Candida krusei, a multidrug-resistant opportunistic fungal pathogen: Geographic and temporal trends from the ARTEMIS DISK Antifungal Surveillance Program, 2001 to 2005

M. A. Pfaller, D. J. Diekema, D. L. Gibbs, V. A. Newell, E. Nagy, S. Dobiasova, M. Rinaldi, R. Barton, A. Veselov, Jorge Finquelievich, Nora Tiraboschi, David Ellis, Dominique Fameree, Anne Marie van den Abeele, Jean Marc Senterre, Arnaldo Lopez Colombo, Robert Rennie, Stephen Sanche, Hu Bijie, Yingchun XuWang Fu, Nan Shan Zhong, Pilar Rivas, Catalina de Bedout, Matilde Mendez, Ricardo Vega, Nada Mallatova, Stanislava Dobiasova, Julio Ayabaca, Jeannete Zurita, M. Mallie, E. Candolfi, W. Fegeler, P. D.G. Haase, A. Rodloff, W. Bar, V. Czaika, George Petrikos, Erzsébet Puskás, Ilona Dóczi, Gyula Mestyan, Radka Nikolova, Uma Banerjee, Nathan Keller, Vivian Tullio, Gian Carlo Schito, Domenico D'Antonio, Pietro Martino, Ng Kee Peng, Celia Alpuche, Jose Santos, Rayo Morfin Ortero, Mussaret Zaidi, Jacques F. Meis, Egil Lingaas, Danuta Dzierzanowska, Waclaw Pawliszyn, Mariada Luz Martins, Luis Albuquerque, Laura Rosado, Rosa Velho, Jose Amorim, Vera N. Ilina, Olga I. Kretchikova, Galina A. Klyasova, Sophia M. Rozanova, Irina G. Multykh, Nikolay N. Klimko, Elena D. Agapova, Natalya V. Dmitrieva, Abdul Mohsen Al-Rasheed, Atef Shibl, Jan Trupl, Hupkova Helena, Anwar Hoosen, Jeannette Wadula, M. N. Janse van Rensburg, Adriano Duse, Kyungwon Lee, Mi Na Kim, A. del Palacio, Aurora Sanchez-Sousa, Jacques Bille, K. Muhlethaler, Shan Chwen Chang, Jen Hsien Wang, Deniz Gur, Volkan Korten, John Paul, Derek Brown, Chris Kibbler, Nigel Weightman, Ian M. Gould, Claire Rennison, Richard Barton, Rosemary Barnes, Jose Antonio Vazquez, Davise Larone, Mike Rinaldi, Heidi Reyes, Axel Santiago

Research output: Contribution to journalArticle

131 Citations (Scopus)

Abstract

Candida krusei is well known as a fungal pathogen for patients with hematologic malignancies and for transplant recipients. Using the ARTEMIS Antifungal Surveillance Program database, we describe geographic and temporal trends in the isolation of C. krusei from clinical specimens and the in vitro susceptibilities of 3,448 isolates to voriconazole as determined by CLSI (formerly NCCLS) disk diffusion testing. In addition, we report the in vitro susceptibilities of bloodstream infection isolates of C. krusei to amphotericin B (304 isolates), flucytosine (254 isolates), anidulafungin (121 isolates), caspofungin (300 isolates), and micafungin (102 isolates) as determined by CLSI broth microdilution methods. Geographic differences in isolation were apparent; the highest frequency of isolation was seen for the Czech Republic (7.6%) and the lowest for Indonesia, South Korea, and Thailand (0 to 0.3%). Overall, 83% of isolates were susceptible to voriconazole, ranging from 74.8% in Latin America to 92.3% in North America. C. krusei was most commonly isolated from hematology-oncology services, where only 76.7% of isolates were susceptible to voriconazole. There was no evidence of increasing resistance of C. krusei to voriconazole from 2001 to 2005. Decreased susceptibilities to amphotericin B (MIC at which 90% of isolates were inhibited [MIC90], 4 μg/ml) and flucytosine (MIC90, 16 μg/ml) were noted, whereas 100% of isolates were inhibited by ≤2 μg/ml of anidulafungin (MIC 90,0.06 μg/ml), micafungin (MIC90, 0.12 μg/ml) or caspofungin (MIC90, 0.25 μg/ml). C. krusei is an uncommon but multidrug-resistant fungal pathogen. Among the systemically active antifungal agents, the echinocandins appear to be the most active against this important pathogen.

