1
|
Zhou WY, Shen L, Shi JX, Gao XH, Yang J, Fu SJ, Pan XF, Zhu MF, Zhang S, Zhang C, Li F, Zhang H, Yao F, Tenover FC, Tang YW, Fang WT. Real-time, random-access organ screening for carbapenem-resistant organisms (CRO) reduces CRO-associated, donor-derived infection mortality in lung transplant recipients. Infection 2024; 52:403-412. [PMID: 37651077 PMCID: PMC10955019 DOI: 10.1007/s15010-023-02089-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Donor-derived infection (DDI) has become an important factor affecting the prognosis of lung transplantation patients. The risks versus benefits of using donor organs infected with multidrug-resistant organisms (MDRO), especially carbapenem-resistant organisms (CRO), are frequently debated. Traditional microbial culture and antimicrobial susceptibility testing at present fail to meet the needs of quick CRO determination for donor lungs before acquisition. In this study, we explored a novel screening method by using Xpert® Carba-R assay for CRO in donor lungs in a real-time manner to reduce CRO-associated DDI mortality. METHODS This study was registered on chictr.org.cn (ChiCTR2100053687) on November 2021. In the Xpert Carba-R screening group, donor lungs were screened for CRO infection by the Xpert Carba-R test on bronchoalveolar fluid (BALF) before acquisition. If the result was negative, donor lung acquisition and subsequent lung transplantation were performed. In the thirty-five potential donors, nine (25.71%) with positive Xpert Carba-R results in BALF were declined for lung transplantation. Twenty-six recipients and the matching CRO-negative donor lungs (74.29%) were included in the Xpert Carba-R screening group. In the control group, nineteen recipients underwent lung transplants without Xpert Carba-R screening. The incidence and mortality of CRO-associated DDI were collected and contrasted between the two groups. RESULTS Multivariate analysis showed that CRO-related death due to DDI within 60 days was significantly lower in the Xpert Carba-R screening group than that in the control group (OR = 0.05, 95% CI 0.003-0.74, p = 0.03). CONCLUSION Real-time CRO screening of donor lungs before transplantation at the point of care by the Xpert Carba-R helps clinicians formulate lung transplantation strategies quickly and reduces the risk of subsequent CRO infection improving the prognosis of lung transplantation.
Collapse
Affiliation(s)
- Wen-Yong Zhou
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Lei Shen
- Shanghai Institute of Immunology, Department of Immunology and Microbiology, and Key Laboratory of Cell Differentiation and Apoptosis of the Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Tumor Microenvironment and Inflammation, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-Xin Shi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xing-Hui Gao
- Medical Affairs, Danaher Diagnostic Platform/Cepheid, Shanghai, China
| | - Jun Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shi-Jie Fu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xu-Feng Pan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min-Fang Zhu
- Department of Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shen Zhang
- Department of Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chong Zhang
- Department of Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Li
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fred C Tenover
- Medical and Scientific Affairs, Cepheid, Sunnyvale, CA, USA
| | - Yi-Wei Tang
- Medical Affairs, Danaher Diagnostic Platform/Cepheid, Shanghai, China.
| | - Wen-Tao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
2
|
Fernandez-Pittol M, Bosch J, Ballesté-Delpierre C, Gonzalez C, Vasilakopoulou A, Berbel D, Riccobono E, Gatermann S, Kamotsay K, Reissier S, Szabo D, Aszalos AZ, Francius L, Volland H, Stankov-Pugès M, Rosenmöller M, Naas T, Vila J. Multicenter study to assess the use of BL-DetecTool for the detection of CTX-M-type ESBLs and carbapenemases directly from clinical specimens. J Clin Microbiol 2024; 62:e0113623. [PMID: 38319119 PMCID: PMC10935652 DOI: 10.1128/jcm.01136-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024] Open
Abstract
Antimicrobial resistance (AMR) is one of the major public health problems worldwide. Multiple strategies have been put in place to address this problem. One of them is the rapid detection of the mechanisms of resistance, such as extended-spectrum beta-lactamases (ESBLs) and/or carbapenemases. We conducted a multicenter study that included nine European centers for the assessment of prototypes of a novel lateral flow immunoassay-based device (BL-DetecTool) for a rapid detection of ESBL (NG-Test CTX-M-MULTI DetecTool) and/or carbapenemases (NG-Test CARBA 5 DetecTool) from Enterobacterales and Pseudomonas aeruginosa in positive urine, positive blood cultures, and rectal swabs. We performed a prospective analysis between January 2021 and June 2022, including overall 22,010 samples. Based on each hospital information, the sensitivity to detect CTX-M was 84%-100%, 90.9%-100%, and 75%-100% for urine, positive blood cultures, and enriched rectal swabs, respectively. On the other hand, the sensitivity to detect carbapenemases was 42.8%-100%, 75%-100%, and 66.6%-100% for urine, positive blood cultures, and enriched rectal swab, respectively. BL-DetecTool allows a rapid and reliable detection of ESBL and carbapenemases directly from urine, positive blood cultures, or enriched rectal swabs, being an easy technique to implement in the workflow of clinical microbiology laboratories. IMPORTANCE The assessed rapid assay to detect CTX-M beta-lactamases and carbapenemases directly from clinical samples can favor in the rapid detection of these mechanisms of resistance and hence the administration of a more adequate antimicrobial treatment.
