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Antibiotic therapy does not alter mitochondrial bioenergetics in lymphocytes of patients with septic shock - A prospective cohort study. Mitochondrion 2022; 66:7-12. [PMID: 35843591 DOI: 10.1016/j.mito.2022.07.001] [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: 12/20/2021] [Revised: 06/02/2022] [Accepted: 07/10/2022] [Indexed: 12/16/2022]
Abstract
Antibiotics may trigger alterations in mitochondrial function, which has been explored in cells culture, and in animal model of sepsis. This study sought to evaluate whether antibiotic therapy affects mitochondrial bioenergetics in a 68-patients clinical study. We studied mitochondrial respiratory rates at two time points: the first day of antibiotic administration and three days after. The Δbasal, ΔCI, ΔCII respiration, and ΔBCE respiratory rates were not different between patients administered with polymyxin, vancomycin, amoxicillin-clavulanate, and azithromycin compared to those who were not administered. Specific beta-lactams are associated with specific modifications in mitochondrial respiratory endpoints - patients who used meropenem had higher delta C2 values compared to those who did not (p = 0.03). Patients who used piperacillin-tazobactam had lower delta C1 (p = 0.03) values than those who did not, but higher delta C2 values (p = 0.02). These mitochondrial metabolic signatures in isolated lymphocytes challenges the proposed effects of antibiotics in mitochondrial bioenergetics of cell cultures, but at current status have an uncertain clinical significance.
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Malinga NZZ, Shobo CO, Molechan C, Amoako DG, Zishiri OT, Bester LA. Molecular Surveillance and Dissemination of Klebsiella pneumoniae on Frequently Encountered Surfaces in South African Public Hospitals. Microb Drug Resist 2021; 28:306-316. [PMID: 34170205 DOI: 10.1089/mdr.2020.0546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Bacteria that cause life-threatening illnesses in humans are also capable of contaminating hospital surfaces, thus pose as a potential source of infection. This study aimed to investigate the prevalence, genetic diversity, virulence, and antibiotic resistance profile of Klebsiella pneumoniae in South Africa. In a nonoutbreak setting involving four public hospitals, 777 samples were collected in three different wards from 11 different sites. Phenotypic and genotypic methods were used for isolation and identification. The Kirby-Bauer disk-diffusion method was used to examine antibiotic resistance followed by the combination disk method to characterize extended-spectrum β-lactamases (ESBLs). Antibiotic resistance and virulence genes were screened using PCR and clonality was investigated using enterobacterial repetitive intergenic consensus (ERIC)-PCR. Seventy-five (10%) K. pneumoniae isolates were recovered. These isolates were obtained from all four hospitals and all three wards involved. However, only six frequently touched surfaces were contaminated. Thirty (40%) isolates were characterized as ESBLs showing high resistance to antibiotics and mostly harboring the blaCTX-M group one gene. Virulence genes were highly prevalent among all the isolates. ERIC-PCR showed that the isolates recovered from different sites within the same hospital were genetically similar. The study highlighted that K. pneumoniae can contaminate various surfaces and this persistence allows for the dissemination of bacteria within the hospital environment. The information from this study can assist hospitals to evaluate and improve current infection prevention and control interventions in place.
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Affiliation(s)
- Nongcebo Z Z Malinga
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Christiana O Shobo
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Chantal Molechan
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Daniel G Amoako
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Oliver T Zishiri
- Discipline of Genetics, School of Life Sciences, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
| | - Linda A Bester
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Almulhim AS, Al-Dahneen BA, Alsowaida YS. Pharmacists' Knowledge About the Impact of Augmented Renal Clearance on Antimicrobial Dosing in Critically Ill Patients: A Cross-Sectional Study. Infect Dis Ther 2020; 9:599-608. [PMID: 32594458 PMCID: PMC7452990 DOI: 10.1007/s40121-020-00310-9] [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: 05/04/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Broad-spectrum antibiotics are commonly prescribed in critically ill patients. While it is commonly believed that only patients with impaired renal function need dose adjustment, augmented renal clearance (ARC) is a phenomenon that warrants dose adjustment as well. In critically ill patients ARC is often undetectable because it is associated with a normal or decreased serum creatinine concentration (SCr). This study's objective was to assess pharmacists' knowledge about ARC identification, risk factors, affected antimicrobials, and dosing of antibiotics in patients with ARC. METHODS In January 2020, we carried out a cross-sectional study by sending out an online survey to the Saudi Pharmaceutical Society, Kuwait Pharmaceutical Association, and Oman Pharmaceutical Society. Due to the expected low response rate, we administered an electronic questionnaire to pharmacists attending Dubai International Pharmaceuticals and Technologies Conference and Exhibition 2020 (DUPHAT). RESULTS Data were collected from 288 respondents. However, only 134 were included in the final analysis following the exclusion of incomplete responses, no experience working in in-patient settings, and respondents who chose "no" universal ARC definition. Those who chose "yes" or "I do not know" regarding the universal definition of ARC were asked about SCr status in ARC. Elevation in SCr was chosen by 67/134 (50%) compared to those who chose decreased or normal (48/134, 35.8%). Regarding risk factors, only 1/134 (0.7%) respondent selected all risk factors. Two/134 (1.4%) respondents chose all hydrophilic antibiotics that are likely to be affected by ARC. Concerning the appropriate dose and frequency of piperacillin-tazobactam and meropenem, they were selected by 60.4% and 30.5%, respectively. CONCLUSION Pharmacists' knowledge about ARC was limited. Implementation of educational programs targeting hospital pharmacists, especially those practicing in critical care settings, and developing antimicrobial institutional guidelines are important.
