Database : MEDLINE
Search on : wound and infection [Words]
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[PMID]: 29501796
[Au] Autor:Trippoli S; Caccese E; Tulli G; Ipponi P; Marinai C; Messori A
[Ad] Address:HTA Unit, ESTAR, Regional Health Service, Firenze, Italy.
[Ti] Title:Biological meshes for abdominal hernia: Lack of evidence-based recommendations for clinical use.
[So] Source:Int J Surg;52:278-284, 2018 Mar 02.
[Is] ISSN:1743-9159
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: In the clinical literature on abdominal hernia repair, no sound criteria have been established to support the use of biological meshes as opposed to synthetic ones. Furthermore, the information on biological meshes is quite scarce, and so their place in therapy has not yet been defined. METHODS: The treatment of primary and incisional ventral hernia was the target intervention evaluated in our analysis. Our study consisted of the following phases: a) Identification of the biologic meshes available on the market; b) Literature search focused on efficacy and safety of these meshes; c) Analysis of the findings derived from the literature search. The information collected this way was reviewed narratively, and presented according to standard meta-analysis. The main end-points of our analysis included infection of surgical wound at 1 month and recurrence at 12 months. RESULTS: Our clinical literature comprised 11 trials that evaluated 5 biological meshes: Permacol (706 patients), Strattice (324 patients), Surgisis (44 patients), Tutomesh (38 patients) and Xenmatrix (22 patients). These studies generally showed a poor methodological quality. Surgical wound infection showed a wide between-study variability (95%CI: from 12.0% to 22.9%). Also the 12-month relapse rate demonstrated a wide 95%CI (from 5.0% to 19.9%). A significantly lower rate of recurrence at 12 months was found for Permacol compared with Strattice (rate difference: -14.2%; 95%CI: -22.1% to -6.2%). DISCUSSION: Our analysis provided an overview of 5 biological meshes currently available on the market. The different types of meshes showed a marked statistical variability in the clinical outcomes. Hence, nearly all comparisons between different meshes in the two clinical end-points did not reach statistical significance. One exception was represented by the finding that cross-linked meshes had a significantly lower recurrence rate at 12 months than non-cross-linked meshes.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  2 / 74711 MEDLINE  
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[PMID]: 29474885
[Au] Autor:Rondelli F; Franco L; Balzarotti Canger RC; Ceccarelli G; Becattini C; Bugiantella W
[Ad] Address:General Surgery, "San Giovanni Battista" Hospital, USL Umbria2, Foligno, Italy; Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy. Electronic address: rondellif@hotmail.com.
[Ti] Title:Purse-string closure versus conventional primary closure of wound following stoma reversal: Meta-analysis of randomized controlled trials.
[So] Source:Int J Surg;52:208-213, 2018 Feb 21.
[Is] ISSN:1743-9159
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:PURPOSE: Surgical site infection (SSI) is one of the most frequent complications after stoma closure and the optimal skin closure technique is still not clear. The goal of this review was to compare outcomes with purse-string closure technique (PSC) versus conventional closure technique (CCT) for skin closure after stoma reversal. METHODS: We performed a systematic review and meta-analysis of available randomized controlled trials (RCTs) to compare SSI rate within 30 days, operative time, hospital stay, incisional hernia and intestinal obstruction rates between PSC and CCT. RESULTS: The pooled analysis of 5 studies showed a statically significant lower rate of SSI in favor of PSC compared to CCT (OR -0.24; 95% CI -0.32, - 0.15; p < 0.00001). No statistically significant differences were observed in the operative time (OR -0.05; 95% CI -3.95, 3.84; p = 0.98) and in the length of hospital stay (OR -0.20; 95% CI -0.76, 0.36; p = 0.48), between the two techniques. Additionally, two out of the five studies provided data on incisional hernia and intestinal obstruction and the pooled analysis revealed no statistically significant differences between PSC and CCT techniques: incisional hernia (OR 0.81, 95% CI 0.27-2.47; p = 0.71) and intestinal obstruction (OR 1.07, 95% CI 0.41-2.84; p = 0.88). CONCLUSIONS: The analysis of 5 RCTs showed that SSI rate is statistically significant lower when PSC is performed, compared to CCT. Whereas, no significant differences were found between the two techniques with regards to operative time, length of hospital stay, incisional hernia and intestinal obstruction rates.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1802
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  3 / 74711 MEDLINE  
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[PMID]: 29454945
[Au] Autor:Singh S; Gupta A; Sharma D; Gupta B
[Ad] Address:Bioengineering Laboratory, Department of Textile Technology, Indian Institute of Technology Delhi, New Delhi 110016, India.
