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Vatn S, Carstens A, Kristoffersen AB, Bergemalm D, Casén C, Moen AEF, Tannaes TM, Lindstrøm J, Detlie TE, Olbjørn C, Lindquist CM, Söderholm JD, Gomollón F, Kalla R, Satsangi J, Vatn MH, Jahnsen J, Halfvarson J, Ricanek P. Faecal microbiota signatures of IBD and their relation to diagnosis, disease phenotype, inflammation, treatment escalation and anti-TNF response in a European Multicentre Study (IBD-Character). Scand J Gastroenterol 2020; 55:1146-1156. [PMID: 32780604 DOI: 10.1080/00365521.2020.1803396] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
METHOD We examined faecal samples, using the GA-map™ Dysbiosis Test, to associate gut microbiota composition with Crohn's disease (CD) and ulcerative colitis (UC) and to identify markers for future biomarker identification. We conducted a prospective case-control study (EU-ref. no. 305676) in an inception cohort of 324 individuals (64 CD, 84 UC, 116 symptomatic non-IBD controls and 44 healthy controls) across five European centres and examined 54 predetermined bacterial markers. We categorized patients according to the Montreal Classification and calculated the dysbiosis index (DI). Non-parametric tests were used to compare groups and the Bonferroni correction to adjust for multiple comparisons. RESULTS The fluorescent signals (FSSs) for Firmicutes and Eubacterium hallii were lower in inflammatory bowel disease (IBD) vs. symptomatic controls (p<.05). FSS for Firmicutes, Lachnospiraceae, Eubacterium hallii and Ruminococcus albus/bromii were lower, whereas the signal for Bacteroides Fragilis was higher in UC vs. symptomatic controls (p<.05). FSS was higher for Bifidobacterium spp., Eubacterium hallii, Actinobacteria and Firmicutes among patients with ulcerative proctitis, compared to extensive colitis (p<.05). In CD, we observed no association with disease location. The DI correlated with faecal-calprotectin in both CD and in UC (p<.001). In terms of treatment escalation and anti-TNF response, differences were observed for some bacterial markers, but none of these associations were statistically significant. CONCLUSION Our data reveal that the GA-map™ Dysbiosis Test holds the potential to characterize the faecal microbiota composition and to assess the degree of dysbiosis in new-onset IBD. On the other hand, our results cannot demonstrate any proven diagnostic or predictive value of this method to support clinical decision making.
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Affiliation(s)
- S Vatn
- Department of Gastroenterology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - A Carstens
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Internal Medicine, Ersta Hospital, Stockholm, Sweden
| | | | - D Bergemalm
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - C Casén
- Genetic Analysis AS, Oslo, Norway
| | - A E F Moen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Clinical Molecular Biology (EpiGen), Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - T M Tannaes
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Clinical Molecular Biology (EpiGen), Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - J Lindstrøm
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway
| | - T E Detlie
- Department of Gastroenterology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - C Olbjørn
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - C M Lindquist
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - J D Söderholm
- Digestive Diseases Unit, IIS Aragón, Zaragoza, Spain
| | - F Gomollón
- Gastrointestinal Unit, Centre for Genomics and Molecular Medicine, Division of Medical and Radiological Sciences, University of Edinburgh, Edinburgh, UK
| | - R Kalla
- Translational Gastroenterology Unit, Medical Sciences/Experimental Medicine Division, University of Oxford, Oxford, UK
| | - J Satsangi
- Translational Gastroenterology Unit, Medical Sciences/Experimental Medicine Division, University of Oxford, Oxford, UK
| | - M H Vatn
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J Jahnsen
- Department of Gastroenterology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - P Ricanek
- Department of Gastroenterology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
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Moen AEF, Lindstrøm JC, Tannæs TM, Vatn S, Ricanek P, Vatn MH, Jahnsen J. The prevalence and transcriptional activity of the mucosal microbiota of ulcerative colitis patients. Sci Rep 2018; 8:17278. [PMID: 30467421 PMCID: PMC6250705 DOI: 10.1038/s41598-018-35243-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/01/2018] [Indexed: 12/16/2022] Open
Abstract
Active microbes likely have larger impact on gut health status compared to inactive or dormant microbes. We investigate the composition of active and total mucosal microbiota of treatment-naïve ulcerative colitis (UC) patients to determine the microbial picture at the start-up phase of disease, using both a 16S rRNA transcript and gene amplicon sequencing. DNA and RNA were isolated from the same mucosal colonic biopsies. Our aim was to identify active microbial members of the microbiota in early stages of disease and reveal which members are present, but do not act as major players. We demonstrated differences in active and total microbiota of UC patients when comparing inflamed to non-inflamed tissue. Several taxa, among them the Proteobacteria phyla and families therein, revealed lower transcriptional activity despite a high presence. The Bifidobacteriaceae family of the Actinobacteria phylum showed lower abundance in the active microbiota, although no difference in presence was detected. The most abundant microbiota members of the inflamed tissue in UC patients were not the most active. Knowledge of active members of microbiota in UC patients could enhance our understanding of disease etiology. The active microbial community composition did not deviate from the total when comparing UC patients to non-IBD controls.
