Antimicrobial Resistance and Infection Control最新文献

{"title":"Differences in surgical site infection rates by state according to state-mandated operating room air changes per hour.","authors":"Andrew Atkinson, Jonas Marschall, Jason P Burnham","doi":"10.1186/s13756-025-01631-5","DOIUrl":"10.1186/s13756-025-01631-5","url":null,"abstract":"<p><strong>Background: </strong>Air changes per hour (ACH) in operating rooms (ORs) are energy intensive, and optimal air change settings are not known.</p><p><strong>Objectives: </strong>We sought to explore whether there is a relationship between surgical site infections (SSIs) across states based on their state-mandated ACHs.</p><p><strong>Design: </strong>Ecological, descriptive, cross-sectional study of publicly reported SSI data in the United States.</p><p><strong>Methods: </strong>Wilcoxon test was used to investigate differences between SSI rates for specific surgery types between ACH mandate levels (15 and 20 ACH). Uni- and multivariable Poisson models at the state level were fitted to estimate differences in SSI rates for each surgery type.</p><p><strong>Results: </strong>OR ACH mandates and SSIs were positively correlated for C-sections and spinal fusion; negatively correlated for colon and laminectomy surgery.</p><p><strong>Conclusion: </strong>For most surgery types, there is no correlation between state-mandated OR ACH. Further studies are needed to determine what changes to mandates can be made safely and effectively.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"115"},"PeriodicalIF":4.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aerosolization of Mycobacterium chelonae from heater-cooler-devices: a continuing risk of exposure during cardiac surgery.","authors":"Sabine Kuster, Pascal Urwyler, Gioele Capoferri, Matthias Von Rotz, Silvio Ragozzino, Richard Kuehl, Claudia Tesoro, Oliver Reuthebuch, Urs Zenklusen, Simon Scheifele, Friedrich Eckstein, Peter Michael Keller, Pascal Schlaepfer, Sarah Tschudin-Sutter","doi":"10.1186/s13756-025-01635-1","DOIUrl":"10.1186/s13756-025-01635-1","url":null,"abstract":"<p><strong>Background: </strong>Following identification of widespread Mycobacterium chimaera infections in 2013 associated with aerosolization from Sorin heater-cooler-devices (HCD), microbiological monitoring of HCDs has become mandatory in Switzerland.</p><p><strong>Methods: </strong>Since 01/2016, four Maquet HCU40 (Getinge) HCDs have been in operation at the University Hospital Basel. Monthly water cultures for Gram-negative bacteria and mycobacteria were performed, including samples from two filling lines equipped with 0.2 μm water filters. Intermittent monthly air sampling for mycobacteria was conducted.</p><p><strong>Results: </strong>Between 01/2016 and 05/2018, various non-fermenting bacteria were cultured. Mycobacterium chelonae was first isolated in 06/2018 from HCD water tanks. Mycobacteria cultures from the filling lines remained negative. The first air sample positive for M. chelonae was collected in 12/2019. Despite intensified disinfection measures from 01/2022 onwards, M. chelonae could be cultured in air samples, collected at 30 cm and 120 cm height adjacent to three of the four running HCDs in 07/2022. Whole genome sequencing identified a cluster of isolates differing by a maximum of four single nucleotide polymorphisms. Despite extensive investigations, the source of M. chelonae remains undetermined. To date, no infections with M. chelonae have been related to the contaminated HCDs at our institution.</p><p><strong>Conclusions: </strong>Our data confirms the risk of aerosolization of non-tuberculous mycobacteria from HCDs, irrespective of HCD-design and manufacturer. These findings underscore the importance of routine microbiological surveillance, including both water and air sampling when HCDs are placed within the operation room to prevent exposure of the operating field to the air exhausts of HCDs.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"117"},"PeriodicalIF":4.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central venous catheter infections: building a causal model with expert domain knowledge to inform future clinical trials.","authors":"Jessica A Schults, Yue Wu, Thomas Snelling, Gladymar Pérez Chacón, Daner Ball, Karina Charles, Julie Marsh, Charlie McLeod, Hideto Yasuda, Claire M Rickard","doi":"10.1186/s13756-025-01630-6","DOIUrl":"10.1186/s13756-025-01630-6","url":null,"abstract":"<p><strong>Aim: </strong>Central venous catheters (CVCs) are essential for long-term therapies but carry a high risk of central line-associated bloodstream infections (CLABSIs), which significantly impact patient outcomes and healthcare costs. This study aimed to develop a causal model for CLABSI using expert knowledge to guide future clinical trials and prevention strategies.