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Affiliation(s)
- Abdulaziz S Almulhim
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia.
| | - Batool A Al-Dahneen
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Yazed S Alsowaida
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
- Department of Pharmacy Services, Pharmacy Administration, Brigham and Women's Hospital, Boston, MA, USA
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Machado-Alba JE, Gaviria-Mendoza A, Machado-Duque ME. Results of the effectiveness of two piperacillin-tazobactam molecules in the real world. Int J Infect Dis 2018; 76:91-96. [PMID: 30244077 DOI: 10.1016/j.ijid.2018.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/03/2018] [Accepted: 09/13/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The objective was to determine the effectiveness of two piperacillin-tazobactam molecules in terms of all-cause mortality, mortality by infection, and hospital stay. METHODS A cohort study was performed involving patients treated with piperacillin-tazobactam at a clinic in Colombia. The patients were divided into those who received the innovator piperacillin-tazobactam (from July to December 2014) and those who received the generic piperacillin-tazobactam (from January to June 2015). Socio-demographic, clinical (all-cause mortality, death by infection, days of hospitalization), microbiological, pharmacological, and comorbidity variables were evaluated. Multivariate analyses were performed. RESULTS A total of 279 patients were included: 140 treated with the innovator piperacillin-tazobactam and 139 with the generic piperacillin-tazobactam. The median age was 63 years, and 56% of the patients were male. There was no statistically significant difference in death from all causes (22.9% vs. 14.4%, p=0.069), death by infection (7.9 vs. 10.8%, p=0.399), or hospital stay (18.1±16.2 vs. 15.7±11.6 days, p=0.178) between the innovator and generic piperacillin-tazobactam, respectively. CONCLUSIONS The generic piperacillin-tazobactam was equivalent to the innovator piperacillin-tazobactam with regards to all-cause mortality, mortality by infection, hospital stay, and safety, and at a lower cost, which may be useful for decision-makers in hospitals.
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Affiliation(s)
- Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Risaralda, Colombia.
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Mali NB, Deshpande SP, Karnik ND, Gogtay NJ, Munshi RP, Divatia JV, Wagle SC, Sridharan K, Thatte UM. A Multicentric, Prospective, Observational Antibacterial Utilization Study in Indian Tertiary Referral Centers. Indian J Crit Care Med 2018; 22:723-729. [PMID: 30405283 PMCID: PMC6201646 DOI: 10.4103/ijccm.ijccm_197_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rationale Antibacterials are largely prescribed to the intensive care unit (ICU) patients due to high prevalence of infections. However, appropriate use of antibacterials is imperative; since the misuse of antibacterials increases antibacterial resistance and ultimately, it has negative impact on health care and economic system. Hence, continuous antibacterials prescription assessments are very important to judge and improve prescription patterns. The present work was carried out at public and private hospitals to assess the differences in antibacterial prescribing pattern. Methods The present study was conducted at three public and two private hospitals over the period of 14 months. Demographic and drug use details were captured daily from patients admitted to medical ICUs to assess the World Health Organization indicators. Results A total of 700 patients were enrolled across the five centers (140 per center), among them 424 were male and 276 were female. Average number of drugs and antibacterials prescribed at public hospitals are significantly higher than the private hospital. However, percentage of antibacterial agents prescribed at public hospitals was significantly lower than the private hospitals (P = 0.0381). Private hospitals had significantly lower percentage of antibacterial agents prescribed by generic name (P < 0.0001). Differences in change of antibacterial agents required were not statistically significantly different (P = 0.1888); however, significant difference was observed in percentage of patients who received antibacterial treatment as per sensitivity pattern (P = 0.0385) between public and private hospitals. Significantly higher mortality was observed in public hospitals compared to private hospitals (<0.0001). Conclusions More generic prescriptions and more number of prescriptions as per the sensitivity pattern are required at each public and private hospital.
