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Brazil, Bolivia, and Argentina had the most MCR-positive isolates, a review finds.
The sample was from 2014, so the discovery has implications for the US spread of colistin resistance.
The two patients shared exposure to a duodenoscope used in endoscopy.
Similar plasmids were found in a hospitalized patient and in hospital sewage.
Fluoroquinolone resistance in hospital-onset E coli bacteremia rose markedly.
The authors say that finding MCR-1 in Shigella flexneri from pig feces suggests it could be circulating on Chinese farms and beyond.
Isolates shared a background that took shape in 2006, when MCR-1 was first mobilized.
Transmission chain mapping points to prolonged colistin use in livestock and poultry.
Scientists report the first detection of MCR-4, as well as MCR-3 in Denmark and Italy.
The authors of the study say they're concerned the gene may already be widely disseminated.
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