sensitive to ampicillin and therefore will not grow on such a medium [83,84]. This is especially important in light of reports implicating A. trota in pancreatic abscess and septic shock with cirrhosis, and A. caviae in cystitis [85-87].
Aeromonas spp are oxidase-positive, polar flagellated, glucose-fermenting, facultatively anaerobic, gram-negative rods that are resistant to the vibriostatic agent O/129 and unable to grow in 6.5 percent NaCl. The presumptive identification of an isolate involves the initial separation from other oxidase-positive genera such as Vibrio and Plesiomonas to avoid misidentification. This can be accomplished with simple tests such as O/129 susceptibility, tolerance to various NaCl broth concentrations, and the ability to ferment inositol [84].
Antimicrobial resistance markers and susceptibility studies should be determined by either the standard agar dilution method or by Kirby-Bauerdisk diffusion method using the 2010 CLSI Standard M45-A2 for Aeromonas species [88]. Some automated MIC systems, such as BioMerieux Vitek, Inc. may not be reliable for detection of beta-lactam resistance [89].
THERAPY
Antimicrobial susceptibility — Clinical studies have demonstrated differences in antimicrobial susceptibility between species, highlighting the importance of both species identification and susceptibility testing for all isolates, particularly in the setting of serious infection. With the caveat that there may be substantial differences in regional resistance patterns, most Aeromonas strains are resistant to penicillin, ampicillin, carbenicillin, and ticarcillin; most are susceptible to trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones, second- and third-generation cephalosporins, aminoglycosides, carbapenems, chloramphenicol, and tetracyclines [8,71,90-95]. There have been several reports of infection with fluoroquinolone-resistant A. hydrophila strains following leech therapy [60,63-65].
Most Aeromonas species produce an inducible chromosomal beta-lactamase, which may not be detected by rapid commercial susceptibility systems [89]. Aeromonads produce beta-lactamases from three different classes: a class C cephalosporinase, a class D penicillinase, and a class B metallo-beta-lactamase (MBL) of the "CphA" type [9]. Two other MBLs (VIM and IMP) in strains of A. hydrophila and A. caviae have also been detected, encoded on an integron and a plasmid, respectively [96,97]. One reported the emergence of multiple Aeromonas spp. displaying CphA-mediated carbapenem resistance in Australia; the predominant species found was A. dhakensis, previously known to be the cause of more serious human infections [98]. (See "Overview of carbapenemase-producing gram-negative bacilli", section on 'Class B beta-lactamases'.)
Regional resistance patterns include the following:
●In Bangladesh, Aeromonas spp have the highest reported level of multidrug resistance (MDR) among enteric pathogens, at 82 percent [99]. This includes resistance to fluroquinolones (73 percent of isolates), macrolides (99.8 percent), tetracycline (72 percent), and TMP-SMX (85percent).
●In Spain, resistance to nalidixic acid has been reported; a surveillance study of 43 strains reported that 26 percent of A. caviae, 20 percent of A. hydrophila, and 88 percent of A. veronii biotype sobria were resistant to nalidixic acid. Although still susceptible to ciprofloxacin, these strains had a mutation in the A subunit of DNA gyrase and could easily develop a second mutation resulting in resistance to ciprofloxacin [92].
●In China, colistin resistance (mcr-3) has been described [100].
Clinical approach — Most cases of Aeromonas-associated diarrhea are self-limited and can be managed with supportive therapy, including oral and intravenous rehydration. Based on anecdotal data, antibiotics may be of value in patients with severe diarrhea and/or a history of immunosuppression [91]. Antibiotic therapy is also indicated in the setting of wound infection and bacteremia [92].
Given emerging patterns of antimicrobial resistance, antimicrobial susceptibility testing of isolates is essential to guide antibiotic selection. Pending species identification and susceptibility testing, initial empiric therapy of suspected Aeromonas spp infections with a fluoroquinolone, third-generation cephalosporin, and/or TMP-SMX would provide reasonable antimicrobial coverage. For infections acquired in areas with high levels of resistance, such as Bangladesh, therapy with a third-generation cephalosporin and/or an aminoglycoside should be considered. Once susceptibility testing results are available, the antibiotic regimen can be tailored appropriately to a single agent.
