Necessity for subsequent surgery in women of child-bearing age with positive margins after conization

Abstract Background 20–25% of women with high-grade cervical intraepithelial neoplasias (HSIL) have residual lesions after conization. The state of the margin is generally considered to be a risk factor for recurrence or persistent lesions. Predictors of positive margins and residual lesions need to be identified. A design for postoperative management and avoidance of overtreatment needs to be provided, especially for women of child-bearing age. Methods This study was a retrospective analysis of 1309 women of child-bearing age with HSIL, who underwent cold knife conization (CKC). Age, gravidity, parity, human papillomavirus (HPV) species, cytology, transformation zone type, results of endocervical curettage (ECC), quadrant involvement, glandular involvement, and Cervical Intraepithelial Neoplasia (CIN) grade were analyzed. Among those with positive margins, 245 patients underwent secondary surgery within three months, including CKC, a loop electrosurgical excision procedure, and total hysterectomy. Risk factors for positive margins and residual lesions were assessed. Results There was no significant difference in age, gravidity, parity, glandular involvement, and CIN grade between the two groups (P > 0.3). There was a significant difference in HPV species, cytology, ECC results, and quadrant involvement (P < 0.002). Multivariate analysis showed a major cytology abnormality, high-risk HPV infection, type III transformation zone, positive ECC result, and multiple quadrant involvement were independent risk factors for positive margins and residual lesions (P < 0.02). Age > 35 years was also a risk factor for residual lesions (P < 0.03). Conclusion High-risk women should be treated appropriately considering fertility. Patients with positive margins should be managed uniquely. Surgery for women without fertility may be appropriate. Close follow-up is necessary for women who have fertility requirements or are unwilling to undergo subsequent surgery if they have no risk factors, especially women < 35 years.

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Necessity for subsequent surgery in women of child-bearing age with positive margins after cold knife conization: A retrospective cohort study

10.21203/rs.3.rs-199393/v1 ◽

2021 ◽

Author(s):

Xinmei Wang ◽

Juan Xu ◽

Yang Gao ◽

Pengpeng Qu

Keyword(s):

Risk Factors ◽

High Risk ◽

High Grade ◽

Transformation Zone ◽

Positive Margins ◽

Child Bearing ◽

Significant Difference ◽

Cold Knife ◽

Cold Knife Conization ◽

Residual Lesions

Abstract Background: Risk factors for positive margins and residual lesions after cold knife conization (CKC) for high-grade cervical intraepithelial neoplasias (CIN) were assessed in women of child-bearing age. A design for postoperative management and avoiding these situations is offered.Methods: This was a retrospective study on 1,309 premenopausal women with high-grade CIN (including CIN3 and CIN2) based on a cervical biopsy under colposcopy used to diagnose a positive or negative margin. Age, gravidity, parity, HPV species, cytology, transformation zone type, results of endocervical curettage (ECC), quadrant involvement, glandular involvement, and CIN grade were analyzed. Among those with positive margins, 245 underwent surgery within three months, including CKC, a loop electrosurgical excision procedure, and total hysterectomy. Residual lesions were also assessed.Results: There was no significant difference in age, gravidity, parity, glandular involvement, and CIN grade between the two groups (P>0.3). There was a significant difference in HPV species, cytology, ECC results, and quadrant involvement (P<0.002). Multivariate analysis showed a major cytology abnormality, high-risk HPV infection, type III transformation zone, positive ECC result, and multiple quadrant involvement were independent risk factors for positive margins and residual lesions (P<0.02). Age >35 years was also a risk factor (P<0.03).Conclusion: High-risk women should be treated appropriately considering fertility. Patients with positive margins should be managed uniquely. Surgery for women without fertility may be appropriate. Close follow-up is necessary for women who have fertility requirements or are unwilling to undergo subsequent surgery if they have no risk factors, especially for women <35 years.

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Risk Factors of Residual Lesions in Cervical High-Grade Intraepithelial Lesion After LEEP in Perimenopausal and Postmenopausal Women

10.21203/rs.3.rs-605502/v1 ◽

2021 ◽

Author(s):

Zhuyun Ding ◽

Lijuan Xu ◽

Luting Chen ◽

Haili Chai ◽

Yan Jin ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Postmenopausal Women ◽

