Top

Infection

Published in:

Open Access 28-05-2022 | Stem Cell Transplantation | Original Paper

Cytomegalovirus infection and rehospitalization rates after allogeneic hematopoietic stem cell and solid organ transplantation: a retrospective cohort study using German claims data

Authors: Daniel Teschner, Jana Knop, Christian Piehl, Sophia Junker, Oliver Witzke

Published in: Infection | Issue 6/2022

Abstract

Purpose

This study aimed to describe the cytomegalovirus (CMV) infection rate, rehospitalizations, and comorbidities following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and solid organ transplantation (SOT).

Methods

Patients who received allo-HSCT or SOT in 01/07/2015–30/06/2018 were identified using anonymized German claims data. The transplantation-related hospital admission date was defined as the index date, and patients were followed for up to 12 months (or death, first event relevant). The frequency of CMV infections (confirmed outpatient/inpatient diagnoses, ICD-10-GM codes: B25.-/B27.1) and the rate, number, and duration of all-cause rehospitalizations in the follow-up period were evaluated.

Results

A total of 226 allo-HSCT and 250 SOT patients were identified (mean age 52.8 years, 38.9% female). During the 12 months after transplantation, 29.2% of allo-HSCT patients and 16.8% of SOT patients received a CMV diagnosis. The majority of these diagnoses were given during the initial hospitalization or within the following 3 months. Across transplantation types, CMV patients had more hospital readmission days per patient-year (allo-HSCT 93.3 vs. 49.4, p = 0.001; SOT 42.0 vs. 20.7, p = 0.005), with a longer mean duration of readmissions (allo-HSCT 22.4 vs. 15.4 days, p < 0.001; SOT 11.6 vs. 7.5 days, p = 0.003). Comorbidity burden in transplantation patients was substantial, with several diagnoses being significantly more common among patients with CMV vs. non-CMV. One-year mortality did not differ significantly between patients with/without CMV.

Conclusion

Burden of transplant recipients with CMV in terms of rehospitalizations and comorbidities is substantial, highlighting the need for improved CMV prevention and treatment.

Available only for authorised users

Lachmann R, Loenenbach A, Waterboer T, Brenner N, Pawlita M, Michel A, et al. Cytomegalovirus (CMV) seroprevalence in the adult population of Germany. PLoS One. 2018;13: e0200267. https://doi.org/10.1371/journal.pone.0200267.CrossRefPubMedPubMedCentral

Staras SAS, Dollard SC, Radford KW, Flanders WD, Pass RF, Cannon MJ. Seroprevalence of cytomegalovirus infection in the United States, 1988–1994. Clin Infect Dis. 2006;43:1143–51. https://doi.org/10.1086/508173.CrossRefPubMed

Zuhair M, Smit GSA, Wallis G, Jabbar F, Smith C, Devleesschauwer B, et al. Estimation of the worldwide seroprevalence of cytomegalovirus: a systematic review and meta-analysis. Rev Med Virol. 2019;29:e2034. https://doi.org/10.1002/rmv.2034.CrossRefPubMed

Gandhi MK, Khanna R. Human cytomegalovirus: clinical aspects, immune regulation, and emerging treatments. Lancet Infect Dis. 2004;4:725–38. https://doi.org/10.1016/s1473-3099(04)01202-2.CrossRefPubMed

Haidar G, Boeckh M, Singh N. Cytomegalovirus infection in solid organ and hematopoietic cell transplantation: state of the evidence. J Infect Dis. 2020;221:S23–31. https://doi.org/10.1093/infdis/jiz454.CrossRefPubMedPubMedCentral

Ljungman P, Boeckh M, Hirsch HH, Josephson F, Lundgren J, Nichols G, et al. Definitions of cytomegalovirus infection and disease in transplant patients for use in clinical trials. Clin Infect Dis. 2017;64:87–91. https://doi.org/10.1093/cid/ciw668.CrossRefPubMed

Gesellschaft für Virologie (GfV e.V.) & Deutsche Vereinigung zur Bekämpfung der Viruskrankheiten (DVV e.V.). Virusinfektionen bei organ- und allogen stammzell-transplantierten: Diagnostik, prävention und therapie - S2k-Leitlinie AWMF registernummer 093–002. AWMF online; 2019. https://www.awmf.org/uploads/tx_szleitlinien/093-002l_S2k_Virusinfektionen-Organtransplantierte-alloge-Stammzell-Transplantierten-Diagnostik-Praevention-Therapie__2019-06.pdf