Guidelines from the Infectious Diseases Society of America suggest a combination of doxycycline plus either ciprofloxacin or ceftriaxone for treatment of necrotizing skin infections caused by Aeromonas spp [101]. However, there are no data that indicate this combination therapy offers a benefit over monotherapy.
Nevertheless, certain agents should be avoided; therapy with ampicillin or first-generation cephalosporins is not appropriate. All species of clinical aeromonads are resistant to ampicillin except for A. trota and sometimes A. caviae. A. veronii biovar sobria (formerly Aeromonas sobria) is uniformly resistant to first-generation cephalosporins, but in vitro testing suggests that it is susceptible to third- and fourth-generation cephalosporins. (See 'Antimicrobial susceptibility' above.)
There are no clinical trial data to guide the duration of therapy; therefore, treatment should be guided by clinical response. Reasonable courses of therapy include three days of therapy for treatment of diarrhea, 7 to 10 days of therapy for treatment of wound infections, and two weeks of therapy for treatment of bacteremia. The course of therapy may need to be adjusted depending on individual circumstances, including immunosuppression or other underlying conditions.
SUMMARY AND RECOMMENDATIONS
●The genus Aeromonas consists of gram-negative rods widely distributed in freshwater, estuarine, and marine environments. Aeromonas species have been isolated with increasing frequency during warmer months. The organisms cause a wide spectrum of disease syndromes among warm and cold-blooded animals. (See 'Microbiology' above.)
●Diarrheal disease is the most common manifestation of Aeromonas infection. The organism has also been associated with a variety of extraintestinal presentations, including wound infections and bacteremia. Necrotizing fasciitis has been reported with species such as Aeromonas hydrophila, Aeromonas veronii biovar sobria, Aeromonas schubertii, and Aeromonas caviae. Aeromonas dhakensis is also associated with severe infections. (See 'Associated diseases' above.)
●Aeromonads are not routinely identified in most microbiology laboratories as part of the normal protocol for isolating stool pathogens. Most molecular testing systems can identify Aeromonas, but suboptimally identify an isolate to the species level. (See 'Diagnosis' above.)
●Clinical studies have demonstrated differences in antimicrobial susceptibility between species and between geographic locations, highlighting the importance of both species identification and susceptibility testing for all isolates, particularly in the setting of serious infection. (See 'Antimicrobial susceptibility' above.)
●Pending species identification and susceptibility testing, we suggest initial empiric therapy of suspected Aeromonas infections (severe diarrhea, wound infections, bacteremia) with a fluoroquinolone, third-generation cephalosporin, and/or TMP-SMX (Grade 2C). For areas with known high levels of resistance (such as Bangladesh), a third-generation cephalosporin and/or an aminoglycoside are alternatives. (See 'Clinical approach' above.)
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6 : Proposal to recognize the family Aeromonadaceae
7 : Proposal to recognize the family Aeromonadaceae
8 : Evolving concepts regarding the genus Aeromonas: an expanding Panorama of species, disease presentations, and unanswered questions.
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11 : Lack of correlation between known virulence properties of Aeromonas hydrophila and enteropathogenicity for humans.
12 : Lack of correlation between known virulence properties of Aeromonas hydrophila and enteropathogenicity for humans.
13 : Aeromonas hemolytic uremic syndrome. A case and a review of the literature.
14 : Host immune responses to aeromonas virulence factors
15 : Aeromonas spp. and traveler's diarrhea: clinical features and antimicrobial resistance.
16 : Prevalence, serotype distribution, antibiotic susceptibility and genetic profiles of mesophilic Aeromonas species isolated from hospitalized diarrhoeal cases in Kolkata, India.
17 : Aeromonas-Associated Diarrhea in Children Under 5 Years: The GEMS Experience.
18 : Cold shock exoribonuclease R (VacB) is involved in Aeromonas hydrophila pathogenesis.
19 : Surface-expressed enolase contributes to the pathogenesis of clinical isolate SSU of Aeromonas hydrophila.
20 : Virulence factors in motile Aeromonas species.
21 : Recent advances in the study of the taxonomy, pathogenicity, and infectious syndromes associated with the genus Aeromonas.
