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In most samples, it was complemented with additional and different pncA, gyrA, rrs mutations leading to the pre-XDR/XDR genotype. Phylogenomic analysis suggests a distant origin of this Russian resistant cluster in the early 1970s but location and circumstances are yet to be clarified.A paraplegic resident needed appropriate accommodation to complete a surgical residency with implementation of provider wheelchair use in the operating room. Current evidence-based guidelines were reviewed for operating room protocol in conjunction with