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T*
-.0195 Tc
[(cal)-423.9(isolate)-424.9(o)2.4(f)]TJ
/F4 1 Tf
5.6675 0 TD
-.0214 Tc
[(A.)-428(ba)-5.2(uma)-5.2(n).5(n)-5.2(i).4(i)]TJ
/F5 1 Tf
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[(re)-6.5(cov)-5.3(e)-.7(re)-6.5(d)-425.8(i).3(n)-425.8(2)-5.3(013)-425.8(i)-5.5(n)-425.8(Ger)-5.3(m)-.8(an)-5.3(y)]TJ
7.3823 0 0 6.5614 546.2361 510.3495 Tm
0 Tc
(5)Tj
9.843 0 0 9.843 310.8472 494.9857 Tm
-.0215 Tc
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0 -1.1116 TD
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[(isola)-5.2(t)1.6(e.)-328.9(The)-327.7(l)1.6(evels)-320.6(o)-4(f)-320.8(a)-5.2(ntibioti)]TJ
11.7095 0 TD
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[(c)-319.9(r)-1.9(es)4(is)4(tan)3.8(c)-3.1(e)-319.9(o)-1.9(f)-318.7(i)-2(s)4(o)3.8(late)-319.9(EF7)-318.7(w)-2.8(ere)]TJ
-11.7095 -1.1116 TD
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[(com)-4.9(p)2(arable)-304.4(with)-303.2(those)-304.4(o)2(f)-303.2(t)-3.9(he)-304.4(clinical)-303.4(isolate)-4.9(s)-303(of)]TJ
/F4 1 Tf
19.0416 0 TD
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[(A.)-307.2(bau)-5.3(man)-5.3(n).4(ii)]TJ
/F5 1 Tf
-19.0416 -1.1174 TD
-.0212 Tc
[(in)-327.6(Cr)-5(oat)-5.2(i).6(a,)]TJ
7.3823 0 0 6.5614 351.3259 466.5258 Tm
-.0248 Tc
(7,17)Tj
9.843 0 0 9.843 366.6896 462.1038 Tm
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[(w)-6.2(ith)-327.9(ex)-5.3(cep)-5.3(ti)-5.5(on)-327.9(tha)-6.5(t)-328(no)-327.9(cli)-5.5(n)]TJ
10.5518 0 TD
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[(ical)-326.1(isolate)-4.6(s)-320(resistant)]TJ
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[(bot)-5.4(h)-627.4(t).3(o)-627.4(a)-.7(mp)-5.3(ici)-5.4(lli)-5.4(n/s)-5.1(u).4(l)-5.4(b).4(ac)-6.5(tam)-628.6(a)-.7(nd)-627.4(co)-5.3(li)-5.4(sti)-5.4(n)-621.6(w)-6.2(e)-.7(r)-5.3(e)-622.8(r)-5.3(e)-.7(gi)-5.4(ste)-6.5(r).5(ed)-5.3(.)]TJ
T*
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[(Ampicillin/sulbac)-5.2(tam)-327.8(a).6(nd)-326.6(co)]TJ
11.2545 0 TD
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[(listin)-320.5(w)-4.6(ere)-327.4(u)2(sed)-320.5(i)-3.8(n)-320.5(r)-3.7(ecommended)]TJ
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0 -1.1174 TD
[(per)-5.4(i).2(o)-5.4(d)-287.6(o)-5.4(f)-293.4(was)-5.2(t).2(e)-6.6(w)-.5(at)-5.6(er)-293.4(sa)-6.6(mpli)-5.6(ng)-5.4(.)-290(I).4(t)-293.5(i)-5.5(s)-293.2(pos)-5.2(si)-5.5(ble)-294.6(t)-5.5(hat)-293.5(t)-5.6(he)-294.6(pan)-293.4(d)-5.4(rug)]TJ
0 -1.1116 TD
[(res)-5.1(i).3(s)-5.1(t).3(an)-5.3(ce)-547.9(was)-546.5(d).4(e)-6.5(v).4(el)-5.4(ope)-6.5(d)-541(i)-5.4(n)-541(h)-5.3(osp)-5.3(i).3(t)-5.5(a)-.7(l)-541.1(a)-6.5(nd)-546.7(is)-5.1(ola)-6.5(t).3(e)-542.1(E)-6.5(F7)-546.7(was)]TJ
T*
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1.0137 -1.1174 TD
0 Tc
[(Multiplex)-260.2(PCR)-264.4(and)-263.6(sequencing)-267.9(conrmed)-265.6(the)-263.8(presence)-272.4(of)]TJ
-1.0137 -1.1116 TD
[(both)-240.7(intrinsic)-241.8(chromosomally)-243.8(located)]TJ
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(bla)Tj
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(OXA-51-like)Tj
9.843 0 0 9.843 514.6581 374.4566 Tm
[(gene)-242.9(and)]TJ
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[(acquired)-386.8(plasmid-located)]TJ
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10.6439 0 TD
(bla)Tj
/F5 1 Tf
7.3823 0 0 6.5614 428.2015 361.8708 Tm
[(OXA-23-)-12.1(like)]TJ
9.843 0 0 9.843 471.4581 363.5149 Tm
[(gene.)-384.5(Sequences)-388.6(of)]TJ
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(bla)Tj
/F5 1 Tf
7.3823 0 0 6.5614 323.433 350.8723 Tm
[(OXA)-11.6(-51-like)]TJ
9.843 0 0 9.843 367.9369 352.5164 Tm
[(\(KX468062\))-519.6(and)]TJ
/F4 1 Tf
7.5798 0 TD
(bla)Tj
/F5 1 Tf
7.3823 0 0 6.5614 455.1873 350.8723 Tm
[(OXA-23-)-12.1(like)]TJ
9.843 0 0 9.843 499.6912 352.5164 Tm
(\(KX468063\))Tj
-19.1856 -1.1116 TD