22 : Recent advances in the study of the taxonomy, pathogenicity, and infectious syndromes associated with the genus Aeromonas.
23 : Molecular characterization of a glucose-inhibited division gene, gidA, that regulates cytotoxic enterotoxin of Aeromonas hydrophila.
24 : Bacteria that express lateral flagella enable dissection of the multifunctional roles of flagella in pathogenesis.
25 : Genome sequence of Aeromonas hydrophila ATCC 7966T: jack of all trades.
26 : Genome sequence of Aeromonas hydrophila ATCC 7966T: jack of all trades.
27 : Molecular characterization of a functional type VI secretion system from a clinical isolate of Aeromonas hydrophila.
28 : Characterization of Aeromonas hydrophila wound pathotypes by comparative genomic and functional analyses of virulence genes.
29 : Prevalence and distribution of Aeromonas hydrophila in the United States.
30 : Isolation, enumeration, and characterization of Aeromonas from polluted waters encountered in diving operations.
31 : Aeromonas hydrophila: ecology and toxigenicity of isolates from an estuary.
32 : Properties of aeromonads and their occurrence and hygienic significance in drinking water.
33 : Distribution and survival of motile Aeromonas spp. in brackish water receiving sewage treatment effluent.
34 : Isolation of Aeromonas spp. from an unchlorinated domestic water supply.
35 : Isolation of Aeromonas hydrophila from a metropolitan water supply: seasonal correlation with clinical isolates.
36 : Isolation of Aeromonas hydrophila from a metropolitan water supply: seasonal correlation with clinical isolates.
37 : Use of TaqMan Array Cards to investigate the aetiological agents of diarrhoea among young infants with severe acute malnutrition.
38 : Clinical features and outcome of Aeromonas sobria bacteremia in pediatric and adult patients with hematologic malignancies: A single-center retrospective study in Peru.
39 : Taxonomy, virulence determinants and antimicrobial susceptibility of Aeromonas spp. isolated from bacteremia in southeastern China.
40 : Spectrum of extraintestinal disease due to Aeromonas species in tropical Queensland, Australia.
41 : Clinical relevance of Aeromonas
42 : Aeromonas spp. clinical microbiology and disease.
43 : Haemolytic-uraemic syndrome associated with Aeromonas hydrophila enterocolitis.
44 : Haemolytic-uraemic syndrome associated with Aeromonas hydrophila enterocolitis.
45 : Controversial data on the association of Aeromonas with diarrhoea in a recent Hong Kong study.
46 : Freshwater wound infection due to Aeromonas hydrophila.
47 : [Rapidly progressive myonecrosis by Aeromonas veronii biotype sobria].
48 : Fatal case of myonecrosis and septicaemia caused by Aeromonas hydrophila in Finland.
49 : Aeromonas hydrophila wound infection following a tiger bite in Nepal.
50 : Surgical site infection due to Aeromonas species: report of nine cases and literature review.
51 : Functional genomic characterization of virulence factors from necrotizing fasciitis-causing strains of Aeromonas hydrophila.
52 : Outbreak of Aeromonas hydrophila wound infections associated with mud football.
53 : The long-distance tertiary air transfer and care of tsunami victims: injury pattern and microbiological and psychological aspects.
54 : Assessment of pathogens and toxicants in New Orleans, LA following Hurricane Katrina.
55 : Necrotising fasciitis in both calves caused by Aeromonas caviae following aesthetic liposuction.
56 : A fatal case of necrotizing Aeromonas schubertii fasciitis after penetrating injury.
57 : A fatal case of necrotizing Aeromonas schubertii fasciitis after penetrating injury.
58 : Aeromonas hydrophila infection associated with the use of medicinal leeches.
59 : Nosocomial Infections with Aeromonas hydrophila from Leeches.
60 : Transmission of Aeromonas hydrophila by leeches.
61 : Symbiosis of Aeromonas veronii biovar sobria and Hirudo medicinalis, the medicinal leech: a novel model for digestive tract associations.
62 : Elimination of symbiotic Aeromonas spp. from the intestinal tract of the medicinal leech, Hirudo medicinalis, using ciprofloxacin feeding.
63 : Ciprofloxacin-resistant Aeromonas hydrophila infection following leech therapy: a case report and review of the literature.
