Use of nebulized antimicrobials for the treatment of respiratory infections in invasively mechanically ventilated adults: a position paper from the European Society of Clinical Microbiology and Infectious Diseases.
Identifieur interne : 000556 ( PubMed/Corpus ); précédent : 000555; suivant : 000557Use of nebulized antimicrobials for the treatment of respiratory infections in invasively mechanically ventilated adults: a position paper from the European Society of Clinical Microbiology and Infectious Diseases.
Auteurs : J. Rello ; C. Solé-Lleonart ; J-J Rouby ; J. Chastre ; S. Blot ; G. Poulakou ; C-E Luyt ; J. Riera ; L B Palmer ; J M Pereira ; T. Felton ; J. Dhanani ; M. Bassetti ; T. Welte ; J A RobertsSource :
- Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [ 1469-0691 ] ; 2017.
Abstract
With an established role in cystic fibrosis and bronchiectasis, nebulized antibiotics are increasingly being used to treat respiratory infections in critically ill invasively mechanically ventilated adult patients. Although there is limited evidence describing their efficacy and safety, in an era when there is a need for new strategies to enhance antibiotic effectiveness because of a shortage of new agents and increases in antibiotic resistance, the potential of nebulization of antibiotics to optimize therapy is considered of high interest, particularly in patients infected with multidrug-resistant pathogens. This Position Paper of the European Society of Clinical Microbiology and Infectious Diseases provides recommendations based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology regarding the use of nebulized antibiotics in invasively mechanically ventilated adults, based on a systematic review and meta-analysis of the existing literature (last search July 2016). Overall, the panel recommends avoiding the use of nebulized antibiotics in clinical practice, due to a weak level of evidence of their efficacy and the high potential for underestimated risks of adverse events (particularly, respiratory complications). Higher-quality evidence is urgently needed to inform clinical practice. Priorities of future research are detailed in the second part of the Position Paper as guidance for researchers in this field. In particular, the panel identified an urgent need for randomized clinical trials of nebulized antibiotic therapy as part of a substitution approach to treatment of pneumonia due to multidrug-resistant pathogens.
DOI: 10.1016/j.cmi.2017.04.011
PubMed: 28412382
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Electronic address: pm.Nebat@gmail.com.</nlm:affiliation></affiliation></author><author><name sortKey="Rouby, J J" sort="Rouby, J J" uniqKey="Rouby J" first="J-J" last="Rouby">J-J Rouby</name><affiliation><nlm:affiliation>Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie of Paris 6, Paris, France.</nlm:affiliation></affiliation></author><author><name sortKey="Chastre, J" sort="Chastre, J" uniqKey="Chastre J" first="J" last="Chastre">J. Chastre</name><affiliation><nlm:affiliation>Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie of Paris, Paris, France.</nlm:affiliation></affiliation></author><author><name sortKey="Blot, S" sort="Blot, S" uniqKey="Blot S" first="S" last="Blot">S. Blot</name><affiliation><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Ghent, Belgium.</nlm:affiliation></affiliation></author><author><name sortKey="Poulakou, G" sort="Poulakou, G" uniqKey="Poulakou G" first="G" last="Poulakou">G. Poulakou</name><affiliation><nlm:affiliation>4th Department of Internal Medicine, Athens University School of Medicine, Attikon University General Hospital, Athens, Greece.</nlm:affiliation></affiliation></author><author><name sortKey="Luyt, C E" sort="Luyt, C E" uniqKey="Luyt C" first="C-E" last="Luyt">C-E Luyt</name><affiliation><nlm:affiliation>Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie of Paris 6, Paris, France.</nlm:affiliation></affiliation></author><author><name sortKey="Riera, J" sort="Riera, J" uniqKey="Riera J" first="J" last="Riera">J. Riera</name><affiliation><nlm:affiliation>Clinical Research & Innovation in Pneumonia and Sepsis, Vall d'Hebron Institute of Research, CIBERES, Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Palmer, L B" sort="Palmer, L B" uniqKey="Palmer L" first="L B" last="Palmer">L B Palmer</name><affiliation><nlm:affiliation>Pulmonary, Critical Care and Sleep Division, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Pereira, J M" sort="Pereira, J M" uniqKey="Pereira J" first="J M" last="Pereira">J M Pereira</name><affiliation><nlm:affiliation>Emergency and Intensive Care Department, Centro Hospitalar S. João EPE, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.</nlm:affiliation></affiliation></author><author><name sortKey="Felton, T" sort="Felton, T" uniqKey="Felton T" first="T" last="Felton">T. Felton</name><affiliation><nlm:affiliation>Acute Intensive Care Unit, University Hospital of South Manchester, Manchester, United Kingdom.