Original languageEnglish (US)
Pages (from-to)515-521
Number of pages7
JournalJournal of clinical microbiology
Volume46
Issue number2
DOIs
StatePublished - Feb 1 2008

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caspofungin
Candida
anidulafungin
Flucytosine
Amphotericin B
Echinocandins
Republic of Korea
Indonesia
Latin America
Antifungal Agents
Czech Republic
Hematology
Hematologic Neoplasms
Thailand
North America
Databases
Voriconazole
Infection
In Vitro Techniques
micafungin

ASJC Scopus subject areas

  • Microbiology (medical)

Cite this

Candida krusei, a multidrug-resistant opportunistic fungal pathogen : Geographic and temporal trends from the ARTEMIS DISK Antifungal Surveillance Program, 2001 to 2005. / Pfaller, M. A.; Diekema, D. J.; Gibbs, D. L.; Newell, V. A.; Nagy, E.; Dobiasova, S.; Rinaldi, M.; Barton, R.; Veselov, A.; Finquelievich, Jorge; Tiraboschi, Nora; Ellis, David; Fameree, Dominique; van den Abeele, Anne Marie; Senterre, Jean Marc; Lopez Colombo, Arnaldo; Rennie, Robert; Sanche, Stephen; Bijie, Hu; Xu, Yingchun; Fu, Wang; Zhong, Nan Shan; Rivas, Pilar; de Bedout, Catalina; Mendez, Matilde; Vega, Ricardo; Mallatova, Nada; Dobiasova, Stanislava; Ayabaca, Julio; Zurita, Jeannete; Mallie, M.; Candolfi, E.; Fegeler, W.; Haase, P. D.G.; Rodloff, A.; Bar, W.; Czaika, V.; Petrikos, George; Puskás, Erzsébet; Dóczi, Ilona; Mestyan, Gyula; Nikolova, Radka; Banerjee, Uma; Keller, Nathan; Tullio, Vivian; Carlo Schito, Gian; D'Antonio, Domenico; Martino, Pietro; Peng, Ng Kee; Alpuche, Celia; Santos, Jose; Morfin Ortero, Rayo; Zaidi, Mussaret; Meis, Jacques F.; Lingaas, Egil; Dzierzanowska, Danuta; Pawliszyn, Waclaw; Luz Martins, Mariada; Albuquerque, Luis; Rosado, Laura; Velho, Rosa; Amorim, Jose; Ilina, Vera N.; Kretchikova, Olga I.; Klyasova, Galina A.; Rozanova, Sophia M.; Multykh, Irina G.; Klimko, Nikolay N.; Agapova, Elena D.; Dmitrieva, Natalya V.; Al-Rasheed, Abdul Mohsen; Shibl, Atef; Trupl, Jan; Helena, Hupkova; Hoosen, Anwar; Wadula, Jeannette; Janse van Rensburg, M. N.; Duse, Adriano; Lee, Kyungwon; Kim, Mi Na; del Palacio, A.; Sanchez-Sousa, Aurora; Bille, Jacques; Muhlethaler, K.; Chang, Shan Chwen; Wang, Jen Hsien; Gur, Deniz; Korten, Volkan; Paul, John; Brown, Derek; Kibbler, Chris; Weightman, Nigel; Gould, Ian M.; Rennison, Claire; Barton, Richard; Barnes, Rosemary; Vazquez, Jose Antonio; Larone, Davise; Rinaldi, Mike; Reyes, Heidi; Santiago, Axel.

In: Journal of clinical microbiology, Vol. 46, No. 2, 01.02.2008, p. 515-521.