</p><p><strong>Methods: </strong>We constructed a directed acyclic graph (DAG) informed by literature and expert knowledge elicitation. A multidisciplinary team of clinicians, including infectious disease and vascular access experts, participated in interviews and workshops to refine the DAG, resulting in a final model with 30 variables representing CLABSI development.</p><p><strong>Findings: </strong>The expert-elicited DAG identified two main pathways, patient-related and CVC-related, each contributing to CLABSI risk. Variables and relationships in the DAG highlighted key patient characteristics, CVC management practices, and overlapping factors influencing infection. This model serves as a novel framework to understand CLABSI causation and supports trial design by identifying confounding factors, causal pathways, and meaningful endpoints.</p><p><strong>Conclusions/implications: </strong>Our causal DAG provides a structured representation of CLABSI risk factors, which may support the design of clinical trials examining interventions to reduce CVC-related infections. By clarifying causal mechanisms, the DAG can enhance the specificity of endpoints and improve the rigor of prevention strategies.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"116"},"PeriodicalIF":4.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NDM-1 plasmid clustering reflects clonal transmission of Klebsiella pneumoniae ST147 in four hospitals in Berlin, Germany.","authors":"Anna Weber, Luisa Denkel, Christine Geffers, Axel Kola, Friederike Maechler","doi":"10.1186/s13756-025-01639-x","DOIUrl":"10.1186/s13756-025-01639-x","url":null,"abstract":"<p><strong>Background: </strong>In recent years, the detection of Klebsiella pneumoniae (KLPN) producing New Delhi metallo-β-lactamase (NDM), particularly NDM-1, has increased in Germany. Plasmids play a crucial role in the dissemination of NDM-1, facilitating its persistence in both clinical and environmental reservoirs. Between 2021 and 2024, a substantial number of NDM-1-producing KLPN isolates were detected across multiple hospital sites in Berlin. This study aimed to investigate a potential multi-site outbreak involving NDM-1-producing KLPN, and to assess the role of clonal versus plasmid-mediated dissemination.</p><p><strong>Methods: </strong>We performed short-read sequencing for all isolates, complemented by long-read sequencing for a subset (Illumina and Oxford Nanopore Technologies). Core genome multi locus sequence typing (cgMLST) was conducted using SeqSphere+. NDM-1 plasmids were characterized with the MOB-suite tools. Reference plasmids were reconstructed from hybrid assemblies using TaDReP. Short-read sequences from all isolates were aligned against these reference plasmids to assess genetic relatedness.</p><p><strong>Results: </strong>Analysis of 57 NDM-1 plasmid carrying KLPN isolates at the clonal level revealed three distinct outbreak clusters (O1-O3). These corresponded to three unique NDM-1 reference plasmids: p1 (54.0 kb IncFIB(pQil)), p2 (54.3 kb IncR), and p3 (355.5 kb; no Inc type specified). Plasmid clustering from short-reads was consistent with the clonal clusters.</p><p><strong>Conclusions: </strong>Both plasmid-level analysis and cgMLST yielded congruent results, effectively ruling out the possibility of multi-site, plasmid-mediated NDM-1 transmission. The detection of a globally disseminated NDM-1 plasmid within one of the clonal clusters highlights its potential role in the spread of resistance during the recent surge of NDM-1 carrying KLPN isolates in Germany.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"114"},"PeriodicalIF":4.4,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical risk factors associated with nosocomial Pseudomonas aeruginosa bacteraemia in patients within a tertiary care healthcare setting - a case control study.","authors":"Özge Yetiş, Shanom Ali, Pietro Coen, Peter Wilson","doi":"10.1186/s13756-025-01628-0","DOIUrl":"10.1186/s13756-025-01628-0","url":null,"abstract":"","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"112"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12486519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of targeted interventions on healthcare-acquired infection prevention and control of Clostridium difficile infections.","authors":"Sisi Zhang, Juping Duan, Lina Zhang, Sidi Liu, Xiujuan Meng, Xiaobei Peng, Wei Liu, Anhua Wu, Chunhui Li","doi":"10.1186/s13756-025-01616-4","DOIUrl":"10.1186/s13756-025-01616-4","url":null,"abstract":"","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"113"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12486958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clean