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Affiliation(s)
- Nitin Bhagwan Mali
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Siddharth P Deshpande
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Niteen D Karnik
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nithya J Gogtay
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Renuka P Munshi
- Department of Clinical Pharmacology, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Jigeeshu V Divatia
- Department of Anaesthesia, Critical Care & Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sanjay C Wagle
- Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Kannan Sridharan
- Department of Pharmacology, Subharti Medical College and Chhatrapati Shivaji Subharti Hospital, Meerut, Uttar Pradesh, India
| | - Urmila Mukund Thatte
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Rossini FDP, Andrade DD, Santos LCDS, Ferreira AM, Tieppo C, Watanabe E. Microbiological testing of devices used in maintaining peripheral venous catheters. Rev Lat Am Enfermagem 2017; 25:e2887. [PMID: 28513768 PMCID: PMC5465976 DOI: 10.1590/1518-8345.1528.2887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 02/21/2017] [Indexed: 11/21/2022] Open
Abstract
Objective to evaluate the use of peripheral venous catheters based on microbiological analysis of devices (dressing and three-way stopcocks) and thus contribute to the prevention and infection control. Methods this was a prospective study of microbiological analysis of 30 three-way stopcocks (external surfaces and lumens) and 30 dressing used in maintaining the peripheral venous catheters of hospitalized adult patients. Results all external surfaces, 40% of lumens, and 86.7% of dressing presented bacterial growth. The main species isolated in the lumen were 50% coagulase-negative Staphylococcus, 14.3% Staphylococcus aureus, and 14.3% Pseudomonas aeruginosa. Fifty nine percent of multidrug-resistant bacteria were isolated of the three-way stopcocks, 42% of the lumens, and 44% of the dressing with a predominance of coagulase-negative Staphylococcus resistant to methicillin. Besides, 18% gram-negative bacteria with resistance to carbapenems were identified from multidrug-resistant bacteria on the external surfaces of the three-way stopcocks. Conclusion it is important to emphasize the isolation of coagulase-negative Staphylococcus and gram-negative bacteria resistant to methicillin and carbapenems in samples of devices, respectively, which reinforces the importance of nursing care in the maintenance of the biologically safe environment as well as prevention and infection control practices.
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Affiliation(s)
- Fernanda de Paula Rossini
- PhD, RN, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Denise de Andrade
- PhD, Associate Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Lissandra Chaves de Sousa Santos
- Doctoral student, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Adriano Menis Ferreira
- PhD, Associate Professor, Universidade Federal do Mato Grosso do Sul, Três Lagoas, MS, Brazil
| | - Caroline Tieppo
- Pharmacy-Biochemistry, Hospital Regional do Mato Grosso do Sul, Campo Grande, MS, Brasil
| | - Evandro Watanabe
- PhD, Professor, Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
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Roberts JA, Choi GYS, Joynt GM, Paul SK, Deans R, Peake S, Cole L, Stephens D, Bellomo R, Turnidge J, Wallis SC, Roberts MS, Roberts DM, Lassig-Smith M, Starr T, Lipman J. SaMpling Antibiotics in Renal Replacement Therapy (SMARRT): an observational pharmacokinetic study in critically ill patients. BMC Infect Dis 2016; 16:103. [PMID: 26932762 PMCID: PMC4773999 DOI: 10.1186/s12879-016-1421-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/09/2016] [Indexed: 11/28/2022] Open
Abstract
Background Optimal antibiotic dosing is key to maximising patient survival, and minimising the emergence of bacterial resistance. Evidence-based antibiotic dosing guidelines for critically ill patients receiving RRT are currently not available, as RRT techniques and settings vary greatly between ICUs and even individual patients. We aim to develop a robust, evidence-based antibiotic dosing guideline for critically ill patients receiving various forms of RRT. We further aim to observe whether therapeutic antibiotic concentrations are associated with reduced 28-day mortality. Methods/Design We designed a multi-national, observational pharmacokinetic study in critically ill patients requiring RRT. The study antibiotics will be vancomycin, linezolid, piperacillin/tazobactam and meropenem. Pharmacokinetic sampling of each patient’s blood, RRT effluent and urine will take place during two separate dosing intervals. In addition, a comprehensive data set, which includes the patients’ demographic and clinical parameters, as well as modality, technique and settings of RRT, will be collected. Pharmacokinetic data will be analysed using a population pharmacokinetic approach to identify covariates associated with changes in pharmacokinetic parameters in critically ill patients with AKI who are undergoing RRT for the five commonly prescribed antibiotics. Discussion Using the comprehensive data set collected, the pharmacokinetic profile of the five antibiotics will be constructed, including identification of RRT and other factors indicative of the need for altered antibiotic dosing requirements. This will enable us to develop a dosing guideline for each individual antibiotic that is likely to be relevant to any critically ill patient with acute kidney injury receiving any of the included forms of RRT. Trial registration Australian New Zealand Clinical Trial Registry (ACTRN12613000241730) registered 28 February 2013
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Affiliation(s)
- Jason A Roberts
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia. .,Royal Brisbane & Women's Hospital, Queensland, Australia.