</nlm:affiliation></affiliation></author><author><name sortKey="Dhanani, J" sort="Dhanani, J" uniqKey="Dhanani J" first="J" last="Dhanani">J. Dhanani</name><affiliation><nlm:affiliation>Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Butterfield Street, Herston, Brisbane, Australia.</nlm:affiliation></affiliation></author><author><name sortKey="Bassetti, M" sort="Bassetti, M" uniqKey="Bassetti M" first="M" last="Bassetti">M. Bassetti</name><affiliation><nlm:affiliation>Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Welte, T" sort="Welte, T" uniqKey="Welte T" first="T" last="Welte">T. Welte</name><affiliation><nlm:affiliation>German Centre for Lung Research (DZL), Department of Respiratory Medicine, Medizinische Hochschule, Hannover, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Roberts, J A" sort="Roberts, J A" uniqKey="Roberts J" first="J A" last="Roberts">J A Roberts</name><affiliation><nlm:affiliation>Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Butterfield Street, Herston, Brisbane, Australia.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2017">2017</date><idno type="RBID">pubmed:28412382</idno><idno type="pmid">28412382</idno><idno type="doi">10.1016/j.cmi.2017.04.011</idno><idno type="wicri:Area/PubMed/Corpus">000556</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000556</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Use of nebulized antimicrobials for the treatment of respiratory infections in invasively mechanically ventilated adults: a position paper from the European Society of Clinical Microbiology and Infectious Diseases.</title><author><name sortKey="Rello, J" sort="Rello, J" uniqKey="Rello J" first="J" last="Rello">J. Rello</name><affiliation><nlm:affiliation>CIBERES, Universitat Autonòma de Barcelona, European Study Group of Infections in Critically Ill Patients, Barcelona, Spain. Electronic address: jrello@crips.es.</nlm:affiliation></affiliation></author><author><name sortKey="Sole Lleonart, C" sort="Sole Lleonart, C" uniqKey="Sole Lleonart C" first="C" last="Solé-Lleonart">C. Solé-Lleonart</name><affiliation><nlm:affiliation>Service de Médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Electronic address: pm.Nebat@gmail.com.</nlm:affiliation></affiliation></author><author><name sortKey="Rouby, J J" sort="Rouby, J J" uniqKey="Rouby J" first="J-J" last="Rouby">J-J Rouby</name><affiliation><nlm:affiliation>Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie of Paris 6, Paris, France.</nlm:affiliation></affiliation></author><author><name sortKey="Chastre, J" sort="Chastre, J" uniqKey="Chastre J" first="J" last="Chastre">J. Chastre</name><affiliation><nlm:affiliation>Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie of Paris, Paris, France.</nlm:affiliation></affiliation></author><author><name sortKey="Blot, S" sort="Blot, S" uniqKey="Blot S" first="S" last="Blot">S. Blot</name><affiliation><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Ghent, Belgium.</nlm:affiliation></affiliation></author><author><name sortKey="Poulakou, G" sort="Poulakou, G" uniqKey="Poulakou G" first="G" last="Poulakou">G. Poulakou</name><affiliation><nlm:affiliation>4th Department of Internal Medicine, Athens University School of Medicine, Attikon University General Hospital, Athens, Greece.</nlm:affiliation></affiliation></author><author><name sortKey="Luyt, C E" sort="Luyt, C E" uniqKey="Luyt C" first="C-E" last="Luyt">C-E Luyt</name><affiliation><nlm:affiliation>Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie of Paris 6, Paris, France.</nlm:affiliation></affiliation></author><author><name sortKey="Riera, J" sort="Riera, J" uniqKey="Riera J" first="J" last="Riera">J. Riera</name><affiliation><nlm:affiliation>Clinical Research & Innovation in Pneumonia and Sepsis, Vall d'Hebron Institute of Research, CIBERES, Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Palmer, L B" sort="Palmer, L B" uniqKey="Palmer L" first="L B" last="Palmer">L B Palmer</name><affiliation><nlm:affiliation>Pulmonary, Critical Care and Sleep Division, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Pereira, J M" sort="Pereira, J M" uniqKey="Pereira J" first="J M" last="Pereira">J M Pereira</name><affiliation><nlm:affiliation>Emergency and Intensive Care Department, Centro Hospitalar S. João EPE, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.</nlm:affiliation></affiliation></author><author><name sortKey="Felton, T" sort="Felton, T" uniqKey="Felton T" first="T" last="Felton">T. Felton</name><affiliation><nlm:affiliation>Acute Intensive Care Unit, University Hospital of South Manchester, Manchester, United Kingdom.</nlm:affiliation></affiliation></author><author><name sortKey="Dhanani, J" sort="Dhanani, J" uniqKey="Dhanani J" first="J" last="Dhanani">J. Dhanani</name><affiliation><nlm:affiliation>Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Butterfield Street, Herston, Brisbane, Australia.