Hospitals Day 2025: the human factors of healthcare environmental hygiene.","authors":"Alexandra Peters, Martina Mocenic, Pierre Parneix, Brett G Mitchell, Stephanie Dancer, David J Weber","doi":"10.1186/s13756-025-01638-y","DOIUrl":"10.1186/s13756-025-01638-y","url":null,"abstract":"","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"111"},"PeriodicalIF":4.4,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12486701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of central line-specific dwell-times for neonatal central line associated bloodstream infections.","authors":"Martina Buttera, Carolyn Luhmann-Lunt, Michael Buettcher, Dirk Lehnick, Martin Stocker","doi":"10.1186/s13756-025-01618-2","DOIUrl":"10.1186/s13756-025-01618-2","url":null,"abstract":"<p><strong>Background: </strong>Central line-associated bloodstream infections (CLABSIs) are among the most serious infectious complications associated with central lines in neonates. CLABSIs can be prevented by healthcare workers using \"bundles\" when inserting and managing central lines. These include prompt removal of the central line when it is no longer needed. The aim of this study was to describe and analyze neonatal CLABSIs, focusing on a minimal data set including specific catheter types and dwell times.</p><p><strong>Methods: </strong>A retrospective descriptive study reviewing the management and outcome of neonates with CLABSI admitted to the Department of Neonatology and Neonatal Intensive Care at the Children's Hospital of Central Switzerland in Lucerne from 1 January 2020 to 31 December 2023.</p><p><strong>Results: </strong>In this four-year period, a total of 27,636 neonates were born in the catchment area and 2599 neonates (9.4%) were admitted to our hospital. In total, 615 neonates (23.7%) had at least one central line with a total of 4940 catheter days. We observed an overall neonatal CLABSI rate of 2.9 per 1,000 catheter days. The rate varied significantly by catheter type: 0 per 1,000 catheter days for umbilical artery catheters (UACs), 0.9 per 1,000 catheter days for peripherally inserted central lines (PICCs), 5.6 per 1,000 catheter days for umbilical venous catheters (UVCs), and 17.9 per 1,000 catheter days for centrally inserted venous catheters (CVCs). All episodes of CLABSI were observed after a dwell time of 5 days, with increasing rates after 9 days.</p><p><strong>Conclusions: </strong>We observed a pronounced variation in CLABSI rates between different catheter types. All episodes of CLABSI were observed after a dwell time of 5 days, with increasing rates after 9 days, and the rate of CLABSI increased with longer dwell times for UVCs and CVCs. This suggests a reduction in dwell time as a potential strategy for future quality improvement programs aiming for a zero CLABSI rate and underlines the importance of reporting central-line specific dwell-times for future publications.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"106"},"PeriodicalIF":4.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Etiology and antimicrobial resistance patterns of sepsis in infants 0-59 days old in Jimma, Ethiopia: a longitudinal study.","authors":"Daniele Gusland, Melkamu Berhane, Mekdes Shimekit, Mulatu Gashaw, Alemseged Abdissa, Jens C Eickhoff, Dawd S Siraj, James H Conway","doi":"10.1186/s13756-025-01626-2","DOIUrl":"10.1186/s13756-025-01626-2","url":null,"abstract":"<p><strong>Introduction: </strong>In Ethiopia, empiric treatment for sepsis or possible serious bacterial infection (PSBI) in infants 0-59 days old is based on World Health Organization (WHO) guidelines. We aimed to assess the etiology, antimicrobial susceptibility and outcomes of empiric treatment in PSBI in Jimma, Ethiopia and created local antibiograms to assess empiric treatment guidelines in this setting.</p><p><strong>Methods: </strong>We prospectively enrolled 363 infants 0-59 days of age admitted to Jimma University Hospital with PSBI over 12-months. Following institutional practice, blood and cerebrospinal fluid (CSF) cultures were collected; positive cultures were identified and evaluated for antibiotic susceptibility. We compared microbiologic results to the WHO guideline based empiric treatment selections at the hospital and evaluated the clinical outcomes at discharge and 30-days of age.