Collapse
Affiliation(s)
- Mariana Fernandez-Pittol
- Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain
- Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | - Jordi Bosch
- Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain
- Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | | | - Camille Gonzalez
- Team "Resist", INSERM Unit 1184, Faculty of Medicine, Université Paris-Saclay, Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, AP-HP Paris-Saclay, Bicêtre Hospital Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
| | - Alexandra Vasilakopoulou
- Laboratory of Clinical Microbiology, Attikon University General Hospital, Medical School, National Kapodistrian University Athens (Greece), Athens, Greece
| | - Dàmaris Berbel
- Microbiology Department, Hospital de Bellvitge. IDIBELL. UB. CIBERES, Barcelona, Spain
| | - Eleonora Riccobono
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Sören Gatermann
- German National Reference Laboratory for Multidrug-Resistant Gram-negative Bacteria, Department of Medical Microbiology, Ruhr-University Bochum, Germany - (Germany), Bochum, Germany
| | - Katalin Kamotsay
- Central Microbiology Laboratory, Central Hospital of Southern Pest National Institute of Hematology and Infectious Disease, Budapest, Hungary
| | - Sophie Reissier
- Department of Bacteriology, Amiens University Hospital, Amiens, France
| | - Dora Szabo
- Semmelweis University, Institute of Medical Microbiology, Budapest, Hungary
| | - Albert Zoltan Aszalos
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
| | | | - Hervé Volland
- Département Médicaments et Technologies pour la Santé (DMTS), Université Paris Saclay, CEA, INRAE, SPI, Gif-sur-Yvette, France
| | | | | | - Thierry Naas
- Team "Resist", INSERM Unit 1184, Faculty of Medicine, Université Paris-Saclay, Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, AP-HP Paris-Saclay, Bicêtre Hospital Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
| | - Jordi Vila
- Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain
- Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
- Department of Clinical Microbiology - CDB, University of Barcelona, Hospital Clínic, Barcelona, Spain
- CIBER de Enfermedades Infecciosas , Barcelona, Spain
| |
Collapse
|
3
|
Xu Y, Song W, Huang P, Mei Y, Zhang Y, Xu T. A Rapid Carbapenemase Genes Detection Method with Xpert Carba-R from Positive Blood Cultures Compared with NG-Test Carba 5 and Sequencing. Infect Drug Resist 2022; 15:7719-7725. [PMID: 36597457 PMCID: PMC9805712 DOI: 10.2147/idr.s392035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/13/2022] [Indexed: 12/29/2022] Open
Abstract
Objective The objective of the current study was to evaluate the performance of Xpert Carba-R for the direct detection and identification of carbapenemase genes from positive blood cultures. Methods Pathogens which extracted from positive blood cultures and identified using MALDI-TOF MS as Enterobacterales were included in this study. Xpert Carba-R was used for the rapid detection of carbapenemase genes from positive blood cultures. NG-Test CARBA 5 and polymerase-chain reaction (PCR) sequencing were used for the detection of carbapenemases and carbapenemase genes in positive blood culture isolates, respectively. Finally, antibiotic susceptibility tests were conducted using the VITEK-2 Compact system. Results A total of 133 positive blood cultures of Enterobacterales were collected and 27 of them were detected to carry carbapenemase genes using Xpert Carba-R. In comparison with PCR sequencing results, the sensitivity and specificity of Xpert Carba-R and NG-Test CARBA 5 were calculated as 100%. Additionally, Xpert Carba-R could significantly shorten the turnaround time by directly detecting positive blood cultures comparing with NG-Test CARBA 5. For 27 carbapenem-producing strains, the resistance rates of carbapenems and aztreonam were 96.3% and 92.6%, respectively. Strains carrying the blaKPC gene were all sensitive to ceftazidime-avibactam. All strains were sensitive to tigecycline and colistin. Conclusion Xpert Carba-R is suitable for the rapid detection of main carbapenemase genes from positive blood cultures with high sensitivity and specificity. In comparison with NG-Test CARBA 5 and PCR sequencing methods, the timely and convenient method can be a useful test to guide optimal therapy and infection control.
