|
1
|
Sękowska A, Czyżewski K, Jaremek K, Zalas-Więcek P, Zając-Spychała O, Wachowiak J, Szmydki-Baran A, Hutnik Ł, Gietka A, Gryniewicz-Kwiatkowska O, Dembowska-Bagińska B, Semczuk K, Dzierżanowska-Fangrat K, Czogała W, Balwierz W, Żak I, Tomaszewska R, Szczepański T, Bień E, Irga-Jaworska N, Machnik K, Urbańska-Rakus J, Pająk S, Płonowski M, Krawczuk-Rybak M, Królak A, Ociepa T, Urasiński T, Wawryków P, Peregud-Pogorzelski J, Brzeski T, Mycko K, Mańko-Glińska H, Badowska W, Urbanek-Dądela A, Karolczyk G, Stolpa W, Skowron-Kandzia K, Mizia-Malarz A, Pierlejewski F, Młynarski W, Musiał J, Chaber R, Zawitkowska J, Zaucha-Prażmo A, Drabko K, Goździk J, Frączkiewicz J, Salamonowicz-Bodzioch M, Kałwak K, Styczyński J. Infections with Klebsiella pneumoniae in Children Undergoing Anticancer Therapy or Hematopoietic Cell Transplantation: A Multicenter Nationwide Study. J Clin Med 2024; 13:4078. [PMID: 39064118 PMCID: PMC11277684 DOI: 10.3390/jcm13144078] [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: 05/29/2024] [Revised: 06/25/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Background:Klebsiella pneumoniae is a nosocomial pathogen that causes severe infections in immunocompromised patients. The aim of the study was to conduct a microbiological and clinical analysis of K. pneumoniae infections in children with malignancies or undergoing hematopoietic cell transplantation in Poland. Methods: We conducted a retrospective, multicenter study including children and adolescents under 19 years old treated between 2012 and 2021. We analyzed patients' characteristics, microbiological data, and the outcomes of antibiotic therapy. Results: A total of 9121 newly diagnosed children were treated for malignancy and 1697 pediatric patients underwent hematopoietic cell transplantation. K. pneumoniae infections were diagnosed in 527 patients. Their overall incidence was 4.86% in pediatric hematology and oncology patients and 4.95% in patients who underwent hematopoietic cell transplantation. The incidence of infection was higher in patients with acute leukemia than with solid tumors (7.8% vs. 4.1%; OR = 2.0; 95% CI = 1.6-2.4; p < 0.0001). The most frequent source of infection was in the urinary tract at 55.2%. More than 57% of K. pneumoniae strains were extended-spectrum β-lactamase-positive and almost 34% were multidrug-resistant. Infections with K. pneumoniae contributed to death in 3.22% of patients. Conclusions: K. pneumoniae is one of the most critical pathogens in children suffering from malignancies or undergoing hematopoietic cell transplantation. The incidence of multidrug-resistant K. pneumoniae strains is increasing and contributing to poor clinical outcome.
Collapse
Affiliation(s)
- Alicja Sękowska
- Microbiology Department, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland;
| | - Krzysztof Czyżewski
- Department of Pediatrics, Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland; (K.C.); (K.J.); (J.S.)
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, 61-701 Poznan, Poland; (O.Z.-S.); (J.W.)
| | - Kamila Jaremek
- Department of Pediatrics, Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland; (K.C.); (K.J.); (J.S.)
| | - Patrycja Zalas-Więcek
- Microbiology Department, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland;
| | - Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, 61-701 Poznan, Poland; (O.Z.-S.); (J.W.)