Avery RK, Silveira FP, Benedict K, Cleveland AA, Kauffman CA, Schuster MG, et al. Cytomegalovirus infections in lung and hematopoietic cell transplant recipients in the organ transplant infection prevention and detection study: a multi-year, multicenter prospective cohort study. Transpl Infect Dis. 2018;20: e12877. https://doi.org/10.1111/tid.12877.CrossRefPubMedPubMedCentral

Robin C, Hémery F, Dindorf C, Thillard J, Cabanne L, Redjoul R, et al. Economic burden of preemptive treatment of CMV infection after allogeneic stem cell transplantation: a retrospective study of 208 consecutive patients. BMC Infect Dis. 2017;17:747. https://doi.org/10.1186/s12879-017-2854-2.CrossRefPubMedPubMedCentral

10.

Schelfhout J, Bonafede M, Cappell K, Cole AL, Manjelievskaia J, Raval AD. Impact of cytomegalovirus complications on resource utilization and costs following hematopoietic stem cell transplant. Curr Med Res Opin. 2020;36:33–41. https://doi.org/10.1080/03007995.2019.1664826.CrossRefPubMed

11.

Ramanan P, Razonable RR. Cytomegalovirus infections in solid organ transplantation: a review. Infect Chemother. 2013;45:260–71.CrossRefPubMedPubMedCentral

12.

Harvala H, Stewart C, Muller K, Burns S, Marson L, MacGilchrist A, et al. High risk of cytomegalovirus infection following solid organ transplantation despite prophylactic therapy. J Med Virol. 2013;85:893–8. https://doi.org/10.1002/jmv.23539.CrossRefPubMed

13.

Manuel O, Kralidis G, Mueller NJ, Hirsch HH, Garzoni C, van Delden C, et al. Impact of antiviral preventive strategies on the incidence and outcomes of cytomegalovirus disease in solid organ transplant recipients. Am J Transplant. 2013;13:2402–10. https://doi.org/10.1111/ajt.12388.CrossRefPubMed

14.

Cervera C, Pineda M, Linares L, Marcos MA, Esteva C, Antón A, et al. Impact of valganciclovir prophylaxis on the development of severe late-cytomegalovirus disease in high-risk solid organ transplant recipients. Transplant Proc. 2007;39:2228–30. https://doi.org/10.1016/j.transproceed.2007.07.039.CrossRefPubMed

15.

Linares L, Sanclemente G, Cervera C, Hoyo I, Cofán F, Ricart MJ, et al. Influence of cytomegalovirus disease in outcome of solid organ transplant patients. Transplant Proc. 2011;43:2145–8. https://doi.org/10.1016/j.transproceed.2011.05.007.CrossRefPubMed

16.

Helanterä I, Schachtner T, Hinrichs C, Salmela K, Kyllönen L, Koskinen P, et al. Current characteristics and outcome of cytomegalovirus infections after kidney transplantation. Transpl Infect Dis. 2014;16:568–77. https://doi.org/10.1111/tid.12247.CrossRefPubMed

17.

Nagai S, Mangus RS, Anderson E, Ekser B, Kubal CA, Fridell JA, et al. Cytomegalovirus infection after intestinal/multivisceral transplantation: a single-center experience with 210 cases. Transplantation. 2016;100:451–60. https://doi.org/10.1097/tp.0000000000000832.CrossRefPubMed

18.

Razonable RR, Humar A, The ASTIDCoP. Cytomegalovirus in solid organ transplantation. Am J Transplant. 2013;13:93–106. https://doi.org/10.1111/ajt.12103.CrossRefPubMed

19.

Stern A, Papanicolaou GA. CMV prevention and treatment in transplantation: what’s new in 2019. Curr Infect Dis Rep. 2019;21:45. https://doi.org/10.1007/s11908-019-0699-0.CrossRefPubMedPubMedCentral

20.

Stern M, Hirsch H, Cusini A, van Delden C, Manuel O, Meylan P, et al. Cytomegalovirus serology and replication remain associated with solid organ graft rejection and graft loss in the era of prophylactic treatment. Transplantation. 2014;98:1013–8. https://doi.org/10.1097/tp.0000000000000160.CrossRefPubMed

21.

Kotton CN, Kumar D, Caliendo AM, Huprikar S, Chou S, Danziger-Isakov L, et al. The third international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation. 2018;102:900–31. https://doi.org/10.1097/tp.0000000000002191.CrossRefPubMed

22.