Research output: Contribution to journalArticle

Pfaller, MA, Diekema, DJ, Gibbs, DL, Newell, VA, Nagy, E, Dobiasova, S, Rinaldi, M, Barton, R, Veselov, A, Finquelievich, J, Tiraboschi, N, Ellis, D, Fameree, D, van den Abeele, AM, Senterre, JM, Lopez Colombo, A, Rennie, R, Sanche, S, Bijie, H, Xu, Y, Fu, W, Zhong, NS, Rivas, P, de Bedout, C, Mendez, M, Vega, R, Mallatova, N, Dobiasova, S, Ayabaca, J, Zurita, J, Mallie, M, Candolfi, E, Fegeler, W, Haase, PDG, Rodloff, A, Bar, W, Czaika, V, Petrikos, G, Puskás, E, Dóczi, I, Mestyan, G, Nikolova, R, Banerjee, U, Keller, N, Tullio, V, Carlo Schito, G, D'Antonio, D, Martino, P, Peng, NK, Alpuche, C, Santos, J, Morfin Ortero, R, Zaidi, M, Meis, JF, Lingaas, E, Dzierzanowska, D, Pawliszyn, W, Luz Martins, M, Albuquerque, L, Rosado, L, Velho, R, Amorim, J, Ilina, VN, Kretchikova, OI, Klyasova, GA, Rozanova, SM, Multykh, IG, Klimko, NN, Agapova, ED, Dmitrieva, NV, Al-Rasheed, AM, Shibl, A, Trupl, J, Helena, H, Hoosen, A, Wadula, J, Janse van Rensburg, MN, Duse, A, Lee, K, Kim, MN, del Palacio, A, Sanchez-Sousa, A, Bille, J, Muhlethaler, K, Chang, SC, Wang, JH, Gur, D, Korten, V, Paul, J, Brown, D, Kibbler, C, Weightman, N, Gould, IM, Rennison, C, Barton, R, Barnes, R, Vazquez, JA, Larone, D, Rinaldi, M, Reyes, H & Santiago, A 2008, 'Candida krusei, a multidrug-resistant opportunistic fungal pathogen: Geographic and temporal trends from the ARTEMIS DISK Antifungal Surveillance Program, 2001 to 2005', Journal of clinical microbiology, vol. 46, no. 2, pp. 515-521. https://doi.org/10.1128/JCM.01915-07
Pfaller, M. A. ; Diekema, D. J. ; Gibbs, D. L. ; Newell, V. A. ; Nagy, E. ; Dobiasova, S. ; Rinaldi, M. ; Barton, R. ; Veselov, A. ; Finquelievich, Jorge ; Tiraboschi, Nora ; Ellis, David ; Fameree, Dominique ; van den Abeele, Anne Marie ; Senterre, Jean Marc ; Lopez Colombo, Arnaldo ; Rennie, Robert ; Sanche, Stephen ; Bijie, Hu ; Xu, Yingchun ; Fu, Wang ; Zhong, Nan Shan ; Rivas, Pilar ; de Bedout, Catalina ; Mendez, Matilde ; Vega, Ricardo ; Mallatova, Nada ; Dobiasova, Stanislava ; Ayabaca, Julio ; Zurita, Jeannete ; Mallie, M. ; Candolfi, E. ; Fegeler, W. ; Haase, P. D.G. ; Rodloff, A. ; Bar, W. ; Czaika, V. ; Petrikos, George ; Puskás, Erzsébet ; Dóczi, Ilona ; Mestyan, Gyula ; Nikolova, Radka ; Banerjee, Uma ; Keller, Nathan ; Tullio, Vivian ; Carlo Schito, Gian ; D'Antonio, Domenico ; Martino, Pietro ; Peng, Ng Kee ; Alpuche, Celia ; Santos, Jose ; Morfin Ortero, Rayo ; Zaidi, Mussaret ; Meis, Jacques F. ; Lingaas, Egil ; Dzierzanowska, Danuta ; Pawliszyn, Waclaw ; Luz Martins, Mariada ; Albuquerque, Luis ; Rosado, Laura ; Velho, Rosa ; Amorim, Jose ; Ilina, Vera N. ; Kretchikova, Olga I. ; Klyasova, Galina A. ; Rozanova, Sophia M. ; Multykh, Irina G. ; Klimko, Nikolay N. ; Agapova, Elena D. ; Dmitrieva, Natalya V. ; Al-Rasheed, Abdul Mohsen ; Shibl, Atef ; Trupl, Jan ; Helena, Hupkova ; Hoosen, Anwar ; Wadula, Jeannette ; Janse van Rensburg, M. N. ; Duse, Adriano ; Lee, Kyungwon ; Kim, Mi Na ; del Palacio, A. ; Sanchez-Sousa, Aurora ; Bille, Jacques ; Muhlethaler, K. ; Chang, Shan Chwen ; Wang, Jen Hsien ; Gur, Deniz ; Korten, Volkan ; Paul, John ; Brown, Derek ; Kibbler, Chris ; Weightman, Nigel ; Gould, Ian M. ; Rennison, Claire ; Barton, Richard ; Barnes, Rosemary ; Vazquez, Jose Antonio ; Larone, Davise ; Rinaldi, Mike ; Reyes, Heidi ; Santiago, Axel. / Candida krusei, a multidrug-resistant opportunistic fungal pathogen : Geographic and temporal trends from the ARTEMIS DISK Antifungal Surveillance Program, 2001 to 2005. In: Journal of clinical microbiology. 2008 ; Vol. 46, No. 2. pp. 515-521.