Margin Status ◽

High Grade ◽

Residual Rate ◽

Significant Difference ◽

Intraepithelial Lesion ◽

Residual Lesions ◽

P16 Expression

Abstract Purpose To investigate the risk factors of residual lesions in cervical high-grade squamous intraepithelial lesion (HSIL) after loop electrosurgical excision procedure (LEEP). Methods A total of 88 patients, including 38 perimenopausal patients and 50 postmenopausal patients, who were diagnosed with cervical HSIL after LEEP in Shanghai Jiaotong University affiliated Songjiang Hospital from May 2016 to May 2021 and then underwent hysterectomy within 3 months were collected. The patients' age, hrHPV typing, liquid-based thin-layer cytology (TCT), cervical biopsy P16 expression under colposcopy, endocervical curettage(ECC) during LEEP , margin status of LEEP and whole uterine pathology were reviewed and the risk factors of residual lesions after LEEP in HSIL patients were analyzed statistically with t test,χ2 test or logistic regression analysis. Results Among the 88 patients, there was no statistical difference in the residual rate between perimenopausal and postmenopausal women (P > 0.05). There were no statistically significant differences in age, hrHPV typing, TCT, P16 expression, and LEEP margin between with and without residue group (P >0.05), but there was statistically significant difference in ECC (P < 0.01). In perimenopausal group, there were no statistically significant differences in all the factors (P >0.05) except ECC (P < 0.01) between with and without residue group. While in postmenopausal group, all the factors were not statistically different(P >0.05) except margin status (P < 0.01).After multivariate, positive endocervical curettage was a risk factor of the residual lesionsin perimenopausal group after LEEP ( P < 0.01), and positive LEEP margin was one for postmenopausal patients (P < 0.05). Conclusions Positive ECC is a risk factor of residual lesions in perimenopausal women with HSIL after LEEP. Positive LEEP margin was a risk factor for the residual lesions in postmenopausal patients.

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Smoking, alcohol consumption and human papillomavirus infection as risk factors for oral cavity and oropharyngeal tumors in Serbia - a pilot study

Vojnosanitetski pregled ◽

10.2298/vsp180223143b ◽

2020 ◽

Vol 77 (7) ◽

pp. 740-745

Author(s):

Ljiljana Bozic ◽

Predrag Jeremic ◽

Milovan Dimitrijevic ◽

Tanja Jovanovic ◽

Aleksandra Knezevic

Keyword(s):

Risk Factors ◽

Human Papillomavirus ◽

High Risk ◽

Alcohol Consumption ◽

Oral Cavity ◽

Tongue Cancer ◽

Hpv Infection ◽

Benign Lesions ◽

Significant Difference ◽

Malignant Lesions

Background/Aim. The oral cavity and oropharyngeal cancers are among the most common cancers worldwide with the multifactorial etiology. The aim of this study was to determine the major risk factors among patients with oral cavity and oropharyngeal tumors in Serbia. Methods. A total of 63 patients with biopsy proven malignant (33 patients) or benign (30 patients) oral cavity or oropharyngeal lesions were included in this study. The data about gender, age, smoking habits and alcohol consumption were obtained from the routine medical files. The detection and genotyping of human papillomavirus (HPV) was done in paraffin embedded tissue samples using in situ hybridization. Results. Malignant lesions were more frequent in men, smokers and patients who consume alcohol with a statistically significant difference compared to the patients with benign lesions. The prevalence of HPV infection was higher in patients with malignant lesions compared to patients with benign lesions, but without statistically significant difference. High risk genotypes were detected only in patients with malignant lesions of tonsils and base tongue cancer, while low risk types were demonstrated in patients with benign lesions with a highly statistically significant difference. Conclusion. The results point to the significant association of tobacco smoking, alcohol consumption and high risk HPV genotypes as risk factors for oral cavity and oropharyngeal carcinomas in Serbian patients.

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Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

BMC Infectious Diseases ◽

10.1186/s12879-021-06391-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sandra Chamat-Hedemand ◽

Niels Eske Bruun ◽

Lauge Østergaard ◽

Magnus Arpi ◽

Emil Fosbøl ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

High Risk ◽

Blood Culture ◽

Positive Blood Culture ◽

Bloodstream Infections ◽

Low Risk ◽

Moderate Risk ◽

Streptococcal Species ◽

Very High

Abstract Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

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Postoperative Pneumocephalus on Computed Tomography Might Predict Post-Corpus Callosotomy Chemical Meningitis

Brain Sciences ◽

10.3390/brainsci11050638 ◽

2021 ◽

Vol 11 (5) ◽

pp. 638

Author(s):

Ayataka Fujimoto ◽

Keisuke Hatano ◽

Toshiki Nozaki ◽

Keishiro Sato ◽

Hideo Enoki ◽

...