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, 61-701 Poznan, Poland; (O.Z.-S.); (J.W.)
| | - Anna Szmydki-Baran
- Department of Oncology, Pediatric Hematology, Clinical Transplantation and Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.S.-B.); (Ł.H.)
| | - Łukasz Hutnik
- Department of Oncology, Pediatric Hematology, Clinical Transplantation and Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.S.-B.); (Ł.H.)
| | - Agnieszka Gietka
- Department of Oncology, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (A.G.); (O.G.-K.); (B.D.-B.)
| | - Olga Gryniewicz-Kwiatkowska
- Department of Oncology, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (A.G.); (O.G.-K.); (B.D.-B.)
| | - Bożenna Dembowska-Bagińska
- Department of Oncology, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (A.G.); (O.G.-K.); (B.D.-B.)
| | - Katarzyna Semczuk
- Department of Clinical Microbiology and Immunology, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (K.S.); (K.D.-F.)
| | - Katarzyna Dzierżanowska-Fangrat
- Department of Clinical Microbiology and Immunology, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (K.S.); (K.D.-F.)
| | - Wojciech Czogała
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 31-008 Krakow, Poland; (W.C.); (W.B.)
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 31-008 Krakow, Poland; (W.C.); (W.B.)
| | - Iwona Żak
- Department of Microbiology, University Children’s Hospital, 30-663 Krakow, Poland;
| | - Renata Tomaszewska
- Department of Pediatric Hematology and Oncology, Silesian Medical University, 41-808 Zabrze, Poland; (R.T.); (T.S.)
| | - Tomasz Szczepański
- Department of Pediatric Hematology and Oncology, Silesian Medical University, 41-808 Zabrze, Poland; (R.T.); (T.S.)
| | - Ewa Bień
- Department of Pediatrics, Hematology and Oncology, Medical University, 80-210 Gdansk, Poland; (E.B.); (N.I.-J.)
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, 80-210 Gdansk, Poland; (E.B.); (N.I.-J.)
| | - Katarzyna Machnik
- Division of Pediatric Hematology and Oncology, Chorzow City Hospital, 41-500 Chorzow, Poland; (K.M.); (J.U.-R.); (S.P.)
| | - Justyna Urbańska-Rakus
- Division of Pediatric Hematology and Oncology, Chorzow City Hospital, 41-500 Chorzow, Poland; (K.M.); (J.U.-R.); (S.P.)
| | - Sonia Pająk
- Division of Pediatric Hematology and Oncology, Chorzow City Hospital, 41-500 Chorzow, Poland; (K.M.); (J.U.-R.); (S.P.)
| | - Marcin Płonowski
- Department of Pediatric Oncology and Hematology, Medical University, 15-089 Bialystok, Poland; (M.P.); (M.K.-R.)
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University, 15-089 Bialystok, Poland; (M.P.); (M.K.-R.)
| | - Aleksandra Królak
- Department of Pediatrics, Pediatric Hematooncology and Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland; (A.K.); (T.O.); (T.U.)
| | - Tomasz Ociepa
- Department of Pediatrics, Pediatric Hematooncology and Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland; (A.K.); (T.O.); (T.U.)
| | - Tomasz Urasiński
- Department of Pediatrics, Pediatric Hematooncology and Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland; (A.K.); (T.O.); (T.U.)
| | - Paweł Wawryków
- Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, 70-204 Szczecin, Poland; (P.W.); (J.P.-P.)
| | - Jarosław Peregud-Pogorzelski
- Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, 70-204 Szczecin, Poland; (P.W.); (J.P.-P.)
| | - Tomasz Brzeski
- Department of Clinical Pediatrics University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland; (T.B.); (K.M.); (H.M.-G.); (W.B.)
- Clinical Divison of Pediatric Oncology and Hematology, Regional Specialised Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Katarzyna Mycko
- Department of Clinical Pediatrics University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland; (T.B.); (K.M.); (H.M.-G.); (W.B.)
- Clinical Divison of Pediatric Oncology and Hematology, Regional Specialised Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Hanna Mańko-Glińska
- Department of Clinical Pediatrics University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland; (T.B.); (K.M.); (H.M.-G.); (W.B.)