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abstract = "Candida krusei is well known as a fungal pathogen for patients with hematologic malignancies and for transplant recipients. Using the ARTEMIS Antifungal Surveillance Program database, we describe geographic and temporal trends in the isolation of C. krusei from clinical specimens and the in vitro susceptibilities of 3,448 isolates to voriconazole as determined by CLSI (formerly NCCLS) disk diffusion testing. In addition, we report the in vitro susceptibilities of bloodstream infection isolates of C. krusei to amphotericin B (304 isolates), flucytosine (254 isolates), anidulafungin (121 isolates), caspofungin (300 isolates), and micafungin (102 isolates) as determined by CLSI broth microdilution methods. Geographic differences in isolation were apparent; the highest frequency of isolation was seen for the Czech Republic (7.6{\%}) and the lowest for Indonesia, South Korea, and Thailand (0 to 0.3{\%}). Overall, 83{\%} of isolates were susceptible to voriconazole, ranging from 74.8{\%} in Latin America to 92.3{\%} in North America. C. krusei was most commonly isolated from hematology-oncology services, where only 76.7{\%} of isolates were susceptible to voriconazole. There was no evidence of increasing resistance of C. krusei to voriconazole from 2001 to 2005. Decreased susceptibilities to amphotericin B (MIC at which 90{\%} of isolates were inhibited [MIC90], 4 μg/ml) and flucytosine (MIC90, 16 μg/ml) were noted, whereas 100{\%} of isolates were inhibited by ≤2 μg/ml of anidulafungin (MIC 90,0.06 μg/ml), micafungin (MIC90, 0.12 μg/ml) or caspofungin (MIC90, 0.25 μg/ml). C. krusei is an uncommon but multidrug-resistant fungal pathogen. Among the systemically active antifungal agents, the echinocandins appear to be the most active against this important pathogen.",
author = "Pfaller, {M. A.} and Diekema, {D. J.} and Gibbs, {D. L.} and Newell, {V. A.} and E. Nagy and S. Dobiasova and M. Rinaldi and R. Barton and A. Veselov and Jorge Finquelievich and Nora Tiraboschi and David Ellis and Dominique Fameree and {van den Abeele}, {Anne Marie} and Senterre, {Jean Marc} and {Lopez Colombo}, Arnaldo and Robert Rennie and Stephen Sanche and Hu Bijie and Yingchun Xu and Wang Fu and Zhong, {Nan Shan} and Pilar Rivas and {de Bedout}, Catalina and Matilde Mendez and Ricardo Vega and Nada Mallatova and Stanislava Dobiasova and Julio Ayabaca and Jeannete Zurita and M. Mallie and E. Candolfi and W. Fegeler and Haase, {P. D.G.} and A. Rodloff and W. Bar and V. Czaika and George Petrikos and Erzs{\'e}bet Pusk{\'a}s and Ilona D{\'o}czi and Gyula Mestyan and Radka Nikolova and Uma Banerjee and Nathan Keller and Vivian Tullio and {Carlo Schito}, Gian and Domenico D'Antonio and Pietro Martino and Peng, {Ng Kee} and Celia Alpuche and Jose Santos and {Morfin Ortero}, Rayo and Mussaret Zaidi and Meis, {Jacques F.} and Egil Lingaas and Danuta Dzierzanowska and Waclaw Pawliszyn and {Luz Martins}, Mariada and Luis Albuquerque and Laura Rosado and Rosa Velho and Jose Amorim and Ilina, {Vera N.} and Kretchikova, {Olga I.} and Klyasova, {Galina A.} and Rozanova, {Sophia M.} and Multykh, {Irina G.} and Klimko, {Nikolay N.} and Agapova, {Elena D.} and Dmitrieva, {Natalya V.} and Al-Rasheed, {Abdul Mohsen} and Atef Shibl and Jan Trupl and Hupkova Helena and Anwar Hoosen and Jeannette Wadula and {Janse van Rensburg}, {M. N.} and Adriano Duse and Kyungwon Lee and Kim, {Mi Na} and {del Palacio}, A. and Aurora Sanchez-Sousa and Jacques Bille and K. Muhlethaler and Chang, {Shan Chwen} and Wang, {Jen Hsien} and Deniz Gur and Volkan Korten and John Paul and Derek Brown and Chris Kibbler and Nigel Weightman and Gould, {Ian M.} and Claire Rennison and Richard Barton and Rosemary Barnes and Vazquez, {Jose Antonio} and Davise Larone and Mike Rinaldi and Heidi Reyes and Axel Santiago",
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language = "English (US)",
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TY - JOUR

