{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T16:21:45Z","timestamp":1784132505632,"version":"3.55.0"},"reference-count":57,"publisher":"Oxford University Press (OUP)","issue":"5","funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,2,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Azithromycin (AZI) is recommended with ceftriaxone (CRO) for treatment of uncomplicated gonococcal urethritis and cervicitis in the United States, and an AZI-susceptibility breakpoint is needed. Neither the Food and Drug Administration (FDA) nor the Clinical and Laboratory Standards Institute (CLSI) has set interpretive breakpoints for AZI susceptibility. As a result, AZI antimicrobial susceptibility testing (AST) cannot be interpreted using recognized standards. This has contributed to increasingly unavailable clinical laboratory AST, although gonorrhea is on the rise with &amp;gt;550 000 US gonorrhea cases reported to the Centers for Disease Control and Prevention in 2017, the highest number of cases since 1991.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This article summarizes the rationale data reviewed by the CLSI in June 2018.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The CLSI decided to set a susceptible-only interpretive breakpoint at the minimum inhibitory concentration of \u22641 \u00b5g\/mL. This is also the epidemiological cutoff value (ECV) (ie, the end of the wild-type susceptibility distribution). This breakpoint presumes that AZI (1-g single dose) is used in an approved regimen that includes an additional antimicrobial agent (ie, CRO 250 mg, intramuscular single dose).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Having a breakpoint can improve patient care and surveillance and allow future development and FDA regulatory approval of modernized AST to guide treatment. The breakpoint coincides with a European Committee on AST decision to remove previously established, differing AZI breakpoints and use the ECV as guidance for testing. The CLSI breakpoint is now the recognized standard that defines AZI susceptibility for gonococcal infections.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciz292","type":"journal-article","created":{"date-parts":[[2019,4,4]],"date-time":"2019-04-04T19:46:30Z","timestamp":1554407190000},"page":"798-804","source":"Crossref","is-referenced-by-count":22,"title":["Rationale for a <i>Neisseria gonorrhoeae<\/i> Susceptible\u2013only Interpretive Breakpoint for Azithromycin"],"prefix":"10.1093","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3819-0324","authenticated-orcid":false,"given":"Ellen N","family":"Kersh","sequence":"first","affiliation":[{"name":"Division of STD Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Allen","sequence":"additional","affiliation":[{"name":"Public Health Ontario , Toronto,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Ransom","sequence":"additional","affiliation":[{"name":"Association of Public Health Laboratories , Silver Spring, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Schmerer","sequence":"additional","affiliation":[{"name":"Division of STD Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sancta","family":"Cyr","sequence":"additional","affiliation":[{"name":"Division of STD Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Workowski","sequence":"additional","affiliation":[{"name":"Division of STD Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia"},{"name":"Emory University, Department of Medicine , Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hillard","family":"Weinstock","sequence":"additional","affiliation":[{"name":"Division of STD Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Jane","family":"Ferraro","sequence":"additional","affiliation":[{"name":"Department of Medicine, Harvard Medical School , Boston"},{"name":"Department of Pathology, Massachusetts General Hospital, Harvard Medical School , Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,4,9]]},"reference":[{"key":"2024111411410529100_CIT0001","first-page":"1","article-title":"Sexually transmitted diseases treatment guidelines, 2015","volume":"64","author":"Workowski","year":"2015","journal-title":"MMWR Recomm Rep"},{"key":"2024111411410529100_CIT0002","first-page":"332","article-title":"Update to CDC\u2019s sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections","volume":"56","author":"Centers for Disease Control and Prevention","year":"2007","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2024111411410529100_CIT0003","first-page":"590","article-title":"Update to CDC\u2019s sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections","volume":"61","author":"Centers for Disease Control and Prevention","year":"2012","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2024111411410529100_CIT0004","author":"Centers for Disease Control and Prevention"},{"key":"2024111411410529100_CIT0005","doi-asserted-by":"crossref","first-page":"473","DOI":"10.15585\/mmwr.mm6716a4","article-title":"Adherence to CDC recommendations for the treatment of uncomplicated gonorrhea\u2014STD Surveillance Network, United States, 2016","volume":"67","author":"Weston","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2024111411410529100_CIT0006","author":"Public Health