</nlm:affiliation></affiliation></author><author><name sortKey="Bassetti, M" sort="Bassetti, M" uniqKey="Bassetti M" first="M" last="Bassetti">M. Bassetti</name><affiliation><nlm:affiliation>Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Welte, T" sort="Welte, T" uniqKey="Welte T" first="T" last="Welte">T. Welte</name><affiliation><nlm:affiliation>German Centre for Lung Research (DZL), Department of Respiratory Medicine, Medizinische Hochschule, Hannover, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Roberts, J A" sort="Roberts, J A" uniqKey="Roberts J" first="J A" last="Roberts">J A Roberts</name><affiliation><nlm:affiliation>Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Butterfield Street, Herston, Brisbane, Australia.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases</title><idno type="eISSN">1469-0691</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">With an established role in cystic fibrosis and bronchiectasis, nebulized antibiotics are increasingly being used to treat respiratory infections in critically ill invasively mechanically ventilated adult patients. Although there is limited evidence describing their efficacy and safety, in an era when there is a need for new strategies to enhance antibiotic effectiveness because of a shortage of new agents and increases in antibiotic resistance, the potential of nebulization of antibiotics to optimize therapy is considered of high interest, particularly in patients infected with multidrug-resistant pathogens. This Position Paper of the European Society of Clinical Microbiology and Infectious Diseases provides recommendations based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology regarding the use of nebulized antibiotics in invasively mechanically ventilated adults, based on a systematic review and meta-analysis of the existing literature (last search July 2016). Overall, the panel recommends avoiding the use of nebulized antibiotics in clinical practice, due to a weak level of evidence of their efficacy and the high potential for underestimated risks of adverse events (particularly, respiratory complications). Higher-quality evidence is urgently needed to inform clinical practice. Priorities of future research are detailed in the second part of the Position Paper as guidance for researchers in this field. In particular, the panel identified an urgent need for randomized clinical trials of nebulized antibiotic therapy as part of a substitution approach to treatment of pneumonia due to multidrug-resistant pathogens.</div></front></TEI><pubmed><MedlineCitation Status="In-Process" Owner="NLM"><PMID Version="1">28412382</PMID><DateCreated><Year>2017</Year><Month>04</Month><Day>16</Day></DateCreated><DateRevised><Year>2017</Year><Month>08</Month><Day>22</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1469-0691</ISSN><JournalIssue CitedMedium="Internet"><Volume>23</Volume><Issue>9</Issue><PubDate><Year>2017</Year><Month>Sep</Month></PubDate></JournalIssue><Title>Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases</Title><ISOAbbreviation>Clin. Microbiol. Infect.</ISOAbbreviation></Journal><ArticleTitle>Use of nebulized antimicrobials for the treatment of respiratory infections in invasively mechanically ventilated adults: a position paper from the European Society of Clinical Microbiology and Infectious Diseases.</ArticleTitle><Pagination><MedlinePgn>629-639</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S1198-743X(17)30219-7</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.cmi.2017.04.011</ELocationID><Abstract><AbstractText>With an established role in cystic fibrosis and bronchiectasis, nebulized antibiotics are increasingly being used to treat respiratory infections in critically ill invasively mechanically ventilated adult patients. Although there is limited evidence describing their efficacy and safety, in an era when there is a need for new strategies to enhance antibiotic effectiveness because of a shortage of new agents and increases in antibiotic resistance, the potential of nebulization of antibiotics to optimize therapy is considered of high interest, particularly in patients infected with multidrug-resistant pathogens. This Position Paper of the European Society of Clinical Microbiology and Infectious Diseases provides recommendations based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology regarding the use of nebulized antibiotics in invasively mechanically ventilated adults, based on a systematic review and meta-analysis of the existing literature (last search July 2016). Overall, the panel recommends avoiding the use of nebulized antibiotics in clinical practice, due to a weak level of evidence of their efficacy and the high potential for underestimated risks of adverse events (particularly, respiratory complications). Higher-quality evidence is urgently needed to inform clinical practice. Priorities of future research are detailed in the second part of the Position Paper as guidance for researchers in this field. In particular, the panel identified an urgent need for randomized clinical trials of nebulized antibiotic therapy as part of a substitution approach to treatment of pneumonia due to multidrug-resistant pathogens.