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Risk Factor ◽

Intractable Epilepsy ◽

Epileptic Seizures ◽

Computed Tomography Scan ◽

Corpus Callosotomy ◽

Significant Difference ◽

Chemical Meningitis ◽

Tomography Scan

Background: A corpus callosotomy (CC) is a procedure in which the corpus callosum, the largest collection of commissural fibers in the brain, is disconnected to treat epileptic seizures. The occurrence of chemical meningitis has been reported in association with this procedure. We hypothesized that intraventricular pneumocephalus after CC surgery represents a risk factor for postoperative chemical meningitis. The purpose of this study was to analyze the potential risk factors for postoperative chemical meningitis in patients with medically intractable epilepsy who underwent a CC. Methods: Among the patients who underwent an anterior/total CC for medically intractable epilepsy between January 2009 and March 2021, participants were comprised of those who underwent a computed tomography scan on postoperative day 0. We statistically compared the groups with (c-Group) or without chemical meningitis (nc-Group) to determine the risk factors. Results: Of the 80 patients who underwent a CC, 65 patients (25 females and 40 males) met the inclusion criteria. Their age at the time of their CC procedure was 0–57 years. The c-Group (17%) was comprised of seven females and four males (age at the time of their CC procedure, 1–43 years), and the nc-Group (83%) was comprised of 18 females and 36 males (age at the time of their CC procedure, 0–57 years). Mann–Whitney U-tests (p = 0.002) and univariate logistic regression analysis (p = 0.001) showed a significant difference in pneumocephalus between the groups. Conclusion: Postoperative pneumocephalus identified on a computed tomography scan is a risk factor for post-CC chemical meningitis.

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Intensive Multiagent Therapy, Including Dose-Compressed Cycles of Ifosfamide/Etoposide and Vincristine/Doxorubicin/Cyclophosphamide, Irinotecan, and Radiation, in Patients With High-Risk Rhabdomyosarcoma: A Report From the Children's Oncology Group

Journal of Clinical Oncology ◽

10.1200/jco.2015.63.4048 ◽

2016 ◽

Vol 34 (2) ◽

pp. 117-122 ◽

Cited By ~ 77

Author(s):

Brenda J. Weigel ◽

Elizabeth Lyden ◽

James R. Anderson ◽

William H. Meyer ◽

David M. Parham ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

High Risk ◽

Bone Marrow Involvement ◽

High Risk Group ◽

Historical Cohort ◽

Dismal Prognosis ◽

Risk Patients ◽

Metastatic Sites

Purpose Patients with metastatic rhabdomyosarcoma (RMS), except those younger than 10 years with embryonal RMS, have an estimated long-term event-free survival (EFS) of less than 20%. The main goal of this study was to improve outcome of patients with metastatic RMS by dose intensification with interval compression, use of the most active agents determined in phase II window studies, and use of irinotecan as a radiation sensitizer. Patients and Methods Patients with metastatic RMS received 54 weeks of therapy: blocks of therapy with vincristine/irinotecan (weeks 1 to 6, 20 to 25, and 47 to 52), interval compression with vincristine/doxorubicin/cyclophosphamide alternating with etoposide/ifosfamide (weeks 7 to 19 and 26 to 34), and vincristine/dactinomycin/cyclophosphamide (weeks 38 to 46). Radiation therapy occurred at weeks 20 to 25 (primary) but was also permitted at weeks 1 to 6 (for intracranial or paraspinal extension) and weeks 47 to 52 (for extensive metastatic sites). Results One hundred nine eligible patients were enrolled, with a median follow-up of surviving patients of 3.8 years (3-year EFS for all patients, 38% [95% CI, 29% to 48%]; survival, 56% [95% CI, 46% to 66%]). Patients with one or no Oberlin risk factor (age > 10 years or < 1 year, unfavorable primary site of disease, ≥ three metastatic sites, and bone or bone marrow involvement) had a 3-year EFS of 69% (95% CI, 52% to 82%); high-risk patients with two or more risk factors had a 3-year EFS of 20% (95% CI, 11% to 30%). Toxicity was similar to that on prior RMS studies. Conclusion Patients with metastatic RMS with one or no Oberlin risk factor had an improved 3-year EFS of 69% on ARST0431 compared with an historical cohort from pooled European and US studies; those with two or more risk factors have a dismal prognosis, and new approaches are needed for this very-high-risk group.

