{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:46:57Z","timestamp":1787636817322,"version":"build-2736575974"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>\nBackground\n<\/jats:title>\n<jats:p>The human intestinal tract contains many commensals. However, during an imbalance of the normal microbiota following exposure to antibiotics, extended-spectrum \u03b2-lactamase- and carbapenemase-producing <jats:italic>Enterobacterales<\/jats:italic> emerge. Individuals colonized with these bacteria may develop subsequent infections themselves. Therefore, this review aimed to estimate the colonization rate of extended-spectrum \u03b2-lactamase- and carbapenemase-producing <jats:italic>Enterobacterales<\/jats:italic> in Ethiopia.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>\nMethods\n<\/jats:title>\n<jats:p>The protocol was registered (PROSPERO ID: CRD42024550137). A systematic literature search was conducted in electronic databases, including PubMed, Google Scholar, and Hinari, to retrieve potential studies. The quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal tool. The data were extracted from the eligible studies using Microsoft Excel 2019 and analyzed using STATA version 11. Heterogeneity between studies was checked using I<jats:sup>2<\/jats:sup> test statistics. Publication bias was assessed using funnel plots and Egger\u2019s test. A random-effects model of DerSimonian-Laird method was employed to estimate the outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>\nResults\n<\/jats:title>\n<jats:p>A total of 15 studies with 4713 participants were included in the meta-analysis. The overall pooled colonization rates of extended-spectrum \u03b2-lactamase-producing and carbapenemase-producing <jats:italic>Enterobacterales<\/jats:italic> in Ethiopia were 28.5% (95% CI: 16.4-40.5%, I<jats:sup>2<\/jats:sup> =\u2009 95.9%, p &lt;\u2009 0.001) and 4.4% (95% CI: 0.9\u20137.9%, I<jats:sup>2<\/jats:sup> =\u2009 0.0%, p =\u2009 0.64), respectively. The majority of the extended-spectrum \u03b2-lactamase producers were <jats:italic>E. coli<\/jats:italic> (20.6%, 95% CI: 9.3\u201331.9%, I<jats:sup>2<\/jats:sup> =\u2009 94.4%, p<jats:italic>\u2009&lt;\u2009<\/jats:italic>0.001), followed by <jats:italic>Klebsiella<\/jats:italic> spp. (11.1%, 95% CI: 7.7\u201314.6%, I<jats:sup>2<\/jats:sup> =\u2009 20.2%, p =\u2009 0.245). Similarly, the predominant carbapenemase producers were <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> (2.7%, 95% CI: -1.3\u20136.7, I<jats:sup>2<\/jats:sup> =\u2009 0.0%, p\u2009= 0.941) and <jats:italic>Klebsiella<\/jats:italic> spp. (2.1%, 95% CI: -1.7\u20135.9%, I<jats:sup>2<\/jats:sup> =\u2009 0.0%, p\u2009= 0.999). Furthermore, the pooled estimate of multidrug resistance among extended-spectrum \u03b2-lactamase producers was 71.7% (95% CI: 55.25\u201388.05%, I<jats:sup>2<\/jats:sup> =\u2009 92.9%, p<jats:italic>\u2009&lt;\u2009<\/jats:italic>0.001).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>\nConclusion and recommendations\n<\/jats:title>\n<jats:p>Approximately one-quarter of Ethiopians are colonized with ESBL-PE, while about one in 25 is colonized with CPE. These findings were obtained from studies with a moderate-to-low risk of bias. However, the results for ESBL-PE showed significant variability, indicating high heterogeneity among the studies. This colonization may lead to subsequent extraintestinal infections. Therefore, proactive action from all stakeholders is required to combat the unrecognized spread of extended-spectrum \u03b2-lactamase- and carbapenemase-producing <jats:italic>Enterobacterales<\/jats:italic> in humans.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0316492","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T21:37:14Z","timestamp":1743543434000},"page":"e0316492","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Colonization with extended-spectrum \u03b2-lactamase and carbapenemase-producing Enterobacterales in Ethiopia: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5532-6097","authenticated-orcid":true,"given":"Mitkie","family":"Tigabie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getu","family":"Girmay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yalewayker","family":"Gashaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6079-0271","authenticated-orcid":true,"given":"Getachew","family":"Bitew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0363-3254","authenticated-orcid":true,"given":"Abebe","family":"Birhanu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eden","family":"Getaneh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azanaw","family":"Amare","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muluneh","family":"Assefa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,4,1]]},"reference":[{"issue":"2","key":"pone.0316492.ref001","doi-asserted-by":"crossref","first-page":"e00174-20","DOI":"10.1128\/CMR.00174-20","article-title":"The