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Research Article
Bacterial and Parasitic Assessment from Fingernails in Debre
Markos, Northwest Ethiopia
Abeba Mengist , Yibeltal Aschale , and Alemayehu Reta
Department of Medical Laboratory Science, College of Medical and Health Sciences, Debre Markos University,
Debre Markos, Ethiopia
Correspondence should be addressed to Abeba Mengist; abymaa@gmail.com
Received 7 July 2018; Revised 8 September 2018; Accepted 27 September 2018; Published 18 October 2018
Guest Editor: Nicola Serra
Copyright ©2018 Abeba Mengist et al. is is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Background. Food handlers with untrimmed finger nails could contribute or serve as a vehicle for the transmission of food
poisoning pathogens. Objectives. is study was conducted to determine the prevalence of bacteria and intestinal parasites among
food handlers and antibiotic susceptibility profile of the isolated bacteria in Debre Markos University, Ethiopia. Materials and
Methods. is laboratory-based cross-sectional study involved 220 food handlers working in food service establishments in Debre
Markos University between 1st January 2015 to 31th June 2016. Subjects’ finger nail specimens of both hands were examined
microscopically for intestinal parasites. For bacterial isolation, samples were cultured and bacterial species were identified
following standard laboratory procedures. Antimicrobial susceptibility test was performed for all bacterial isolates by using Kirby-
Bauer disk diffusion method. Results. Of the total 220 subjects examined, 29.5% showed positive culture for different bacterial
species from their fingernail contents. Coagulase-negative Staphylococcus was the predominant bacteria species (12.3%) followed
by Staphylococcus aureus (5%), E. coli (2.7%), Klebsiella species (2.7%), Enterococcus species (1.8%), Pseudomonas aeruginosa
(1.8%), Proteus species (1.4%), Citrobacter species (1.4%), and Serratia species (0.9%). None of the food handlers showed positive
culture for Shigella and salmonella and parasites in respect of their finger nail specimens. Isolation of bacteria in finger nail has
significant association with finger nail status (P�0.044) and inverse relation with service years (P�0.048). All Staphylococcus
aureus and coagulase-negative Staphylococcus species isolates were uniformly susceptible to vancomycin. Only one (9.1%) of
Staphylococcus aureus isolates was resistant for methicillin. Conclusion. To prevent the food poisoning pathogens, implementation
and adherence to infection are the key practices, specially food handlers with long finger nail harbor food debris, microbial
contaminations, and allergens.
1. Background
Food-borne disease is a public health problem in developed
and developing countries due to poor food handling and
sanitation habit, inadequate food safety programs, lack of
clean water supply, poverty, and lack of knowledge of food
handlers [1]. According to the World Health Organization
(WHO) statement, most of the populations suffer from
food-borne diseases every year in both developed and de-
veloping countries [2]. e spread of food-borne disease
through food handlers is a common and persistent problem
worldwide [3]. Infected food handlers with poor hygiene
practice working in food service establishments are potential
sources and transmitters of the disease due to pathogenic
organisms like infection with various intestinal helminths,
protozoal, and enteropathogenic bacteria [4, 5]. ey can
transmit both enteric and nonenteric bacterial and parasitic
infections through the food that they handled [3].
Microorganisms such as bacteria, parasites, and viruses
are the common agents for food contamination. Vibrio
cholera, Campylobacter jejuni, Enterotoxigenic Escherichia
coli, Salmonella typhi, Shigella species, and Polio are the most
common food-borne disease causing organisms in developing
countries [6, 7]. Protozoan and helminthic parasites such as
Giardia lamblia,Entamoeba histolytica,Cryptosporidium
species,Ascaris lumbricoides, and Enterobius vermicularis are
Hindawi
Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 2018, Article ID 6532014, 7 pages
https://doi.org/10.1155/2018/6532014
also important agents of food-borne disease. ese infections
in food handlers pose a significant threat to food consumers
[6, 7].
Transmission of finger nail bacteria occurs through food,
water, nails, and fingers contaminated with feces demon-
strating the role of fecal-oral person-to-person transmission
[8]. Food handlers who harbor and excrete bacteria may
contaminate foods from their feces via their fingers and then to
food preparation and servicing and lastly infect healthy in-
dividuals [9]. e area under the fingernail spreads pathogenic
microorganisms via cross contamination, and it is challenging
to clean when compared with other parts of the hand [5].
