{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T19:20:54Z","timestamp":1775503254645,"version":"3.50.1"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T00:00:00Z","timestamp":1681776000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T00:00:00Z","timestamp":1681776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100012681","name":"Universit\u00e4tsklinikum K\u00f6ln","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100012681","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infection"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Spinal injections are increasingly used for back pain treatment. Vertebral osteomyelitis (VO) after spinal injection (SIVO) is rare, but patient characteristics and outcome have not been well characterized. The aim of this study was to assess patient characteristics of SIVO in comparison to patients with native vertebral osteomyelitis (NVO) and to determine predictors for 1-year survival.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This is a single-center cohort study from a tertiary referral hospital. This is a retrospective analysis of Patients with VO who were prospectively enrolled into a spine registry from 2008 to 2019. Student\u2019s <jats:italic>t<\/jats:italic>-test, Kruskal\u2013Wallis test or Chi-square test were applied for group comparisons. Survival analysis was performed using a log-rank test and a multivariable Cox regression model.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>283 VO patients were enrolled in the study, of whom 44 (15.5%) had SIVO and 239 (84.5%) NVO. Patients with SIVO were significantly younger, had a lower Charlson comorbidity index and a shorter hospital stay compared to NVO. They also showed a higher rate of psoas abscesses and spinal empyema (38.6% [SIVO] vs. 20.9% [NVO]). <jats:italic>Staphylococcus aureus<\/jats:italic> (27%) and coagulase-negative staphylococci (CNS) (25%) were equally often detected in SIVO while <jats:italic>S. aureus<\/jats:italic> was more frequently than CNS in NVO (38.1% vs. 7.9%).Patients with SIVO (<jats:italic>P<\/jats:italic>\u2009=\u20090.04) had a higher 1-year survival rate (Fig.\u00a01). After multivariate analysis, ASA score was associated with a lower 1-year survival in VO.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The results from this study emphasize unique clinical features of SIVO, which warrant that SIVO should be estimated as a separate entity of VO.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s15010-023-02024-9","type":"journal-article","created":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T15:28:43Z","timestamp":1681831723000},"page":"599-607","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Clinical features and outcome of vertebral osteomyelitis after spinal injection: is it worth the price?"],"prefix":"10.1007","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1723-5995","authenticated-orcid":false,"given":"Ayla","family":"Yagdiran","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1075-4362","authenticated-orcid":false,"given":"Gregor","family":"Paul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6711-6516","authenticated-orcid":false,"given":"Charlotte","family":"Meyer-Schwickerath","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5145-8992","authenticated-orcid":false,"given":"Justus","family":"Scheder-Bieschin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5528-6059","authenticated-orcid":false,"given":"David","family":"Tobys","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8540-5725","authenticated-orcid":false,"given":"Nikolaus","family":"Kernich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9929-3370","authenticated-orcid":false,"given":"Peer","family":"Eysel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5740-0772","authenticated-orcid":false,"given":"Norma","family":"Jung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,4,18]]},"reference":[{"key":"2024_CR1","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1056\/NEJMoa1313265","volume":"371","author":"JL Friedly","year":"2014","unstructured":"Friedly JL, Comstock BA, Turner JA, Heagerty PJ, Deyo RA, Sullivan SD, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med. 2014;371:11\u201321. https:\/\/doi.org\/10.1056\/NEJMoa1313265.","journal-title":"N Engl J Med"},{"key":"2024_CR2","doi-asserted-by":"publisher","first-page":"E365","DOI":"10.36076\/ppj\/2016.19.E365","volume":"19","author":"L Manchikanti","year":"2016","unstructured":"Manchikanti L, Knezevic NN, Boswell MV, Kaye AD, Hirsch JA. Epidural injections for lumbar radiculopathy and spinal stenosis: a comparative systematic review and meta-analysis. Pain Physician. 