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HPV genotyping and risk factors for anal high-risk HPV infection in men who have sex with men from Toronto, Canada

Scientific Reports ◽

10.1038/s41598-021-84079-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yoojin Choi ◽

Mona Loutfy ◽

Robert S. Remis ◽

Juan Liu ◽

Anuradha Rebbapragada ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Hpv Vaccine ◽

Hpv Infection ◽

Categorical Variables ◽

Genotype Distribution ◽

Continuous Variables ◽

Chi Square ◽

Hpv Genotypes ◽

Sex With Men

AbstractMen who have sex with men (MSM) are disproportionately affected by anal cancer, predominantly caused by high-risk (HR) human papillomavirus (HPV) infection. Currently, the nonavalent HPV vaccine provides coverage against nine HPV genotypes, including seven HR-HPV genotypes. Here, we characterize anal HR-HPV genotype distribution and associated risk factors in MSM from Toronto, Canada recruited between September 2010 and June 2012. Wilcoxon–Mann–Whitney test was used for continuous variables, Chi-square test was performed for categorical variables, and a multivariable model using logistic regression was created to assess for correlates of anal HR-HPV infection. A total of 442 MSM were recruited, with a median age of 45 (IQR 38–50) and an overall HPV prevalence of 82%. The prevalence of any HR-HPV infection was 65.3% and 50.7% in the HIV-positive and HIV-negative MSM, respectively. No participant tested positive for all genotypes covered by the nonavalent vaccine. HIV status (aOR 1.806; 95% CI 1.159–2.816), smoking (aOR 2.176; 95% CI 1.285–3.685) and the number of lifetime sexual partners (aOR 2.466; 95% CI 1.092–5.567) were independent risk factors for anal HR-HPV infection. Our findings will be useful to inform HPV vaccine rollout and HPV prevention strategies in Canadian MSM.

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Abstract 18634: Favorable Cardiovascular Health and the Compression of Morbidity: Findings From the Chicago Heart Detection Project in Industry Study

Circulation ◽

10.1161/circ.132.suppl_3.18634 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Norrina B Allen ◽

Lihui Zhao ◽

Lei Liu ◽

Martha Daviglus ◽

Kiang Liu ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

High Risk ◽

Healthcare Costs ◽

Cardiovascular Health ◽

Heart Association ◽

Baseline Risk ◽

Compression Of Morbidity ◽

High Risk Factors ◽

Morbidity Score

Introduction: We sought to determine the association of CV health at younger ages with the proportion of life lived free of morbidity, the cumulative burden of morbidity, and average healthcare costs at older ages. Methods: The Chicago Heart Association (CHA) study is a longitudinal cohort of employed men and women aged 18-59 years at baseline exam in 1967-1973. Baseline risk factor levels included blood pressure, cholesterol, diabetes, BMI and smoking. Individuals were classified into one of four strata: favorable levels of all factors, 0 factors high but 1+ elevated, 1 high, and ≥2 high risk factors. Linked CMS/NDI data from 1984-2010 were used to determine morbidity in older age providing up to 40 years of follow-up. We included participants who were age 65+ between 1984 and 2010 and enrolled in Medicare FFS. All-cause morbidity was defined using the Gagne score. A CV morbidity score was defined as the sum of 4 CVDs including CHD (includes MI), PVD, cerebrovascular disease and CHF. Results: We included 25,390 participants (43% female, 90% White, mean age 44 at baseline); 6% had favorable levels, 19% had 1+ risk factors at elevated levels, 40% had 1 high risk factor and 35% had 2+ high risk factors. As compared to those with 2+ high risk factors, favorable CV health had lower levels of all-cause and CV morbidity from age 65-90 years, and a lower cumulative morbidity burden (p<0.001) translating to lower average annual healthcare costs ($15,905 vs $20,791 per year, p<0.001). Favorable CV health postponed the onset of all-cause morbidity by 4.5 years, the onset of CV morbidity by almost 7 years and extended life by almost 4 years resulting in a compression of morbidity on both the absolute and relative scale (see figure). Conclusion: Individuals in favorable CV health live a longer, healthier life and a greater proportion of life free of morbidity. These findings provide support for prevention efforts aimed at preserving cardiovascular health and reducing the burden of disease in older ages.