Food storage systems such as temperature and time, food
preparation, handling, servicing practices, and food han-
dlers’ knowledge and skill are some of the factors that affect
the safety of food directly or indirectly [10]. Biofilm for-
mation is an important factor in persistence of microor-
ganisms on the surface. Cells in a biofilm are embedded in an
extracellular polymeric matrix constituent, proving resistant
to conventional therapeutic doses of antimicrobial agents
and clearance by the host response. Biofilm formation
proceeds via initial adhesion to the surface and subsequent
aggregation into multicellular structures. us, the devel-
opment of a biofilm requires adhesive forces for the colo-
nization of surfaces and cell interaction. Specifically, S.
epidermidisis, one of the major biofilm-producing bacteria,
works by attaching itself to several surfaces [11].
Various measures have been implemented to reduce
incidence of food-borne diseases both in developed and
developing countries. However, there has been increased
occurrence of emerging and reemerging food-borne dis-
eases. Among the factors responsible for this is the resistance
of food-borne pathogens to antibiotics. Humans are exposed
to resistant bacteria through sources such as food products,
environment, and food handlers. Among the factors re-
sponsible for this occurrence and prevalence are poor food-
production processes, inadequate food storage in-
frastructure, unhygienic food handling, limited resources,
and poorly enforced regulatory standards [12].
erefore, appropriate screening method is useful to
detect bacterial and parasitic infections among food han-
dler’s finger nails, thus preventing probable illness and
protecting the health of the consumers. us, this study was
carried out to determine the prevalence and susceptibility
pattern of finger nail bacteria and parasites among food
handlers in Debre Markos University food service estab-
lishments to address appropriate recommendations for the
enhancement of good food safety and sanitary conditions
within food establishments in the University.
2. Materials and Methods
2.1. Study Design, Area, Period, and Participants. e present
laboratory-based cross-sectional survey included 220 food
handlers working in food establishments of Debre Markos
University during the period from January 2015 to June
2016. e University is found in northwestern part of
Ethiopia at Debre Markos town. e town is located 300 km
northwest of Addis Ababa.
2.2. Data Collection. Data were collected by the data col-
lectors after obtaining written informed consent using
a well-structured questionnaire designed to obtain socio-
demographic data and other relevant data related to food
handlers’ service year, status of medical screening, status of
certification, education, and hand-hygiene practices from
participants following their written informed consent and
the ethical approval of the study from Debre Markos
University ethics review board.
2.3. Sample Collection and Transport. Swab samples under
the finger nails from both hands of each subject were col-
lected using sterile-moistened cotton-tipped swabs and
placed into a sterile test tube. Until inoculated on to re-
spective cultured media, the samples were kept with normal
saline in a test tube for not more than 5 minutes [13].
2.4. Culture and Identification
2.4.1. Processing of Fingernail Swabs and Identification of
Bacteria and Parasites. A single under finger nail swab
obtained from each food handler was cultured immediately
on Mannitol salt agar (MSA) for isolation of S. aureus and
Coagulase-Negative Staphylococci (CNS). Finger nail swabs
were cultured on to Salmonella-Shigella agar (Oxoid),
MacConkey agar (Difco), and Blood agar (Oxoid) and then
incubated at 37°C for 24 hours for isolation of Gram-
negative bacteria. e bacterial colonies grown on the
agar media were presumptively identified by colonial
morphology and gram staining and a battery of biochemical
tests like reaction on oxidase, catalase, simmon citrate, in-
dole production, urease, motility, KIA, and gas and hy-
drogen sulfide (H
2
S) production [14]. For parasite
identification, samples were examined microscopically fol-
lowing direct wet mount preparations in normal saline and
iodine solution [10].