</AbstractText><CopyrightInformation>Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Rello</LastName><ForeName>J</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>CIBERES, Universitat Autonòma de Barcelona, European Study Group of Infections in Critically Ill Patients, Barcelona, Spain. Electronic address: jrello@crips.es.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Solé-Lleonart</LastName><ForeName>C</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Service de Médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Electronic address: pm.Nebat@gmail.com.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rouby</LastName><ForeName>J-J</ForeName><Initials>JJ</Initials><AffiliationInfo><Affiliation>Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie of Paris 6, Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chastre</LastName><ForeName>J</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie of Paris, Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Blot</LastName><ForeName>S</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Ghent, Belgium.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Poulakou</LastName><ForeName>G</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>4th Department of Internal Medicine, Athens University School of Medicine, Attikon University General Hospital, Athens, Greece.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Luyt</LastName><ForeName>C-E</ForeName><Initials>CE</Initials><AffiliationInfo><Affiliation>Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie of Paris 6, Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Riera</LastName><ForeName>J</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Clinical Research & Innovation in Pneumonia and Sepsis, Vall d'Hebron Institute of Research, CIBERES, Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Palmer</LastName><ForeName>L B</ForeName><Initials>LB</Initials><AffiliationInfo><Affiliation>Pulmonary, Critical Care and Sleep Division, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pereira</LastName><ForeName>J M</ForeName><Initials>JM</Initials><AffiliationInfo><Affiliation>Emergency and Intensive Care Department, Centro Hospitalar S. João EPE, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Felton</LastName><ForeName>T</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Acute Intensive Care Unit, University Hospital of South Manchester, Manchester, United Kingdom.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Dhanani</LastName><ForeName>J</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Butterfield Street, Herston, Brisbane, Australia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bassetti</LastName><ForeName>M</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Welte</LastName><ForeName>T</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>German Centre for Lung Research (DZL), Department of Respiratory Medicine, Medizinische Hochschule, Hannover, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Roberts</LastName><ForeName>J A</ForeName><Initials>JA</Initials><AffiliationInfo><Affiliation>Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Butterfield Street, Herston, Brisbane, Australia.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2017</Year><Month>04</Month><Day>13</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Clin Microbiol Infect</MedlineTA><NlmUniqueID>9516420</NlmUniqueID><ISSNLinking>1198-743X</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Aminoglycosides</Keyword><Keyword MajorTopicYN="N">Antibiotic aerosolization</Keyword><Keyword MajorTopicYN="N">Colistin</Keyword><Keyword MajorTopicYN="N">Multidrug-resistant organisms</Keyword><Keyword MajorTopicYN="N">Nosocomial pneumonia</Keyword><Keyword MajorTopicYN="N">Regulatory issues</Keyword><Keyword MajorTopicYN="N">Ventilator-associated pneumonia</Keyword><Keyword MajorTopicYN="N">Ventilator-associated tracheobronchitis</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2017</Year><Month>03</Month><Day>28</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2017</Year><Month>04</Month><Day>03</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2017</Year><Month>04</Month><Day>06</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2017</Year><Month>4</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2017</Year><Month>4</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2017</Year><Month>4</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">28412382</ArticleId><ArticleId IdType="pii">S1198-743X(17)30219-7</ArticleId><ArticleId IdType="doi">10.1016/j.cmi.2017.04.011</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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