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Affiliation(s)
- Aina E Fossum Moen
- Department of Clinical Molecular Biology (EpiGen), Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Oslo, Norway
| | - Jonas Christoffer Lindstrøm
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Tone Møller Tannæs
- Department of Clinical Molecular Biology (EpiGen), Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Oslo, Norway.
| | - Simen Vatn
- Department of Gastroenterology, Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Oslo, Norway
| | - Petr Ricanek
- Department of Gastroenterology, Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Oslo, Norway
| | - Morten H Vatn
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Jørgen Jahnsen
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Division of Medicine, Akershus University Hospital, Lørenskog, and University of Oslo, Oslo, Norway
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Abstract
Background Norway has one of the lowest prevalences of methicillin-resistant Staphylococcus aureus (MRSA) infections in the world. This study exploits the extensive data on MRSA infections in the Norwegian surveillance system to investigate the important factors defining the MRSA epidemiology. Methods We performed a quasi-Poisson regression of the monthly notification rate (NR) of MRSA infections reported from January 2006 to December 2015, comparing the time trend among people with an immigrant vs. Norwegian background and domestic vs. imported infections, stratified by age groups. Findings A total of 5289 MRSA infections were reported during the study period, of which 2255 (42·6%) were acquired in Norway, 1370 (25·9%) abroad, and 1664 (31·5%) with an unknown place of acquisition. Overall, the monthly NR increased significantly from 2006 to 2015 (+0·8% each month). The monthly increase in immigrants (+1·3%) was steeper than that in people with a Norwegian background (+0·6%). There was a significant growth (+0·4%) in the rate of domestically acquired infections, however, the NR of infections acquired abroad increased faster (+0·8%). For both imported and domestic infections, the increase occurred in persons aged < 70 years. Interpretation Our analysis suggests that immigration and importation, especially among persons aged < 40 years, represent important factors for the increasing notification rate of MRSA infections in Norway.
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Affiliation(s)
- Francesco Di Ruscio
- Department of Infectious Disease Epidemiology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway
- * E-mail:
| | - Jørgen Vildershøj Bjørnholt
- Department of Infectious Disease Epidemiology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Truls Michael Leegaard
- Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Aina E. Fossum Moen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Molecular Biology (EpiGen), Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Birgitte Freiesleben de Blasio
- Department of Infectious Disease Epidemiology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Tunsjø HS, Kalyanasundaram S, Worren MM, Leegaard TM, Moen AEF. High frequency of occupied attB regions in Norwegian Staphylococcus aureus isolates supports a two-step MRSA screening algorithm. Eur J Clin Microbiol Infect Dis 2016; 36:65-74. [PMID: 27638009 DOI: 10.1007/s10096-016-2771-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/25/2016] [Indexed: 01/10/2023]
Abstract
Rapid nucleic acid amplification tests for methicillin-resistant Staphylococcus aureus (MRSA) diagnostics commonly target the mec resistance gene, genes specific for S. aureus, and the integration site for the SCCmec resistance cassette, orfX. Due to poor specificity when these target genes are used individually, additional culture is required to verify positive results. The combination of these targets is useful, but the optimal algorithm may depend on the presence of the genetic markers in S. aureus isolates, as well as the prevalence of MRSA in a population. The aim of the present study was to identify a rapid, low-cost, and functional screening algorithm in order to reduce the response time for MRSA diagnostics. An in-house orfX-SCCmec polymerase chain reaction (PCR) assay was established and evaluated. The results were compared with an existing mec/nuc PCR assay and traditional culture. Methicillin-sensitive S. aureus (MSSA) that tested false-positive in the orfX-SCCmec PCR assay were further investigated with full genome sequencing using the Ion PGM™ System to verify results and causality. Based on these data, a two-step screening algorithm with initial mec/nuc PCR followed by orfX-SCCmec PCR on positive samples was suggested and tested on 1443 patient samples. 22.5 % of MSSA isolates tested false-positive with the orfX-SCCmec PCR. Full genome sequencing of these isolates identified genetic variation in the attB region of S. aureus, including empty cassette variants and non-mec SCC. The suggested two-step MRSA screening algorithm allowed us to report MRSA results for 95.6 % of all samples and 99 % of MRSA-negative samples after one day.
