Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

{"title":"Time to antibiotic administration in intra-amniotic infections: impact of cefoxitin monotherapy versus traditional antibiotic therapy.","authors":"Hannah Bischoff, Sarah Tennant Withers, Caroline Jozefczyk, Joseph Kohn, R Jake Crocker, Jasmine Lewis, Carolyn Ellison, Joseph A Ewing, Pamela Bailey","doi":"10.1017/ash.2026.10748","DOIUrl":"10.1017/ash.2026.10748","url":null,"abstract":"<p><strong>Objective: </strong>This study addresses treatment of intra-amniotic infection (IAI) by comparing timely receipt of recommended antibiotic administration between cefoxitin and traditional antimicrobial therapy, ampicillin and gentamicin, with or without clindamycin.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at a large, multi-site health system. The combination therapy group treated with ampicillin plus gentamicin, with or without clindamycin from June 2022 to May 2023, was compared to patients treated with cefoxitin from June 2023 to May 2024, following an institutional guideline update.</p><p><strong>Participants: </strong>Pregnant individuals aged 16 and older with diagnosed or presumed IAI were included.</p><p><strong>Results: </strong>Three hundred patients were included, 150 each in both the combination therapy and cefoxitin groups. Baseline characteristics were similar between the combination therapy and cefoxitin patients. Vaginal delivery was the most common mode of delivery, and rates of cesarean delivery were similar between groups. Most patients had a negative group B <i>Streptococcus</i> screen. Timely receipt of antimicrobials within 60-90 minutes of order entry occurred in significantly more patients in the cefoxitin group compared to combination therapy group (69.3% vs 4.7%, <i>P</i> < .001). Time to recommended therapy was significantly shorter in the cefoxitin group (76.4 ± 93.3 vs 183.7 ± 228.9 min, <i>P</i> < .001). There were no differences in mortality, 30-day infection-related readmission, or need for additional surgical/procedural intervention.</p><p><strong>Conclusions: </strong>Cefoxitin for IAI significantly improves timeliness of recommended antibiotic treatment, aligning with current guideline recommendations for prompt therapy. The absence of differences in secondary outcomes supports the clinical efficacy of cefoxitin and its consideration as a first-line agent in the management of IAI.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e218"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of patients with <i>Candidozyma auris</i> vs. <i>Candida glabrata</i> and <i>C. krusei</i>: the after-effect of lifetime contact precautions.","authors":"Anjali Kewalramani, Kimberly Mae Soultan, Durga Prasad Matlapudi, Tamara Nawar, Marie Abdallah, Briana Episcopia, Jennifer Lee, John Quale","doi":"10.1017/ash.2026.10789","DOIUrl":"10.1017/ash.2026.10789","url":null,"abstract":"<p><strong>Background: </strong><i>Candidozyma auris, Candida glabrata</i>, and <i>C. krusei</i> are all fungal pathogens intrinsically resistant to azoles. Patient characteristics and outcomes were compared for patients with cultures positive for these three pathogens.</p><p><strong>Methods: </strong>A retrospective cohort study was performed involving patients from an 11 acute care safety net hospital system in New York City. Echinocandin susceptibility rates and patient outcomes, including overall mortality and lengths of hospital stay, were compared for patients with <i>C. auris</i> versus <i>C glabrata/krusei</i>.</p><p><strong>Results: </strong>Resistance to caspofungin was low in all three pathogens. Compared to patients with <i>C. glabrata/C. krusei</i>, patients with <i>C. auris</i> had similar mortality rates. However, compared to patients harboring <i>C. glabrata/C krusei</i>, those with <i>C. auris</i> had longer hospital stays when discharged to a skilled nursing facility, including from the time from culture positivity to discharge (78 ± 148 vs 33 ± 44 d, P = .06). Multivariate regression analysis revealed two factors associated with length of stay: presence of <i>C. auris</i> (P < .001) and hemodialysis (P = .051).</p><p><strong>Discussion: </strong>Echinocandin resistance was unusual, and overall mortality rates were similar, for patients with <i>C. auris, C. glabrata</i>, and <i>C. krusei</i>. However, for patients discharged to skilled nursing facilities, the length of hospital stay was longer for patients with <i>C. auris</i>. The implementation of lifelong contact precautions for <i>C. auris</i> may be an impediment for discharge planning.