2016;19:E365-410.","journal-title":"Pain Physician"},{"key":"2024_CR3","doi-asserted-by":"publisher","first-page":"373","DOI":"10.7326\/M15-0934","volume":"163","author":"R Chou","year":"2015","unstructured":"Chou R, Hashimoto R, Friedly J, Fu R, Bougatsos C, Dana T, et al. Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis. Ann Intern Med. 2015;163:373\u201381. https:\/\/doi.org\/10.7326\/M15-0934.","journal-title":"Ann Intern Med"},{"key":"2024_CR4","unstructured":"Research C for DE and. FDA Drug Safety Communication: FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. FDA 2019."},{"key":"2024_CR5","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1007\/s12178-008-9035-2","volume":"1","author":"BS Goodman","year":"2008","unstructured":"Goodman BS, Posecion LWF, Mallempati S, Bayazitoglu M. Complications and pitfalls of lumbar interlaminar and transforaminal epidural injections. Curr Rev Musculoskelet Med. 2008;1:212\u201322. https:\/\/doi.org\/10.1007\/s12178-008-9035-2.","journal-title":"Curr Rev Musculoskelet Med"},{"key":"2024_CR6","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1007\/s00330-017-4977-7","volume":"28","author":"JW Lee","year":"2018","unstructured":"Lee JW, Lee E, Lee GY, Kang Y, Ahn JM, Kang HS. Epidural steroid injection-related events requiring hospitalisation or emergency room visits among 52,935 procedures performed at a single centre. Eur Radiol. 2018;28:418\u201327. https:\/\/doi.org\/10.1007\/s00330-017-4977-7.","journal-title":"Eur Radiol"},{"key":"2024_CR7","doi-asserted-by":"publisher","first-page":"1598","DOI":"10.1056\/NEJMoa1213978","volume":"369","author":"RM Smith","year":"2013","unstructured":"Smith RM, Schaefer MK, Kainer MA, Wise M, Finks J, Duwve J, et al. Fungal infections associated with contaminated methylprednisolone injections. N Engl J Med. 2013;369:1598\u2013609. https:\/\/doi.org\/10.1056\/NEJMoa1213978.","journal-title":"N Engl J Med"},{"key":"2024_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jhin.2021.07.004","volume":"116","author":"G Paul","year":"2021","unstructured":"Paul G, Mei\u00dfner A, Neuneier J, Neuschmelting V, Grau S, Yagdiran A, et al. Outbreak of Pseudomonas aeruginosa infections after CT-guided spinal injections. J Hosp Infect. 2021;116:1\u20139. https:\/\/doi.org\/10.1016\/j.jhin.2021.07.004.","journal-title":"J Hosp Infect"},{"key":"2024_CR9","doi-asserted-by":"publisher","first-page":"693","DOI":"10.36076\/ppj.2008\/11\/693","volume":"11","author":"TT Simopoulos","year":"2008","unstructured":"Simopoulos TT, Kraemer JJ, Glazer P, Bajwa ZH. Vertebral osteomyelitis: a potentially catastrophic outcome after lumbar epidural steroid injection. Pain Physician. 2008;11:693\u20137.","journal-title":"Pain Physician"},{"key":"2024_CR10","doi-asserted-by":"publisher","first-page":"E209","DOI":"10.1097\/01.BRS.0000067280.29261.57","volume":"28","author":"W-M Yue","year":"2003","unstructured":"Yue W-M, Tan S-B. Distant skip level discitis and vertebral osteomyelitis after caudal epidural injection: a case report of a rare complication of epidural injections. Spine. 2003;28:E209-211. https:\/\/doi.org\/10.1097\/01.BRS.0000067280.29261.57.","journal-title":"Spine"},{"key":"2024_CR11","doi-asserted-by":"publisher","first-page":"1426","DOI":"10.1097\/BRS.0000000000003542","volume":"45","author":"M Breuninger","year":"2020","unstructured":"Breuninger M, Yagdiran A, Willinger A, Biehl LM, Otto-Lambertz C, Kuhr K, et al. Vertebral osteomyelitis after spine surgery: a disease with distinct characteristics. Spine. 2020;45:1426\u201334. https:\/\/doi.org\/10.1097\/BRS.0000000000003542.","journal-title":"Spine"},{"key":"2024_CR12","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1016\/j.spinee.2018.11.012","volume":"19","author":"UJ Kim","year":"2019","unstructured":"Kim UJ, Bae JY, Kim S-E, Kim C-J, Kang S-J, Jang H-C, et al. Comparison of pyogenic postoperative and native vertebral osteomyelitis. Spine J Off J North Am Spine Soc. 2019;19:880\u20137. https:\/\/doi.org\/10.1016\/j.spinee.2018.11.012.","journal-title":"Spine J Off J North Am Spine Soc"},{"key":"2024_CR13","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1097\/ALN.0000000000003947","volume":"135","author":"B Horvath","year":"2021","unstructured":"Horvath B, Kloesel B, Todd MM, Cole DJ, Prielipp RC. The evolution, current value, and future of the american society of anesthesiologists physical status classification system. Anesthesiology. 2021;135:904\u201319. https:\/\/doi.org\/10.1097\/ALN.0000000000003947.","journal-title":"Anesthesiology"},{"key":"2024_CR14","volume-title":"Bakterielle Infektionen der Knochen und Gelenke","author":"KM Peters","year":"1997","unstructured":"Peters KM, Klosterhalfen B. Bakterielle Infektionen der Knochen und Gelenke. Stuttgart: Thieme; 1997."