</p><p><strong>Results: </strong>Of 279 patients who had blood cultures obtained, 212(76.0%) were positive, yielding 216 isolates. Four CSF cultures were positive and were included in analysis of blood cultures due to the smaller number of isolates. The most common isolates were Klebsiella (31.8%), coagulase-negative Staphylococci (24.6%), and Staphylococcus aureus (11.6%). Of Klebsiella species, 87% were resistant to at least one commonly utilized antibiotic and 82% were resistant to first-line empiric antimicrobials. In-hospital mortality was 12.3% and it was highest (41%) in participants with Klebsiella. At 30-days of age, mortality for infants with positive culture was 6.6%.</p><p><strong>Conclusions: </strong>Isolates from PSBI showed high rates of antibiotic resistance to first- and second-line antimicrobials. In this setting, the WHO empiric treatment guidelines inadequately treat infants admitted with PSBI, particularly those with Klebsiella. To provide the most effective care for PSBI in 0-59 days old infants, institutionally used guidelines should be customized to reflect local epidemiology and resistance patterns.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"108"},"PeriodicalIF":4.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of AmpC beta-lactamase producing Escherichia coli and Klebsiella pneumoniae in Africa: a systematic review and meta-analysis.","authors":"Saba Gebremichael Tekele, Zewudu Mulatie, Alemu Gedefie, Hussen Ebrahim, Brukitawit Eshetu, Mihret Tilahun, Habtu Debash, Agumas Shibabew, Ousman Mohammed, Ermiyas Alemayehu, Daniel Gebretsadik Weldehanna, Melaku Ashagrie Belete","doi":"10.1186/s13756-025-01578-7","DOIUrl":"10.1186/s13756-025-01578-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The emergence of AmpC beta-lactamase (AmpC) poses a significant challenge in the context of antimicrobial resistance (AMR). AmpC confers resistance to narrow- and broad- spectrum cephalosporins, beta-lactam/beta-lactamase inhibitor combinations and aztreonam making it clinically relevant and presenting a formidable threat to effective therapeutic interventions. Thus, the aim of this study was to assess magnitude of AmpC producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) in Africa.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Articles were extensively searched in bibliographic databases and grey literature using entry terms and combinations key words. Electronic databases such as PubMed, Scopus, Science Direct, Embase, and other online sources such as African Journal Online, Google Scholar, and ResearchGate were used to find relevant articles. Furthermore, the Joanna Briggs Institute quality appraisal tool was used to assess the quality of the included studies. Studies meeting eligibility criteria were extracted in MS Excel and exported to STATA version 14 software for statistical analysis. A random-effects model was used to compute the pooled prevalence of AmpC producing E. coli and K. pneumoniae. Heterogeneity was quantified by using the Cochrane Q test and I&lt;sup&gt;2&lt;/sup&gt; statistics. Publication bias was assessed using a funnel plot and Egger's test. Additionally, sensitivity analysis was conducted to assess the impact of a single study on the pooled effect size.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result: &lt;/strong&gt;Of the 2,619 studies identified, 25 studies were eligible for quantitative analysis, involving a total of 11,908 E. coli, and 4,654 K. pneumoniae isolates. The overall pooled prevalence of AmpC producing E. coli and K. pneumoniae in Africa was 18.79% (95% CI: 15.00, 22.58). The pooled prevalence of AmpC producing E. coli and K. pneumoniae were 15.32% (95% CI: 12.03, 18.61) and 17.25% (95% CI: 13.18, 21.32), respectively. There was significant heterogeneity among studies (I&lt;sup&gt;2&lt;/sup&gt; = 99.0%, p &lt; 0.001). Our study depicted that Egypt had the highest pooled prevalence of AmpC producing E. coli and K. pneumoniae with 28.91% (14.74, 43.08) and 27.84% (8.47, 47.21) respectively. Furthermore, studies conducted after 2020 showed the highest pooled prevalence of AmpC producing E. coli 28.29% (11.78, 44.80) and K. pneumoniae 29.04% (13.13, 44.85) while lowest pooled prevalence of AmpC producing E. coli 6.28% (95% CI: 2.99, 9.58) and K. pneumoniae 5.41% (95% CI: 1.73, 9.09) was observed among studies conducted before the year 2016.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study showed an increase in AmpC producing E. coli and K. pneumoniae in Africa over the past 20 years. Therefore, regular identification of AmpC, infection prevention control, strengthening of the antimicrobial resistance surveillance system and an effective antibiotic policy are required to combat the antibiotics resistance in Africa.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Pr","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"109"},"PeriodicalIF":4.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}