[(genes)-399.3(showed)-400.1(100%)-402.9(identity)-396.4(with)-403(sequences)-400.1(from)-403(clinical)]TJ
T*
[(isolates)-425.8(available)-435.4(in)-422.8(GenBank)-426.6(\(Fig.)-428.2(1\),)-426.1(which)-428.1(suggest)-429.1(the)]TJ
T*
[(potential)-456.3(origin)-461.8(of)-457.2(isolate)-459.5(EF7)-453.6(in)-457.3(hospitalize)-10.2(d)-456.1(patients)-460.6(or)]TJ
0 -1.1174 TD
[(hospital)-482.5(wastewaters.)]TJ
7.3823 0 0 6.5614 397.4739 313.0582 Tm
(18)Tj
9.843 0 0 9.843 409.6062 308.6928 Tm
[(Untreated)-486.8(hospital)-482.5(wastewaters)-490.7(in)]TJ
-10.0334 -1.1116 TD
[(Zagreb)-269.3(are)-270.5(directly)-270.7(discharged)-273.6(into)-269.6(sewage)-270(system,)-271.4(which)-272.6(is)]TJ
T*
[(collected)-608.2(and)-609.2(treated)-610.4(at)-602.5(investigated)-610.3(central)-610.4(wastewater)]TJ
0 -1.1174 TD
[(treatment)-412.4(plant.)-413.5(Removal)-409.9(of)-411.1(carbapenem-resistant)-423(bacteria)]TJ
0 -1.1116 TD
(and)Tj
/F4 1 Tf
1.918 0 TD
[(A.)-472.3(baumannii)]TJ
/F5 1 Tf
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[(in)-474.6(the)-471.1(secondary)-479.7(wastewater)-478.2(treatment)]TJ
-8.0117 -1.1116 TD
[(plant)-243.1(is)-238.3(moderate.)]TJ
7.3823 0 0 6.5614 381.203 258.2928 Tm
(10)Tj
9.843 0 0 9.843 391.0109 253.9275 Tm
[(Thus,)-239.2(certain)-247.6(number)-245.1(of)]TJ
/F4 1 Tf
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[(A.)-241.9(baumannii)]TJ
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5.633 0 TD
(is)Tj
-23.6263 -1.1174 TD
[(released)-502.9(through)-503.1(the)-499.9(efuent)-499.6(wastewater)-507(into)-500(the)-505.7(natural)]TJ
0 -1.1116 TD
[(recipient)-440(Sava)-438.5(River.)-437.5(In)-439.9(aquatic)-443.4(environmental)-439.9(conditions)]TJ
T*
(MDR)Tj
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[(has)-246.2(the)-246.5(potential)-248.9(to)-244.2(multiply)-246.7(and)-246.4(survive)]TJ
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[(up)-474.5(to)-480.4(50)-474.5(days.)]TJ
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(10)Tj
9.843 0 0 9.843 384.8881 210.0472 Tm
[(Therefore,)-484.5(the)-476.9(viable)-481.5(pan)-476.8(drug-resistant)]TJ
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[(A.)-357.1(baumannii)]TJ
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5.8576 0 TD
[(recovered)-360.1(from)-356.9(efuent)-355.6(wastewater)-363(could)-358.1(be)]TJ
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[(easily)-383.4(spread)-383.1(through)-376.4(the)-384.7(natural)-384.6(water)-383.2(body,)-376.5(which)-382(could)]TJ
T*
[(represent)-710.2(an)-700.3(environmen)-8.9(tal)-701.6(reservoir)-709(of)-704.9(this)-707.2(emerging)]TJ
ET
59.754 699.534 239.131 .28345 re
f
59.754 527.584 239.131 .22681 re
f
59.754 680.882 239.131 .22681 re
f
BT
/F9 1 Tf
9.845 0 0 9.845 81.3543 725.1588 Tm
(Table)Tj
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3.0002 0 TD
(1.)Tj
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1.2496 0 TD
[(MIC)-333(Values)-335.8(of)-331.2(Tested)-335(Antibiotics)]TJ
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[(Against)-331(Environmental)-340.7(Isolate)]TJ
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(of)Tj
/F11 1 Tf
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[(Acinetobacter)-331.4(baumannii)]TJ
/F4 1 Tf
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[(Antimicrobial)-339.2(category)-5079(Antibiotic)-946(MIC)-333.2(\(mg/L\))]TJ
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[(Carbapenems)-9835.9(MEM)]TJ
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(16)Tj
7.3837 0 0 6.5625 280.7999 672.7747 Tm
(a)Tj
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(IMI)Tj
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(a)Tj
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[(Fluoroquinolones)-8228.9(CIP)]TJ
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(4)Tj
7.3837 0 0 6.5625 278.3621 649.8707 Tm
