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Cristina ML, Spagnolo AM, Sartini M, Carbone A, Oliva M, Schinca E, Boni S, Pontali E. An Overview on Candida auris in Healthcare Settings. J Fungi (Basel) 2023; 9:913. [PMID: 37755021 PMCID: PMC10532978 DOI: 10.3390/jof9090913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023] Open
Abstract
Candida auris has become a major concern in critical care medicine due to the increasing number of immunocompromised patients and candidiasis is the most frequent cause of fungal infections. C. auris and other fungal pathogens are responsible for at least 13 million infections and 1.5 million deaths globally per year. In immunocompromised patients, infections can quickly become severe, causing wound infections, otitis and candidemia, resulting in high morbidity and mortality. The clinical presentation of C. auris is often non-specific and similar to other types of systemic infections; in addition, it is harder to identify from cultures than other, more common types of Candida spp. Some infections are particularly difficult to treat due to multi-resistance to several antifungal agents, including fluconazole (and other azoles), amphotericin B and echinocandins. This entails treatment with more drugs and at higher doses. Even after treatment for invasive infections, patients generally remain colonized for long periods, so all infection control measures must be followed during and after treatment of the C. auris infection. Screening patients for C. auris colonization enables facilities to identify individuals with C. auris colonization and to implement infection prevention and control measures. This pathogenic fungus shows an innate resilience, enabling survival and persistence in healthcare environment and the ability to rapidly colonize the patient's skin and be easily transmitted within the healthcare setting, thus leading to a serious and prolonged outbreak.
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Affiliation(s)
- Maria Luisa Cristina
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (A.M.S.); (E.S.)
- Hospital Hygiene Unit, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Anna Maria Spagnolo
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (A.M.S.); (E.S.)
- Hospital Hygiene Unit, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Marina Sartini
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (A.M.S.); (E.S.)
- Hospital Hygiene Unit, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Alessio Carbone
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (A.M.S.); (E.S.)
| | - Martino Oliva
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (A.M.S.); (E.S.)
| | - Elisa Schinca
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (A.M.S.); (E.S.)
- Hospital Hygiene Unit, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Silvia Boni
- Infectious Disease Unit, Galliera Hospital, 16128 Genoa, Italy
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Laganà A, Facciolà A, Iannazzo D, Celesti C, Polimeni E, Biondo C, Di Pietro A, Visalli G. Promising Materials in the Fight against Healthcare-Associated Infections: Antibacterial Properties of Chitosan-Polyhedral Oligomeric Silsesquioxanes Hybrid Hydrogels. J Funct Biomater 2023; 14:428. [PMID: 37623672 PMCID: PMC10456118 DOI: 10.3390/jfb14080428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023] Open
Abstract
New technologies and materials could help in this fight against healthcare-associated infections. As the majority of these infections are caused by antibiotic-resistant bacteria, the development of materials with intrinsic antibacterial properties is a promising field of research. We combined chitosan (CS), with antibacterial properties, with polyhedral oligomeric silsesquioxanes (POSS), a biocompatible polymer with physico-chemical, mechanical, and rheological properties, creating a hydrogel using cross-linking agent genipin. The antibacterial properties of CS and CS-POSS hydrogels were investigated against nosocomial Gram-positive and Gram-negative bacteria both in terms of membrane damage and surface charge variations, and finally, the anti-biofilm property was studied through confocal microscopy. Both materials showed a good antibacterial capacity against all analyzed strains, both in suspension, with % decreases between 36.36 and 73.58 for CS and 29.86 and 66.04 for CS-POSS, and in plates with % decreases between 55.29 and 78.32 and 17.00 and 53.99 for CS and CS-POSS, respectively. The treated strains compared to the baseline condition showed an important membrane damage, which also determined a variation of surface charges, and finally, for both hydrogels, a remarkable anti-biofilm property was highlighted. Our findings showed a possible future use of these biocompatible materials in the manufacture of medical and surgical devices with intrinsic antibacterial and anti-biofilm properties.
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Affiliation(s)
- Antonio Laganà
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; (A.L.); (A.F.); (A.D.P.)
