1
|
Ong HH, Toh WK, Thong LY, Phoon LQ, Clarke SC, Cheah ESG. Investigation of Upper Respiratory Carriage of Bacterial Pathogens among University Students in Kampar, Malaysia. Trop Med Infect Dis 2023; 8:tropicalmed8050269. [PMID: 37235317 DOI: 10.3390/tropicalmed8050269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
The carriage of bacterial pathogens in the human upper respiratory tract (URT) is associated with a risk of invasive respiratory tract infections, but the related epidemiological information on this at the population level is scarce in Malaysia. This study aimed to investigate the URT carriage of Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa among 100 university students by nasal and oropharyngeal swabbing. The presence of S. aureus, K. pneumoniae and P. aeruginosa was assessed via swab culture on selective media and PCR on the resulting isolates. For S. pneumoniae, H. influenzae and N. meningitidis, their presence was assessed via multiplex PCR on the total DNA extracts from chocolate agar cultures. The carriage prevalence of H. influenzae, S. aureus, S. pneumoniae, K. pneumoniae, N. meningitidis and P. aeruginosa among the subjects was 36%, 27%, 15%, 11%, 5% and 1%, respectively, by these approaches. Their carriage was significantly higher in males compared to females overall. The S. aureus, K. pneumoniae and P. aeruginosa isolates were also screened by the Kirby-Bauer assay, in which 51.6% of S. aureus were penicillin-resistant. The outcomes from carriage studies are expected to contribute to informing infectious disease control policies and guidelines.
Collapse
Affiliation(s)
- Hing Huat Ong
- Department of Biological Science, Faculty of Science, Kampar Campus, Universiti Tunku Abdul Rahman, Kampar 31900, Malaysia
| | - Wai Keat Toh
- Department of Biological Science, Faculty of Science, Kampar Campus, Universiti Tunku Abdul Rahman, Kampar 31900, Malaysia
| | - Li Ying Thong
- Department of Biological Science, Faculty of Science, Kampar Campus, Universiti Tunku Abdul Rahman, Kampar 31900, Malaysia
| | - Lee Quen Phoon
- Department of Allied Health Sciences, Faculty of Science, Kampar Campus, Universiti Tunku Abdul Rahman, Kampar 31900, Malaysia
- Centre for Biomedical and Nutrition Research, Kampar Campus, Universiti Tunku Abdul Rahman, Kampar 31900, Malaysia
| | - Stuart C Clarke
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
- Global Health Research Institute, University of Southampton, Southampton SO17 1BJ, UK
- School of Postgraduate Studies, International Medical University, Kuala Lumpur 57000, Malaysia
- Centre for Translational Research, Institute for Research, Development, and Innovation, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Eddy Seong Guan Cheah
- Department of Biological Science, Faculty of Science, Kampar Campus, Universiti Tunku Abdul Rahman, Kampar 31900, Malaysia
- Centre for Biomedical and Nutrition Research, Kampar Campus, Universiti Tunku Abdul Rahman, Kampar 31900, Malaysia
| |
Collapse
|
2
|
Biofilm-Forming Bacteria Implicated in Complex Otitis Media in Children in the Post-Heptavalent Pneumococcal Conjugate Vaccine (PCV7) Era. Microorganisms 2023; 11:microorganisms11030545. [PMID: 36985119 PMCID: PMC10056165 DOI: 10.3390/microorganisms11030545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
Background: Chronic media with effusion (COME) and recurrent acute otitis media (RAOM) are closely related clinical entities that affect childhood. The aims of the study were to investigate the microbiological profile of otitis-prone children in the post-PCV7 era and, to examine the biofilm-forming ability in association with clinical history and outcome during a two-year post-operative follow-up. Methods: In this prospective study, pathogens from patients with COME and RAOM were isolated and studied in vitro for their biofilm-forming ability. The minimum inhibitory concentrations (MIC) of both the planktonic and the sessile forms were compared. The outcome of the therapeutic method used in each case and patient history were correlated with the pathogens and their ability to form biofilms. Results: Haemophilus influenzae was the leading pathogen (35% in COME and 40% in RAOM), and Streptococcus pneumoniae ranked second (12% in COME and 24% in RAOM). Polymicrobial infections were identified in 5% of COME and 19% of RAOM cases. Of the isolated otopathogens, 94% were positive for biofilm formation. Conclusions: This is the first Greek research studying biofilm formation in complex otitis media-prone children population in the post-PCV7 era. High rates of polymicrobial infections, along with treatment failure in biofilms, may explain the lack of antimicrobial efficacy in otitis-prone children.
Collapse
|
3
|
Kiemde F, Compaore A, Koueta F, Some AM, Kabore B, Valia D, Rouamba T, Bocoum FY, Sawadogo S, Nana M, Some DY, Kone NA, Pagbeleguem V, Sangare I, Bere AW, Bonko MDA, Tougri G, Youl SY, Schallig H, Tinto H. Development and evaluation of an electronic algorithm using a combination of a two-step malaria RDT and other rapid diagnostic tools for the management of febrile illness in children under 5 attending outpatient facilities in Burkina Faso. Trials 2022; 23:779. [PMID: 36109766 PMCID: PMC9476427 DOI: 10.1186/s13063-022-06717-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background In Sub-Saharan Africa (SSA), febrile illnesses remain a major public health problem in children. However, the persistence of hrp2 antigen and the low sensitivity of pLDH RDT negatively affect antimalarials and antibiotics prescription practices. These limitations lead to poor management of febrile diseases and antimicrobial resistance (AMR). To improve the diagnosis of these febrile diseases and subsequent prescription of antimicrobials, it is hypothesized that the implementation of an algorithm including a two-step malaria RDT PfHRP2/pLDH supported by point-of-care (PoC) tests for bacterial infections could significantly improve the management of febrile diseases and thereby tackling AMR. Methods To assess the value of the proposed algorithm, an open-label randomized controlled trial with three arms, enrolling febrile children from 6 to 59 months is proposed. In the control arm, febrile children will be managed according to the Integrated Management of Childhood Illnesses (IMCI), which is part of the standard of care in Burkina Faso. Treatment will be done according to national guidelines. In the RDT decisional algorithm (RDT-DA) arm (intervention), the clinical examination based on IMIC will be supported by a two-step malaria RDT and bacterial infections RDTs. Prescription will be left to the discretion of the healthcare workers based on clinical examination and PoC test results. In the e-algorithm arm (intervention), artificial intelligence integrating multiple layers of clinical information such as clinical examination, signs/symptoms and medical history, and biological information such as biomarkers (CRP and WBC) and pathogen-specific PoC tests, and oximetry will be developed. The e-algorithm will serve to guide the diagnostic and management of febrile infections in children. In the 3 arms, the case report forms will be digitalized. A final follow-up visit (day 7) will be scheduled for all participants. Patients will be asked to come back to the health facilities before the scheduled visit if the symptoms persist or in case of health condition worsening. Discussion If successful, this study could contribute to improve the management of febrile diseases and reduce inappropriate use of antimicrobials. Trial registration The trial is registered at ClinicalTrial.gov, NCT05285657. Enrolment started on 4 March 2022 with long-term outcome being assessed completely by 2023.
Collapse
|
4
|
Xirogianni A, Georgakopoulou T, Patsourakos V, Magaziotou I, Papandreou A, Simantirakis S, Tzanakaki G. Impact of a Single-Tube PCR Assay for the Detection of Haemophilus influenzae Serotypes a, c, d, e and f on the Epidemiological Surveillance in Greece. Microorganisms 2022; 10:microorganisms10071367. [PMID: 35889086 PMCID: PMC9322709 DOI: 10.3390/microorganisms10071367] [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: 05/30/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 12/07/2022] Open
Abstract
Background: The decrease in the rate of meningitis due to Haemophilus influenzae type b after vaccine introduction and a possible change in epidemiology of H. influenzae disease highlights the need for continuous serotype surveillance. Methods: A single-tube multiplex PCR assay for serotyping of H. influenzae was developed and deployed. Results: During 2003−2020, 108 meningitis cases due to H. influenzae were notified; 86 (80%) were confirmed and serotyped by molecular methods. The overall specificity and sensitivity of the assay were estimated (100% PPV and NPV respectively). The overall mean annual reported incidence for H. influenzae was 0.02, while for Hib and non-b meningitis equaled 0.02 and 0.03 per 100 000, respectively. Analysis by age group revealed that H. influenzae peaks in toddlers and children 0−4 years and in adults >45 years old. Among the serotyped cases, 39.8% were identified as Hib, 46.3% as NTHi, and 0.9% and 2.8% as serotypes a (Hia) and f (Hif)) respectively. Conclusions: Low incidence due to Hib was observed while non-typeable H. influenzae (NTHi) and serotypes Hia and Hif seem to emerge. The application of the current assay discloses the ongoing change of invasive H. influenzae disease trends during the Hib post-vaccine era.
Collapse
Affiliation(s)
- Athanasia Xirogianni
- National Meningitis Reference Laboratory, Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens, Greece; (A.X.); (V.P.); (A.P.); (S.S.)
| | - Theano Georgakopoulou
- Department of Vaccine Preventable Diseases, National Public Health Organization (NPHO), 15123 Athens, Greece; (T.G.); (I.M.)
| | - Vassileios Patsourakos
- National Meningitis Reference Laboratory, Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens, Greece; (A.X.); (V.P.); (A.P.); (S.S.)
| | - Ioanna Magaziotou
- Department of Vaccine Preventable Diseases, National Public Health Organization (NPHO), 15123 Athens, Greece; (T.G.); (I.M.)
| | - Anastasia Papandreou
- National Meningitis Reference Laboratory, Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens, Greece; (A.X.); (V.P.); (A.P.); (S.S.)
| | - Stelmos Simantirakis
- National Meningitis Reference Laboratory, Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens, Greece; (A.X.); (V.P.); (A.P.); (S.S.)
| | - Georgina Tzanakaki
- National Meningitis Reference Laboratory, Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens, Greece; (A.X.); (V.P.); (A.P.); (S.S.)
- Correspondence: ; Tel.: +30-213-20-10-267
| |
Collapse
|
5
|
Artificial Intelligence in Differential Diagnostics of Meningitis: A Nationwide Study. Diagnostics (Basel) 2021; 11:diagnostics11040602. [PMID: 33800653 PMCID: PMC8065596 DOI: 10.3390/diagnostics11040602] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022] Open
Abstract
Differential diagnosis between bacterial and viral meningitis is crucial. In our study, to differentiate bacterial vs. viral meningitis, three machine learning (ML) algorithms (multiple logistic regression (MLR), random forest (RF), and naïve-Bayes (NB)) were applied for the two age groups (0-14 and >14 years) of patients with meningitis by both conventional (culture) and molecular (PCR) methods. Cerebrospinal fluid (CSF) neutrophils, CSF lymphocytes, neutrophil-to-lymphocyte ratio (NLR), blood albumin, blood C-reactive protein (CRP), glucose, blood soluble urokinase-type plasminogen activator receptor (suPAR), and CSF lymphocytes-to-blood CRP ratio (LCR) were used as predictors for the ML algorithms. The performance of the ML algorithms was evaluated through a cross-validation procedure, and optimal predictions of the type of meningitis were above 95% for viral and 78% for bacterial meningitis. Overall, MLR and RF yielded the best performance when using CSF neutrophils, CSF lymphocytes, NLR, albumin, glucose, gender, and CRP. Also, our results reconfirm the high diagnostic accuracy of NLR in the differential diagnosis between bacterial and viral meningitis.
Collapse
|
6
|
Mentis AFA, Kyprianou MA, Tzanakaki G. Age-specific application of neutrophil-to-lymphocyte ratio in meningitis: a nationwide study. Eur J Clin Microbiol Infect Dis 2017; 36:1553-1557. [PMID: 28337608 DOI: 10.1007/s10096-017-2967-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/09/2017] [Indexed: 01/24/2023]
Abstract
Cerebrospinal fluid (CSF) neutrophil counts and neutrophil-to-lymphocyte ratio (NLR) are useful in distinguishing bacterial and viral meningitis. Given that meningitis is clinically heterogeneous with regard to age, here we investigated the validity of the CSF NLR and neutrophil assay according to age group. Data from the nationwide referral of >4,000 meningitis cases to the Hellenic Meningitis Reference Laboratory between 2006 and 2013 were examined. CSF NLR and neutrophil counts were stratified according to age, and assay performance was determined using previous cut-off values of 2 and 287 cells/μl for CSF NLR and neutrophils respectively. The distribution of bacterial versus viral meningitis was heterogenous across age groups, with a low proportion of bacterial meningitis in patients aged 5-14. CSF neutrophil count and NLR were significantly more discriminatory for bacterial meningitis in patients aged over 14 years than those aged 0-14. The odds ratio (OR), sensitivity, specificity and positive predictive value (PPV) were significantly higher in older patients for both biomarkers. When combined, the false-positive and false-negative detection of bacterial meningitis was 3.9 and 8.5% respectively, and the OR of 262.2 was 2.5-fold greater than expected from a multiplicative effect alone in patients aged >14 years. Care is required when applying diagnostic tests for meningitis in different age groups because of patient heterogeneity. This is the first description of the age distribution of meningitis cases in Greece, and knowledge of the age-related distribution of neutrophils and NLR in meningitis cases could help towards developing age-specific meningitis diagnostic assays.
Collapse
Affiliation(s)
- A-F A Mentis
- Hellenic National Meningitis Reference Laboratory, Department of Public Health, National School of Public Health, Athens, Greece.
- AAP, The Johns Hopkins University, 3400 North Charles Street, Wyman Park Building S 612, Baltimore, MD, 21218, USA.
| | - M A Kyprianou
- Hellenic National Meningitis Reference Laboratory, Department of Public Health, National School of Public Health, Athens, Greece
| | - G Tzanakaki
- Hellenic National Meningitis Reference Laboratory, Department of Public Health, National School of Public Health, Athens, Greece
| |
Collapse
|
7
|
Neutrophil-to-lymphocyte ratio in the differential diagnosis of acute bacterial meningitis. Eur J Clin Microbiol Infect Dis 2016; 35:397-403. [PMID: 26792137 DOI: 10.1007/s10096-015-2552-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/07/2015] [Indexed: 01/04/2023]
Abstract
The differential diagnosis of acute community-acquired meningitis is of paramount importance in both therapeutic and healthcare-related economic terms. Despite the routinely used markers, novel, easily calculated, and rapidly available biomarkers are needed particularly in resource-poor settings. A promising, exponentially studied inflammatory marker is the neutrophil-to-lymphocyte ratio (NLR), albeit not assessed in meningitis. The aim of this study was to investigate the utility of the NLR in the differential diagnosis of acute meningitis. Data on cerebrospinal fluid (CSF) and blood leukocyte parameters from more than 4,000 patients diagnosed with either bacterial or viral meningitis in Greece during the period 2006-2013 were retrospectively examined. The diagnostic accuracy of the NLR and neutrophil counts in CSF and blood were evaluated by receiver operating characteristic curves. The discrimination ability of both the NLR and neutrophil counts was significantly higher in CSF than in blood. The optimal cutoff values of the NLR and neutrophil counts were 2 in CSF vs 8 in blood, and 287 cells in CSF vs 12,100 cells in blood, respectively. For these values, sensitivity, negative predictive value, and odds ratio were statistically significantly higher in CSF than blood for both markers. Logistic regression analysis showed that the CSF NLR carries independent and additive information to neutrophil counts in the differential diagnosis of acute meningitis. This study is the first one to assess NLR in acute meningitis, providing promising results for its differential diagnosis.
Collapse
|
8
|
Mishra AK, Dufour H, Roche PH, Lonjon M, Raoult D, Fournier PE. Molecular revolution in the diagnosis of microbial brain abscesses. Eur J Clin Microbiol Infect Dis 2014; 33:2083-93. [DOI: 10.1007/s10096-014-2166-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 05/15/2014] [Indexed: 12/30/2022]
|
9
|
Microbiology of acute mastoiditis and complicated or refractory acute otitis media among hospitalized children in the postvaccination era. Pediatr Infect Dis J 2014; 33:111-3. [PMID: 23897291 DOI: 10.1097/inf.0b013e3182a6adb7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the post-heptavalent pneumococcal conjugate vaccine era, Streptococcus pneumoniae remains the leading cause of acute mastoiditis and other complicated or refractory acute otitis media among hospitalized children in our settings. Serotype 19A is predominant, invasive and multidrug resistant causing more than half of all mastoiditis cases, two-thirds of cases with subperiosteal abscess and all those requiring mastoidectomy. Continuous surveillance is required.
Collapse
|
10
|
Arabestani MR, Fazzeli H, Bahram NE, Alikhani MY. Development and Assessment of a Single Tube Internally Controlled Multiplex PCR Assay to Detect Different Pathogenic Bacteria Involved in Blood Stream Infections. INTERNATIONAL JOURNAL OF ENTERIC PATHOGENS 2013. [DOI: 10.17795/ijep10601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
11
|
Xirogianni A, Tsolia M, Voyiatzi A, Sioumala M, Makri A, Argyropoulou A, Paniara O, Markoulatos P, Kourea-Kremastinou J, Tzanakaki G. Diagnosis of Upper and Lower Respiratory Tract Bacterial Infections with the Use of Multiplex PCR Assays. Diagnostics (Basel) 2013; 3:222-31. [PMID: 26835676 PMCID: PMC4665534 DOI: 10.3390/diagnostics3020222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 03/08/2013] [Accepted: 03/21/2013] [Indexed: 11/16/2022] Open
Abstract
The investigation of respiratory infections by molecular techniques provides important information about the epidemiology of respiratory disease, especially during the post-vaccination era. The objective of the present study was the detection of bacterial pathogens directly in clinical samples from patients with upper and lower respiratory tract infections using multiplex polymerase chain reaction (PCR) assays developed in our laboratory. Clinical samples taken over a three-year period (2007–2009) and obtained from 349 patients (adults (n = 66); children (n = 283)) with signs and symptoms of certain upper or lower respiratory tract infections, consisted of: bronchoalveolar lavages (BAL, n = 83), pleural fluids (n = 29), and middle-ear aspirates (n = 237). Overall, 212 samples (61%) were confirmed by culture and/or PCR. Among the positive samples, Streptococcus pneumoniae (mainly serotype 3) was predominant (104/212; 49.0%), followed by non-typable Haemophilus influenzae (NTHi) 59/212; 27.8%) and Streptococcus pyogenes (47/212; 22%). Haemophilus influenzae type b was detected in only three samples. The underlying microbiology of respiratory infections is gradually changing in response to various selective pressures, such as vaccine use and antibiotic consumption. The application of multiplex PCR (mPCR) assays is particularly useful since it successfully identified the microorganisms implicated in acute otitis media or lower respiratory tract infections in nearly 75% of patients with a positive result compared to conventional cultures. Non-culture identification of the implicated pneumococcal serotypes is also an important issue for monitoring pneumococcal infections in the era of conjugate pneumococcal vaccines.
Collapse
Affiliation(s)
- Athanasia Xirogianni
- National Meningitis Reference Laboratory, National School of Public Health, 196, Alexandras Avenue, Athens 11521, Greece.
- School of Health Sciences, Department of Biochemistry and Biotechnology, University of Thessaly, Ploutonos 26 & Aiolou str, Larissa 41221, Greece.
| | - Maria Tsolia
- Second Department of Pediatrics, University of Athens School of Medicine, P. and A. Kyriakou Children's Hospital, Thevon & Levadeias str, Athens 11527, Greece.
| | - Aliki Voyiatzi
- Penteli's Children's Hospital, Microbiology Laboratory, 8 Ippokratous str., Penteli, Attiki 15236, Greece.
| | - Maria Sioumala
- National Meningitis Reference Laboratory, National School of Public Health, 196, Alexandras Avenue, Athens 11521, Greece.
| | - Antonia Makri
- Penteli's Children's Hospital, Microbiology Laboratory, 8 Ippokratous str., Penteli, Attiki 15236, Greece.
| | - Athina Argyropoulou
- "Evaggelismos" General Hospital of Athens, Microbiology Laboratory, 45-47 Ipsilantou Str, Athens 10676, Greece.
| | - Olga Paniara
- "Evaggelismos" General Hospital of Athens, Microbiology Laboratory, 45-47 Ipsilantou Str, Athens 10676, Greece.
| | - Panayotis Markoulatos
- School of Health Sciences, Department of Biochemistry and Biotechnology, University of Thessaly, Ploutonos 26 & Aiolou str, Larissa 41221, Greece.
| | - Jenny Kourea-Kremastinou
- National Meningitis Reference Laboratory, National School of Public Health, 196, Alexandras Avenue, Athens 11521, Greece.
| | - Georgina Tzanakaki
- National Meningitis Reference Laboratory, National School of Public Health, 196, Alexandras Avenue, Athens 11521, Greece.
| |
Collapse
|
12
|
Tzanakaki G, Paparoupa M, Kyprianou M, Barbouni A, Eugen-Olsen J, Kourea-Kremastinou J. Elevated soluble urokinase receptor values in CSF, age and bacterial meningitis infection are independent and additive risk factors of fatal outcome. Eur J Clin Microbiol Infect Dis 2011; 31:1157-62. [DOI: 10.1007/s10096-011-1423-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 09/12/2011] [Indexed: 10/17/2022]
|
13
|
Rapid detection of Staphylococcus aureus via a sensitive DNA hybridization assay based on a long-lifetime luminescent europium marker. Mikrochim Acta 2011. [DOI: 10.1007/s00604-011-0654-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|