Geographic Distribution of Staphylococcus aureus Causing Invasive Infections in Europe: A Molecular-Epidemiological Analysis
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{"title"=>"Geographic distribution of Staphylococcus aureus causing invasive infections in Europe: A molecular-epidemiological analysis", "type"=>"journal", "authors"=>[{"first_name"=>"Hajo", "last_name"=>"Grundmann", "scopus_author_id"=>"7006654463"}, {"first_name"=>"David M.", "last_name"=>"Aanensen", "scopus_author_id"=>"6507460526"}, {"first_name"=>"Cees C.", "last_name"=>"Van Den Wijngaard", "scopus_author_id"=>"8892339100"}, {"first_name"=>"Brian G.", "last_name"=>"Spratt", "scopus_author_id"=>"7006187882"}, {"first_name"=>"Dag", "last_name"=>"Harmsen", "scopus_author_id"=>"55648218700"}, {"first_name"=>"Alexander W.", "last_name"=>"Friedrich", "scopus_author_id"=>"7103020644"}, {"first_name"=>"Artur J.", "last_name"=>"Sabat", "scopus_author_id"=>"8634813200"}, {"first_name"=>"Jan", "last_name"=>"Muilwijk", "scopus_author_id"=>"16319362200"}, {"first_name"=>"Jos", "last_name"=>"Monen", "scopus_author_id"=>"6506133725"}, {"first_name"=>"Adriana", "last_name"=>"Tami", 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"last_name"=>"Codita", "scopus_author_id"=>"6602911535"}, {"first_name"=>"Maria", "last_name"=>"Perez-Vazquez", "scopus_author_id"=>"6603903886"}, {"first_name"=>"Oscar", "last_name"=>"Cuevas", "scopus_author_id"=>"6602425505"}, {"first_name"=>"Vesna Cvitkovic", "last_name"=>"Spik", "scopus_author_id"=>"25648532400"}, {"first_name"=>"Manica", "last_name"=>"Mueller-Premru", "scopus_author_id"=>"6505908297"}, {"first_name"=>"Sara", "last_name"=>"Haegman", "scopus_author_id"=>"35363775700"}, {"first_name"=>"Barbro", "last_name"=>"Olsen-Liljequist", "scopus_author_id"=>"35364490100"}, {"first_name"=>"Matthew", "last_name"=>"Ellington", "scopus_author_id"=>"11138831400"}, {"first_name"=>"Angela", "last_name"=>"Kearns", "scopus_author_id"=>"7006464758"}, {"first_name"=>"Robin", "last_name"=>"Köck", "scopus_author_id"=>"23993960700"}, {"first_name"=>"Alexander", "last_name"=>"Mellmann", "scopus_author_id"=>"8729275100"}, {"first_name"=>"Karsten", "last_name"=>"Becker", "scopus_author_id"=>"57192482343"}, {"first_name"=>"Ulrich", "last_name"=>"Vogel", "scopus_author_id"=>"7102692496"}], "year"=>2010, "source"=>"PLoS Medicine", "identifiers"=>{"pui"=>"358224423", "issn"=>"15491277", "isbn"=>"1549-1676 (Electronic)\\r1549-1277 (Linking)", "doi"=>"10.1371/journal.pmed.1000215", "scopus"=>"2-s2.0-75749133613", "pmid"=>"20084094", "sgr"=>"75749133613"}, "id"=>"42ac42bd-0c89-38f9-9746-d09de09adda6", "abstract"=>"BACKGROUND: Staphylococcus aureus is one of the most important human pathogens and methicillin-resistant variants (MRSAs) are a major cause of hospital and community-acquired infection. We aimed to map the geographic distribution of the dominant clones that cause invasive infections in Europe. METHODS AND FINDINGS: In each country, staphylococcal reference laboratories secured the participation of a sufficient number of hospital laboratories to achieve national geo-demographic representation. Participating laboratories collected successive methicillin-susceptible (MSSA) and MRSA isolates from patients with invasive S. aureus infection using an agreed protocol. All isolates were sent to the respective national reference laboratories and characterised by quality-controlled sequence typing of the variable region of the staphylococcal spa gene (spa typing), and data were uploaded to a central database. Relevant genetic and phenotypic information was assembled for interactive interrogation by a purpose-built Web-based mapping application. Between September 2006 and February 2007, 357 laboratories serving 450 hospitals in 26 countries collected 2,890 MSSA and MRSA isolates from patients with invasive S. aureus infection. A wide geographical distribution of spa types was found with some prevalent in all European countries. MSSA were more diverse than MRSA. Genetic diversity of MRSA differed considerably between countries with dominant MRSA spa types forming distinctive geographical clusters. We provide evidence that a network approach consisting of decentralised typing and visualisation of aggregated data using an interactive mapping tool can provide important information on the dynamics of MRSA populations such as early signalling of emerging strains, cross border spread, and importation by travel. CONCLUSIONS: In contrast to MSSA, MRSA spa types have a predominantly regional distribution in Europe. This finding is indicative of the selection and spread of a limited number of clones within health care networks, suggesting that control efforts aimed at interrupting the spread within and between health care institutions may not only be feasible but ultimately successful and should therefore be strongly encouraged.", "link"=>"http://www.mendeley.com/research/geographic-distribution-staphylococcus-aureus-causing-invasive-infections-europe-molecularepidemiolo", "reader_count"=>232, "reader_count_by_academic_status"=>{"Unspecified"=>4, "Professor > Associate Professor"=>11, "Librarian"=>2, "Student > Doctoral Student"=>12, "Researcher"=>45, "Student > Ph. D. 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Student"=>66, "Student > Postgraduate"=>10, "Other"=>12, "Student > Master"=>27, "Student > Bachelor"=>19, "Lecturer"=>10, "Lecturer > Senior Lecturer"=>2, "Professor"=>12}, "reader_count_by_subject_area"=>{"Unspecified"=>10, "Agricultural and Biological Sciences"=>101, "Arts and Humanities"=>1, "Veterinary Science and Veterinary Medicine"=>4, "Chemistry"=>3, "Computer Science"=>4, "Earth and Planetary Sciences"=>1, "Economics, Econometrics and Finance"=>2, "Engineering"=>2, "Environmental Science"=>3, "Biochemistry, Genetics and Molecular Biology"=>10, "Nursing and Health Professions"=>1, "Medicine and Dentistry"=>76, "Psychology"=>1, "Social Sciences"=>1, "Immunology and Microbiology"=>12}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>76}, "Social Sciences"=>{"Social Sciences"=>1}, "Psychology"=>{"Psychology"=>1}, "Unspecified"=>{"Unspecified"=>10}, "Environmental Science"=>{"Environmental Science"=>3}, "Arts and Humanities"=>{"Arts and Humanities"=>1}, "Engineering"=>{"Engineering"=>2}, "Chemistry"=>{"Chemistry"=>3}, "Earth and Planetary Sciences"=>{"Earth and Planetary Sciences"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>2}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>12}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>101}, "Computer Science"=>{"Computer Science"=>4}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>1}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>10}, "Veterinary Science and Veterinary Medicine"=>{"Veterinary Science and Veterinary Medicine"=>4}}, "reader_count_by_country"=>{"United States"=>5, "United Kingdom"=>5, "Kenya"=>2, "Thailand"=>1, "Portugal"=>1, "Spain"=>1, "Canada"=>1, "Netherlands"=>2, "Sweden"=>1, "Belgium"=>1, "Denmark"=>1, "Brazil"=>1, "France"=>2, "Australia"=>1, "Germany"=>2}, "group_count"=>12}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/868877"], "description"=>"<p>STs in parentheses are those associated with the spa type in the SeqNet.org Spa typing data base.</p>a<p>MLST as determined by SRLs.</p>", "links"=>[], "tags"=>["types", "sts", "mssa", "mrsa", "26", "european"], "article_id"=>539328, "categories"=>["Medicine", "Computational Biology"], "users"=>["Hajo Grundmann", "David M. Aanensen", "Cees C. van den Wijngaard", "Brian G. Spratt", "Dag Harmsen", "Alexander W. Friedrich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000215.t003", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_20_most_frequent_spa_types_and_their_STs_among_MSSA_and_MRSA_isolated_in_26_European_countries_/539328", "title"=>"20 most frequent <i>spa</i> types and their STs among MSSA and MRSA isolated in 26 European countries.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-01-12 02:35:28"}
  • {"files"=>["https://ndownloader.figshare.com/files/868333"], "description"=>"<p>Locations of participating laboratories.</p>", "links"=>[], "tags"=>["participating"], "article_id"=>538787, "categories"=>["Medicine", "Computational Biology"], "users"=>["Hajo Grundmann", "David M. Aanensen", "Cees C. van den Wijngaard", "Brian G. Spratt", "Dag Harmsen", "Alexander W. Friedrich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000215.g001", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Locations_of_participating_laboratories_/538787", "title"=>"Locations of participating laboratories.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-01-12 02:26:27"}