T1 - Candida krusei, a multidrug-resistant opportunistic fungal pathogen

T2 - Geographic and temporal trends from the ARTEMIS DISK Antifungal Surveillance Program, 2001 to 2005

AU - Pfaller, M. A.

AU - Diekema, D. J.

AU - Gibbs, D. L.

AU - Newell, V. A.

AU - Nagy, E.

AU - Dobiasova, S.

AU - Rinaldi, M.

AU - Barton, R.

AU - Veselov, A.

AU - Finquelievich, Jorge

AU - Tiraboschi, Nora

AU - Ellis, David

AU - Fameree, Dominique

AU - van den Abeele, Anne Marie

AU - Senterre, Jean Marc

AU - Lopez Colombo, Arnaldo

AU - Rennie, Robert

AU - Sanche, Stephen

AU - Bijie, Hu

AU - Xu, Yingchun

AU - Fu, Wang

AU - Zhong, Nan Shan

AU - Rivas, Pilar

AU - de Bedout, Catalina

AU - Mendez, Matilde

AU - Vega, Ricardo

AU - Mallatova, Nada

AU - Dobiasova, Stanislava

AU - Ayabaca, Julio

AU - Zurita, Jeannete

AU - Mallie, M.

AU - Candolfi, E.

AU - Fegeler, W.

AU - Haase, P. D.G.

AU - Rodloff, A.

AU - Bar, W.

AU - Czaika, V.

AU - Petrikos, George

AU - Puskás, Erzsébet

AU - Dóczi, Ilona

AU - Mestyan, Gyula

AU - Nikolova, Radka

AU - Banerjee, Uma

AU - Keller, Nathan

AU - Tullio, Vivian

AU - Carlo Schito, Gian

AU - D'Antonio, Domenico

AU - Martino, Pietro

AU - Peng, Ng Kee

AU - Alpuche, Celia

AU - Santos, Jose

AU - Morfin Ortero, Rayo

AU - Zaidi, Mussaret

AU - Meis, Jacques F.

AU - Lingaas, Egil

AU - Dzierzanowska, Danuta

AU - Pawliszyn, Waclaw

AU - Luz Martins, Mariada

AU - Albuquerque, Luis

AU - Rosado, Laura

AU - Velho, Rosa

AU - Amorim, Jose

AU - Ilina, Vera N.

AU - Kretchikova, Olga I.

AU - Klyasova, Galina A.

AU - Rozanova, Sophia M.

AU - Multykh, Irina G.

AU - Klimko, Nikolay N.

AU - Agapova, Elena D.

AU - Dmitrieva, Natalya V.

AU - Al-Rasheed, Abdul Mohsen

AU - Shibl, Atef

AU - Trupl, Jan

AU - Helena, Hupkova

AU - Hoosen, Anwar

AU - Wadula, Jeannette

AU - Janse van Rensburg, M. N.

AU - Duse, Adriano

AU - Lee, Kyungwon

AU - Kim, Mi Na

AU - del Palacio, A.

AU - Sanchez-Sousa, Aurora

AU - Bille, Jacques

AU - Muhlethaler, K.

AU - Chang, Shan Chwen

AU - Wang, Jen Hsien

AU - Gur, Deniz

AU - Korten, Volkan

AU - Paul, John

AU - Brown, Derek

AU - Kibbler, Chris

AU - Weightman, Nigel

AU - Gould, Ian M.