England","year":"2018"},{"key":"2024111411410529100_CIT0007","doi-asserted-by":"crossref","unstructured":"Whiley DM, Jennison A, Pearson J, Lahra MM. Genetic characterisation of Neisseria gonorrhoeae resistant to both ceftriaxone and azithromycin. Lancet Infect Dis. 2018;1:717-8. PMID: 29976521. doi:10.1016\/S1473-3099(18)30340-2","DOI":"10.1016\/S1473-3099(18)30340-2"},{"key":"2024111411410529100_CIT0008","first-page":"1","article-title":"Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014","volume":"63","author":"Centers for Disease Control and Prevention","year":"2014","journal-title":"MMWR Recomm Rep"},{"key":"2024111411410529100_CIT0009","volume-title":"Performance standards for antimicrobial susceptibility testing. CLSI supplement M100","author":"Clinical and Laboratory Standards Institute","year":"2018","edition":"28"},{"key":"2024111411410529100_CIT0010","volume-title":"FDA-recognized antimicrobial susceptibility test interpretive criteria","author":"Food and Drug Administration","year":"2018"},{"key":"2024111411410529100_CIT0011","volume-title":"Development of in vitro susceptibility testing criteria and quality control parameters; approved guideline. CLSI Document M23 \u2013 A3","author":"Clinical and Laboratory Standards Institute","year":"2008","edition":"3"},{"key":"2024111411410529100_CIT0012","unstructured":"European Committee on Antimicrobial Susceptibility Testing (EUCAST). Setting breakpoints for new antimicrobial agents.2016. Available at: http:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/EUCAST_SOPs\/EUCAST_SOP_1.2_Setting_breakpoints_new_agents_20161121.pdf. Accessed 7 February 2019."},{"key":"2024111411410529100_CIT0013","unstructured":"European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint review and revision. 2018. Available at: http:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/EUCAST_SOPs\/2018\/EUCAST_SOP_3.2_Breakpoint_Review_and_Revision_20180123.pdf. Accessed 7 February 2019."},{"key":"2024111411410529100_CIT0014","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss6507a1","article-title":"Neisseria gonorrhoeae antimicrobial susceptibility surveillance\u2014the gonococcal isolate surveillance project, 27 sites, United States, 2014","volume":"65","author":"Kirkcaldy","year":"2016","journal-title":"MMWR Surveill Summ"},{"key":"2024111411410529100_CIT0015","volume-title":"Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. CLSI standard M07","author":"Clinical and Laboratory Standards Institute","year":"2018","edition":"11"},{"key":"2024111411410529100_CIT0016","author":"Centers for Disease Control and Prevention","year":"2016"},{"key":"2024111411410529100_CIT0017","doi-asserted-by":"crossref","first-page":"3142","DOI":"10.1128\/JCM.00940-09","article-title":"Wild-type MIC distribution and epidemiological cutoff values for Aspergillus fumigatus and three triazoles as determined by the Clinical and Laboratory Standards Institute broth microdilution methods","volume":"47","author":"Pfaller","year":"2009","journal-title":"J Clin Microbiol"},{"key":"2024111411410529100_CIT0018","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1093\/jac\/dkg312","article-title":"European harmonization of MIC breakpoints for antimicrobial susceptibility testing of bacteria","volume":"52","author":"Kahlmeter","year":"2003","journal-title":"J Antimicrob Chemother"},{"key":"2024111411410529100_CIT0019","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1128\/AAC.01256-09","article-title":"Echinocandin susceptibility testing of Candida species: comparison of EUCAST EDef 7.1, CLSI M27-A3, Etest, disk diffusion, and agar dilution methods with RPMI and isosensitest media","volume":"54","author":"Arendrup","year":"2010","journal-title":"Antimicrob Agents Chemother"},{"key":"2024111411410529100_CIT0020","author":"Clinical and Laboratory Standards Institute"},{"key":"2024111411410529100_CIT0021","doi-asserted-by":"crossref","first-page":"3109","DOI":"10.1093\/jac\/dkw279","article-title":"WGS analysis and molecular resistance mechanisms of azithromycin-resistant (MIC &gt;2 mg\/L) Neisseria gonorrhoeae isolates in Europe from 2009 to 2014","volume":"71","author":"Jacobsson","year":"2016","journal-title":"J Antimicrob Chemother"},{"key":"2024111411410529100_CIT0022","doi-asserted-by":"crossref","first-page":"2086","DOI":"10.1093\/jac\/dku118","article-title":"Treatment failure with 2 g of azithromycin (extended-release formulation) in gonorrhoea in Japan caused by the international multidrug-resistant ST1407 strain of Neisseria gonorrhoeae","volume":"69","author":"Morita-Ishihara","year":"2014","journal-title":"J Antimicrob Chemother"},{"key":"2024111411410529100_CIT0023","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/OLQ.0000000000000265","article-title":"Failure of azithromycin 2.0 g in the treatment of gonococcal urethritis caused by high-level resistance in California","volume":"42","author":"Gose","year":"2015","journal-title":"Sex Transm Dis"},{"key":"2024111411410529100_CIT0024","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1093\/infdis\/jiw420","article-title":"Genomic epidemiology of gonococcal resistance to extended-spectrum cephalosporins, macrolides, and fluoroquinolones in the United States, 