64 : Ciprofloxacin-resistant Aeromonas hydrophila cellulitis following leech therapy.
65 : Leech-transmitted ciprofloxacin-resistant Aeromonas hydrophila.
66 : Aeromonas hydrophila bacteraemia and portal pyaemia.
67 : Recurrent Aeromonas Bacteremia Due to Contaminated Well Water.
68 : Sepsis due to extended-spectrum beta-lactamase-producing Aeromonas hydrophila in a pediatric patient with diarrhea and pneumonia.
69 : Acute renal failure in an infant associated with cytotoxic Aeromonas sobria isolated from patient's stool and from aquarium water as suspected source of infection.
70 : Aeromonas spp. bacteremia in pregnant women, Thailand-Myanmar border, 2011.
71 : Aeromonas spp. bacteremia in pregnant women, Thailand-Myanmar border, 2011.
72 : Aeromonas meningitis complicating medicinal leech therapy.
73 : Clinical significance of spontaneous Aeromonas bacterial peritonitis in cirrhotic patients: a matched case-control study.
74 : Aeromonas hydrophila with plasmid-borne class A extended-spectrumβ-lactamase TEM-24 and three chromosomal class B, C, and Dβ-lactamases, isolated from a patient with necrotizing fasciitis.
75 : Necrotizing fasciitis and sepsis caused by Aeromonas hydrophila after crush injury of the lower extremity.
76 : A possible new cause of spa bath folliculitis: Aeromonas hydrophila.
77 : Misidentification of unusual Aeromonas species as members of the genus Vibrio: a continuing problem.
78 : [Discordancies between classical and API 20E microtest biochemical identification of Vibrio and Aeromonas strains].
79 : Evaluation of two miniaturized systems, MicroScan W/A and BBL Crystal E/NF, for identification of clinical isolates of Aeromonas spp.
80 : Accuracy of 6 commercial systems for identifying clinical Aeromonas isolates.
81 : Aerokey II: a flexible key for identifying clinical Aeromonas species.
82 : Clinical implications of species identification in monomicrobial Aeromonas bacteremia.
83 : Aeromonas trota sp. nov., an ampicillin-susceptible species isolated from clinical specimens.
84 : Aeromonas trota sp. nov., an ampicillin-susceptible species isolated from clinical specimens.
85 : Pancreatic abscess due to Aeromonas hydrophila.
86 : Wound infection and septic shock due to Aeromonas trota in a patient with liver cirrhosis.
87 : Cystitis caused by Aeromonas caviae.
88 : Cystitis caused by Aeromonas caviae.
89 : Failure of the Vitek AutoMicrobic system to detect beta-lactam resistance in Aeromonas species.
90 : In vitro susceptibilities of Aeromonas hydrophila, Aeromonas sobria, and Aeromonas caviae to 22 antimicrobial agents.
91 : Antimicrobial susceptibility patterns of Aeromonas jandaei, A. schubertii, A. trota, and A. veronii biotype veronii.
92 : In vitro antimicrobial susceptibility of clinical isolates of Aeromonas caviae, Aeromonas hydrophila and Aeromonas veronii biotype sobria.
93 : Unexpected occurrence of plasmid-mediated quinolone resistance determinants in environmental Aeromonas spp.
94 : Development of imipenem resistance in an Aeromonas veronii biovar sobria clinical isolate recovered from a patient with cholangitis.
95 : Antimicrobial susceptibilities of Aeromonas strains isolated from clinical and environmental sources to 26 antimicrobial agents.
96 : Identification of the first VIM metallo-beta-lactamase-producing multiresistant Aeromonas hydrophila strain.
97 : First occurrence of an IMP metallo-beta-lactamase in Aeromonas caviae: IMP-19 in an isolate from France.
98 : Genotypic and phenotypic identification of Aeromonas species and CphA-mediated carbapenem resistance in Queensland, Australia.
99 : Multidrug-resistant enteric pathogens in older children and adults with diarrhea in Bangladesh: epidemiology and risk factors.
100 : Genetic Diversity, Antimicrobial Resistance, and Virulence Genes of Aeromonas Isolates from Clinical Patients, Tap Water Systems, and Food.
101 : Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America.