Collapse
Affiliation(s)
- Yuqiao Xu
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People’s Republic of China
| | - Weijuan Song
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People’s Republic of China
| | - Peijun Huang
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People’s Republic of China
| | - Yaning Mei
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People’s Republic of China
| | - Yan Zhang
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People’s Republic of China,Correspondence: Yan Zhang; Ting Xu, Department of Laboratory Medicine, Jiangsu Province Hospital, Guangzhou Street No. 300, Nanjing, 210029, People’s Republic of China, Tel +8625-6830-6287, Fax +8625- 8372-4440, Email ;
| | - Ting Xu
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People’s Republic of China
| |
Collapse
|
4
|
Burillo A, Bouza E. Faster infection diagnostics for intensive care unit (ICU) patients. Expert Rev Mol Diagn 2022; 22:347-360. [PMID: 35152813 DOI: 10.1080/14737159.2022.2037422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : The patient admitted to intensive care units (ICU) is critically ill, to some extent immunosuppressed, with a high risk of infection, sometimes by multidrug-resistant microorganisms. In this context, the intensivist expects from the microbiology service quick and understandable information so that appropriate antimicrobial treatment for that particular patient and infection can be initiated. AREAS COVERED : In this review of recent literature (2015-2021), we identified diagnostic methods for the most prevalent infections in these patients through a search of the databases Pubmed, evidence-based medicine online, York University reviewers group, Cochrane, MBE-Trip, and Sumsearch using the terms: adult, clinical laboratory techniques, critical care, early diagnosis, microbiology, molecular diagnostic techniques, spectrometry and metagenomics. EXPERT OPINION : There has been an exponential surge in diagnostic systems used directly on blood and other samples to expedite microbial identification and antimicrobial susceptibility testing of pathogens. Few studies have thus far assessed their clinical impact; final outcomes will also depend on preanalytical and post-analytical factors. Besides, many of the resistance mechanisms cannot yet be detected with molecular techniques, which impairs the prediction of the actual resistance phenotype. Nonetheless, this is an exciting field with much yet to explore.
Collapse
Affiliation(s)
- Almudena Burillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, Ciudad Universitaria, 28040 Madrid, Spain.,Gregorio Marañón Health Research Institute, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, Ciudad Universitaria, 28040 Madrid, Spain.,Gregorio Marañón Health Research Institute, Doctor Esquerdo 46, 28007, Madrid, Spain.,CIBER of Respiratory Diseases (CIBERES CB06/06/0058), Av. Monforte de Lemos 3-5, Pabellón 11, Planta, 28029 Madrid, Spain
| |
Collapse
|
5
|
Performance Evaluation of Diagnostic Assays for Detection and Classification of Carbapenemase-Producing Organisms. Antibiotics (Basel) 2021; 10:antibiotics10121457. [PMID: 34943669 PMCID: PMC8698775 DOI: 10.3390/antibiotics10121457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/12/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
Abstract
Rapid and accurate detection can help optimize patient treatment and improve infection control against nosocomial carbapenemase-producing organisms (CPO). In this study, a total of 217 routine clinical isolates (Enterobacterales and A. baumannii), including 178 CPOs and 39 non-CPOs, were tested to evaluate the performance of six phenotypic carbapenemase detection and classification assays, i.e., BD Phoenix CPO detect panel, Rapidec Carba-NP, O.K.N detection kit, and three carbapenem inactivation methods (CIMs; mCIM, eCIM, sCIM). The overall detection sensitivity and specificity were 98.78% (95.21–99.79%) and 79.49% (63.06–90.13%), respectively, for the BD phoenix CPO P/N test; 91.93% (86.30–95.45%) and 100% (88.83–100%), respectively, for the Rapidec Carba-NP; 98.06% (94.00–99.50%) and 97.44% (84.92–99.87%), respectively, for mCIM; and 96.89% (92.52–98.85%) and 94.87% (81.37–99.11%), respectively, for sCIM. The classification sensitivity and specificity for the BD phoenix CPO Ambler test, the O.K.N detection kit, and the mCIM and eCIM were 56.71% (48.75–64.34%) and 94.87% (81.37–99.11%), 99.28% (95.43–99.96%) and 100% (88.83–100%), and 92.90% (87.35–96.23%) and 97.44% (84.92–99.87%), respectively. All detection assays were reliable in detecting carbapenemase. However, the Rapidec Carba-NP and mCIM were insufficient in detecting OXA-48-like enzymes. The BD phoenix CPO detect panel had a strong ability to detect carbapenemase but failed to classify 48/59 (81.36%) KPC, 8/52 (15.38%) NDM, 8/22 (36.36%) OXA-23-like, and 6/11 (54.55%) dual enzymes. The O.K.N detection kit accurately detected and differentiated KPC, NDM, and OXA-48-like enzymes existing alone or in combination. The results of this study will support reliable laboratory work tools and promote therapeutic and infection control decisions.