2000-2013","volume":"214","author":"Grad","year":"2016","journal-title":"J Infect Dis"},{"key":"2024111411410529100_CIT0025","doi-asserted-by":"crossref","DOI":"10.1128\/mBio.01747-18","article-title":"Mosaic drug efflux gene sequences from commensal Neisseria can lead to low-level azithromycin resistance expressed by Neisseria gonorrhoeae clinical isolates","volume":"9","author":"Shafer","year":"2018","journal-title":"MBio"},{"key":"2024111411410529100_CIT0026","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/S1473-3099(13)70693-5","article-title":"Genomic epidemiology of Neisseria gonorrhoeae with reduced susceptibility to cefixime in the USA: a retrospective observational study","volume":"14","author":"Grad","year":"2014","journal-title":"Lancet Infect Dis"},{"key":"2024111411410529100_CIT0027","doi-asserted-by":"crossref","first-page":"e235","DOI":"10.1016\/S1473-3099(17)30310-9","article-title":"Sexually transmitted infections: challenges ahead","volume":"17","author":"Unemo","year":"2017","journal-title":"Lancet Infect Dis"},{"key":"2024111411410529100_CIT0028","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1056\/NEJMoa041681","article-title":"Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection","volume":"352","author":"Golden","year":"2005","journal-title":"N Engl J Med"},{"key":"2024111411410529100_CIT0029","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1258\/0956462961917212","article-title":"Azithromycin in gonorrhoea","volume":"7","author":"Waugh","year":"1996","journal-title":"Int J STD AIDS"},{"key":"2024111411410529100_CIT0030","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1097\/00007435-199403000-00010","article-title":"Multicenter trial of single-dose azithromycin vs. ceftriaxone in the treatment of uncomplicated gonorrhea. Azithromycin Gonorrhea Study Group","volume":"21","author":"Handsfield","year":"1994","journal-title":"Sex Transm Dis"},{"key":"2024111411410529100_CIT0031","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1056\/NEJMoa1706988","article-title":"Single-dose zoliflodacin (ETX0914) for treatment of urogenital gonorrhea","volume":"379","author":"Taylor","year":"2018","journal-title":"N Engl J Med"},{"key":"2024111411410529100_CIT0032","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1093\/jac\/31.suppl_E.193","article-title":"Open study of the safety and efficacy of a single oral dose of azithromycin for the treatment of uncomplicated gonorrhoea in men and women","volume":"31","author":"Waugh","year":"1993","journal-title":"J Antimicrob Chemother"},{"key":"2024111411410529100_CIT0033","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1093\/jac\/25.suppl_A.109","article-title":"Azithromycin in the treatment of sexually transmitted disease","volume":"25","author":"Steingrimsson","year":"1990","journal-title":"J Antimicrob Chemother"},{"key":"2024111411410529100_CIT0034","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1136\/sti.2010.044586","article-title":"Azithromycin in the treatment of infection with Neisseria gonorrhoeae","volume":"86","author":"Bignell","year":"2010","journal-title":"Sex Transm Infect"},{"key":"2024111411410529100_CIT0035","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1258\/095646204773557767","article-title":"Efficacy of azithromycin 1g single dose in the management of uncomplicated gonorrhoea","volume":"15","author":"Habib","year":"2004","journal-title":"Int J STD AIDS"},{"key":"2024111411410529100_CIT0036","doi-asserted-by":"crossref","first-page":"3116","DOI":"10.1093\/jac\/dku221","article-title":"A single 2 g oral dose of extended-release azithromycin for treatment of gonococcal urethritis","volume":"69","author":"Yasuda","year":"2014","journal-title":"J Antimicrob Chemother"},{"key":"2024111411410529100_CIT0037","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1093\/cid\/ciu873","article-title":"Persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea is influenced by antibiotic susceptibility and reinfection","volume":"60","author":"Bissessor","year":"2015","journal-title":"Clin Infect Dis"},{"key":"2024111411410529100_CIT0038","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1093\/cid\/ciu876","article-title":"Editorial commentary: persistent gonococcal DNA: artifact or real? Further insights into the biology of a remarkable pathogen","volume":"60","author":"Zenilman","year":"2015","journal-title":"Clin Infect Dis"},{"key":"2024111411410529100_CIT0039","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1586\/eri.11.103","article-title":"Antimicrobial resistance in Neisseria gonorrhoeae in the UK: surveillance and management","volume":"9","author":"Ison","year":"2011","journal-title":"Expert Rev Anti Infect Ther"},{"key":"2024111411410529100_CIT0040","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1097\/OLQ.0b013e3182685d2b","article-title":"Emergence of increased azithromycin resistance during unsuccessful treatment of Neisseria gonorrhoeae infection with azithromycin (Portland, OR, 2011)","volume":"39","author":"Soge","year":"2012","journal-title":"Sex Transm Dis"},{"key":"2024111411410529100_CIT0041","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1258\/0956462052932746","article-title":"Efficacy of azithromycin 1 g single dose in the management