  • {"files"=>["https://ndownloader.figshare.com/files/868912"], "description"=>"*<p><i>p</i>-Value for the comparison of MSSA versus MRSA.</p>a<p>Number of isolates for which data were available.</p>b<p>Total number of <i>spa</i> types includes 60 <i>spa</i> types that contain both MSSA and MRSA.</p>c<p>Deduced from non-overlapping 95% confidence intervals.</p>d<p>Includes only MRSA and MSSA with more than ten isolates per <i>spa</i> type.</p><p>IQR, interquartile range.</p>", "links"=>[], "tags"=>["26", "european"], "article_id"=>539366, "categories"=>["Medicine", "Computational Biology"], "users"=>["Hajo Grundmann", "David M. Aanensen", "Cees C. van den Wijngaard", "Brian G. Spratt", "Dag Harmsen", "Alexander W. Friedrich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000215.t002", "stats"=>{"downloads"=>2, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_statistics_of_S_aureus_isolated_in_26_European_countries_/539366", "title"=>"Summary statistics of <i>S. aureus</i> isolated in 26 European countries.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-01-12 02:36:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/868526"], "description"=>"<p>Only countries for which <i>spa</i> type information for more then ten MRSA isolates were available were included in this figure.</p>", "links"=>[], "tags"=>["country-specific", "types", "mssa", "mrsa", "cis"], "article_id"=>538982, "categories"=>["Medicine", "Computational Biology"], "users"=>["Hajo Grundmann", "David M. Aanensen", "Cees C. van den Wijngaard", "Brian G. Spratt", "Dag Harmsen", "Alexander W. Friedrich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000215.g003", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Estimates_of_country_specific_genetic_diversity_expressed_as_Simpson_s_index_of_diversity_of_spa_types_as_a_percentage_for_MSSA_light_blue_diamonds_and_MRSA_dark_blue_diamonds_and_95_CIs_bars_/538982", "title"=>"Estimates of country-specific genetic diversity expressed as Simpson's index of diversity of <i>spa</i> types (as a percentage) for MSSA (light blue diamonds) and MRSA (dark blue diamonds) and 95% CIs (bars).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-01-12 02:29:42"}
  • {"files"=>["https://ndownloader.figshare.com/files/868758"], "description"=>"<p>Isolates from LAB ES056 in Madrid, Spain, and the distribution of all other t067 isolates are shown (<i>n</i> = 62). Each placemark indicates whether isolates are MSSA (green), MRSA (red), or a mixture (yellow) and the selected laboratory is blue. The numbers of isolates are indicated inside the placemark. The pie charts on the right show the proportion of MRSA/MSSA and all-cause mortality after 14 d, and the bar chart displays patient age distribution.</p>", "links"=>[], "tags"=>["laboratories", "isolating", "spa", "t067", "shown", "viewed"], "article_id"=>539209, "categories"=>["Medicine", "Computational Biology"], "users"=>["Hajo Grundmann", "David M. Aanensen", "Cees C. van den Wijngaard", "Brian G. Spratt", "Dag Harmsen", "Alexander W. Friedrich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000215.g005", "stats"=>{"downloads"=>3, "page_views"=>14, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Location_of_laboratories_isolating_S_aureus_spa_type_t067_as_shown_in_Figure_4_viewed_using_SRL_Maps_/539209", "title"=>"Location of laboratories isolating <i>S. aureus</i> spa type t067 (as shown in Figure 4) viewed using SRL-Maps.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-01-12 02:33:29"}
  • {"files"=>["https://ndownloader.figshare.com/files/431044", "https://ndownloader.figshare.com/files/431124"], "description"=>"<div><h3>Background</h3><p><em>Staphylococcus aureus</em> is one of the most important human pathogens and methicillin-resistant variants (MRSAs) are a major cause of hospital and community-acquired infection. We aimed to map the geographic distribution of the dominant clones that cause invasive infections in Europe.</p><h3>Methods and Findings</h3><p>In each country, staphylococcal reference laboratories secured the participation of a sufficient number of hospital laboratories to achieve national geo-demographic representation. Participating laboratories collected successive methicillin-susceptible (MSSA) and MRSA isolates from patients with invasive <em>S. aureus</em> infection using an agreed protocol. All isolates were sent to the respective national reference laboratories and characterised by quality-controlled sequence typing of the variable region of the staphylococcal <em>spa</em> gene (<em>spa</em> typing), and data were uploaded to a central database. Relevant genetic and phenotypic information was assembled for interactive interrogation by a purpose-built