},{"key":"2024_CR15","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1038\/sc.1969.30","volume":"7","author":"HL Frankel","year":"1969","unstructured":"Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I Paraplegia. 1969;7:179\u201392. https:\/\/doi.org\/10.1038\/sc.1969.30.","journal-title":"I Paraplegia"},{"key":"2024_CR16","doi-asserted-by":"publisher","first-page":"254.e1","DOI":"10.1016\/j.cmi.2014.09.007","volume":"21","author":"O Murillo","year":"2015","unstructured":"Murillo O, Grau I, Lora-Tamayo J, Gomez-Junyent J, Ribera A, Tubau F, et al. The changing epidemiology of bacteraemic osteoarticular infections in the early 21st century. Clin Microbiol Infect. 2015;21:254.e1-254.e8. https:\/\/doi.org\/10.1016\/j.cmi.2014.09.007.","journal-title":"Clin Microbiol Infect"},{"key":"2024_CR17","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1016\/j.spinee.2015.02.021","volume":"15","author":"M Kehrer","year":"2015","unstructured":"Kehrer M, Pedersen C, Jensen TG, Hallas J, Lassen AT. Increased short- and long-term mortality among patients with infectious spondylodiscitis compared with a reference population. Spine J. 2015;15:1233\u201340. https:\/\/doi.org\/10.1016\/j.spinee.2015.02.021.","journal-title":"Spine J"},{"key":"2024_CR18","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1007\/s15010-018-1177-6","volume":"46","author":"J Aguilar-Company","year":"2018","unstructured":"Aguilar-Company J, Pigrau C, Fern\u00e1ndez-Hidalgo N, Rodr\u00edguez-Pardo D, Falc\u00f3 V, Lung M, et al. Native vertebral osteomyelitis in aged patients: distinctive features. An observational cohort study. Infection. 2018;46:679\u201386. https:\/\/doi.org\/10.1007\/s15010-018-1177-6.","journal-title":"Infection"},{"key":"2024_CR19","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1093\/cid\/civ633","volume":"61","author":"EF Berbari","year":"2015","unstructured":"Berbari EF, Kanj SS, Kowalski TJ, Darouiche RO, Widmer AF, Schmitt SK, et al. Executive summary: 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis. 2015;61:859\u201363. https:\/\/doi.org\/10.1093\/cid\/civ633.","journal-title":"Clin Infect Dis"},{"key":"2024_CR20","unstructured":"Herren C, von der H\u00f6h N. Diagnostik und Therapie der Spondylodiszitis_S2k-Leitlinie 2020:101."},{"key":"2024_CR21","unstructured":"Lutchman L, Kakisi O, Cubelo C. Joint Trust Guideline for the Management of Vertebral Osteomyelitis (VOM), Infective Discitis (ID) and Spinal Epidural Abscess (SEA) in Adults 2020."},{"key":"2024_CR22","doi-asserted-by":"publisher","first-page":"ofaa176","DOI":"10.1093\/ofid\/ofaa176","volume":"7","author":"DY Kim","year":"2020","unstructured":"Kim DY, Kim UJ, Yu Y, Kim S-E, Kang S-J, Jun K-I, et al. Microbial etiology of pyogenic vertebral osteomyelitis according to patient characteristics. Open Forum Infect Dis. 2020;7:ofaa176. https:\/\/doi.org\/10.1093\/ofid\/ofaa176.","journal-title":"Open Forum Infect Dis"},{"key":"2024_CR23","doi-asserted-by":"publisher","unstructured":"Layer F, Strommenger B, Cuny C, Werner G. Eigenschaften, H\u00e4ufigkeit und Verbreitung von MRSA in Deutschland \u2013 Zur Situation 2019\/2020 2021. https:\/\/doi.org\/10.25646\/9007.","DOI":"10.25646\/9007"},{"key":"2024_CR24","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1080\/1120009X.2020.1761638","volume":"32","author":"YM Ibrahim","year":"2020","unstructured":"Ibrahim YM, Abu El-Wafa WM. Evaluation of fosfomycin combined with vancomycin against vancomycin-resistant coagulase negative staphylococci. J Chemother Florence Italy. 2020;32:411\u20139. https:\/\/doi.org\/10.1080\/1120009X.2020.1761638.","journal-title":"J Chemother Florence Italy"},{"key":"2024_CR25","doi-asserted-by":"publisher","first-page":"2819","DOI":"10.1128\/JCM.38.8.2819-2823.2000","volume":"38","author":"C von Eiff","year":"2000","unstructured":"von Eiff C, Reinert RR, Kresken M, Brauers J, Hafner D, Peters G. Nationwide German Multicenter Study on prevalence of antibiotic resistance in staphylococcal bloodstream isolates and comparative in vitro activities of quinupristin-dalfopristin. J Clin Microbiol. 2000;38:2819\u201323.","journal-title":"J Clin Microbiol"},{"key":"2024_CR26","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.9559","volume":"12","author":"MFM Ballestero","year":"2020","unstructured":"Ballestero MFM, Carneiro V, Luz Lima JP, Santos de Oliveira R. Psoas abscess after lumbar facet joint injection: case report and literature review. Cureus. 