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Affiliation(s)
- H S Tunsjø
- Department of Health Sciences, Oslo and Akershus University College, Oslo, Norway. .,Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway.
| | - S Kalyanasundaram
- Bioinformatics Core Facility, Department of Core Facilities, Institute of Cancer Research, Radium Hospital, part of Oslo University Hospital, Oslo, Norway
| | - M M Worren
- Institute for Cancer Genetics and Informatics, Radium Hospital, part of Oslo University Hospital, Oslo, Norway
| | - T M Leegaard
- Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - A E F Moen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Clinical Molecular Biology and Laboratory Sciences (EpiGen), Akershus University Hospital, Lørenskog, Norway
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Abstract
OBJECTIVES Study the time development of methicillin-resistant Staphylococcus aureus (MRSA) and forecast future behaviour. The major question: Is the number of MRSA isolates in Norway increasing and will it continue to increase? DESIGN Time trend analysis using non-stationary γ-Poisson distributions. SETTING Two data sets were analysed. The first data set (data set I) consists of all MRSA isolates collected in Oslo County from 1997 to 2010; the study area includes the Norwegian capital of Oslo and nearby surrounding areas, covering approximately 11% of the Norwegian population. The second data set (data set II) consists of all MRSA isolates collected in Health Region East from 2002 to 2011. Health Region East consists of Oslo County and four neighbouring counties, and is the most populated area of Norway. PARTICIPANTS Both data sets I and II consist of all persons in the area and time period described in the Settings, from whom MRSA have been isolated. PRIMARY AND SECONDARY OUTCOME MEASURES MRSA infections have been mandatory notifiable in Norway since 1995, and MRSA colonisation since 2004. In the time period studied, all bacterial samples in Norway have been sent to a medical microbiological laboratory at the regional hospital for testing. In collaboration with the regional hospitals in five counties, we have collected all MRSA findings in the South-Eastern part of Norway over long time periods. RESULTS On an average, a linear or exponential increase in MRSA numbers was observed in the data sets. A Poisson process with increasing intensity did not capture the dispersion of the time series, but a γ-Poisson process showed good agreement and captured the overdispersion. The numerical model showed numerical internal consistency. CONCLUSIONS In the present study, we find that the number of MRSA isolates is increasing in the most populated area of Norway during the time period studied. We also forecast a continuous increase until the year 2017.
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Affiliation(s)
- John F Moxnes
- Protection and Social Security Division, Norwegian Defence Research Establishment, Kjeller, Norway
| | - Aina E Fossum Moen
- Section of Clinical Molecular Biology (EpiGen), Division of Medicine, Akershus University Hospital and University of Oslo, Lørenskog, Norway
| | - Truls Michael Leegaard
- Department of Microbiology and Health Control, Division of Technology, Akershus University Hospital and University of Oslo, Lørenskog, Norway
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Skråmm I, Fossum Moen AE, Årøen A, Bukholm G. Surgical Site Infections in Orthopaedic Surgery Demonstrate Clones Similar to Those in Orthopaedic Staphylococcus aureus Nasal Carriers. J Bone Joint Surg Am 2014; 96:882-888. [PMID: 24897735 DOI: 10.2106/jbjs.m.00919] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Staphylococcus aureus is the main microbial pathogen in orthopaedic infections, and it adds considerable extra costs to the national health-care system each year. Nasal carriers of Staphylococcus aureus have an increased risk of invasive disease, including surgical site infection. The purpose of the present study was to investigate whether the Staphylococcus aureus carrier clones found in patients undergoing elective orthopaedic surgery were the same as the clones found in isolates from orthopaedic patients with Staphylococcus aureus surgical site infections. METHODS Patients admitted for elective orthopaedic surgery underwent nasal cultures for Staphylococcus aureus. Further, orthopaedic patients with a deep surgical site infection caused by Staphylococcus aureus were characterized using the same genotyping methods: multilocus sequence typing and staphylococcal protein A typing. RESULTS Multilocus sequence typing revealed a large number of genotypes in the two populations. However, 85% of nasal carriers and 90% of surgical site infection isolates could be classified into the same four multilocus sequence typing clonal complexes. The risk of Staphylococcus aureus surgical site infection in nasal carriers compared with non-carriers was 5.8 times higher (95% confidence interval, 1.5 to 23.1 times). Of the nasal carriers, 6.3% (95% confidence interval, 1.7% to 10.9% [seven of 111 patients]) developed a deep Staphylococcus aureus surgical site infection, and all but one patient had identical genotypes in the nasal and surgical site infection isolates. CONCLUSIONS Staphylococcus aureus isolates from nasal carriers and patients with surgical site infection clustered into the same few multilocus sequence typing clonal complexes. This finding confirms the existence of some commonly occurring Staphylococcus aureus clones in different population groups within a geographically restricted area. The almost complete individual concordance between Staphylococcus aureus genotypes in carriers who developed a deep surgical site infection strongly supports transmission from the nose, skin surfaces, and other endogenous body regions as a possible route. CLINICAL RELEVANCE Surgical site infections might be more frequently caused by endogenous transmission than was previously assumed. Perioperative preventive efforts must focus more on this route to further decrease the risk of postoperative orthopaedic infections.