- Istituto Clinico Polispecialistico C.O.T., Cure Ortopediche Traumatologiche s.p.a., 98124 Messina, Italy
| | - Alessio Facciolà
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; (A.L.); (A.F.); (A.D.P.)
| | - Daniela Iannazzo
- Department of Electronic Engineering, Industrial Chemistry and Engineering, University of Messina, 98166 Messina, Italy; (D.I.); (C.C.)
| | - Consuelo Celesti
- Department of Electronic Engineering, Industrial Chemistry and Engineering, University of Messina, 98166 Messina, Italy; (D.I.); (C.C.)
| | - Evelina Polimeni
- Department of Human Pathology, University of Messina, 98125 Messina, Italy; (E.P.); (C.B.)
| | - Carmelo Biondo
- Department of Human Pathology, University of Messina, 98125 Messina, Italy; (E.P.); (C.B.)
| | - Angela Di Pietro
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; (A.L.); (A.F.); (A.D.P.)
| | - Giuseppa Visalli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; (A.L.); (A.F.); (A.D.P.)
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Liu H, Yang L, Chen Q, Song H, Bo X, Guo J, Li P, Ni M. Time Series Genomics of Pseudomonas aeruginosa Reveals the Emergence of a Hypermutator Phenotype and Within-Host Evolution in Clinical Inpatients. Microbiol Spectr 2022; 10:e0005722. [PMID: 35861512 PMCID: PMC9430856 DOI: 10.1128/spectrum.00057-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/06/2022] [Indexed: 11/20/2022] Open
Abstract
Pseudomonas aeruginosa, a common opportunistic pathogen, is one of the leading etiological agents of nosocomial infections. Many previous studies have reported the nosocomial transmission and epidemiology of P. aeruginosa infections. However, longitudinal studies regarding the dynamics of P. aeruginosa colonization and infection in health care settings are limited. We obtained longitudinal samples from aged patients with prolonged intensive care unit (ICU) stays (~4 to 19 months). P. aeruginosa was isolated from 71 samples obtained from seven patients and characterized by whole-genome sequencing. The P. aeruginosa isolates were assigned to 10 clonal complexes, and turnover of main clones was observed in sequential sputum samples from two patients. By comparing intraclonal genomic diversities, we identified two clones that had significantly higher numbers of single nucleotide polymorphisms and variations in homopolymeric sequences than the other clones, indicating a hypermutator phenotype. These hypermutator clones were associated with mutations T147I/G521S and P27L in the MutL protein, and their mutation rates were estimated to be 3.20 × 10-5 and 6.59 × 10-5 per year per nucleotide, respectively. We also identified 24 recurrently mutated genes that exhibited intraclonal diversity in two or more clones. Notably, one recurrent mutation, S698F in FptA, was observed in four clones. These findings suggest that convergent microevolution and adaption of P. aeruginosa occur in long-term ICU patients. IMPORTANCE Pseudomonas aeruginosa is a predominant opportunistic pathogen that causes nosocomial infections. Inappropriate empirical therapy can lead to prolonged hospital stays and increased mortality. In our study of sequential P. aeruginosa isolates from inpatients, high intrahost diversity was observed, including switching of clones and the emergence of a hypermutator phenotype. Recurrently mutated genes also suggested that convergent microevolution and adaption of P. aeruginosa occur in inpatients, and genomic diversity is associated with differences in multiple-drug-resistance profiles. Taken together, our findings highlight the importance of longitudinal surveillance of nosocomial P. aeruginosa clones.
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Affiliation(s)
- Hongjie Liu
- Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Lang Yang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Qichao Chen
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Hongbin Song
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Xiaochen Bo
- Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Jingyu Guo
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
- The 316th Hospital of Chinese PLA, Beijing, China
| | - Peng Li
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Ming Ni
- Institute of Health Service and Transfusion Medicine, Beijing, China
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Cristina ML, Sartini M, Schinca E, Ottria G, Casini B, Spagnolo AM. Evaluation of Multidrug-Resistant P. aeruginosa in Healthcare Facility Water Systems. Antibiotics (Basel) 2021; 10:1500. [PMID: 34943711 PMCID: PMC8698422 DOI: 10.3390/antibiotics10121500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022] Open
Abstract
According to the WHO, P. aeruginosa is one of the antibiotic-resistant bacteria that represent the biggest threat to public health. The aim of the study was to establish the prevalence of antibiotic-resistant P. aeruginosa in the water systems of various healthcare facilities over the course of nine years. A total of 4500 tap water system samples were taken from seventeen healthcare facilities. The culture method was used to detect P. aeruginosa, and the isolates were then tested for antibiotic resistance using the standardised disc diffusion method. Eleven antibiotics from five different classes were tested. P. aeruginosa was found to have contaminated 2.07% (no. 93) of the water samples. The majority of positive samples came from the dental units (30.11%) and the ward kitchens (23.66%). Considering the total isolates, 56.99% (no. 3) were resistant to at least one of the antibiotics tested. A total of 71.43% of P. aeruginosa isolated from water emerging from dental unit handpieces was antibiotic-resistant, with 45% of it resistant to ≥3 classes of antibiotics. Out of the total isolates, 19.35% showed resistance to carbapenems. It would be advisable to systematically screen tap water for opportunistic micro-organisms such as P. aeruginosa, as many countries already do, including this in the Water Safety Plan.