- Clinical Divison of Pediatric Oncology and Hematology, Regional Specialised Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Wanda Badowska
- Department of Clinical Pediatrics University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland; (T.B.); (K.M.); (H.M.-G.); (W.B.)
- Clinical Divison of Pediatric Oncology and Hematology, Regional Specialised Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Agnieszka Urbanek-Dądela
- Division of Pediatric Hematology and Oncology, Children Hospital, 25-736 Kielce, Poland; (A.U.-D.); (G.K.)
| | - Grażyna Karolczyk
- Division of Pediatric Hematology and Oncology, Children Hospital, 25-736 Kielce, Poland; (A.U.-D.); (G.K.)
| | - Weronika Stolpa
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, 40-055 Katowice, Poland; (W.S.); (K.S.-K.); (A.M.-M.)
| | - Katarzyna Skowron-Kandzia
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, 40-055 Katowice, Poland; (W.S.); (K.S.-K.); (A.M.-M.)
| | - Agnieszka Mizia-Malarz
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, 40-055 Katowice, Poland; (W.S.); (K.S.-K.); (A.M.-M.)
| | - Filip Pierlejewski
- Department of Pediatrics, Hematology and Oncology, Medical University, 90-419 Lodz, Poland; (F.P.); (W.M.)
| | - Wojciech Młynarski
- Department of Pediatrics, Hematology and Oncology, Medical University, 90-419 Lodz, Poland; (F.P.); (W.M.)
| | - Jakub Musiał
- Department of Pediatric Oncohematology, Medical Faculty University of Rzeszow, Clinical Provincial Hospital No. 2, 35-301 Rzeszow, Poland; (J.M.); (R.C.)
| | - Radosław Chaber
- Department of Pediatric Oncohematology, Medical Faculty University of Rzeszow, Clinical Provincial Hospital No. 2, 35-301 Rzeszow, Poland; (J.M.); (R.C.)
| | - Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-059 Lublin, Poland; (J.Z.); (A.Z.-P.); (K.D.)
| | - Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-059 Lublin, Poland; (J.Z.); (A.Z.-P.); (K.D.)
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-059 Lublin, Poland; (J.Z.); (A.Z.-P.); (K.D.)
| | - Jolanta Goździk
- Stem Cell Transplant Center, University Children’s Hospital, Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, 31-008 Krakow, Poland;
| | - Jowita Frączkiewicz
- Department of Pediatric Hematology, Oncology and BMT, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.F.); (M.S.-B.); (K.K.)
| | - Małgorzata Salamonowicz-Bodzioch
- Department of Pediatric Hematology, Oncology and BMT, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.F.); (M.S.-B.); (K.K.)
| | - Krzysztof Kałwak
- Department of Pediatric Hematology, Oncology and BMT, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.F.); (M.S.-B.); (K.K.)
| | - Jan Styczyński
- Department of Pediatrics, Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland; (K.C.); (K.J.); (J.S.)
| |
Collapse
|
|
2
|
Chen J, Tang L, Song W, Sun C, Zhang W. Infection associated with CDK4/6 inhibitors: a pharmacovigilance analysis of the FDA adverse event reporting system database. Front Pharmacol 2024; 15:1371346. [PMID: 39011505 PMCID: PMC11247343 DOI: 10.3389/fphar.2024.1371346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/14/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors are first-line treatments for hormone receptor-positive/human epidermal growth factor receptor 2-negative breast cancer. With their increasing clinical use, infection-related adverse events (AEs) associated with CDK4/6 inhibitors have been widely reported in recent years. This study aimed to analyze the occurrence of infections associated with the CDK4/6 inhibitors (palbociclib, ribociclib and abemaciclib) based on the real-world data from the US Food and Drug Administration Adverse Event Reporting System (FAERS) database. Methods Data were extracted from the FAERS database between 2015Q1 and 2022Q3. The clinical characteristics of patients with primary suspected infection-related AEs were analyzed. A disproportionality analysis was performed to investigate the potential association between AEs and CDK4/6 inhibitors. The influencing factors were evaluated using Pearson's chi-square test. Results Reports of infection-related AEs associated with ribociclib accounted for 8.58% of the total reports of AEs associated with ribociclib, followed by palbociclib (2.72%) and abemaciclib (1.24%). Ribociclib (67.65%) was associated with more serious outcome events than palbociclib (30%) or abemaciclib (48.08%). The sex and age were not associated with outcome severity. Disproportionality analysis showed that fourteen, sixteen and two infection-related preferred terms were detected for palbociclib, ribociclib and abemaciclib, respectively. Conclusion Infection-related AEs were highly associated with three CDK4/6 inhibitors, especially palbociclib and ribociclib, based on the real-world data from the FAERS database. However, further causality assessment is required.