Collapse
|
6
|
Hagihara M, Kato H, Sugano T, Okade H, Sato N, Shibata Y, Sakanashi D, Hirai J, Asai N, Suematsu H, Yamagishi Y, Mikamo H. In Vivo Pharmacodynamics of β-Lactams/Nacubactam against Carbapenem-Resistant and/or Carbapenemase-Producing Enterobacter cloacae and Klebsiella pneumoniae in Murine Pneumonia Model. Antibiotics (Basel) 2021; 10:antibiotics10101179. [PMID: 34680760 PMCID: PMC8532682 DOI: 10.3390/antibiotics10101179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022] Open
Abstract
Carbapenem-resistant Enterobacterales (CRE) and carbapenemase-producing Enterobacterales (CPE) have become global threats. CRE− and CPE− derived infections have been associated with high mortality due to limited treatment options. Nacubactam is a β-lactamase inhibitor and belongs to the new class of diazabicyclooctane. The agent has an in vitro antimicrobial activity against several classes of β-lactamase-producing Enterobacterales. This study evaluated antimicrobial activity of combination therapies including β-lactams (aztreonam, cefepime, and meropenem) and nacubactam against four Enterobacter cloacae and six Klebsiella pneumoniae isolates with murine pneumonia model. Based on changes in bacterial quantity, antimicrobial activities of some regimens were assessed. Combination therapies including β-lactams (aztreonam, cefepime, and meropenem) with nacubactam showed enhanced antimicrobial activity against CRE E. cloacae (−3.70 to −2.08 Δlog10 CFU/lungs) and K. pneumoniae (−4.24 to 1.47 Δlog10 CFU/lungs) with IMP-1, IMP-6, or KPC genes, compared with aztreonam, cefepime, meropenem, and nacubactam monotherapies. Most combination therapies showed bacteriostatic (−3.0 to 0 Δlog10 CFU/lungs) to bactericidal (<−3.0 Δlog10 CFU/lungs) activities against CRE isolates. This study revealed that combination regimens with β-lactams (aztreonam, cefepime, and meropenem) and nacubactam are preferable candidates to treat pneumonia due to CRE and CPE.
Collapse
Affiliation(s)
- Mao Hagihara
- Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University, Nagakute 480-1195, Japan;
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute 480-1195, Japan; (H.K.); (Y.S.); (D.S.); (J.H.); (N.A.); (H.S.); (Y.Y.)
| | - Hideo Kato
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute 480-1195, Japan; (H.K.); (Y.S.); (D.S.); (J.H.); (N.A.); (H.S.); (Y.Y.)
| | - Toshie Sugano
- Meiji Seika Pharma Co., Ltd., Tokyo 104-8002, Japan; (T.S.); (H.O.); (N.S.)
| | - Hayato Okade
- Meiji Seika Pharma Co., Ltd., Tokyo 104-8002, Japan; (T.S.); (H.O.); (N.S.)
| | - Nobuo Sato
- Meiji Seika Pharma Co., Ltd., Tokyo 104-8002, Japan; (T.S.); (H.O.); (N.S.)
| | - Yuichi Shibata
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute 480-1195, Japan; (H.K.); (Y.S.); (D.S.); (J.H.); (N.A.); (H.S.); (Y.Y.)
| | - Daisuke Sakanashi
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute 480-1195, Japan; (H.K.); (Y.S.); (D.S.); (J.H.); (N.A.); (H.S.); (Y.Y.)
| | - Jun Hirai
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute 480-1195, Japan; (H.K.); (Y.S.); (D.S.); (J.H.); (N.A.); (H.S.); (Y.Y.)
| | - Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute 480-1195, Japan; (H.K.); (Y.S.); (D.S.); (J.H.); (N.A.); (H.S.); (Y.Y.)
| | - Hiroyuki Suematsu
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute 480-1195, Japan; (H.K.); (Y.S.); (D.S.); (J.H.); (N.A.); (H.S.); (Y.Y.)
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute 480-1195, Japan; (H.K.); (Y.S.); (D.S.); (J.H.); (N.A.); (H.S.); (Y.Y.)
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute 480-1195, Japan; (H.K.); (Y.S.); (D.S.); (J.H.); (N.A.); (H.S.); (Y.Y.)
- Correspondence: ; Tel./Fax: +81-561-61-1842
| |
Collapse
|