[Ti] Title:Dextran based herbal nanobiocomposite membranes for scar free wound healing.
[So] Source:Int J Biol Macromol;113:227-239, 2018 Feb 15.
[Is] ISSN:1879-0003
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:Dextran based bionanocomposite membranes encapsulating clove oil (CO) and sandalwood oil (SO) that are capable of preventing infection due to their inherent virtue of antibacterial activity and modifying the wound healing cascade for accelerated scar free healing, were developed. A facile solvent casting technique was used to fabricate dextran/nanosoy/glycerol/chitosan (DNG/Ch) nanocomposite membranes followed by subsequent addition of CO and SO to obtain DNG/Ch/CO and DNG/Ch/SO herbal nanodressings. Dressings exhibited >98% antibacterial activity against both Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) at extremely low loadings of 5% and 10% for CO and SO, respectively. This encapsulation strategy allowed controlled diffusion of EO over a period of 72h which was measured in terms of drug efficacy using bacterial reduction count test and serial plate transfer disk diffusion test (SPTDDT). Swelling behavior and mechanical properties were also examined. Bacterial adherence study was performed to demonstrate the efficiency of dressings for arresting microbial invasion. In vivo wound healing studies were conducted using male swiss albino mice of BALB/c strain and DNG/Ch/CO dressings exhibited complete healing within 14days with remarkable efficacy in scar prevention. Histological analysis revealed that CO and SO treatment led to deposition of ordered collagen along with fibroblast migration.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  4 / 74711 MEDLINE  
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[PMID]: 29278835
[Au] Autor:Drampalos E; Mohammad HR; Kosmidis C; Balal M; Wong J; Pillai A
[Ad] Address:Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester, United Kingdom. Electronic address: Efstathios.Drampalos@uhsm.nhs.uk.
[Ti] Title:Single stage treatment of diabetic calcaneal osteomyelitis with an absorbable gentamicin-loaded calcium sulphate/hydroxyapatite biocomposite: The Silo technique.
[So] Source:Foot (Edinb);34:40-44, 2017 Nov 23.
[Is] ISSN:1532-2963
[Cp] Country of publication:Scotland
[La] Language:eng
[Ab] Abstract:BACKGROUND: Chronic osteomyelitis necessities appropriate infected bone and soft tissue excision. The authors describe the Silo surgical technique for the treatment of calcaneal osteomyelitis using a new antibiotic-loaded absorbable calcium sulphate/hydroxyapatite biocomposite. METHODS: The Silo method involves debridement of the dead bone and local delivery of antibiotic in drilled tunnels using the biocomposite. It is combined with multiple sampling and culture-specific systemic antibiotic treatment guided by a multidisciplinary team. Twelve consecutive diabetic patients with heel ulcers and calcaneal osteomyelitis were treated with the above method. All had comorbidities (Cierny-Mader (C-M) Class B hosts). The mean age was 68 years (range 50-85). A retrospective review of radiographs and electronic medical records was conducted. RESULTS: Patients were followed up until clinical cure of the ulcer for a mean of 16 weeks (range 12-18). Infection was eradicated in all 12 patients with a single stage procedure following a bone preserving technique. One patient required a subsequent flap operation and six vacuum-assisted closure (V.A.C.). There was also one case of prolonged wound leakage and no calcaneal fractures. CONCLUSIONS: The Silo technique is an effective method of local delivery of antibiotics and can be effectively implemented into the single-stage treatment of calcaneal osteomyelitis offering increased bone preservation and local delivery of antibiotic, decreasing the need for a major amputation. LEVEL OF EVIDENCE: Level IV- case series.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  5 / 74711 MEDLINE  
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[PMID]: 29523989
[Au] Autor:Juratli MA; Nour-Eldin NA; Ackermann H; Habbe N; Hannes S; Bechstein WO; Woeste G
[Ad] Address:Department of General and Visceral Surgery, Frankfurt University Hospital, Frankfurt am Main, Germany.
[Ti] Title:Purse-string closure technique reduces the incidence of incisional hernias following the reversal of temporary ileostomy.