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(LVX)Tj
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[(Aminoglycosides)-8282.9(TOB)]TJ
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/F5 1 Tf
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(16)Tj
7.3837 0 0 6.5625 280.7999 626.9668 Tm
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(a)Tj
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(AMK)Tj
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(a)Tj
9.845 0 0 9.845 59.7543 589.7195 Tm
[(Tetracyclines)-9878.9(MIN)-4185.3(8)]TJ
7.3837 0 0 6.5625 275.4708 594.0849 Tm
(b)Tj
9.845 0 0 9.845 210.274 579.7416 Tm
[(TGC)-4123.3(2)]TJ
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(b)Tj
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(Penicillins/)Tj
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[(-lactamase)-339.6(inhibitors)-1738(SAM)]TJ
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7.3837 0 0 6.5625 280.7999 571.181 Tm
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(a)Tj
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[(Folate)-336.7(pathway)-338.5(inhibitors)-4870.6(SXT)]TJ
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7.3837 0 0 6.5625 283.2944 548.277 Tm
(a)Tj
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[(Polymyxins)-10508.9(CST)]TJ
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(16)Tj
7.3837 0 0 6.5625 280.7999 538.2991 Tm
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(a)Tj
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[(Intermediate)-331.5(according)-333.7(to)-333.3(EUCAST)-335.4(and)-334.6(CLSI)-335.7(criteria.)]TJ
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[(AMK,)-337.8(amikacin;)-343.1(CIP,)-330.4(cipro)-10.7(oxacin;)-335(CST)-7.9(,)-333.1(colistin;)-339.1(GEN,)-336.7(genta-)]TJ
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[(micin)-9.8(;)-179(IMI,)-187.9(imipen)-8.7(em;)-181.9(LVX,)-187.7(levo)-8.2(oxacin;)-191.2(MEM,)-184.1(meropenem;)-191.6(MIC,)]TJ
T*
[(minimum)-338.3(inhibitor)-8.9(y)-329.2(conce)-10.7(ntration;)-334(MIN,)-334.1(minocy)-9.9(cline;;)-339(SAM,)-335.4(am-)]TJ
T*
[(picill)-8.6(in/sulbac)-12.4(tam;)-820.8(SXT,)-826.6(trimethop)-8.9(rim/sulfamet)-12.8(hoxazole;)-826.2(TGC,)]TJ
T*
[(tigecyc)-12.3(line;)-250.7(TIM)-7.9(,)-248.8(ticarcill)-11.2(in/clavula)-12.7(nic)-249.1(acid;)-259.6(TOB,)-252.7(tobramycin)-10.2(.)]TJ
ET
q
336.132 0 0 106.583 61.795 57.373 cm
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Q
BT
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[(FIG.)-233.1(1.)]TJ
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[(Unrooted)-154(phylogentic)-152(tree)]TJ
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[(\(NJ)-239.7(method,)-242.2(number)-244.4(of)-238.1(differences\))]TJ
T*
[(constructed)-256.4(on)-249.6(the)-251.9(basis)-247.8(of)]TJ
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(OXA)Tj
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[(genes)-254.7(encoding)-252.3(OXA-type)-253.6(carba-)]TJ
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[(penemases.)-253.9(GenBank)-252.9(accession)]TJ
T*
[(numbers)-251(are)-252.9(given)-253.9(next)-247.2(to)-249.8(the)-251.9(name)]TJ
T*
[(of)-249.6(each)-255.1(strain.)-252.5(Gene)-249(sequences)-255.1(of)]TJ
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(OXA-51)Tj
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[(type)-252.9(are)-252.9(marked)-251.3(with)-252.8(a)]TJ
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[(OXA)-11.2(-23)]TJ
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[(type)-201.1(with)]TJ
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[(PAN)-338.6(DRUG-RESISTANT)-340.4(ENVIRONMENTAL)]TJ
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[(A.)-332.3(BAUMANNII)]TJ
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ET
endstream
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