Web-based mapping application. Between September 2006 and February 2007, 357 laboratories serving 450 hospitals in 26 countries collected 2,890 MSSA and MRSA isolates from patients with invasive <em>S. aureus</em> infection. A wide geographical distribution of <em>spa</em> types was found with some prevalent in all European countries. MSSA were more diverse than MRSA. Genetic diversity of MRSA differed considerably between countries with dominant MRSA <em>spa</em> types forming distinctive geographical clusters. We provide evidence that a network approach consisting of decentralised typing and visualisation of aggregated data using an interactive mapping tool can provide important information on the dynamics of MRSA populations such as early signalling of emerging strains, cross border spread, and importation by travel.</p><h3>Conclusions</h3><p>In contrast to MSSA, MRSA <em>spa</em> types have a predominantly regional distribution in Europe. This finding is indicative of the selection and spread of a limited number of clones within health care networks, suggesting that control efforts aimed at interrupting the spread within and between health care institutions may not only be feasible but ultimately successful and should therefore be strongly encouraged.</p><h3></h3><p><em>Please see later in the article for the Editors' Summary</em></p></div>", "links"=>[], "tags"=>["geographic", "causing", "invasive", "infections", "molecular-epidemiological"], "article_id"=>145068, "categories"=>["Medicine", "Biological Sciences"], "users"=>["Hajo Grundmann", "David M. Aanensen", "Cees C. van den Wijngaard", "Brian G. Spratt", "Dag Harmsen", "Alexander W. Friedrich"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000215.s001", "https://dx.doi.org/10.1371/journal.pmed.1000215.s002"], "stats"=>{"downloads"=>34, "page_views"=>26, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Geographic_Distribution_of_Staphylococcus_aureus_Causing_Invasive_Infections_in_Europe_A_Molecular_Epidemiological_Analysis/145068", "title"=>"Geographic Distribution of <em>Staphylococcus aureus</em> Causing Invasive Infections in Europe: A Molecular-Epidemiological Analysis", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2010-01-12 01:24:28"}
  • {"files"=>["https://ndownloader.figshare.com/files/868954"], "description"=>"a<p><i>spa</i> complexes group <i>spa</i> types that differ by only a single evolutionary event (single indel or nucleotide polymorphism) into the same complex.</p>b<p>As determined by SRLs.</p>c<p>Average number of isolates with this <i>spa</i> type expected in country after 10,000 simulations on the basis of European-wide cumulative frequency.</p>", "links"=>[], "tags"=>["types", "assuming", "european-wide"], "article_id"=>539407, "categories"=>["Medicine", "Computational Biology"], "users"=>["Hajo Grundmann", "David M. Aanensen", "Cees C. van den Wijngaard", "Brian G. Spratt", "Dag Harmsen", "Alexander W. Friedrich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000215.t005", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Unexpectedly_frequent_spa_types_at_country_level_assuming_a_European_wide_random_distribution_/539407", "title"=>"Unexpectedly frequent <i>spa</i> types at country level assuming a European-wide random distribution.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-01-12 02:36:47"}
  • {"files"=>["https://ndownloader.figshare.com/files/869014"], "description"=>"<p>Analyses were performed for <i>spa</i> types with five or more isolates during the study period.</p>a<p><i>spa</i> complexes group <i>spa</i> types that differ by only a single evolutionary event (single indel or nucleotide polymorphism) into the same complex.</p>b<p>As determined by SRLs.</p>c<p>Average number of isolates with this spa type expected in window after 10,000 simulations on the basis of European-wide cumulative frequency.</p><p>AT, Austria; BE, Belgium; BG, Bulgaria; CY, Cyprus; CZ, Czech Republic; DE, Germany; DK, Denmark; ES, Spain; FI, Finland; FR, France; GR, Greece; HR, Croatia; HU, Hungary; IE, Ireland; IT, Italy; LV, Latvia; MT, Malta; NL, Netherlands; PL, Poland; PT, Portugal; RO, Romania; SE, Sweden, SI, Slovenia; UK, United Kingdom.</p>", "links"=>[], "tags"=>["clusters"], "article_id"=>539474, "categories"=>["Medicine", "Computational Biology"], "users"=>["Hajo Grundmann", "David M. Aanensen", "Cees C. van den Wijngaard", "Brian G. Spratt", "Dag Harmsen", "Alexander W. Friedrich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000215.t006", "stats"=>{"downloads"=>0, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Regional_clusters_of_spa_types_/539474", "title"=>"Regional clusters of <i>spa</i> types.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-01-12 02:37:54"}