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Affiliation(s)
- Inge Skråmm
- Departments of Orthopedic Surgery (I.S. and A.A.) and Clinical Molecular Biology and Laboratory Sciences (EpiGen) (I.S. and A.E.F.M.), Division of Surgery, Akershus University Hospital, Sykehusvn 25, N-1478 Lørenskog, Norway. E-mail address for I. Skråmm:
| | - Aina E Fossum Moen
- Departments of Orthopedic Surgery (I.S. and A.A.) and Clinical Molecular Biology and Laboratory Sciences (EpiGen) (I.S. and A.E.F.M.), Division of Surgery, Akershus University Hospital, Sykehusvn 25, N-1478 Lørenskog, Norway. E-mail address for I. Skråmm:
| | - Asbjørn Årøen
- Departments of Orthopedic Surgery (I.S. and A.A.) and Clinical Molecular Biology and Laboratory Sciences (EpiGen) (I.S. and A.E.F.M.), Division of Surgery, Akershus University Hospital, Sykehusvn 25, N-1478 Lørenskog, Norway. E-mail address for I. Skråmm:
| | - Geir Bukholm
- Department of Infection Prevention, Oslo University Hospital, Kirkevn 166, Postboks 4950, Nydalen, N-0424 Oslo, Norway
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Moxnes JF, de Blasio BF, Leegaard TM, Moen AEF. Methicillin-resistant Staphylococcus aureus (MRSA) is increasing in Norway: a time series analysis of reported MRSA and methicillin-sensitive S. aureus cases, 1997-2010. PLoS One 2013; 8:e70499. [PMID: 23936442 PMCID: PMC3731260 DOI: 10.1371/journal.pone.0070499] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 06/21/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Accurate estimates of the incidence and prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infections are needed to inform public health policies. In Norway, where both MRSA infection and carriage are notifiable conditions, the reported incidence of MRSA is slowly increasing. However, the proportion of MRSA in relation to all S. aureus isolates is unknown, making it difficult to determine if the rising incidence is real or an artifact of an increasing number of tests performed. AIM To characterize recent trends in MRSA infections and obtain a more complete understanding of the MRSA level in Norway. METHODS All reported cases of MRSA and methicillin-sensitive S. aureus (MSSA) from Oslo County (1997-2010) and Health Region East (2008-2008), representing approximately 11% and 36% of the Norwegian population, respectively, were analyzed using a stochastic time series analysis to characterize trends. RESULTS In Oslo County, the proportion of methicillin-resistant cases increased from 0.73% to 3.78% during the study period and was well modeled by an exponential growth with a doubling constant of 5.7 years (95% CI 4.5-7.4 years). In Health Region East, the proportion of MRSA cases increased from 0.4% to 2.1% from 2002 to 2008, with a best-fitting linear increase of 0.26% (95% CI 0.21-0.30%) per year. In both cases, the choice of a linear or exponential model for the time trend produced only marginally different model fits. We found no significant changes due to revised national MRSA guidelines published in June 2009. Significant variations in the increasing time trend were observed in the five hospitals within the region. The yearly reported incidence of MSSA was relatively stable in both study areas although we found seasonal patterns with peaks in August. CONCLUSION The level of MRSA is increasing in Norway, and the proportion of methicillin resistance in all S. aureus isolates are higher than the reported proportion of MRSA in invasive infections.
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Affiliation(s)
- John F Moxnes
- Department for Protection, Norwegian Defense Research Establishment, Kjeller, Norway.
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Fossum Moen AE, Tannaes TM, Leegaard TM. USA300 methicillin-resistantStaphylococcus aureusin Norway. APMIS 2013; 121:1091-6. [DOI: 10.1111/apm.12077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 01/09/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Aina E. Fossum Moen
- Department of Clinical Molecular Biology and Laboratory Sciences (EpiGen); Division of Medicine; Akershus University Hospital and University of Oslo; Lørenskog Norway
| | - Tone Møller Tannaes
- Department of Clinical Molecular Biology and Laboratory Sciences (EpiGen); Division of Medicine; Akershus University Hospital and University of Oslo; Lørenskog Norway
| | - Truls Michael Leegaard
- Department of Microbiology and Infection Control; Division of Diagnostics and Technology; Akershus University Hospital and University of Oslo; Lørenskog Norway
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