2.4.2. Antimicrobial Susceptibility Testing. Antimicrobial
susceptibility tests were performed on Muller Hinton Agar
(Oxoid, Hampshire, UK) by disc diffusion method. e
following antimicrobial agents were used for Gram-positive
isolates: methicillin (10 µg), penicillin (10 µg), erythromycin
(15 µg), ampicillin (30 µg), ciprofloxacin (10 µg), tetracycline
(30 µg), cotrimoxazole (25 µg), and vancomycin (30 µg). To
characterize Gram-negative isolates, ampicillin (10 µg),
tetracycline (30 µg), chloramphenicol (30 µg), gentamicin
(10 µg) and norfloxacillin (10 µg) and cotrimoxazole (25 µg)
and ciprofloxacin (10 µg) have been used. e susceptibility
profiles (i.e., resistance and sensitivity) of the isolates were
interpreted according to the National Committee for
Clinical Laboratory Standards [15].
2.4.3. Data Processing and Analysis. All statistical calcula-
tions were done using SPSS for windows version 20. De-
scriptive statistics were computed to determine the rate of
bacteria and other variables. e relationships between the
presence of bacteria and various risk factors were tested
2Canadian Journal of Infectious Diseases and Medical Microbiology
using the Chi square test. A Pvalue of ≤0.05 was considered
indicative of a statistically significant.
3. Result
3.1. Sociodemographic Data. Two hundred twenty food
handlers were participated in this study. Among them, 69.1%
were females and 30.9% were males. e age of the study
participants ranged from 18 through 43 with a mean age of
25.1 (SD ±4.1). Regarding their job, 45.9% had one to two
years of work experience and only 30.9% had more than two
years of work experience (Table 1).
In this study, the majority (97.3%) and only few (17%) of
food handlers had a habit of hand washing after toilet and
after touching different body parts, respectively (Table 2).
3.2. Prevalence of Bacteria Isolated from Finger Nail of Food
Handlers. e frequency and type of bacteria isolated from
fingernail content of the 220 food handlers studied are
presented in Table 3. Bacteria isolated include coagulase-
negative Staphylococcus (12.3%), Staphylococcus aureus
(5%), Escherichia coli (2.7%), Klebsiella species (2.7%), En-
terococcus species (1.8%), Pseudomonas aeruginosa (1.8%),
Proteus species (1.4%), Citrobacter species (1.4%), and Ser-
ratia species (0.9%). While no bacteria were isolated from
the finger nail content of 70.5% of participants. None of the
food handlers showed positive culture for Shigella and
salmonella in respect of their finger nail specimens. No more
than one enteric bacterium was observed in the subject
under study. In addition, no intestinal parasites were de-
tected from the samples of fingernail contents.
In this study, different factors were assessed for possible
association with finger nail bacterial isolation rate among the
study participants (Table 2 and 4). e number of positive
cultures from finger nail contents was higher among female
subjects (30.7%) than those of male subjects (26.9%), but the
difference was not statistically significant (P�0.564)
(Table 4).
e isolation rate of bacteria in finger nail of food
handlers was relatively higher 22(43.1%) among food han-
dlers served for a period of less than one year and lower 16
(23.5%)s among those served for a period of greater than 2
years (Table 4). erefore, the inverse relationship between
service year and finger nail bacterial isolation rate was
statistically significant (P�0.048). In addition, food han-
dlers with long finger nails showed more 33(37.1%)s bac-
terial isolation rate with their finger nails as compared to
those food handlers with short (properly cut) finger nails 32
(24.4%) (P�0.044) (Table 2). However, the other expected
risk factors (i.e., age, educational background, medical
check-up, food hygiene training, and hand washing habit)
had not been found to be associated with bacterial fingernail
rate (Table 2 and 4).
3.3. Antimicrobial Susceptibility Pattern of Isolated Pathogens.
All Staphylococcus aureus and coagulase-negative Staphy-
lococcus species isolates were uniformly susceptible to
vancomycin. Relatively, Staphylococcus aureus showed low
resistance to methicillin (9.1%), cirofloxacin (9.1%) and
erythromycin (18.2%), and cotrimoxazole (18.2%); high
resistance to penicillin (63.6%) and ampicillin (63.6%) fol-
lowed by amoxycillin and tetracycline with 54.5%% and
45.5%, respectively (Table 5). e susceptibility profile of the
Gram-negative isolates is presented in Table 6.
4. Discussion
Improper food handlings practices by food handlers may
cause food contamination and food-borne diseases, which
may pose a possible risk to community or customers [16].
erefore, this study was undertaken to assess the prevalence
of bacteria and intestinal parasites among food handlers and
antibiotic susceptibility profile of the isolated bacteria in
Debre Markos University, Ethiopia.