| | - Gordon Y S Choi
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.
| | - Gavin M Joynt
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.
| | - Sanjoy K Paul
- Clinical Trials & Biostatistics Unit, QIMR Berghofer, Queensland, Australia.
| | - Renae Deans
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.
| | - Sandra Peake
- The Queen Elizabeth Hospital, South Australia, Australia.
| | - Louise Cole
- Nepean Hospital, New South Wales, Australia.
| | | | | | - John Turnidge
- Royal Women's and Children's Hospital, Queensland, Australia.
| | - Steven C Wallis
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.
| | - Michael S Roberts
- Therapeutics Research Unit, The University of Queensland, Queensland, Australia.
| | - Darren M Roberts
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.
| | | | - Therese Starr
- Royal Brisbane & Women's Hospital, Queensland, Australia.
| | - Jeffrey Lipman
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia. .,Royal Brisbane & Women's Hospital, Queensland, Australia.
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Costello SE, Gales AC, Morfin-Otero R, Jones RN, Castanheira M. Mechanisms of Resistance, Clonal Expansion, and Increasing Prevalence of Acinetobacter baumannii Strains Displaying Elevated Tigecycline MIC Values in Latin America. Microb Drug Resist 2015; 22:253-8. [PMID: 26716768 DOI: 10.1089/mdr.2015.0168] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of the study was to characterize forty-eight Acinetobacter baumannii (ACB) isolates with confirmed tigecycline MIC values >2 mg/L observed in six Latin American (LATAM) hospitals (four countries) in 2011. During 2005-2011, 6,923 ACB isolates were collected as part of the SENTRY Program, and tigecycline susceptibility was quantified using the reference broth microdilution method. A total of 102/1881 ACB from LATAM hospitals displayed tigecycline minimum inhibitory concentration (MIC) values >2 mg/L, showing an increase from 4.3% in 2010 to 10.5% in 2011, which is considerably high when compared to other geographical regions. Forty-eight ACB from 2011 displaying elevated tigecycline MICs were typed by pulsed-field gel electrophoresis, which showed multiple clusters in Sao Paulo, Brazil, and a major clone in Guadalajara, Mexico. Eighteen unique isolates had the expression of adeA and adeF determined and results compared to a group of tigecycline-susceptible strains, which demonstrated that 18/18 strains had significantly increased expression of AdeABC and three isolates overexpressed AdeFGH. Sequencing of adeS and adeR revealed that 11 isolates displayed adeS mutations, and 5 isolates had mutations in adeR. Sequencing of trm showed frameshift mutations in eight isolates and insertion sequences leading to nonfunctional proteins in three isolates. TetX-encoding genes were not detected. We documented the recent increase of ACB displaying elevated tigecycline MICs in LATAM hospitals, dominantly due to the clonal expansion of isolates in Brazil and Mexico. Control of tigecycline usage in those countries and more strict infection control practices in the involved hospitals should be considered to reduce such outbreaks.
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Affiliation(s)
| | - Ana C Gales
- 2 Laboratorio Alerta , UNIFESP, Sao Paulo, Brazil
| | - Rayo Morfin-Otero
- 3 Instituto de Patologia Infecciosa/Hospital Civil , Guadalajara, Mexico
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