AU - Rennison, Claire

AU - Barton, Richard

AU - Barnes, Rosemary

AU - Vazquez, Jose Antonio

AU - Larone, Davise

AU - Rinaldi, Mike

AU - Reyes, Heidi

AU - Santiago, Axel

PY - 2008/2/1

Y1 - 2008/2/1

N2 - Candida krusei is well known as a fungal pathogen for patients with hematologic malignancies and for transplant recipients. Using the ARTEMIS Antifungal Surveillance Program database, we describe geographic and temporal trends in the isolation of C. krusei from clinical specimens and the in vitro susceptibilities of 3,448 isolates to voriconazole as determined by CLSI (formerly NCCLS) disk diffusion testing. In addition, we report the in vitro susceptibilities of bloodstream infection isolates of C. krusei to amphotericin B (304 isolates), flucytosine (254 isolates), anidulafungin (121 isolates), caspofungin (300 isolates), and micafungin (102 isolates) as determined by CLSI broth microdilution methods. Geographic differences in isolation were apparent; the highest frequency of isolation was seen for the Czech Republic (7.6%) and the lowest for Indonesia, South Korea, and Thailand (0 to 0.3%). Overall, 83% of isolates were susceptible to voriconazole, ranging from 74.8% in Latin America to 92.3% in North America. C. krusei was most commonly isolated from hematology-oncology services, where only 76.7% of isolates were susceptible to voriconazole. There was no evidence of increasing resistance of C. krusei to voriconazole from 2001 to 2005. Decreased susceptibilities to amphotericin B (MIC at which 90% of isolates were inhibited [MIC90], 4 μg/ml) and flucytosine (MIC90, 16 μg/ml) were noted, whereas 100% of isolates were inhibited by ≤2 μg/ml of anidulafungin (MIC 90,0.06 μg/ml), micafungin (MIC90, 0.12 μg/ml) or caspofungin (MIC90, 0.25 μg/ml). C. krusei is an uncommon but multidrug-resistant fungal pathogen. Among the systemically active antifungal agents, the echinocandins appear to be the most active against this important pathogen.

AB - Candida krusei is well known as a fungal pathogen for patients with hematologic malignancies and for transplant recipients. Using the ARTEMIS Antifungal Surveillance Program database, we describe geographic and temporal trends in the isolation of C. krusei from clinical specimens and the in vitro susceptibilities of 3,448 isolates to voriconazole as determined by CLSI (formerly NCCLS) disk diffusion testing. In addition, we report the in vitro susceptibilities of bloodstream infection isolates of C. krusei to amphotericin B (304 isolates), flucytosine (254 isolates), anidulafungin (121 isolates), caspofungin (300 isolates), and micafungin (102 isolates) as determined by CLSI broth microdilution methods. Geographic differences in isolation were apparent; the highest frequency of isolation was seen for the Czech Republic (7.6%) and the lowest for Indonesia, South Korea, and Thailand (0 to 0.3%). Overall, 83% of isolates were susceptible to voriconazole, ranging from 74.8% in Latin America to 92.3% in North America. C. krusei was most commonly isolated from hematology-oncology services, where only 76.7% of isolates were susceptible to voriconazole. There was no evidence of increasing resistance of C. krusei to voriconazole from 2001 to 2005. Decreased susceptibilities to amphotericin B (MIC at which 90% of isolates were inhibited [MIC90], 4 μg/ml) and flucytosine (MIC90, 16 μg/ml) were noted, whereas 100% of isolates were inhibited by ≤2 μg/ml of anidulafungin (MIC 90,0.06 μg/ml), micafungin (MIC90, 0.12 μg/ml) or caspofungin (MIC90, 0.25 μg/ml). C. krusei is an uncommon but multidrug-resistant fungal pathogen. Among the systemically active antifungal agents, the echinocandins appear to be the most active against this important pathogen.

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UR - http://www.scopus.com/inward/citedby.url?scp=38949166771&partnerID=8YFLogxK

U2 - 10.1128/JCM.01915-07

DO - 10.1128/JCM.01915-07

M3 - Article

C2 - 18077633

AN - SCOPUS:38949166771

VL - 46

SP - 515

EP - 521

JO - Journal of Clinical Microbiology

JF - Journal of Clinical Microbiology

SN - 0095-1137

IS - 2

ER -