of uncomplicated gonorrhoea","volume":"16","author":"Waters","year":"2005","journal-title":"Int J STD AIDS"},{"key":"2024111411410529100_CIT0042","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/01.OLQ.0000109514.91508.FC","article-title":"The emergence of Neisseria gonorrhoeae with decreased susceptibility to azithromycin in Kansas City, Missouri, 1999 to 2000","volume":"31","author":"McLean","year":"2004","journal-title":"Sex Transm Dis"},{"key":"2024111411410529100_CIT0043","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1093\/jac\/dkp188","article-title":"Emergence of high-level azithromycin resistance in Neisseria gonorrhoeae in England and Wales","volume":"64","author":"Chisholm","year":"2009","journal-title":"J Antimicrob Chemother"},{"key":"2024111411410529100_CIT0044","doi-asserted-by":"crossref","first-page":"2504","DOI":"10.1056\/NEJMc1512757","article-title":"Failure of dual antimicrobial therapy in treatment of gonorrhea","volume":"374","author":"Fifer","year":"2016","journal-title":"N Engl J Med"},{"key":"2024111411410529100_CIT0045","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1136\/sti.79.1.56","article-title":"Detection of mixed infection of Neisseria gonorrhoeae","volume":"79","author":"Martin","year":"2003","journal-title":"Sex Transm Infect"},{"key":"2024111411410529100_CIT0046","author":"Pfizer","year":"2013"},{"key":"2024111411410529100_CIT0047","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1093\/jac\/25.suppl_A.73","article-title":"The pharmacokinetics of azithromycin in human serum and tissues","volume":"25","author":"Foulds","year":"1990","journal-title":"J Antimicrob Chemother"},{"key":"2024111411410529100_CIT0048","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1007\/BF01975832","article-title":"The pharmacokinetics of azithromycin and their clinical significance","volume":"10","author":"Lode","year":"1991","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2024111411410529100_CIT0049","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1002\/bdd.2510120704","article-title":"Pharmacokinetics of azithromycin after single oral dosing of experimental animals","volume":"12","author":"Davila","year":"1991","journal-title":"Biopharm Drug Dispos"},{"key":"2024111411410529100_CIT0050","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1093\/jac\/25.suppl_A.49","article-title":"Pharmacokinetics of azithromycin in rats and dogs","volume":"25","author":"Shepard","year":"1990","journal-title":"J Antimicrob Chemother"},{"key":"2024111411410529100_CIT0051","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1093\/jac\/dku574","article-title":"The efficacy of azithromycin and doxycycline for the treatment of rectal chlamydia infection: a systematic review and meta-analysis","volume":"70","author":"Kong","year":"2015","journal-title":"J Antimicrob Chemother"},{"key":"2024111411410529100_CIT0052","doi-asserted-by":"crossref","first-page":"e0174372","DOI":"10.1371\/journal.pone.0174372","article-title":"Pharmacokinetics of a single 1g dose of azithromycin in rectal tissue in men","volume":"12","author":"Kong","year":"2017","journal-title":"PLoS One"},{"key":"2024111411410529100_CIT0053","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1128\/AAC.00852-06","article-title":"Comparative pharmacokinetics of azithromycin in serum and white blood cells of healthy subjects receiving a single-dose extended-release regimen versus a 3-day immediate-release regimen","volume":"51","author":"Liu","year":"2007","journal-title":"Antimicrob Agents Chemother"},{"key":"2024111411410529100_CIT0054","doi-asserted-by":"crossref","DOI":"10.1128\/AAC.01409-17","article-title":"Evaluation of the microbiological efficacy of a single 2-gram dose of extended-release azithromycin by population pharmacokinetics and simulation in Japanese patients with gonococcal urethritis","volume":"62","author":"Soda","year":"2018","journal-title":"Antimicrob Agents Chemother"},{"key":"2024111411410529100_CIT0055","author":"Centers for Disease Control and Prevention","year":"2018"},{"key":"2024111411410529100_CIT0056","unstructured":"US Committee on Antimicrobial Susceptibility Testing (USCAST). Breakpoint tables for interpretation of MICs and zone diameters.2018. Available at: http:\/\/www.uscast.org. Accessed 7 February 2019."},{"key":"2024111411410529100_CIT0057","unstructured":"European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. 2019. Available at: http:\/\/www.eucast.org. Accessed 21 January 2019."}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciz292\/28702187\/ciz292.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/70\/5\/798\/32449943\/ciz292.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/70\/5\/798\/32449943\/ciz292.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T12:27:37Z","timestamp":1731587257000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/70\/5\/798\/5432326"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,9]]},"references-count":57,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2019,4,9]]},"published-print":{"date-parts":[[2020,2,14]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciz292","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,3,1]]},"published":{"date-parts":[[2019,4,9]]}}}