Ariza-Heredia EJ, Nesher L, Chemaly RF. Cytomegalovirus diseases after hematopoietic stem cell transplantation: a mini-review. Cancer Lett. 2014;342:1–8. https://doi.org/10.1016/j.canlet.2013.09.004.CrossRefPubMed

23.

Cantoni N, Hirsch HH, Khanna N, Gerull S, Buser A, Bucher C, et al. Evidence for a bidirectional relationship between cytomegalovirus replication and acute graft-versus-host disease. Biol Blood Marrow Transplant. 2010;16:1309–14. https://doi.org/10.1016/j.bbmt.2010.03.020.CrossRefPubMed

24.

Bhutani D, Dyson G, Manasa R, Deol A, Ratanatharathorn V, Ayash L, et al. Incidence, risk factors, and outcome of cytomegalovirus viremia and gastroenteritis in patients with gastrointestinal graft-versus-host disease. Biol Blood Marrow Transplant. 2015;21:159–64. https://doi.org/10.1016/j.bbmt.2014.10.004.CrossRefPubMed

25.

Witzke O, Nitschke M, Bartels M, Wolters H, Wolf G, Reinke P, et al. Valganciclovir prophylaxis versus preemptive therapy in cytomegalovirus-positive renal allograft recipients: long-term results after 7 years of a randomized clinical trial. Transplantation. 2018;102:876–82. https://doi.org/10.1097/tp.0000000000002024.CrossRefPubMed

26.

El Helou G, Razonable RR. Letermovir for the prevention of cytomegalovirus infection and disease in transplant recipients: an evidence-based review. Infect Drug Resist. 2019;12:1481–91. https://doi.org/10.2147/idr.S180908.CrossRefPubMedPubMedCentral

27.

Danziger-Isakov L, Mark BG. Hematologic complications of anti-CMV therapy in solid organ transplant recipients. Clin Transplant. 2009;23:295–304. https://doi.org/10.1111/j.1399-0012.2008.00942.x.CrossRefPubMed

28.

Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47:1245–51. https://doi.org/10.1016/0895-4356(94)90129-5.CrossRefPubMed

29.

Deutsche stiftung organtransplantation. Jahresbericht: Organspende und transplantation in Deutschland 2020. 2020. https://dso.de/SiteCollectionDocuments/DSO-Jahresbericht%202020.pdf

30.

Schelfhout J, Brown H, House JA, Raval AD. Cytomegalovirus infection and associated hospitalization and costs among individuals undergoing allogeneic hematopoietic stem cell transplant. Curr Med Res Opin. 2020;36:43–50. https://doi.org/10.1080/03007995.2019.1664827.CrossRefPubMed

31.

Hakimi Z, Aballéa S, Ferchichi S, Scharn M, Odeyemi IA, Toumi M, et al. Burden of cytomegalovirus disease in solid organ transplant recipients: a national matched cohort study in an inpatient setting. Transpl Infect Dis. 2017. https://doi.org/10.1111/tid.12732.CrossRefPubMed

32.

Chemaly RF, El Haddad L, Winston DJ, Rowley SD, Mulane KM, Chandrasekar P, et al. Cytomegalovirus (CMV) cell-mediated immunity and CMV infection after allogeneic hematopoietic cell transplantation: the REACT study. Clin Infect Dis. 2020;71:2365–74. https://doi.org/10.1093/cid/ciz1210.CrossRefPubMedPubMedCentral

33.

Wei L, Chen SJ, Huang SF, Chan YJ, Wang FD, Chen HP. Clinical significance of human cytomegalovirus viruria and the effect of antiviral therapy in hematopoietic stem cell transplant recipients. J Microbiol Immunol Infect. 2019;52:402–8. https://doi.org/10.1016/j.jmii.2017.08.019.CrossRef

34.

Smedbråten YV, Sagedal S, Leivestad T, Mjøen G, Osnes K, Rollag H, et al. The impact of early cytomegalovirus infection after kidney transplantation on long-term graft and patient survival. Clin Transplant. 2014;28:120–6. https://doi.org/10.1111/ctr.12288.CrossRefPubMed

35.

Sagedal S, Rollag H, Hartmann A. Cytomegalovirus infection in renal transplant recipients is associated with impaired survival irrespective of expected mortality risk. Clin Transplant. 2007;21:309–13. https://doi.org/10.1111/j.1399-0012.2006.00639.x.CrossRefPubMed

36.