[So] Source:Int J Colorectal Dis;, 2018 Mar 09.
[Is] ISSN:1432-1262
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: The incidence of incisional hernia (IH) at ileostomy closure site has not been sufficiently evaluated. Temporary loop ileostomy is routinely used in patients after low anterior resection for rectal cancer. The goal of this study was to compare the IH rates of standard suture skin closure and purse-string skin closure techniques. PATIENTS AND METHODS: Patients undergoing ileostomy reversal and follow-up CT scan at the University Hospital Frankfurt between January 2009 and December 2015 were retrospectively analyzed regarding IH and associated risk factors. Patients received either direct stitch skin closure (group DC) or purse-string skin closure (group PS). RESULTS: In total, 111 patients underwent ileostomy reversal in the aforementioned period. In 88 patients, a CT scan was performed 12-24months after ileostomy reversal for cancer follow-up. Median follow-up was 12months. Median time interval between ileostoma formation and closure was 12 ( 4 SD) weeks. In 19 of 88 patients (21.5%), an IH was detected. The incidence of IH detected by CT scan was significantly lower in the PS group (n = 7, 12.9%) compared to the DC group (n = 12, 35.2%, p = 0.017). CONCLUSIONS: This retrospective study shows an advantage of the purse-string skin closure technique in ileostomy reversals. The use of this technique for skin closure following ileostomy reversals is recommended to reduce the IH rates. Randomized controlled trials are needed to confirm these findings.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher
[do] DOI:10.1007/s00384-018-2986-x

  6 / 74711 MEDLINE  
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[PMID]: 29523908
[Au] Autor:Papaconstantinou HT; Ricciardi R; Margolin DA; Bergamaschi R; Moesinger RC; Lichliter WE; Birnbaum EH
[Ad] Address:Department of Surgery, Baylor Scott & White Healthcare, Texas A&M University College of Medicine, 2401 South 31st Street, Temple, TX, USA. Harry.Papaconstantinou@bswhealth.org.
[Ti] Title:A Novel Wound Retractor Combining Continuous Irrigation and Barrier Protection Reduces Incisional Contamination in Colorectal Surgery.
[So] Source:World J Surg;, 2018 Mar 09.
[Is] ISSN:1432-2323
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Surgical site infection (SSI) remains a persistent and morbid problem in colorectal surgery. Key to its pathogenesis is the degree of intraoperative bacterial contamination at the surgical site. The purpose of this study was to evaluate a novel wound retractor at reducing bacterial contamination. METHODS: A prospective multicenter pilot study utilizing a novel wound retractor combining continuous irrigation and barrier protection was conducted in patients undergoing elective colorectal resections. Culture swabs were collected from the incision edge prior to device placement and from the exposed and protected incision edge prior to device removal. The primary and secondary endpoints were the rate of enteric and overall bacterial contamination on the exposed incision edge as compared to the protected incision edge, respectively. The safety endpoint was the absence of serious device-related adverse events. RESULTS: A total of 86 patients were eligible for analysis. The novel wound retractor was associated with a 66% reduction in overall bacterial contamination at the protected incision edge compared to the exposed incision edge (11.9 vs. 34.5%, P < 0.001), and 71% reduction in enteric bacterial contamination (9.5% vs. 33.3%, P < 0.001). The incisional SSI rate was 2.3% in the primary analysis and 1.2% in those that completed the protocol. There were no adverse events attributed to device use. CONCLUSIONS: A novel wound retractor combining continuous irrigation and barrier protection was associated with a significant reduction in bacterial contamination. Improved methods to counteract wound contamination represent a promising strategy for SSI prevention (NCT 02413879).
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[Cl] Clinical Trial:ClinicalTrial
[St] Status:Publisher
[do] DOI:10.1007/s00268-018-4568-z

  7 / 74711 MEDLINE  
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[PMID]: 29523721
[Au] Autor:Acquisto NM; Bodkin RP; Brown JE; Graman PS; Jones CMC; Li T; Hardy DJ; Dodds Ashley E
[Ad] Address:Department of Pharmacy, University of Rochester Medical Center, Rochester, New York, USA.
[Ti] Title:MRSA nares swab is a more accurate predictor of MRSA wound infection compared with clinical risk factors in emergency department patients with skin and soft tissue infections.
[So] Source:Emerg Med J;, 2018 Mar 09.