  • {"files"=>["https://ndownloader.figshare.com/files/868642"], "description"=>"<p>The numbers within each placemark represent the number of isolates and the colours represent resistance phenotypes: red, MRSA; green, MSSA; yellow, a mixture of MRSA and MSSA.</p>", "links"=>[], "tags"=>["laboratories", "isolating", "types", "clusters"], "article_id"=>539094, "categories"=>["Medicine", "Computational Biology"], "users"=>["Hajo Grundmann", "David M. Aanensen", "Cees C. van den Wijngaard", "Brian G. Spratt", "Dag Harmsen", "Alexander W. Friedrich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000215.g004", "stats"=>{"downloads"=>4, "page_views"=>15, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Location_of_laboratories_isolating_S_aureus_of_spa_types_t067_t041_t032_and_t003_which_are_the_four_most_significant_regional_clusters_on_SRL_Maps_/539094", "title"=>"Location of laboratories isolating <i>S. aureus</i> of <i>spa</i> types t067, t041, t032, and t003, which are the four most significant regional clusters on SRL-Maps.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-01-12 02:31:34"}
  • {"files"=>["https://ndownloader.figshare.com/files/868990"], "description"=>"a<p>All remaining spa types equally distributed.</p>b<p>No ranking, all spa types equally distributed.</p>", "links"=>[], "tags"=>["mssa", "mrsa", "types"], "article_id"=>539448, "categories"=>["Medicine", "Computational Biology"], "users"=>["Hajo Grundmann", "David M. Aanensen", "Cees C. van den Wijngaard", "Brian G. Spratt", "Dag Harmsen", "Alexander W. Friedrich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000215.t004", "stats"=>{"downloads"=>0, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_First_second_and_third_most_frequent_MSSA_and_MRSA_spa_types_per_country_and_their_relative_proportions_/539448", "title"=>"First, second, and third most frequent MSSA and MRSA <i>spa</i> types per country and their relative proportions.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-01-12 02:37:28"}
  • {"files"=>["https://ndownloader.figshare.com/files/868835"], "description"=>"a<p>The number of MRSA isolates does not reflect a prevalence or occurrence in particular countries as the protocol requested submission of the first five MSSA and MRSA isolates.</p>", "links"=>[], "tags"=>["overview", "participating", "invasive", "isolates", "mssa", "types"], "article_id"=>539291, "categories"=>["Medicine", "Computational Biology"], "users"=>["Hajo Grundmann", "David M. Aanensen", "Cees C. van den Wijngaard", "Brian G. Spratt", "Dag Harmsen", "Alexander W. Friedrich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000215.t001", "stats"=>{"downloads"=>1, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_overview_of_participating_laboratories_hospitals_number_of_invasive_isolates_of_MSSA_and_MRSA_and_spa_types_by_country_/539291", "title"=>"Summary overview of participating laboratories, hospitals, number of invasive isolates of MSSA and MRSA, and <i>spa</i> types by country.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-01-12 02:34:51"}
  • {"files"=>["https://ndownloader.figshare.com/files/868403"], "description"=>"<p>Age divided in bands of 5 y, except for infants under 1 y (−1).</p>", "links"=>[], "tags"=>["all-cause", "patients", "14", "invasive", "infections"], "article_id"=>538853, "categories"=>["Medicine", "Computational Biology"], "users"=>["Hajo Grundmann", "David M. Aanensen", "Cees C. van den Wijngaard", "Brian G. Spratt", "Dag Harmsen", "Alexander W. Friedrich"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000215.g002", "stats"=>{"downloads"=>0, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Age_distribution_and_all_cause_mortality_of_patients_14_d_after_diagnosis_of_invasive_S_aureus_infections_in_Europe_/538853", "title"=>"Age distribution and all-cause mortality of patients 14 d after diagnosis of invasive <i>S. aureus</i> infections in Europe.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-01-12 02:27:33"}

PMC Usage Stats | Further Information

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Relative Metric

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