Collapse
Affiliation(s)
- Jinhua Chen
- Department of Pharmacy, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Henan Engineering Research Center for Tumor Precision Medicine and Comprehensive Evaluation, Henan Provincial Key Laboratory of Anticancer Drug Research, Zhengzhou, China
| | - Linlin Tang
- Department of Pharmacy, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Wenping Song
- Department of Pharmacy, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Henan Engineering Research Center for Tumor Precision Medicine and Comprehensive Evaluation, Henan Provincial Key Laboratory of Anticancer Drug Research, Zhengzhou, China
| | - Cuicui Sun
- Department of Pharmacy, Qilu Hospital of Shandong University, Ji’nan, China
| | - Wenzhou Zhang
- Department of Pharmacy, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Henan Engineering Research Center for Tumor Precision Medicine and Comprehensive Evaluation, Henan Provincial Key Laboratory of Anticancer Drug Research, Zhengzhou, China
| |
Collapse
|
|
4
|
Sardzikova S, Andrijkova K, Svec P, Beke G, Klucar L, Minarik G, Bielik V, Kolenova A, Soltys K. Gut diversity and the resistome as biomarkers of febrile neutropenia outcome in paediatric oncology patients undergoing hematopoietic stem cell transplantation. Sci Rep 2024; 14:5504. [PMID: 38448687 PMCID: PMC10918076 DOI: 10.1038/s41598-024-56242-8] [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: 11/13/2023] [Accepted: 03/04/2024] [Indexed: 03/08/2024] Open
Abstract
The gut microbiota of paediatric oncology patients undergoing a conditioning regimen before hematopoietic stem cell transplantation is recently considered to play role in febrile neutropenia. Disruption of commensal microbiota and evolution of opportune pathogens community carrying a plethora of antibiotic-resistance genes play crucial role. However, the impact, predictive role and association of patient´s gut resistome in the course of the therapy is still to be elucidated. We analysed gut microbiota composition and resistome of 18 paediatric oncology patients undergoing hematopoietic stem cell transplantation, including 12 patients developing febrile neutropenia, hospitalized at The Bone Marrow Transplantation Unit of the National Institute of Children´s disease in Slovak Republic and healthy individuals (n = 14). Gut microbiome of stool samples obtained in 3 time points, before hematopoietic stem cell transplantation (n = 16), one week after hematopoietic stem cell transplantation (n = 16) and four weeks after hematopoietic stem cell transplantation (n = 14) was investigated using shotgun metagenome sequencing and bioinformatical analysis. We identified significant decrease in alpha-diversity and nine antibiotic-resistance genes msr(C), dfrG, erm(T), VanHAX, erm(B), aac(6)-aph(2), aph(3)-III, ant(6)-Ia and aac(6)-Ii, one week after hematopoietic stem cell transplantation associated with febrile neutropenia. Multidrug-resistant opportune pathogens of ESKAPE, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli found in the gut carried the significant subset of patient's resistome. Over 50% of patients treated with trimethoprim/sulfamethoxazole, piperacillin/tazobactam and amikacin carried antibiotic-resistance genes to applied treatment. The alpha diversity and the resistome of gut microbiota one week after hematopoietic stem cell transplantation is relevant predictor of febrile neutropenia outcome after hematopoietic stem cell transplantation. Furthermore, the interindividual diversity of multi-drug resistant opportunistic pathogens with variable portfolios of antibiotic-resistance genes indicates necessity of preventive, personalized approach.