[Is] ISSN:1472-0213
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVES: Skin and soft tissue infections (SSTI) caused by methicillin-resistant (MRSA) are prevalent in the emergency department (ED). We determined whether MRSA nasal carriage better identifies patients with MRSA wound infection than clinical risk factors or emergency medicine (EM) provider's choice of discharge prescriptions. METHODS: Adult patients presenting to a large academic medical centre ED in the USA with SSTI between May 2010 and November 2011 were screened. Research assistants administered a questionnaire regarding MRSA risk factors, and MRSA nares swab PCR testing, wound culture results and information on antibiotics prescribed at discharge were collected. Measures of classification accuracy for nares swab, individual risk factors and physician's prescription for MRSA coverage were compared with gold standard wound culture. RESULTS: During the study period, 116 patients with SSTI had both wound cultures and nares swabs for MRSA. was isolated in 59.5%, most often MRSA (75.4%). Thirty patients (25.9%) had a positive MRSA nares swab and culture for a sensitivity of 57.7% and specificity of 92.2%. Positive predictive value (PPV) for MRSA nares swab was 85.7% and positive likelihood ratio was 7.4, while negative predictive value was 72.8% and negative likelihood ratio 0.5. None of the individual risk factors nor EM provider's prescription for MRSA coverage had a PPV or positive likelihood ratio higher than nares swabs. CONCLUSIONS: MRSA nares swab is a more accurate predictor of MRSA wound infection compared with clinical risk factors or EM provider's choice of antibiotics. MRSA nares swab may be a useful tool in the ED.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  8 / 74711 MEDLINE  
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[PMID]: 29523404
[Au] Autor:Malaisrie SC; McCarthy PM; Kruse J; Matsouaka R; Andrei AC; Grau-Sepulveda MV; Friedman DJ; Cox JL; Brennan JM
[Ad] Address:Division of Cardiac Surgery, Northwestern University, Bluhm Cardiovascular Institute, Chicago, Ill. Electronic address: Chris.Malaisrie@nm.org.
[Ti] Title:Burden of preoperative atrial fibrillation in patients undergoing coronary artery bypass grafting.
[So] Source:J Thorac Cardiovasc Surg;, 2018 Feb 09.
[Is] ISSN:1097-685X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: This study compares early and late outcomes in patients undergoing coronary artery bypass grafting with and without preoperative atrial fibrillation in a contemporary, nationally representative Medicare cohort. METHODS: In the Medicare-Linked Society of Thoracic Surgeons database, 361,138 patients underwent isolated coronary artery bypass from 2006 to 2013, of whom 37,220 (10.3%) had preoperative atrial fibrillation; 13,161 (35.4%) were treated with surgical ablation and were excluded. Generalized estimating equations were used to compare 30-day mortality and morbidity. Long-term survival was summarized using Kaplan-Meier curves and Cox regression models. Stroke and systemic embolism incidence was modeled using the Fine-Gray model and the CHA DS -VAScscore was used to analyze stroke risk. Median follow-up was 4years. RESULTS: Preoperative atrial fibrillation was associated with a higher adjusted 30-day mortality (odds ratio [OR], 1.5; P<.0001) and combined major morbidity including stroke, renal failure, prolonged ventilation, reoperation, and deep sternal wound infection (OR, 1.32; P<.0001). Patients with preoperative atrial fibrillation experienced a higher adjusted long-term risk of all-cause mortality and cumulative risk of stroke and systemic embolism compared to those without atrial fibrillation. At 5years, the survival probability in the preoperative atrial fibrillation versus no atrial fibrillation groups stratified by CHA DS -VASc scores was 74.8% versus 86.3% (score 1-3), 56.5% versus 73.2% (score 4-6), and 41.2% versus 57.2% (score 7-9; all P<.001). CONCLUSIONS: Preoperative atrial fibrillation is independently associated with worse early and late postoperative outcomes. CHA DS -VASc stratifies risk, even in those without preoperative atrial fibrillation.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  9 / 74711 MEDLINE  
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[PMID]: 29523122
[Au] Autor:Shih JT; Kuo CL; Yeh TT; Shen HC; Pan RY; Wu CC
[Ad] Address:Department of Orthopaedic Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu Dist, Taipei City, 11472, Taiwan, Republic of China.