2020;12: e9559. https:\/\/doi.org\/10.7759\/cureus.9559.","journal-title":"Cureus"},{"key":"2024_CR27","doi-asserted-by":"publisher","first-page":"90","DOI":"10.4097\/kjae.2017.70.1.90","volume":"70","author":"K-S Kim","year":"2016","unstructured":"Kim K-S, Kim Y-K, Kim S-S, Shim SM, Cho HJ. Cerebrospinal fluid infection after lumbar nerve root steroid injection: a case report. Korean J Anesthesiol. 2016;70:90\u20134. https:\/\/doi.org\/10.4097\/kjae.2017.70.1.90.","journal-title":"Korean J Anesthesiol"},{"key":"2024_CR28","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1007\/s00701-018-3467-2","volume":"160","author":"S Lener","year":"2018","unstructured":"Lener S, Hartmann S, Barbagallo GMV, Certo F, Thom\u00e9 C, Tschugg A. Management of spinal infection: a review of the literature. Acta Neurochir (Wien). 2018;160:487\u201396. https:\/\/doi.org\/10.1007\/s00701-018-3467-2.","journal-title":"Acta Neurochir (Wien)"},{"key":"2024_CR29","doi-asserted-by":"publisher","first-page":"1732","DOI":"10.1056\/NEJMcp2032396","volume":"386","author":"A Chiarotto","year":"2022","unstructured":"Chiarotto A, Koes BW. Nonspecific low back pain. N Engl J Med. 2022;386:1732\u201340. https:\/\/doi.org\/10.1056\/NEJMcp2032396.","journal-title":"N Engl J Med"},{"key":"2024_CR30","doi-asserted-by":"publisher","first-page":"528","DOI":"10.14423\/SMJ.0000000000000144","volume":"107","author":"DD Dean","year":"2014","unstructured":"Dean DD, Maruszak MB, Sandoval LF. Spinal injections: trends in the US outpatient population. South Med J. 2014;107:528\u20139. https:\/\/doi.org\/10.14423\/SMJ.0000000000000144.","journal-title":"South Med J"},{"key":"2024_CR31","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1111\/1469-0691.12653","volume":"20","author":"S ErenG\u00f6k","year":"2014","unstructured":"ErenG\u00f6k S, Kaptano\u011flu E, Celikba\u015f A, Erg\u00f6n\u00fcl O, Baykam N, Ero\u011flu M, et al. Vertebral osteomyelitis: clinical features and diagnosis. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2014;20:1055\u201360. https:\/\/doi.org\/10.1111\/1469-0691.12653.","journal-title":"Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis"},{"key":"2024_CR32","doi-asserted-by":"publisher","first-page":"2065","DOI":"10.1007\/s10096-020-03929-1","volume":"39","author":"M Amsilli","year":"2020","unstructured":"Amsilli M, Epaulard O. How is the microbial diagnosis of bacterial vertebral osteomyelitis performed? An 11-year retrospective study. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. 2020;39:2065\u201376. https:\/\/doi.org\/10.1007\/s10096-020-03929-1.","journal-title":"Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol"},{"key":"2024_CR33","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1001\/archinternmed.2011.593","volume":"172","author":"SP Cohen","year":"2012","unstructured":"Cohen SP, Gupta A, Strassels SA, Christo PJ, Erdek MA, Griffith SR, et al. Effect of MRI on treatment results or decision making in patients with lumbosacral radiculopathy referred for epidural steroid injections: a multicenter, randomized controlled trial. Arch Intern Med. 2012;172:134\u201342. https:\/\/doi.org\/10.1001\/archinternmed.2011.593.","journal-title":"Arch Intern Med"}],"container-title":["Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-023-02024-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s15010-023-02024-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-023-02024-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T18:38:51Z","timestamp":1684867131000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s15010-023-02024-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,18]]},"references-count":33,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,6]]}},"alternative-id":["2024"],"URL":"https:\/\/doi.org\/10.1007\/s15010-023-02024-9","relation":{},"ISSN":["0300-8126","1439-0973"],"issn-type":[{"value":"0300-8126","type":"print"},{"value":"1439-0973","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,18]]},"assertion":[{"value":"31 January 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 March 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 April 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent\/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members except for NJ. NJ has received lecture fees from Gilead, Infectopharm, MSD, Bayer; Medacta and Labor Stein and travel grants from Pfizer, Gilead, Basilea, Correvio, Pfizer and Novartis and grants from an observational study from Infectopharm.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was approved by the ethics committee of our institution (file number: 09-182) and complies with the principles of the Declaration of Helsinki (1996).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}