Falagas ME, Paya C, Ruthazer R, Badley A, Patel R, Wiesner R, et al. Significance of cytomegalovirus for long-term survival after orthotopic liver transplantation: a prospective derivation and validation cohort analysis. Transplantation. 1998;66:1020–8. https://doi.org/10.1097/00007890-199810270-00010.CrossRefPubMed

37.

Falagas ME, Snydman DR, Griffith J, Ruthazer R, Werner BG. Effect of cytomegalovirus infection status on first-year mortality rates among orthotopic liver transplant recipients. The Boston center for liver transplantation CMVIG study group. Ann Intern Med. 1997;126:275–9. https://doi.org/10.7326/0003-4819-126-4-199702150-00003.CrossRefPubMed

38.

Au BK, Gooley TA, Armand P, Fang M, Madtes DK, Sorror ML, et al. Reevaluation of the pretransplant assessment of mortality score after allogeneic hematopoietic transplantation. Biol Blood Marrow Transplant. 2015;21:848–54. https://doi.org/10.1016/j.bbmt.2015.01.011.CrossRefPubMedPubMedCentral

39.

Ljungman P, Brand R, Hoek J, de la Camara R, Cordonnier C, Einsele H, et al. Donor cytomegalovirus status influences the outcome of allogeneic stem cell transplant: a study by the European group for blood and marrow transplantation. Clin Infect Dis. 2014;59:473–81. https://doi.org/10.1093/cid/ciu364.CrossRefPubMed

40.

Desai R, Collett D, Watson CJ, Johnson PJ, Moss P, Neuberger J. Impact of cytomegalovirus on long-term mortality and cancer risk after organ transplantation. Transplantation. 2015;99:1989–94. https://doi.org/10.1097/tp.0000000000000641.CrossRefPubMed

41.

Suarez-Pierre A, Giuliano K, Lui C, Almaguer D, Etchill E, Choi CW, et al. Impact of cytomegalovirus serologic status on heart transplantation. J Card Surg. 2020;35:1431–8. https://doi.org/10.1111/jocs.14588.CrossRefPubMed

42.

Mabilangan C, Preiksaitis J, Cervera C. Impact of donor and recipient cytomegalovirus serology on long-term survival of lung transplant recipients. Transpl Infect Dis. 2018;20: e12964. https://doi.org/10.1111/tid.12964.CrossRefPubMed

43.

Mabilangan C, Preiksaitis JK, Cervera C. Impact of donor and recipient cytomegalovirus serology on long-term survival of heart transplant recipients. Transpl Infect Dis. 2019;21: e13015. https://doi.org/10.1111/tid.13015.CrossRefPubMed

44.

Serrano-Alonso M, Guillen-Grima F, Martin-Moreno P, Rabago G, Manrique J, Garcia-Del-Barrio M, et al. Reduction in mortality associated with secondary cytomegalovirus prophylaxis after solid organ transplantation. Transpl Infect Dis. 2018;20: e12873. https://doi.org/10.1111/tid.12873.CrossRefPubMed

45.

Ljungman P, Schmitt M, Marty FM, Maertens J, Chemaly RF, Kartsonis NA, et al. A mortality analysis of letermovir prophylaxis for cytomegalovirus (CMV) in CMV-seropositive recipients of allogeneic hematopoietic cell transplantation. Clin Infect Dis. 2020;70:1525–33. https://doi.org/10.1093/cid/ciz490.CrossRefPubMed

46.

Mori Y, Jinnouchi F, Takenaka K, Aoki T, Kuriyama T, Kadowaki M, et al. Efficacy of prophylactic letermovir for cytomegalovirus reactivation in hematopoietic cell transplantation: a multicenter real-world data. Bone Marrow Transplant. 2021;56:853–62. https://doi.org/10.1038/s41409-020-01082-z.CrossRefPubMed

47.

Committee for medicinal products for human Use (CHMP). Clinical investigation of immunosuppressants for solid organ transplantation. European medicines agency; 2009. https://www.ema.europa.eu/en/documents/scientific-guideline/guideline-clinical-investigation-immunosuppressants-solid-organ-transplantation_en.pdf

48.

Berger SP, Sommerer C, Witzke O, Tedesco H, Chadban S, Mulgaonkar S, et al. Two-year outcomes in de novo renal transplant recipients receiving everolimus-facilitated calcineurin inhibitor reduction regimen from the TRANSFORM study. Am J Transplant. 2019;19:3018–34. https://doi.org/10.1111/ajt.15480.CrossRefPubMed

49.