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Affiliation(s)
- Maria Luisa Cristina
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (E.S.); (G.O.); (A.M.S.)
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Marina Sartini
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (E.S.); (G.O.); (A.M.S.)
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Elisa Schinca
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (E.S.); (G.O.); (A.M.S.)
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Gianluca Ottria
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (E.S.); (G.O.); (A.M.S.)
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Beatrice Casini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Anna Maria Spagnolo
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (E.S.); (G.O.); (A.M.S.)
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genova, Italy
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Epidemiology and Prevention of Healthcare-Associated Infections in Geriatric Patients: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105333. [PMID: 34067797 PMCID: PMC8156303 DOI: 10.3390/ijerph18105333] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/16/2022]
Abstract
Demographic studies show that life expectancy is increasing in developed countries; increased longevity has also increased the share of the older population with often concomitant chronic conditions. An ageing population and increased comorbidities lead to more complex pharmacological therapies (polypharmacy). The particular picture provided by chronic conditions and polypharmacy can lead to longer hospital stays and a greater need for healthcare. Elderly patients are identified as being in the high-risk group for the development of healthcare-associated infections (HAIs) due to the age-related decline of the immune system, known as immunosenescence. Comorbid conditions can often complicate infections, diminishing our ability to treat them effectively. Respiratory tract infections are the most common healthcare-associated infections, followed by urinary tract infections. HAIs in geriatric patients are responsible for longer hospital stays, extended antibiotic therapy, significant mortality, and higher healthcare costs. This is because the microorganisms involved are multidrug-resistant and, therefore, more difficult to eliminate. Moreover, geriatric patients are frequently transferred from one facility (nursing homes, skilled nursing facilities, home care, and other specialty clinics) to another or from one hospital ward to another; these transitions cause care fragmentation, which can undermine the effectiveness of treatment and allow pathogens to be transferred from one setting to another and from one person to another. Multifactorial efforts such as early recognition of infections, restricted use of invasive devices, and effective infection control measures (surveillance, isolation practices, hand hygiene, etc.) can contribute to significant reduction of HAIs in geriatric patients.
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Cristina ML, Sartini M, Schinca E, Ottria G, Dupont C, Bova P, Coccia G, Casini B, Spagnolo AM. Is Post-Reprocessing Microbiological Surveillance of Duodenoscopes Effective in Reducing the Potential Risk in Transmitting Pathogens? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010140. [PMID: 31878150 PMCID: PMC6982321 DOI: 10.3390/ijerph17010140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 12/20/2022]
Abstract
Background: The use of a contaminated endoscope may lead to infections due to the transmission of potential pathogens from patient to patient. Methods: Post-reprocessing microbiological surveillance of four duodenoscopes was carried out over a three-year period in the Digestive Endoscopy Unit of an Italian hospital. Sampling of duodenoscopes was performed after the devices have been reprocessed. The initial phase of surveillance involved the contemporary evaluation of the four duodenoscopes; afterwards, microbiological surveillance proceeded at monthly intervals. Results: The initial phase of surveillance revealed that three duodenoscopes presented a high level of contamination with “high-concern” micro-organisms, some of which were multi-drug-resistant. The highest values of contamination regarded the species P. aeruginosa (2500 CFU/duodenoscope), K. pneumoniae (2580 CFU/duodenoscope), and A. baumannii (2600 CFU/duodenoscope). Since the cultures were repeatedly positive on three successive occasions, the contaminated devices were sent to the manufacturer for evaluation. Audits were carried out with the personnel responsible for reprocessing, which was aimed to optimize the procedures used, and subsequently, only one case of non-conformity was found. Conclusions: Our study highlighted both the potential risk of transmitting pathogens through the use of duodenoscopes and the importance of implementing a well-structured system of microbiological surveillance and training programs, in order to reduce the risk of spreading retrograde cholangiopancreatography (ERCP)-associated infections.
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Affiliation(s)
- Maria Luisa Cristina
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy; (M.L.C.); (E.S.); (G.O.); (C.D.); (A.M.S.)
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Marina Sartini
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy; (M.L.C.); (E.S.); (G.O.); (C.D.); (A.M.S.)
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genova, Italy
- Correspondence:
| | - Elisa Schinca
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy; (M.L.C.); (E.S.); (G.O.); (C.D.); (A.M.S.)
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Gianluca Ottria
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy; (M.L.C.); (E.S.); (G.O.); (C.D.); (A.M.S.)
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Chiara Dupont
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy; (M.L.C.); (E.S.); (G.O.); (C.D.); (A.M.S.)
| | - Palmira Bova
- S.C. Gastroenterology, E.O. Ospedali Galliera, 16128 Genova, Italy; (P.B.); (G.C.)
| | - Gianni Coccia
- S.C. Gastroenterology, E.O. Ospedali Galliera, 16128 Genova, Italy; (P.B.); (G.C.)
| | - Beatrice Casini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Anna Maria Spagnolo
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy; (M.L.C.); (E.S.); (G.O.); (C.D.); (A.M.S.)
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genova, Italy
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Serratia marcescens Infections in Neonatal Intensive Care Units (NICUs). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040610. [PMID: 30791509 PMCID: PMC6406414 DOI: 10.3390/ijerph16040610] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 01/21/2023]
Abstract
Serratia marcescens belongs to the family Enterobacteriaceae, which is commonly found in water, soil, animals, insects, plants. Although S. marcescens displays relatively low virulence, it causes nosocomial infections and outbreaks in severely immunocompromised or critically ill patients, particularly in settings such as intensive care units (ICUs), especially neonatal units (NICUs). This microorganism gives rise to a wide range of clinical manifestations in newborns: from asymptomatic colonization to keratitis, conjunctivitis, urinary tract infections, pneumonia, surgical wound infections, sepsis, bloodstream infection and meningitis. The most frequent site of infection is the bloodstream, followed by the respiratory apparatus and the gastrointestinal tract. Strains of S. marcescens involved in epidemic events have frequently proved to be multi-resistant. Indeed, this species displays intrinsic resistance to several classes of antibiotics. Often, the specific source of the infection cannot be identified. However, the contaminated hands of healthcare workers are believed to be a major vehicle of its transmission. In neonatal intensive care units, colonized or infected newborns are the main potential source of S. marcescens, particularly in the respiratory apparatus, but also in the gastrointestinal tract. The early identification of colonized or infected patients and the prompt implementation of infection control measures, particularly rigorous hand hygiene and contact precautions, are essential in order to curb the spread of infection.
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Novel pyridyl nitrofuranyl isoxazolines show antibacterial activity against multiple drug resistant Staphylococcus species. Bioorg Med Chem 2017; 25:3971-3979. [DOI: 10.1016/j.bmc.2017.05.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/08/2017] [Accepted: 05/17/2017] [Indexed: 11/21/2022]
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Ghantoji SS, Stibich M, Stachowiak J, Cantu S, Adachi JA, Raad II, Chemaly RF. Non-inferiority of pulsed xenon UV light versus bleach for reducing environmental Clostridium difficile contamination on high-touch surfaces in Clostridium difficile infection isolation rooms. J Med Microbiol 2015. [DOI: 10.1099/jmm.0.000004] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Shashank S. Ghantoji
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd/Box 402, Houston, TX 77030, USA
| | - Mark Stibich
- Xenex Disinfection Services, 121 Interpark, Suite 104, San Antonio, Texas, 78216, USA
| | - Julie Stachowiak
- Xenex Disinfection Services, 121 Interpark, Suite 104, San Antonio, Texas, 78216, USA
| | - Sherry Cantu
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd/Box 402, Houston, TX 77030, USA
| | - Javier A. Adachi
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd/Box 402, Houston, TX 77030, USA
| | - Issam I. Raad
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd/Box 402, Houston, TX 77030, USA
| | - Roy F. Chemaly
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd/Box 402, Houston, TX 77030, USA
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