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Estimation of risk factors associated with difficult birth in ewes

Animal Production Science ◽

10.1071/an16339 ◽

2018 ◽

Vol 58 (6) ◽

pp. 1125 ◽

Cited By ~ 3

Author(s):

B. J. Horton ◽

R. Corkrey ◽

G. N. Hinch

Keyword(s):

Risk Factors ◽

Risk Factor ◽

High Risk ◽

Litter Size ◽

Low Birthweight ◽

Condition Score ◽

Cause Of Deaths ◽

Ease Score ◽

Very High ◽

Australian Merino

In eight closely recorded Australian Merino and crossbred sheep flocks, all lamb deaths were examined and the cause of deaths identified if possible. Dystocia was identified as one of the major causes of lamb death and this study examined factors that could be used to identify ewes at high risk of dystocia, either to avoid dystocia or to assist with early intervention where possible. Dystocia was least common in lambs of ~4.8 kg, but there was a higher risk at both lower and higher birthweights. Dystocia with both low and high birthweight was more common in older ewes, ranging from negligible low birthweight dystocia in ewes less than 3 years old at lambing, to 5% in older ewes. Low birthweight dystocia increased with increasing litter size, with 40% dystocia in ewes at least 4 years of age with triplets. In contrast, high birthweight dystocia was not affected by litter size. A previous record of low birthweight dystocia was a risk factor for future low birthweight dystocia, but the same relationship was not observed for high birthweight dystocia. A high lambing ease score (difficult birth) with high birthweight was a risk factor for future high birthweight dystocia, but this was not the case for low birthweight dystocia. These differences between the risk factors for low and high birthweight dystocia suggest that they have different causes. High ewe liveweight and condition score during pregnancy may be additional indicators of the risk of dystocia, particularly for ewes with high liveweight in the first 60 days of pregnancy. For most ewes dystocia was difficult to predict, but there was a small proportion of ewes with a very high risk of dystocia and if these could be identified in advance they could be monitored much more closely than the rest of the flock.

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Outcomes for and Risk Factors Associated With Vancomycin-ResistantEnterococcus faecalisand Vancomycin-ResistantEnterococcus faeciumBacteremia in Cancer Patients

Infection Control and Hospital Epidemiology ◽

10.1086/519932 ◽

2007 ◽

Vol 28 (9) ◽

pp. 1054-1059 ◽

Cited By ~ 47

Author(s):

G. Ghanem ◽

R. Hachem ◽

Y. Jiang ◽

R. F. Chemaly ◽

I. Raad

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Mortality Rate ◽

Cancer Patients ◽

Independent Risk Factor ◽

Response To Therapy ◽

Aminoglycoside Therapy ◽

Significant Difference ◽

Vancomycin Resistant ◽

And Control

Objective.Vancomycin-resistant enterococci (VRE) are a major cause of nosocomial infection. We sought to compare vancomycin-resistant (VR)Enterococcus faecalisbacteremia and VREnterococcus faeciumbacteremia in cancer patients with respect to risk factors, clinical presentation, microbiological characteristics, antimicrobial therapy, and outcomes.Methods.We identified 210 cancer patients with VRE bacteremia who had been treated between January 1996 and December 2004; 16 of these 210 had VRE. faecalisbacteremia and were matched with 32 patients with VRE. faeciumbacteremia and 32 control patients. A retrospective review of medical records was conducted.Results.Logistic regression analysis showed that, compared with VRE. faecalisbacteremia, VRE. faeciumbacteremia was associated with a worse clinical response to therapy (odds ratio [OR], 0.3 [95% confidence interval (CI), 0.07-0.98];P= .046) and a higher overall mortality rate (OR, 8.3 [95% CI, 1.9-35.3];P= .004), but the VRE-related mortality rate did not show a statistically significant difference (OR, 6.8 [95% CI, 0.7-61.8];P= .09). Compared with control patients, patients with VRE. faecalisbacteremia were more likely to have received an aminoglycoside in the 30 days before the onset of bacteremia (OR, 5.8 [95% CI, 1.2-27.6];P= .03), whereas patients with VRE. faeciumbacteremia were more likely to have received a carbapenem in the 30 days before the onset of bacteremia (OR, 11.7 [95% CI, 3.6-38.6];P<.001). In a multivariate model that compared patients with VRE. faeciumbacteremia and control patients, predictors of mortality included acute renal failure on presentation (OR, 15.1 [95% CI, 2.3-99.2];P= .004) and VRE. faeciumbacteremia (OR, 11 [95% CI, 2.7-45.1];P<.001). No difference in outcomes was found between patients with VRE. faecalisbacteremia and control patients.Conclusions.VRE. faeciumbacteremia in cancer patients was associated with a poorer outcome than was VRE. faecalisbacteremia. Recent receipt of carbapenem therapy was an independent risk factor for VRE. faeciumbacteremia, and recent receipt of aminoglycoside therapy was independent risk factor forE. faecalisbacteremia.

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