In this study of 220 food handlers examined, 29.5% were
carriers of enteric bacteria including coagulase-negative
Staphylococcus (12.3%), Staphylococcus aureus (5%),
Escherichia coli (2.7%), Klebsiella species (2.7%), Entero-
coccus species (1.8%), Pseudomonas aeruginosa (1.8%),
Proteus species (1.4%), Citrobacter species (1.4%), and
Serratia species (0.9%) in their finger nail.erefore, food
handlers should ensure that their finger nails are trimmed.
Similar types of bacterial isolate were identified among food
handlers in other parts of Ethiopia including Jimma and
Gondar [10, 17]. Our finding also goes parallel with different
studies carried out in other countries like Nigeria [18], Iran
[19], Brazil [20], and Turkey [21].
Table 1: Sociodemographic characteristics of food handlers
(n�220) working at food service establishments in Debre Markos
University (1st January 2015 to 31st June 2016).
Sociodemographic characteristics Frequency Percent (%)
Sex
Male 67 30.5
Female 153 69.5
Age in years
≤20 20 9.1
21–30 189 85.9
31–40 6 2.7
41–50 5 2.3
Educational level
Primary (1–8) 64 29.1
Secondary (9–12) 71 32.3
Postsecondary(>12) 85 38.6
Service years
<1 51 23.2
1-2 101 45.9
>2 68 30.9
Certified in food preparation and
handling
Yes 34 15.5
No 186 84.5
Medical check-up
Yes 138 62.7
No 82 37.3
Canadian Journal of Infectious Diseases and Medical Microbiology 3
In the present study, approximately one-sixth of cultures
of fingernail contents was found to be positive for coagulase-
negative Staphylococci (12.3%) followed by Staphylococcus
aureus (5%). Our results are in agreement with previous
studies reported from other parts of the country [10, 16, 17]
and are similar to findings of Zaglool et al. from Saudi Arabia
who reported these bacteria as the most common pathogen
isolated from food handlers [9]. Coagulase-negative
Staphylococci are the normal flora of the skin, and this is
the reason why high prevalence in this study. In addition,
isolation of Staphylococcus aureus in this study was because
it is the true pathogenic bacteria included in the resident
microflora of the skin and nose. Food handlers can easily
contaminate food with Staphylococcus aureus (common
cause of food poising) if they do not wash their hands
properly after using toilet and after making contact with
their nose [22]. Tambekar et al. also reported the reduction
in the number of pathogens after hand washing [23].
Different species of Enterobacteriaceae were isolated in
11.5% of food handlers (data not shown) in the present
study. Klebsiella and Escherichia coli were the predominates,
supporting the concept of contamination by fecal bacteria
due to inadequate handwashing by the food handlers, which
are a cause of concern for the public [24]. Furthermore, only
15.5% of the food handlers in our institution had been
trained in safe food handling practices.
Escherichia coli is a normal flora usually present in the
intestine even though some serotypes (i.e., 0157:H7) can
cause serious diseases to humans [25]. It is normally absent
in hands, and the presence of this bacterium gives a clue of
current fecal contamination with enteric pathogens [26].
Foods that are contaminated with Escherichia coli and
Staphylococcus aureus that do not require further heat
treatment could cause food-borne illnesses [27]. Escherichia
coli was detected on the hands of 2.7% of food handlers’ in
the current study, which is in accordance with 1.8%–3.9%
isolation rates reported in earlier studies [17, 28, 29].
However, this figure is lower than 22%, 10.9%, and 7.8%
carriage reported in Jimma, Iran, and Turkey, respectively
[16, 19, 28]. e difference between our results and the other
studies may be attributed to sampling techniques as well as
the different used methods for detection.
Pathogens that can be originated from undercooked or
uncooked animal products like Proteus and Klebsiella can
contaminate hands of food handlers from where they could
be transferred to foods and the customers [16]. Pseudomonas
aeruginosa is resistant to most antibiotics and disinfectants;
hence, when transferred to foods through the nails of food
handlers, food poisoning may occur, and isolating or
identifying this pathogen is dangerous [27].