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e219"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drawing conclusions: blood culture yield across clinical scenarios in hematologic malignancy.","authors":"Jessica Seidelman, Patrick Tam, Julia Messina, Alicia Gray, JoAnn Liu, Kimberiey Milliam, Jonathan Huggins, Jennifer Saullo","doi":"10.1017/ash.2026.10784","DOIUrl":"10.1017/ash.2026.10784","url":null,"abstract":"<p><p>Patients with hematologic malignancies are excluded from most blood culture stewardship algorithms. We evaluated blood culture collection patterns and bloodstream infection incidence across clinical scenarios in this population. Blood culture yield varied substantially by indication, identifying high-yield scenarios and opportunities to refine diagnostic stewardship while preserving patient safety.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e217"},"PeriodicalIF":0.0,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is cefazolin an appropriate choice for preoperative prophylaxis in patients undergoing surgery for fracture-related infection.","authors":"Lauren Daddi, Marjorie Golden, David Frumberg, Anne Spichler-Moffarah","doi":"10.1017/ash.2026.10755","DOIUrl":"10.1017/ash.2026.10755","url":null,"abstract":"<p><p>Prophylaxis against fracture-related infections includes first generation cephalosporins. Open fractures may have soil contamination, increasing risk for infection with gram negative organisms. Broad spectrum antibiotics prevent infections for high-risk patients but cause antibiotic resistance and <i>C. difficile</i> colitis. We examined concordance between pathogens and time to infection based on prophylaxis.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e216"},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multidrug-resistant organism tracking and alert system is associated with lower MRSA and CP-CRE infection rates at Veterans Affairs Medical Centers.","authors":"Amanda Vivo, Cara Ray, Tarek El Ali, Geneva M Wilson, Reside Jacob, Makoto M Jones, Natalie R Hicks, Christopher D Pfeiffer, Charlesnika T Evans","doi":"10.1017/ash.2026.10787","DOIUrl":"10.1017/ash.2026.10787","url":null,"abstract":"<p><p>This study investigates Veterans Affairs Bug Alert (VABA) usage on methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) and carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) infection rates in VA facilities. Significant association between increased VABA use and decreased MRSA and CP-CRE infection rates supports VABA as part of infection control strategies.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e214"},"PeriodicalIF":0.0,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatotoxicity in hematologic malignancy and hematopoietic stem cell transplant patients receiving posaconazole or isavuconazole prophylaxis: a single-center cohort study.","authors":"Samantha Steele, Courtney Nichols, Kelci Coe, Nikki Tran","doi":"10.1017/ash.2026.10797","DOIUrl":"10.1017/ash.2026.10797","url":null,"abstract":"<p><strong>Objective: </strong>To assess and compare the incidence, timing, and severity of hepatotoxicity associated with prophylactic isavuconazole and posaconazole in patients with hematologic malignancies or a history of hematopoietic stem cell transplant (HSCT).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Large academic tertiary-care center.</p><p><strong>Patients: </strong>Hospitalized adult patients with hematologic malignancies or a history of HSCT who received posaconazole or isavuconazole for antifungal prophylaxis between August 2015 and August 2024.</p><p><strong>Methods: </strong>The primary outcome was the incidence of hepatotoxicity, defined by elevations in aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), or bilirubin. Secondary outcomes included time to hepatotoxicity, severity grading per Common Terminology Criteria for Adverse Events (CTCAE) v5.0., and causality assessment using the Naranjo Adverse Drug Reaction Probability Scale.</p><p><strong>Results: </strong>A total of 154 patients were included (100 receiving posaconazole, 54 receiving isavuconazole). Hepatotoxicity occurred in 17% of the isavuconazole group and 7% of the posaconazole group (<i>P</i> = .06), with all events classified as mild. The median time to hepatotoxicity was longer for isavuconazole (96 vs. 15 days, <i>P</i> = .16). Survival analysis showed no significant difference in time to hepatotoxicity between groups (<i>P</i> = .07). Most hepatotoxic events were classified as \"possible\" according to the Naranjo Scale.