{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T12:26:44Z","timestamp":1792931204483,"version":"4.5.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T00:00:00Z","timestamp":1775260800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Johann Wolfgang Goethe-Universit\u00e4t, Frankfurt am Main"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Antimicrob Resist Infect Control"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mobile phones are integral to modern clinical workflows and increasingly bridge clinical and private environments. Yet, their role as portable high-touch surfaces in infection prevention remains insufficiently characterized. We hence assessed prevalence and molecular epidemiology of multidrug-resistant organisms (MDRO) on mobile phones used by healthcare workers (HCWs) at a German university hospital and compared them with devices used by non-HCWs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this 30-month cross-sectional study, 232 HCW and 241 non-HCW mobile phones were analyzed to determine MDRO prevalence and overall bacterial count. A subset of devices was examined before and after disinfection with alcohol-based wipes. Whole genome sequencing with subsequent core genome multilocus sequence typing (cgMLST) was applied to identify clonal clusters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      MDRO prevalence was significantly higher on HCW phones compared to non-HCW phones (15.1% vs. 0.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), with particularly high rates on intensive care unit devices and shared phones (23.4% and 23.0%, respectively). Vancomycin-resistant\n                      <jats:italic>Enterococcus faecium<\/jats:italic>\n                      , predominantly the endemic ST117\/CT71 clone, and methicillin-resistant\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      were detected on 11.2% and 4.7% of devices, respectively. In contrast, no multidrug-resistant Gram-negatives (MDRGN) were identified, despite contamination with susceptible\n                      <jats:italic>Enterobacterales<\/jats:italic>\n                      or nonfermenters. cgMLST analyses revealed clonal MDRO strains mainly within wards and only rarely across wards, consistent with both local clustering and possible cross-ward dissemination. Total bacterial count did not predict MDRO detection. Alcohol-based wipes reliably eliminated MDRO from all tested devices.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Given the high MDRO burden on HCW mobile phones and genomic clustering across wards, mobile phones may represent a relevant reservoir with potential to facilitate in-hospital MDRO dissemination. Standardized mobile phone disinfection routines - particularly for shared and ICU devices - should be considered in infection prevention strategies to reduce potential phone-associated MDRO transmission risk and may represent a conceptual \u201cSixth Moment\u201d complementing the WHO \u201cFive Moments for Hand Hygiene\u201d.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13756-026-01739-2","type":"journal-article","created":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T17:36:22Z","timestamp":1775324182000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Molecular epidemiology of multidrug-resistant organisms on mobile phones: an observational study conducted at a German university hospital"],"prefix":"10.1186","volume":"15","author":[{"given":"Daniel","family":"Hack","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tilman G.","family":"Schultze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volkhard A. J.","family":"Kempf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Genuneit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Reinheimer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"G\u00f6ttig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,4]]},"reference":[{"issue":"8","key":"1739_CR1","doi-asserted-by":"publisher","first-page":"CD015705","DOI":"10.1002\/14651858.CD015705.pub2","volume":"8","author":"C