Collapse
Affiliation(s)
- Sara Sardzikova
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia
| | - Kristina Andrijkova
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia
| | - Peter Svec
- Department of Paediatric Haematology and Oncology, Children's Haematology and Oncology Clinic and Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Gabor Beke
- Institute of Molecular Biology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Lubos Klucar
- Institute of Molecular Biology, Slovak Academy of Sciences, Bratislava, Slovakia
| | | | - Viktor Bielik
- Department of Biological and Medical Science, Faculty of Physical Education and Sport, Comenius University in Bratislava, Bratislava, Slovakia
| | - Alexandra Kolenova
- Department of Paediatric Haematology and Oncology, Children's Haematology and Oncology Clinic and Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Katarina Soltys
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia.
| |
Collapse
|
|
5
|
Zheng C, Wang G, Qiu L, Luo X, Zhang X, Zhong L, Zhang C, Lin R, Chen Q. Clinical characteristics, risk factors, and outcomes of patients with polymicrobial Pseudomonas aeruginosa bloodstream infections. J Chin Med Assoc 2023; 86:1066-1073. [PMID: 37792994 DOI: 10.1097/jcma.0000000000001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Previous studies on polymicrobial Pseudomonas aeruginosa bloodstream infections (Pa-BSIs) are dated, and it is necessary to reanalyze polymicrobial Pa-BSIs. The aim of this study was to investigate clinical characteristics and risk factors for polymicrobial Pa-BSI in comparison with monomicrobial Pa-BSI. METHODS A double-center retrospective observational study was performed between January 1, 2013 and June 30, 2022, in two tertiary hospitals. All patients with Pa-BSI were enrolled, and their clinical data were collected by reviewing electronic medical records. RESULTS A total of 278 patients with Pa-BSI were enrolled, including 77 patients (27.7%) with polymicrobial Pa-BSI. Compared with monomicrobial Pa-BSI, the main source of polymicrobial Pa-BSI was pneumonia (49.4% vs 31.3%, p < 0.01), whereas the main source of monomicrobial Pa-BSI was primary BSIs (21.9% vs 2.6%, p = 0.04). In multivariate analysis, a history of cerebrovascular accident (CVA) (adjusted odds ratio [OR], 3.62; 95% CI, 1.46-8.92) was independently associated with polymicrobial Pa-BSI. Primary BSI was associated with monomicrobial Pa-BSI (OR, 0.08; 95% CI, 0.02-0.38). Patients with polymicrobial Pa-BSI had a longer intensive care unit (ICU) length of stay after onset of BSI than those with monomicrobial Pa-BSI (2 [2, 16] vs 13 [3.75, 29], p = 0.02). CONCLUSION Patients with Pa-BSI and the presence of CVA need to be alert to the possibility of polymicrobial BSI occurrence. Prolonged ICU stay and pneumonia as a source of BSI warrant clinician attention for polymicrobial Pa-BSI, and primary BSIs are likely associated with monomicrobial BSIs.
Collapse
Affiliation(s)
- Cheng Zheng
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Guangtao Wang
- Department of Neurosurgery, Municipal Hospital Affiliated to Taizhou University, Taizhou, Zhejiang, China
- Department of Neurointensive Care Unit, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lingling Qiu
- Department of Neurology, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Xinhua Luo
- Department of Clinical Microbiology Laboratory, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Xijiang Zhang
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Li Zhong
- Department of Critical Care Medicine, Huzhou First People's Hospital, Huzhou, Zhejiang, China
| | - Chuming Zhang
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Ronghai Lin
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Qingqing Chen
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| |
Collapse
|