</p><p><strong>Conclusions: </strong>In this retrospective analysis, no statistically significant difference in hepatotoxicity incidence was observed between isavuconazole and posaconazole for prophylaxis. Larger prospective studies are needed to confirm these findings and further define the hepatic safety profiles of these antifungal agents.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e215"},"PeriodicalIF":0.0,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Charting new territory: outpatient stewardship in immunocompromised patients (first of a two-part series).","authors":"Alexander Shaffer, Rachel Bartash, Margaret E McCort, Raneem H Pallotta, Hannah Imlay","doi":"10.1017/ash.2026.10780","DOIUrl":"10.1017/ash.2026.10780","url":null,"abstract":"<p><p>Antimicrobial stewardship (AS) among immunocompromised (IC) patients is a growing field. Since most antibiotic use occurs in the outpatient setting, antimicrobial use among IC outpatients represents an opportune area for stewardship. This two-part review explores the current state of outpatient AS in immunocompromised hosts, highlighting potential stewardship interventions and published strategies, as well as barriers in this vulnerable population. In this first section, we will highlight stewardship interventions in clinical syndromes relevant to both immunocompetent and IC hosts, including spectrum and duration of antibiotics for common bacterial infections, antibiotic allergy management, immunizations, periprocedural antimicrobial management, and multiplex polymerase chain reaction diagnostics.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e213"},"PeriodicalIF":0.0,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial stewardship in community pharmacies in Uyo, Akwa Ibom State: practices, barriers, and facilitators.","authors":"Mbuotidem Ime Akpan, Idongesit Linus Jackson, Unyime Israel Eshiet, Mary Richard Akpan","doi":"10.1017/ash.2026.10773","DOIUrl":"10.1017/ash.2026.10773","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the practices, barriers, and facilitators related to antimicrobial stewardship (AMS) in community pharmacies (CPs).</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>CPs in Uyo, Akwa Ibom State, Nigeria.</p><p><strong>Participants: </strong>One hundred and twelve pharmacists working in CPs, who had been practicing for at least six months and gave informed consent to participate, were surveyed.</p><p><strong>Methods: </strong>Potential participants were approached at their CPs during working hours and the study's objectives explained to them. Data were collected using a 31-item self-administered questionnaire from October to November 2023 and analyzed with SPSS version 25.0.</p><p><strong>Result: </strong>Participants were predominantly male (61.6%). Eighty-seven (77.7%) indicated that they often/always encourage patients to run a culture/sensitivity test before taking antibiotics. Most (95.5%) indicated that their choice of antibiotics is based on such results. The most frequently cited barriers to implementing AMS in CPs were limited access to patient records (93.8%), unrestricted patient access to antimicrobials without a prescription (90.1%), and physicians' resistance to pharmacists intervening in antibiotic selection (58.0%) or the dose/duration of prescribed antibiotics (50.9%). The most commonly reported facilitators of AMS were increased availability of pharmacy education programs on AMS (92.9%), improved access to patients' clinical/laboratory data (88.4%), improved collaboration with physicians in hospitals (85.7%), and public awareness initiatives emphasizing the role of community pharmacists in AMS (85.7%).</p><p><strong>Conclusion: </strong>Participants reported generally favorable AMS practices. However, tailored AMS education programs for pharmacists and the general public, along with stronger collaboration between pharmacists and physicians and between CPs and hospitals are recommended.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e211"},"PeriodicalIF":0.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors associated with extended spectrum beta lactamase <i>Klebsiella pneum</i>oniae outbreak in a neonatal intensive care unit.","authors":"Areej Yousef Al Ali, Gautam Hebbar, Dalal Al-Ghanim, Khaled Alkulaib, Nasser Althefiri, Kholoud Al-Fadhalah","doi":"10.1017/ash.2026.10785","DOIUrl":"10.1017/ash.2026.10785","url":null,"abstract":"<p><strong>Objective: </strong>(1) identify risk factors for extended-spectrum beta-lactamase <i>Klebsiella pneumoniae</i> (ESBL-KP) acquisition in the neonatal intensive care unit (NICU) and (2) evaluate the clinical impact of ESBL-KP acquisition on neonatal outcomes at NICU discharge.