[Ti] Title:Modified Essex-Lopresti procedure with percutaneous calcaneoplasty for comminuted intra-articular calcaneal fractures: a retrospective case analysis.
[So] Source:BMC Musculoskelet Disord;19(1):77, 2018 Mar 09.
[Is] ISSN:1471-2474
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: The ideal treatment for comminuted intraarticular calcaneal fractures is still debated. Open reduction and internal fixation (ORIF) is the most popular surgical procedure; however, wound complications, implant choice, and infection remain major concerns. This study aimed to demonstrate the results of an innovative, minimally invasive surgical procedure, namely, a closed reduction technique using large-diameter Steinmann pins and percutaneous calcaneoplasty using injectable calcium sulfate cement (MIIG X3, Wright Medical Technology, Inc., Arlington, TN), in patients with comminuted calcaneal fractures. METHODS: From January 2012 to January 2014, 20 patients (three women, 17 men) with comminuted calcaneus fractures (Sanders classification type III and Essex-Lopresti classification joint-depression type fracture) were included. Plain films and CT scans were obtained preoperatively in all patients. The operation was performed within three days post-injury, and patients were not allowed to bear weight until three months postoperatively. During this period, the patients were educated on how to perform bed exercises for joints above the surgical site, including muscle strengthening and body conditioning. Early active range of motion exercises for the ankle and forefoot began 3 to 6weeks postoperatively. All patients were followed up regularly. The results were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score and Bhler's angle of the calcaneus. RESULTS: After an average follow-up of two years, none of the patients required further surgery or experienced soft tissue complications. The clinical results were rated good to excellent on the AOFAS scale in 80% of the cases (16 of 20 patients), and most patients had pain relief and returned to their former daily activities at the same level as before the injury. CONCLUSIONS: A modified Essex-Lopresti procedure with percutaneous calcaneoplasty appears to be a safe and effective procedure to treat comminuted calcaneal fractures with acceptable functional results. Long-term outcomes and additional cases using this technique are required to support our conclusion.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Data-Review
[do] DOI:10.1186/s12891-018-1995-9

  10 / 74711 MEDLINE  
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[PMID]: 29523087
[Au] Autor:Czajka U; Wiatrzyk A; Mosiej E; Forminska K; Zasada AA
[Ad] Address:Department of Vaccines and Sera Evaluation, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791, Warsaw, Poland.
[Ti] Title:Changes in MLST profiles and biotypes of Corynebacterium diphtheriae isolates from the diphtheria outbreak period to the period of invasive infections caused by nontoxigenic strains in Poland (1950-2016).
[So] Source:BMC Infect Dis;18(1):121, 2018 Mar 09.
[Is] ISSN:1471-2334
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Corynebacterium diphtheriae is a re-emerging pathogen in Europe causing invasive infections in vaccinated persons and classical diphtheria in unvaccinated persons. In the presented study we analysed genetic changes in C. diphtheriae isolates collected in Poland from the period before the introduction of the mass anti-diphtheria vaccination to the present time when over 98% of the population is vaccinated. METHODS: A total of 62 C. diphtheriae isolates collected in the 1950s-1960s, 1990s and 2000-2016 in Poland were investigated. Examined properties of the isolates included toxigenic status, presence of tox gene, biotype, MLST type (ST) and type of infection. RESULTS: A total of 12 sequence types (STs) were identified among the analysed C. diphtheriae isolates. The highest variability of STs was observed among isolates from diphtheria and asymptomatic carriers collected in the XX century. Over 95% of isolates collected from invasive and wound infections in 2004-2016 belonged to ST8. Isolates from the XX century represented all four biotypes: mitis, gravis, intermedius and belfanti, but the belfanti biotype appeared only after the epidemic in the 1990s. All except three isolates from the XXI century represented the biotype gravis. CONCLUSIONS: During a diphtheria epidemic period, non-epidemic clones of C. diphtheriae might also disseminate and persist in a particular area after the epidemic. An increase of the anti-diphtheria antibody level in the population causes not only the elimination of toxigenic strains from the population but may also influence the reduction of diversity of C. diphtheriae isolates. MLST types do not reflect the virulence of isolates. Each ST can be represented by various virulent variants representing various pathogenic capacities, for example toxigenic non-invasive, nontoxigenic invasive and nontoxigenic non-invasive.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Data-Review
[do] DOI:10.1186/s12879-018-3020-1


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