Masouridi-Levrat S, Simonetta F, Chalandon Y. Immunological basis of bone marrow failure after allogeneic hematopoietic stem cell transplantation. Front Immunol. 2016. https://doi.org/10.3389/fimmu.2016.00362.CrossRefPubMedPubMedCentral

50.

Wilkinson AH, Danovitch G, Mischel M. Fluid and electrolyte disorders associated with orthotopic liver transplantation. Springer; 1990. https://doi.org/10.1007/978-1-4613-1491-2_1CrossRef

51.

Pochineni V, Rondon-Berrios H. Electrolyte and acid-base disorders in the renal transplant recipient. Front Med (Lausanne). 2018;5:261. https://doi.org/10.3389/fmed.2018.00261.CrossRefPubMed

52.

Rondón G, Saliba RM, Chen J, Ledesma C, Alousi AM, Oran B, et al. Impact of fluid overload as new toxicity category on hematopoietic stem cell transplantation outcomes. Biol Blood Marrow Transplant. 2017;23:2166–71. https://doi.org/10.1016/j.bbmt.2017.08.021.CrossRefPubMedPubMedCentral

53.

Anderson A, Raja M, Vazquez N, Morris M, Komanduri K, Camargo J. Clinical, “real-world” experience with letermovir for prevention of cytomegalovirus infection in allogeneic hematopoietic cell transplant recipients. Clin Transplant. 2020;34: e13866. https://doi.org/10.1111/ctr.13866.CrossRefPubMed

54.

Derigs P, Radujkovic A, Schubert ML, Schnitzler P, Schöning T, Müller-Tidow C, et al. Letermovir prophylaxis is effective in preventing cytomegalovirus reactivation after allogeneic hematopoietic cell transplantation: single-center real-world data. Ann Hematol. 2021;100:2087–93. https://doi.org/10.1007/s00277-020-04362-2.CrossRefPubMed

55.

Imlay HN, Kaul DR. Letermovir and maribavir for the treatment and prevention of cytomegalovirus infection in solid organ and stem cell transplant recipients. Clin Infect Dis. 2021;73:156–60. https://doi.org/10.1093/cid/ciaa1713.CrossRefPubMed

56.

Maertens J, Cordonnier C, Jaksch P, Poiré X, Uknis M, Wu J, et al. Maribavir for preemptive treatment of cytomegalovirus reactivation. N Engl J Med. 2019;381:1136–47. https://doi.org/10.1056/NEJMoa1714656.CrossRefPubMed

57.

Wang LH, Peck RW, Yin Y, Allanson J, Wiggs R, Wire MB. Phase I safety and pharmacokinetic trials of 1263W94, a novel oral anti-human cytomegalovirus agent, in healthy and human immunodeficiency virus-infected subjects. Antimicrob Agents Chemother. 2003;47:1334–42. https://doi.org/10.1128/aac.47.4.1334-1342.2003.CrossRefPubMedPubMedCentral

58.

Avery RK, Alain S, Alexander BD, Blumberg EA, Chemaly RF, Cordonnier C, et al. Maribavir for refractory cytomegalovirus infections with or without resistance post-transplant: results from a phase 3 randomized clinical trial. Clinical Infect Dis. 2021. https://doi.org/10.1093/cid/ciab988.CrossRef

Title: Cytomegalovirus infection and rehospitalization rates after allogeneic hematopoietic stem cell and solid organ transplantation: a retrospective cohort study using German claims data
Authors: Daniel Teschner
Jana Knop
Christian Piehl
Sophia Junker
Oliver Witzke
Publication date: 28-05-2022
Publisher: Springer Berlin Heidelberg
Keywords: Stem Cell Transplantation
Stem Cell Transplantion
Stem Cell Transplantation
Published in: Infection / Issue 6/2022
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI: https://doi.org/10.1007/s15010-022-01847-2

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2022

Implementation of EACS vaccination recommendations among people living with HIV

Seroprevalence of SARS-CoV-2 in German secondary schools from October 2020 to July 2021: a longitudinal study

Asymptomatic bacteriospermia and infertility—what is the connection?

Performance of two methods of carbapenem-resistant Enterobacterales surveillance on a kidney transplant ward: selective culture of and real-time PCR directly from rectal swabs

Incidence and outcomes of SARS-CoV-2-associated PIMS in Germany: a nationwide analysis

Detection of diphtheria toxin production by toxigenic corynebacteria using an optimized Elek test

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage