{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T10:44:52Z","timestamp":1761129892994,"version":"3.37.3"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2021,4,29]],"date-time":"2021-04-29T00:00:00Z","timestamp":1619654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Staphylococcus aureus bloodstream infection (SAB) is a common, life-threatening infection. The impact of immunosuppressive agents on the outcome of patients with SAB is incompletely understood.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data from 2 large prospective, international, multicenter cohort studies (Invasive Staphylococcus aureus Infections Cohort [INSTINCT] and International Staphylococcus aureus Collaboration [ISAC]) between 2006 and 2015 were analyzed. Patients receiving immunosuppressive agents were identified and a 1:1 propensity score\u2013matched analysis was performed to adjust for baseline characteristics of patients. Overall survival and time to SAB-related late complications (SAB relapse, infective endocarditis, osteomyelitis, or other deep-seated manifestations) were analyzed by Cox regression and competing risk analyses, respectively. This approach was then repeated for specific immunosuppressive agents (corticosteroid monotherapy and immunosuppressive agents other than steroids [IMOTS]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 3188 analyzed patients, 309 were receiving immunosuppressive treatment according to our definitions and were matched to 309 nonimmunosuppressed patients. After propensity score matching, baseline characteristics were well balanced. In the Cox regression analysis, we observed no significant difference in survival between the 2 groups (death during follow-up: 105\/309 [33.9%] immunosuppressed vs 94\/309 [30.4%] nonimmunosuppressed; hazard ratio [HR], 1.20 [95% confidence interval {CI}, .84\u20131.71]). Competing risk analysis showed a cause-specific HR of 1.81 (95% CI, .85\u20133.87) for SAB-related late complications in patients receiving immunosuppressive agents. The cause-specific HR was higher in patients taking IMOTS (3.69 [95% CI, 1.41\u20139.68]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Immunosuppressive agents were not associated with an overall higher mortality. The risk for SAB-related late complications in patients receiving specific immunosuppressive agents such as IMOTS warrants further investigations.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciab385","type":"journal-article","created":{"date-parts":[[2021,4,26]],"date-time":"2021-04-26T20:22:36Z","timestamp":1619468556000},"page":"1239-1247","source":"Crossref","is-referenced-by-count":5,"title":["Impact of Immunosuppressive Agents on Clinical Manifestations and Outcome of <i>Staphylococcus aureus<\/i> Bloodstream Infection: A Propensity Score\u2013Matched Analysis in 2 Large, Prospectively Evaluated Cohorts"],"prefix":"10.1093","volume":"73","author":[{"given":"Johannes","family":"Camp","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine II, Medical Centre \u2013 University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lina","family":"Glaubitz","sequence":"additional","affiliation":[{"name":"Institute for Occupational, Social and Environmental Medicine, Center for Health and Society, Faculty of Medicine, Heinrich Heine University D\u00fcsseldorf, D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Filla","sequence":"additional","affiliation":[{"name":"Institute of Medical Biometry and Bioinformatics, Faculty of Medicine, Heinrich-Heine-University D\u00fcsseldorf, D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Achim J","family":"Kaasch","sequence":"additional","affiliation":[{"name":"Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Faculty of Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frieder","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matt","family":"Scarborough","sequence":"additional","affiliation":[{"name":"Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation, Oxford, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong Bin","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Tilley","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4099-3487","authenticated-orcid":false,"given":"Chun-Hsing","family":"Liao","sequence":"additional","affiliation":[{"name":"Infectious Diseases, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Edgeworth","sequence":"additional","affiliation":[{"name":"Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King\u2019s College London NHS Foundation Trust and Guy\u2019s and St Thomas\u2019 Hospitals NHS Foundation Trust, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Nsutebu","sequence":"additional","affiliation":[{"name":"Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis Eduardo","family":"L\u00f3pez-Cort\u00e9s","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario Virgen Macarena, Department of Medicine, University of Seville, Seville, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Morata","sequence":"additional","affiliation":[{"name":"Service of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6811-1124","authenticated-orcid":false,"given":"Martin","family":"Llewelyn","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Microbiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"Vance G","family":"Fowler","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guy","family":"Thwaites","sequence":"additional","affiliation":[{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harald","family":"Seifert","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Winfried V","family":"Kern","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine II, Medical Centre \u2013 University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Kuss","sequence":"additional","affiliation":[{"name":"German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine-University D\u00fcsseldorf, Institute for Biometrics and Epidemiology, D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7493-7080","authenticated-orcid":false,"given":"Siegbert","family":"Rieg","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine II, Medical Centre \u2013 University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,4,29]]},"reference":[{"key":"2021100522324411200_CIT0001","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1128\/CMR.00134-14","article-title":"Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management","volume":"28","author":"Tong","year":"2015","journal-title":"Clin Microbiol Rev"},{"key":"2021100522324411200_CIT0002","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1080\/00365540600810026","article-title":"The epidemiology of and risk factors for invasive Staphylococcus aureus infections in western Sweden","volume":"39","author":"Jacobsson","year":"2007","journal-title":"Scand J Infect Dis"},{"key":"2021100522324411200_CIT0003","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.jinf.2013.10.015","article-title":"Staphylococcus aureus bloodstream infection: a pooled analysis of five prospective, observational studies","volume":"68","author":"Kaasch","year":"2014","journal-title":"J Infect"},{"key":"2021100522324411200_CIT0004","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1097\/QCO.0b013e32833bcc8a","article-title":"Management of Staphylococcus aureus bacteremia and endocarditis: progresses and challenges","volume":"23","author":"Kern","year":"2010","journal-title":"Curr Opin Infect Dis"},{"key":"2021100522324411200_CIT0005","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.jinf.2017.03.003","article-title":"Staphylococcus aureus bacteremia in patients with rheumatoid arthritis\u2014data from the prospective INSTINCT cohort","volume":"74","author":"Joost","year":"2017","journal-title":"J Infect"},{"key":"2021100522324411200_CIT0006","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1128\/CMR.05022-11","article-title":"Predictors of mortality in Staphylococcus aureus bacteremia","volume":"25","author":"van Hal","year":"2012","journal-title":"Clin Microbiol Rev"},{"key":"2021100522324411200_CIT0007","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.cmi.2016.06.002","article-title":"Gender differences in the outcome of community-acquired Staphylococcus aureus bacteraemia: a historical population-based cohort study","volume":"23","author":"Smit","year":"2017","journal-title":"Clin Microbiol Infect"},{"key":"2021100522324411200_CIT0008","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.cmi.2018.02.009","article-title":"ESCMID Study Group for Infections in Compromised Hosts (ESGICH) consensus document on the safety of targeted and biological therapies: an infectious diseases perspective (intracellular signaling pathways: tyrosine kinase and mTOR inhibitors)","volume":"24(Suppl 2)","author":"Reinwald","year":"2018","journal-title":"Clin Microbiol Infect"},{"key":"2021100522324411200_CIT0009","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1111\/j.1444-0903.2001.00029.x","article-title":"Prospective study of 424 cases of Staphylococcus aureus bacteraemia: determination of factors affecting incidence and mortality","volume":"31","author":"Hill","year":"2001","journal-title":"Intern Med J"},{"key":"2021100522324411200_CIT0010","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1111\/j.1469-0691.2005.01359.x","article-title":"Course and outcome of Staphylococcus aureus bacteraemia: a retrospective analysis of 308 episodes in a Swiss tertiary-care centre","volume":"12","author":"Kaech","year":"2006","journal-title":"Clin Microbiol Infect"},{"key":"2021100522324411200_CIT0011","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1007\/s10096-017-2914-y","article-title":"Staphylococcus aureus bacteremia in immunosuppressed patients: a multicenter, retrospective cohort study","volume":"36","author":"Sasson","year":"2017","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2021100522324411200_CIT0012","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.jinf.2009.07.015","article-title":"Mortality of S. aureus bacteremia and infectious diseases specialist consultation\u2014a study of 521 patients in Germany","volume":"59","author":"Rieg","year":"2009","journal-title":"J Infect"},{"key":"2021100522324411200_CIT0013","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J Chronic Dis"},{"key":"2021100522324411200_CIT0014","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1007\/s15010-018-1165-x","article-title":"Onset of symptoms, diagnostic confirmation, and occurrence of multiple infective foci in patients with Staphylococcus aureus bloodstream infection: a look into the order of events and potential clinical implications","volume":"46","author":"Smit","year":"2018","journal-title":"Infection"},{"key":"2021100522324411200_CIT0015","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1002\/sim.6004","article-title":"A comparison of 12 algorithms for matching on the propensity score","volume":"33","author":"Austin","year":"2014","journal-title":"Stat Med"},{"key":"2021100522324411200_CIT0016","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1016\/j.jclinepi.2013.06.001","article-title":"The z-difference can be used to measure covariate balance in matched propensity score analyses","volume":"66","author":"Kuss","year":"2013","journal-title":"J Clin Epidemiol"},{"key":"2021100522324411200_CIT0017","doi-asserted-by":"crossref","first-page":"dwj154","DOI":"10.1093\/jnci\/djw154","article-title":"Beyond composite endpoints analysis: semicompeting risks as an underutilized framework for cancer research","volume":"108","author":"Jazi\u0107","year":"2016","journal-title":"J Natl Cancer Inst"},{"key":"2021100522324411200_CIT0018","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1093\/biomet\/88.4.907","article-title":"On semi-competing risks data","volume":"88","author":"Fine","year":"2001","journal-title":"Biometrika"},{"key":"2021100522324411200_CIT0019","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1161\/CIRCULATIONAHA.115.017719","article-title":"Introduction to the analysis of survival data in the presence of competing risks","volume":"133","author":"Austin","year":"2016","journal-title":"Circulation"},{"key":"2021100522324411200_CIT0020","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1002\/sim.8008","article-title":"Propensity-score matching with competing risks in survival analysis","volume":"38","author":"Austin","year":"2019","journal-title":"Stat Med"},{"key":"2021100522324411200_CIT0021","doi-asserted-by":"crossref","first-page":"4609","DOI":"10.1002\/sim.5876","article-title":"On model specification and selection of the Cox proportional hazards model","volume":"32","author":"Lin","year":"2013","journal-title":"Stat Med"},{"key":"2021100522324411200_CIT0022","doi-asserted-by":"crossref","first-page":"2601","DOI":"10.1056\/NEJMra064928","article-title":"Infection in solid-organ transplant recipients","volume":"357","author":"Fishman","year":"2007","journal-title":"N Engl J Med"},{"key":"2021100522324411200_CIT0023","first-page":"923","article-title":"Staphylococcus aureus bacteremia in patients with hematologic malignancies: a retrospective case-control study","volume":"88","author":"Venditti","year":"2003","journal-title":"Haematologica"},{"key":"2021100522324411200_CIT0024","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10096-005-0077-8","article-title":"Comparative study of clinical characteristics of neutropenic and non-neutropenic adult cancer patients with bloodstream infections","volume":"25","author":"Velasco","year":"2006","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2021100522324411200_CIT0025","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1097\/CCM.0000000000001465","article-title":"A dysregulated balance of proinflammatory and anti-inflammatory host cytokine response early during therapy predicts persistence and mortality in Staphylococcus aureus bacteremia","volume":"44","author":"Minejima","year":"2016","journal-title":"Crit Care Med"},{"key":"2021100522324411200_CIT0026","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1186\/s13054-018-2025-x","article-title":"Distinct T-helper cell responses to Staphylococcus aureus bacteremia reflect immunologic comorbidities and correlate with mortality","volume":"22","author":"Greenberg","year":"2018","journal-title":"Crit Care"},{"key":"2021100522324411200_CIT0027","doi-asserted-by":"crossref","first-page":"2919","DOI":"10.4049\/jimmunol.1400980","article-title":"Systemic inflammatory response elicited by superantigen destabilizes T regulatory cells, rendering them ineffective during toxic shock syndrome","volume":"193","author":"Tilahun","year":"2014","journal-title":"J Immunol"},{"key":"2021100522324411200_CIT0028","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.micinf.2012.01.001","article-title":"The impact of tacrolimus on the immunopathogenesis of staphylococcal enterotoxin-induced systemic inflammatory response syndrome and pneumonia","volume":"14","author":"Tilahun","year":"2012","journal-title":"Microbes Infect"},{"key":"2021100522324411200_CIT0029","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/0162-3109(93)90062-U","article-title":"Effect of mycophenolate mofetil (RS-61443) on cytokine production: inhibition of superantigen-induced cytokines","volume":"26","author":"Nagy","year":"1993","journal-title":"Immunopharmacology"},{"key":"2021100522324411200_CIT0030","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s12967-015-0420-5","article-title":"Calcineurin inhibitors differentially alter the circadian rhythm of T-cell functionality in transplant recipients","volume":"13","author":"Leyking","year":"2015","journal-title":"J Transl Med"},{"key":"2021100522324411200_CIT0031","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1097\/CCM.0000000000001502","article-title":"Cytokine imbalance predicts poor outcomes in Staphylococcus aureus bacteremia\u2014but what can we do about it?","volume":"44","author":"Rhee","year":"2016","journal-title":"Crit Care Med"},{"key":"2021100522324411200_CIT0032","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1007\/s10096-015-2563-y","article-title":"Should all adjunctive corticosteroid therapy be avoided in the management of hemodynamically stabile Staphylococcus aureus bacteremia?","volume":"35","author":"Forsblom","year":"2016","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2021100522324411200_CIT0033","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1080\/00365540500372846","article-title":"Persistence in Staphylococcus aureus bacteremia: incidence, characteristics of patients and outcome","volume":"38","author":"Khatib","year":"2006","journal-title":"Scand J Infect Dis"},{"key":"2021100522324411200_CIT0034","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1056\/NEJM199808203390806","article-title":"Staphylococcus aureus infections","volume":"339","author":"Lowy","year":"1998","journal-title":"N Engl J Med"},{"key":"2021100522324411200_CIT0035","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1038\/nrmicro2508","article-title":"Are bloodstream leukocytes Trojan horses for the metastasis of Staphylococcus aureus?","volume":"9","author":"Thwaites","year":"2011","journal-title":"Nat Rev Microbiol"},{"key":"2021100522324411200_CIT0036","doi-asserted-by":"crossref","first-page":"3713","DOI":"10.4049\/jimmunol.164.7.3713","article-title":"Survival of Staphylococcus aureus inside neutrophils contributes to infection","volume":"164","author":"Gresham","year":"2000","journal-title":"J Immunol"},{"key":"2021100522324411200_CIT0037","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.jinf.2019.08.001","article-title":"Predictors of recurrence, early treatment failure and death from Staphylococcus aureus bacteraemia: observational analyses within the ARREST trial","volume":"79","author":"Szubert","year":"2019","journal-title":"J Infect"},{"key":"2021100522324411200_CIT0038","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1093\/infdis\/154.2.352","article-title":"Effects of cyclosporine on pulmonary clearance of Staphylococcus aureus and Pseudomonas aeruginosa","volume":"154","author":"Nugent","year":"1986","journal-title":"J Infect Dis"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciab385\/38894412\/ciab385.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/73\/7\/1239\/40511576\/ciab385.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/73\/7\/1239\/40511576\/ciab385.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,8]],"date-time":"2021-10-08T23:25:46Z","timestamp":1633735546000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/73\/7\/1239\/6259211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,29]]},"references-count":38,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,4,29]]},"published-print":{"date-parts":[[2021,10,5]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciab385","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"type":"print","value":"1058-4838"},{"type":"electronic","value":"1537-6591"}],"subject":[],"published-other":{"date-parts":[[2021,10,1]]},"published":{"date-parts":[[2021,4,29]]}}}