Glenton","year":"2024","unstructured":"Glenton C, Paulsen E, Agarwal S, Gopinathan U, Johansen M, Kyaddondo D, et al. Healthcare workers\u2019 informal uses of mobile phones and other mobile devices to support their work: a qualitative evidence synthesis. Cochrane Database Syst Rev. 2024;8(8):CD015705. https:\/\/doi.org\/10.1002\/14651858.CD015705.pub2.","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"1739_CR2","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.jhin.2008.06.007","volume":"70","author":"J Ramesh","year":"2008","unstructured":"Ramesh J, Carter AO, Campbell MH, Gibbons N, Powlett C, Moseley H, Sr, et al. Use of mobile phones by medical staff at Queen Elizabeth Hospital, Barbados: evidence for both benefit and harm. J Hosp Infect. 2008;70(2):160\u20135. https:\/\/doi.org\/10.1016\/j.jhin.2008.06.007.","journal-title":"J Hosp Infect"},{"key":"1739_CR3","unstructured":"dscout Inc. The mobile touches study: how people really use their phones. dscout. 2016. https:\/\/pages.dscout.com\/hubfs\/downloads\/dscout_mobile_touches_study_2016.pdf"},{"key":"1739_CR4","doi-asserted-by":"publisher","unstructured":"Hossein Falaki R, Mahajan S, Kandula D, Lymberopoulos. Ramesh Govindan, and Deborah Estrin. Diversity in smartphone usage. In Proceedings of the 8th international conference on Mobile systems, applications, and services (MobiSys \u201810). Association for Computing Machinery, New York, NY, USA, 179\u2013194. https:\/\/doi.org\/10.1145\/1814433.1814453","DOI":"10.1145\/1814433.1814453"},{"issue":"4","key":"1739_CR5","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1016\/j.ajic.2021.09.025","volume":"50","author":"R Tannh\u00e4user","year":"2022","unstructured":"Tannh\u00e4user R, Nickel O, Lindner M, Bethge A, Wolf J, Borte S, et al. Bacterial contamination of the smartphones of healthcare workers in a German tertiary-care hospital before and during the COVID-19 pandemic. Am J Infect Control. 2022;50(4):414\u20139. https:\/\/doi.org\/10.1016\/j.ajic.2021.09.025.","journal-title":"Am J Infect Control"},{"issue":"2","key":"1739_CR6","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1007\/s12223-014-0350-2","volume":"60","author":"M Egert","year":"2015","unstructured":"Egert M, Sp\u00e4th K, Weik K, Kunzelmann H, Horn C, Kohl M, et al. Bacteria on smartphone touchscreens in a German university setting and evaluation of two cleaning methods using commercially available cleaning products. Folia Microbiol. 2015;60(2):159\u201364. https:\/\/doi.org\/10.1007\/s12223-014-0350-2.","journal-title":"Folia Microbiol (Praha)"},{"issue":"9","key":"1739_CR7","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1080\/15459624.2012.697419","volume":"9","author":"C Ustun","year":"2012","unstructured":"Ustun C, Cihangiroglu M. Health care workers\u2019 mobile phones: a potential cause of microbial cross-contamination between hospitals and community. J Occup Environ Hyg. 2012;9(9):538\u201342. https:\/\/doi.org\/10.1080\/15459624.2012.697419.","journal-title":"J Occup Environ Hyg"},{"issue":"3","key":"1739_CR8","doi-asserted-by":"publisher","first-page":"100162","DOI":"10.1016\/j.infpip.2021.100162","volume":"3","author":"M Bhalla","year":"2021","unstructured":"Bhalla M, Aggarwal A, Fatima KH. Carbapenem-resistant bacteria on hand-held and hands-free electronic devices of healthcare workers and non-healthcare workers in Delhi, India. Infect Prev Pract. 2021;3(3):100162. https:\/\/doi.org\/10.1016\/j.infpip.2021.100162.","journal-title":"Infect Prev Pract"},{"key":"1739_CR9","doi-asserted-by":"publisher","unstructured":"Torres-L\u00e9vano E, Moya-Salazar J, Li J, Lozada-Urbano M, Rosales-Rimache J. High efficiency of 70% isopropanol in reducing microbial contamination on healthcare workers\u2019 smartphone surfaces: a pre-post study in Peru. Antimicrob Resist Infect Control. 