In the present study, no intestinal parasites were detected
in the fingernails of food handlers. is finding is in line with
the result obtained from study done earlier in Gondar town,
Ethiopia and Makkah, Saudi Arabia [9, 10]. ough, other
previous reports indicated the presence of intestinal para-
sites in the fingernails contents of study participants [29, 30].
Likewise, all of the food handlers were not positive for
salmonella and Shigella species in respect of their fingernail
contents in the present study, which is also in line with
previous studies done in Gondar [10, 17] and Abuja, Nigeria
[29].
e Staphylococcus aureus and coagulase-negative
Staphylococcus found in the finger nail content were re-
sistant to multiple antibiotics in this study. Staphylococcus
aureus isolated from finger nail contents was resistant to
methicillin. If it is transmitted to patients, it may cause
epidemics in patients. e finding of this study is consistent
with the previous study done in Gondar University Cafe-
teria, Northwest Ethiopia [17].
Table 2: Hygienic practices of food handlers (n�220), in relation to finger nail bacterial isolates, working at food service establishments in
Debre Markos University (1st January 2015 to 31st June 2016).
Variables Total Bacterial culture result from finger nail Association
Positive n(%) Negative n(%)
Finger nail status
Trimmed 131 32 (24.4) 99 (75.6) X2�4.075
Not trimmed 89 33 (37.1) 56 (62.9) P�0.044
Hand washing after using the toilet
Yes 214 63 (29.4) 151 (70.6) X2�0.043
No 6 2 (33.3) 4 (66.7) P�0.837
Hand washing after touching body parts
Yes 22 5 (22.7) 17 (77.3) X2�0.546
No 198 60 (30.3) 138 (69.7) P�0.460
Table 3: Types of bacteria isolated from finger nail content of food
handlers (n�220) working at food service establishments in Debre
Markos University (1st January 2015 to 31st June 2016).
Bacteria Frequency Percent (%)
Coag. Neg. Staph 27 12.3
S. aureus 11 5
Klebsiella spp. 6 2.7
Escherichia coli 6 2.7
Enterococcus spp. 4 1.8
Proteus species 3 1.4
Pseudomonas aeruginosa 3 1.4
Serratia species 2 0.9
Citrobacter species 3 1.4
None 155 70.5
Total 220 100
Coag. Neg. Staph: coagulase-negative Staphylococcus.
4Canadian Journal of Infectious Diseases and Medical Microbiology
In the current study, there was significant association
between bacterial isolation rate and service years (P�0.048).
is finding is in line with the result obtained from the
previous study done in Debre Markos Ethiopia [13]. However,
this was in contrary with the findings from Addis Ababa and
Arba Minch University, South Ethiopia [31, 32] where no
statistical significant association between bacterial isolation
and service was seen. is result indicated that food handlers
with more work experience have less risk of bacterial finger
nail isolation. is could be explained as food handlers with
more work experience have better personal hygienic practices
than inexperienced food handlers [13].
Colonization of bacteria on hands can be facilitated by
having untrimmed fingernails because it makes hand
Table 4: Sociodemographic characteristics of food handlers (n�220), in relation to finger nail bacterial positivity, working at food service
establishments in Debre Markos University (1st January 2015 to 31st June 2016).
Variables Total Bacterial culture result from finger nail Association
Positive n(%) Negative n(%)
Sex
Male 67 18 (26.9) 49 (73.1) X2�0.332
Female 153 47 (30.7) 106 (69.3) P�0.564
Age in years
≤20 20 6 (30) 14 (70)
21–30 189 56 (29.6) 133 (70.4)
31–40 6 1 (16.7) 5 (83.3) X2�0.743
41–50 5 2 (40) 3 (60) P�0.863
Educational level
Primary (1–8) 64 20 (31.2) 44 (68.8)
Secondary (9–12) 71 20 (28.2) 51 (71.8) X2�0.155
Postsecondary(>12) 85 25 (29.4) 60 (70.6) P�0.926
Service years
<1 51 22 (43.1) 29 (56.9) X2�6.092
1–2 101 27 (26.7) 74 (73.3) P�0.048
>2 68 16 (23.5) 52 (76.5)
Certified in food preparation and handling
Yes 34 10 (29.4) 24 (70.6%) X2�0.000
No 186 55 (29.6) 131 (70.4) P�0.985
Medical check-up
Yes 138 43 (31.2) 95 (68.8) X2�0.463
No 82 22 (26.8) 60 (73.2) P�0.496
Table 5: Antimicrobial resistance pattern of S. aureus and CNS isolated from finger nail cultures of food handlers working at food service
establishments in Debre Markos University (1st January 2015 to 31st June 2016).