</p><p><strong>Design: </strong>This retrospective case-control study (Aug 2022-Sept 2025) compared neonates who acquired ESBL-KP in the NICU (cases) with those who did not (controls).</p><p><strong>Patients: </strong>600 neonates admitted to a Kuwaiti NICU located in a general hospital.</p><p><strong>Methods: </strong>Data included clinical, demographic, antibiotic, and laboratory records. The primary outcome was ESBL-KP acquisition. The secondary outcome was status at NICU discharge. Regression analysis was used to evaluate associations for the primary and secondary outcomes.</p><p><strong>Results: </strong>Of 600 neonates, 30% acquired ESBL-KP. Among these, 12% had bloodstream infections (BSIs). Length of NICU stay (OR:1.02, 95% CI:1.01-1.03), intrauterine growth restriction (IUGR) (OR:2.59, 95% CI:1.08-6.24), extreme-prematurity (OR:2.89, 95% CI:1.29-6.47), previous hospital admission (OR:4.45, 95% CI:1.75-11.32), and prior ampicillin use (OR:3.51, 95% CI:2.12-5.82) were statistically significant risk factors for acquisition of ESBL-KP in the adjusted regression model. Moreover, ESBL-KP-positive neonates faced 12.83 times greater odds of death from sepsis (95 % CI: 2.41-68.22), than ESBL-KP negative neonates.</p><p><strong>Conclusions: </strong>ESBL-KP acquisition was strongly linked to IUGR, extreme prematurity, previous admission, and ampicillin use. While a longer hospital stay correlated with acquisition, this relationship is prone to time-dependent bias and reverse causation. Acquisition also raised sepsis-related mortality risk, though small sample sizes require cautious interpretation. Targeted prevention is essential to improve neonatal outcomes.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e210"},"PeriodicalIF":0.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Where antibiotic time-outs work: department- and ward-stratified effects of a pharmacist-led anti-MRSA time-out.","authors":"Risako Yamamoto, Yasuaki Tagashira, Do Dang An, Yui Enatsu, Maya Satake, Yoshibumi Aiso, Yoshiaki Gu","doi":"10.1017/ash.2026.10778","DOIUrl":"10.1017/ash.2026.10778","url":null,"abstract":"<p><strong>Objective: </strong>To assess the impact of a pharmacist-led anti-methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) agents' time-out and identify clinical areas most likely to benefit.</p><p><strong>Design: </strong>Single-center before-after interrupted time-series study.</p><p><strong>Setting: </strong>An 813-bed tertiary hospital in Tokyo, Japan.</p><p><strong>Patients: </strong>Inpatients receiving intravenous anti-MRSA agents.</p><p><strong>Methods: </strong>Stewardship pharmacists alerted physicians to reassess intravenous anti-MRSA therapy at 72 hours after its start. Monthly days of therapy per 1,000 patient-days (DOT) were compared between October 2017 to September 2022 and October 2022 to September 2024 after stratification by ward and department. Acceptance rate and therapeutic drug monitoring (TDM) tests were also assessed.</p><p><strong>Results: </strong>Hospital-wide DOT showed an immediate non-significant decrease (-19.23; 95% confidence interval [CI] -59.17 to 20.72; <i>P</i> = .35) and no significant trend change (+0.82; 95% CI -1.18 to 2.82; <i>P</i> = .42). In emergency medicine, DOT decreased in critical care (slope change -20.3; 95% CI -36.25 to -4.28; <i>P</i> = .01) and general wards (-31.6; 95% CI -61.4 to -1.79; <i>P</i> = .04). In emergency medicine critical care, vancomycin use decreased (level change -406.1; 95% CI -801.3 to -10.9; <i>P</i> = .04) with a reduced trend (slope change -24.5; 95% CI -41.2 to -7.8; <i>P</i> < .001). Acceptance was higher in critical care than in general wards (77.1% [27/35] vs 33.6% [40/119]). TDM tests per 1,000 patient-days decreased (8.47 ± 2.39 to 6.55 ± 1.18; <i>P</i> < .001), with no increase in length of stay or in-hospital mortality.</p><p><strong>Conclusions: </strong>Targeting an implementation to areas most likely to benefit from it may improve antimicrobial stewardship when resources are limited. Complementary strategies may be needed if acceptance is poor.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e208"},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}