2026. https:\/\/doi.org\/10.1186\/s13756-025-01692-6.","DOI":"10.1186\/s13756-025-01692-6"},{"key":"1739_CR10","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1186\/s13756-019-0546-y","volume":"8","author":"PM Frey","year":"2019","unstructured":"Frey PM, Marti GR, Droz S, de Roche von Arx M, Suter-Riniker F, Aujesky D, et al. Bacterial colonization of handheld devices in a tertiary care setting: a hygiene intervention study. Antimicrob Resist Infect Control. 2019;8:97. https:\/\/doi.org\/10.1186\/s13756-019-0546-y.","journal-title":"Antimicrob Resist Infect Control"},{"key":"1739_CR11","doi-asserted-by":"publisher","first-page":"Doc13","DOI":"10.3205\/dgkh000468","volume":"19","author":"Commission for Hospital Hygiene and Infection Prevention (KRINKO)","year":"2024","unstructured":"Commission for Hospital Hygiene and Infection Prevention (KRINKO). Hygiene requirements for cleaning and disinfection of surfaces: recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. GMS Hyg Infect Control. 2024;19:Doc13. https:\/\/doi.org\/10.3205\/dgkh000468.","journal-title":"GMS Hyg Infect Control"},{"key":"1739_CR12","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s13756-021-01041-3","volume":"11","author":"C Ullrich","year":"2022","unstructured":"Ullrich C, Luescher AM, Koch J, Grass RN, Sax H. Silica nanoparticles with encapsulated DNA (SPED) to trace the spread of pathogens in healthcare. Antimicrob Resist Infect Control. 2022;11:4. https:\/\/doi.org\/10.1186\/s13756-021-01041-3.","journal-title":"Antimicrob Resist Infect Control"},{"issue":"1","key":"1739_CR13","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1017\/ice.2018.275","volume":"40","author":"LF Chen","year":"2019","unstructured":"Chen LF, Knelson LP, Gergen MF, Better OM, Nicholson BP, Woods CW, et al. CDC Prevention Epicenters Program. A prospective study of transmission of Multidrug-Resistant Organisms (MDROs) between environmental sites and hospitalized patients-the TransFER study. Infect Control Hosp Epidemiol. 2019;40(1):47\u201352. https:\/\/doi.org\/10.1017\/ice.2018.275.","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"10459","key":"1739_CR14","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1016\/S0140-6736(24)01867-1","volume":"404","author":"W GBD 2021 Antimicrobial Resistance Collaborators","year":"2024","unstructured":"W GBD 2021 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance 1990\u20132021: a systematic analysis with forecasts to 2050. Lancet. 2024;404(10459):1199\u2013226. https:\/\/doi.org\/10.1016\/S0140-6736(24)01867-1.","journal-title":"Lancet"},{"issue":"5 Suppl 1","key":"1739_CR15","doi-asserted-by":"publisher","first-page":"S12","DOI":"10.1016\/j.ajic.2012.12.010","volume":"41","author":"CJ Donskey","year":"2013","unstructured":"Donskey CJ. Does improving surface cleaning and disinfection reduce health care-associated infections? Am J Infect Control. 2013;41(5 Suppl 1):S12\u20139. https:\/\/doi.org\/10.1016\/j.ajic.2012.12.010.","journal-title":"Am J Infect Control"},{"key":"1739_CR16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13756-017-0291-z","volume":"7","author":"L Puchter","year":"2018","unstructured":"Puchter L, Chaberny IF, Schwab F, Vonberg R-P, Bange F-C, Ebadi E. Economic burden of nosocomial infections caused by vancomycin-resistant enterococci. Antimicrob Resist Infect Control. 2018;7:1. https:\/\/doi.org\/10.1186\/s13756-017-0291-z.","journal-title":"Antimicrob Resist Infect Control"},{"issue":"4","key":"1739_CR17","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1111\/1475-6773.13135","volume":"54","author":"KJ Johnston","year":"2019","unstructured":"Johnston KJ, Thorpe KE, Jacob JT, Murphy DJ. The incremental cost of infections associated with multidrug-resistant organisms in the inpatient hospital setting-A national estimate. Health Serv Res. 2019;54(4):782\u201392. https:\/\/doi.org\/10.1111\/1475-6773.13135.","journal-title":"Health Serv Res"},{"issue":"3","key":"1739_CR18","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1001\/archinte.165.3.302","volume":"165","author":"AN Duckro","year":"2005","unstructured":"Duckro AN, Blom DW, Lyle EA, Weinstein RA, Hayden MK. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med. 2005;165(3):302\u20137. https:\/\/doi.org\/10.1001\/archinte.165.3.302.","journal-title":"Arch Intern Med"},{"issue":"7","key":"1739_CR19","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1086\/660363","volume":"32","author":"JA Otter","year":"2011","unstructured":"Otter JA, Yezli S, French GL. The role played by contaminated surfaces in the transmission of nosocomial pathogens. Infect Control Hosp Epidemiol. 2011;32(7):687\u201399. https:\/\/doi.org\/10.1086\/660363.","journal-title":"Infect Control Hosp Epidemiol"},{"key":"1739_CR20","doi-asserted-by":"publisher","first-page":"Doc42","DOI":"10.3205\/dgkh000497","volume":"19","author":"A Kramer","year":"2024","unstructured":"Kramer A, Seifert J, Abele-Horn M, Arvand M, Biever P, Blacky A, et al. S2k-guideline hand antisepsis and hand hygiene. GMS Hyg Infect Control. 2024;19:Doc42. https:\/\/doi.org\/10.3205\/dgkh000497.","journal-title":"GMS Hyg Infect Control"},{"key":"1739_CR21","unstructured":"German Federal Ministry of Health. Infection Protection Act (IfSG) \u00a7 23. https:\/\/www.gesetze-im-internet.de\/ifsg\/__23.html. Accessed 2025 Jan 27."},{"key":"1739_CR22","unstructured":"European Committee on Antimicrobial Susceptibility Testing (EUCAST). Clinical breakpoints. https:\/\/www.eucast.org\/clinical_breakpoints. Accessed 27 Jan 2025."},{"key":"1739_CR23","unstructured":"PAUL HARTMANN AG. Bacillol\u00ae 30 sensitive tissues. Heidenheim an der Brenz (DE): PAUL HARTMANN AG. 2024. https:\/\/www.hartmann.info\/de-de\/campaign\/desinfektion\/2024\/bacillol-30-sensitive-tissues"},{"issue":"12","key":"1739_CR24","doi-asserted-by":"publisher","first-page":"3788","DOI":"10.1128\/JCM.01946-15","volume":"53","author":"M de Been","year":"2015","unstructured":"de Been M, Pinholt M, Top J, Bletz S, Mellmann A, van Schaik W, et al. Core Genome Multilocus Sequence Typing Scheme for High-Resolution Typing of Enterococcus faecium. J Clin Microbiol. 2015;53(12):3788\u201397. https:\/\/doi.org\/10.1128\/JCM.01946-15.","journal-title":"J Clin Microbiol"},{"issue":"3","key":"1739_CR25","doi-asserted-by":"publisher","first-page":"e0517422","DOI":"10.1128\/spectrum.05174-22","volume":"11","author":"L Leukert","year":"2023","unstructured":"Leukert L, Tietgen M, Krause FF, Schultze TG, Fuhrmann DC, Debruyne C, et al. Infection of endothelial cells with acinetobacter baumannii reveals remodelling of mitochondrial protein complexes. Microbiol Spectr. 2023;11(3):e0517422. https:\/\/doi.org\/10.1128\/spectrum.05174-22.","journal-title":"Microbiol Spectr"},{"key":"1739_CR26","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1186\/1471-2334-6-130","volume":"6","author":"A Kramer","year":"2006","unstructured":"Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006;6:130. https:\/\/doi.org\/10.1186\/1471-2334-6-130.","journal-title":"BMC Infect Dis"},{"issue":"6","key":"1739_CR27","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1016\/j.ajic.2020.11.011","volume":"49","author":"Y Kaiki","year":"2021","unstructured":"Kaiki Y, Kitagawa H, Hara T, Nomura T, Omori K, Shigemoto N, et al. Methicillin-resistant Staphylococcus aureus contamination of hospital-use-only mobile phones and efficacy of 222-nm ultraviolet disinfection. Am J Infect Control. 