Antimicrobial agents tested Sensitivity pattern Staphylococcus aureus (n�11), no. (%) CNS (n�27), no. (%)
Methicillin S 10 (90.9) 25 (92.6)
R 1 (9.1) 2 (7.4)
Vancomycin S 11 (100) 27 (100)
R 0 (0) 0 (0)
Amoxicillin S 5 (45.5) 17 (63)
R 6 (54.5) 10 (37)
Ampicillin S 4 (36.4) 19 (70.4)
R 7 (63.6) 8 (29.6)
Penicillin S 4 (36.4) 16 (52.3)
R 7 (63.6) 11 (40.7)
Ciprofloxacin S 10 (90.9) 22 (81.5)
R 1 (9.1) 5 (18.5)
Tetracycline S 5 (45.5) 15 (55.6)
R 6 (54.5) 12 (44.44)
Erythromycin S 9 (81.8) 24 (88.9)
R 2 (18.2) 3 (11.1)
Cotrimoxazole S 9 (81.8) 25 (92.6)
R 2 (18.2) 2 (7.4)
CNS: coagulase-negative Staphylococcus aureus, N �number, R �resistant, S �sensitive.
Canadian Journal of Infectious Diseases and Medical Microbiology 5
washing difficult and less effective. Wachukwu et al. have
showed that food handlers with long nail become colonized
and become a possible risk for transmission of pathogens
[27]. In addition, a study conducted by Lau et al. on removal
of Escherichia coli hands with natural or artificial fingernails
indicated that untrimmed fingernails tend to carries more
microorganisms than untrimmed nails [33]. Our study also
indicated statistically significant association between the
isolation of bacteria and finger nail status (P�0.044).
In our study, no significant association was found for
finger nail bacterial content by sex, age, educational back-
ground, medical checkup, training status, and hand washing
habit of food handlers. However previous study conducted
in Jimma indicates significant association between bacterial
hand contamination rates with age [16]. Similarly, finding in
Sari, northern Iran, showed that statistical significant as-
sociation was observed particularly bacterial infestation
comparable for educational level and handwashing practice
after using toilet [22]. But this may be due to the small
sample size.
5. Conclusion
In general, the present study emphasized the use of different
intervention measures that can be used to decrease or
eliminate contamination of foods by food-handlers as well as
spread of pathogens to the customers or the public.
erefore, creating awareness specially on food handling
practices and hygienic measures of food handlers is a crucial
issue to prevent the food poisoning pathogens. Specially,
individuals with long finger nail harbor food debris, mi-
crobial contaminations, and allergens. erefore, their use
should be under control or supervision by the responsible
body in the institution with much customers.
Abbreviations
WHO: World Health Organization.
Data Availability
e data used to support the findings of this study are
available from the corresponding author upon request.
Conflicts of Interest
e authors declare that they have no competing interests.
Authors’ Contributions
AM was the primary researcher and conceived the idea for
this study. AR participated in data collection, conducted data
analysis, and drafted and finalized the manuscript for pub-
lication. YA participated in data collection, conducted data
analysis, and drafted and finalized the manuscript for pub-
lication. AR and YA read and approved the final manuscript.
Acknowledgments
e authors acknowledge the financial support by the Debre
Markos University College of medical and health sciences.
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Table 6: Antimicrobial resistance pattern of different Gram-negative bacterial species isolated from finger nail content of food handlers
working at food service establishments in Debre Markos University (1st January 2015 to 31st June 2016).
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Escherichia coli 6S 2 (33.3) 4 (66.7) 3 (50) 6 (100) 5 (83.3) 3 (50) 6 (100)
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R 1 (25) 1 (25) 1 (25) 0 (0) 1 (25) 0 (0)
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SPP: species; Gentam: gentamycin; Tetracy: tetracycline; Ciprof: ciprofloxacin.
6Canadian Journal of Infectious Diseases and Medical Microbiology
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