2021;49(6):800\u20133. https:\/\/doi.org\/10.1016\/j.ajic.2020.11.011.","journal-title":"Am J Infect Control"},{"issue":"2","key":"1739_CR28","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1080\/15459624.2018.1546051","volume":"16","author":"L Missri","year":"2019","unstructured":"Missri L, Smiljkovski D, Prigent G, Lesenne A, Obadia T, Joumaa M, et al. Bacterial colonization of healthcare workers\u2019 mobile phones in the ICU and effectiveness of sanitization. J Occup Environ Hyg. 2019;16(2):97\u2013100. https:\/\/doi.org\/10.1080\/15459624.2018.1546051.","journal-title":"J Occup Environ Hyg"},{"key":"1739_CR29","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1186\/s13756-019-0573-8","volume":"8","author":"L Falgenhauer","year":"2019","unstructured":"Falgenhauer L, Fritzenwanker M, Imirzalioglu C, Steul K, Scherer M, Rhine-Main VREfm study group. Near-ubiquitous presence of a vancomycin-resistant Enterococcus faecium ST117\/CT71\/vanB clone in the Rhine-Main metropolitan area of Germany. Antimicrob Resist Infect Control. 2019;8:128. https:\/\/doi.org\/10.1186\/s13756-019-0573-8.","journal-title":"Antimicrob Resist Infect Control"},{"key":"1739_CR30","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s13756-018-0353-x","volume":"7","author":"C Remschmidt","year":"2018","unstructured":"Remschmidt C, Schr\u00f6der C, Behnke M, Gastmeier P, Geffers C. Kramer TS Continuous increase of vancomycin resistance in enterococci causing nosocomial infections in Germany\u2009\u2013\u200910 years of surveillance. Antimicrob Resist Infect Control. 2018;7:54.","journal-title":"Antimicrob Resist Infect Control"},{"key":"1739_CR31","doi-asserted-by":"publisher","first-page":"Doc13","DOI":"10.3205\/dgkh000348","volume":"15","author":"A H\u00e4ring","year":"2020","unstructured":"H\u00e4ring A, Heudorf U, Exner M, Pitten FA, Waidmann O, Hack D, et al. Impact of surface disinfection with hydrogen peroxide on the prevalence of vancomycin-resistant enterococci (VRE) in hospital wards. GMS Hyg Infect Control. 2020;15:Doc13. https:\/\/doi.org\/10.3205\/dgkh000348.","journal-title":"GMS Hyg Infect Control"},{"key":"1739_CR32","unstructured":"National Reference Center for Surveillance of Nosocomial Infections (NRZ). Routine admission screening of general and ICU risk patients for MDRO. https:\/\/www.nrz-hygiene.de\/KISS-Modul\/archiv\/KISS\/STATIONS-KISS-Infektions-Surveillance. Accessed\u00a022\u00a0 Aug\u00a02025."},{"key":"1739_CR33","unstructured":"National Reference Center for Surveillance of Nosocomial Infections (NRZ). KISS Module: hand hygiene surveillance archive. https:\/\/www.nrz-hygiene.de\/KISS-Modul\/archiv\/KISS\/HAND"},{"issue":"3","key":"1739_CR34","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/j.ajic.2018.08.004","volume":"47","author":"A Jeanes","year":"2019","unstructured":"Jeanes A, Coen PG, Gould DJ, Drey NS. Validity of hand hygiene compliance measurement by observation: a systematic review. Am J Infect Control. 2019;47(3):313\u201322. https:\/\/doi.org\/10.1016\/j.ajic.2018.08.004.","journal-title":"Am J Infect Control"},{"key":"1739_CR35","unstructured":"World Health Organization. Five moments for hand hygiene. Geneva: WHO; https:\/\/www.who.int\/publications\/m\/item\/five-moments-for-hand-hygiene"}],"container-title":["Antimicrobial Resistance &amp; Infection Control"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13756-026-01739-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13756-026-01739-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13756-026-01739-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T09:59:26Z","timestamp":1775815166000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13756-026-01739-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,4]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1739"],"URL":"https:\/\/doi.org\/10.1186\/s13756-026-01739-2","relation":{},"ISSN":["2047-2994"],"issn-type":[{"value":"2047-2994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,4]]},"assertion":[{"value":"27 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted within the legal requirements given by the German Infection Protection Act \u00a7\u00a023. When data originating from patient files were analyzed, this was approved by the Ethics Board of the University Hospital Frankfurt, Germany (ethics votum No. 2024\u20132145).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"52"}}