Changing Face of the Family Enterobacteriaceae (Order: \u201cEnterobacterales\u201d): New Members, Taxonomic Issues, Geographic Expansion, and New Diseases and Disease Syndromes","volume":"34","author":"JM Janda","year":"2021","journal-title":"Clin Microbiol Rev"},{"issue":"9","key":"pone.0316492.ref002","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.3390\/antibiotics10091140","article-title":"Detection of Multidrug-Resistant Enterobacterales-From ESBLs to Carbapenemases","volume":"10","author":"J Noster","year":"2021","journal-title":"Antibiotics (Basel)"},{"key":"pone.0316492.ref003","article-title":"Updates list of drug-resistant bacteria most threatening to human health.","author":"World Health Organization"},{"issue":"5","key":"pone.0316492.ref004","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.ajic.2015.12.005","article-title":"Risk of infection following colonization with carbapenem-resistant Enterobactericeae: A systematic review","volume":"44","author":"J Tischendorf","year":"2016","journal-title":"Am J Infect Control"},{"issue":"5","key":"pone.0316492.ref005","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/j.ijantimicag.2017.07.003","article-title":"Bloodstream infections due to extended-spectrum \u03b2-lactamase-producing Enterobacteriaceae among patients with malignancy: a systematic review and meta-analysis","volume":"50","author":"M Alevizakos","year":"2017","journal-title":"Int J Antimicrob Agents"},{"issue":"1","key":"pone.0316492.ref006","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.diagmicrobio.2014.01.022","article-title":"Prior colonization is associated with increased risk of antibiotic-resistant Gram-negative bacteremia in cancer patients","volume":"79","author":"AS Hess","year":"2014","journal-title":"Diagn Microbiol Infect Dis"},{"key":"pone.0316492.ref007","doi-asserted-by":"crossref","first-page":"1387497","DOI":"10.3389\/fcimb.2024.1387497","article-title":"A review of the mechanisms that confer antibiotic resistance in pathotypes of E. coli","volume":"14","author":"S Nasrollahian","year":"2024","journal-title":"Front Cell Infect Microbiol"},{"issue":"3","key":"pone.0316492.ref008","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1093\/cid\/ciw283","article-title":"Fecal Colonization With Extended-spectrum Beta-lactamase-Producing Enterobacteriaceae and Risk Factors Among Healthy Individuals: A Systematic Review and Metaanalysis","volume":"63","author":"S Karanika","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"5","key":"pone.0316492.ref009","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.ijantimicag.2017.08.003","article-title":"Extended-spectrum \u03b2-lactamase-producing Enterobacteriaceae colonisation in long-term care facilities: a systematic review and meta-analysis","volume":"50","author":"ME Flokas","year":"2017","journal-title":"Int J Antimicrob Agents"},{"key":"pone.0316492.ref010","doi-asserted-by":"crossref","first-page":"160","DOI":"10.12688\/wellcomeopenres.15514.1","article-title":"Gut mucosal colonisation with extended-spectrum beta-lactamase producing Enterobacteriaceae in sub-Saharan Africa: a systematic review and meta-analysis","volume":"4","author":"JM Lewis","year":"2019","journal-title":"Wellcome Open Res"},{"key":"pone.0316492.ref011","first-page":"2489063","article-title":"Antibiotic Use and Resistance Pattern in Ethiopia: Systematic Review and Meta-Analysis","author":"OA Muhie","year":"2019","journal-title":"Int J Microbiol"},{"issue":"6","key":"pone.0316492.ref012","doi-asserted-by":"crossref","first-page":"e0287043","DOI":"10.1371\/journal.pone.0287043","article-title":"Multidrug-resistant and extended-spectrum beta-lactamase-producing Enterobacteriaceae isolated from chicken droppings in poultry farms at Gondar City, Northwest Ethiopia","volume":"18","author":"M Tigabie","year":"2023","journal-title":"PLoS ONE"},{"issue":"11","key":"pone.0316492.ref013","doi-asserted-by":"crossref","first-page":"e0293528","DOI":"10.1371\/journal.pone.0293528","article-title":"Colonization with extended spectrum beta-lactamase and carbapenemases producing Enterobacteriaceae among hospitalized patients at the global level: A systematic review and meta-analysis","volume":"18","author":"D Abera","year":"2023","journal-title":"PLoS One"},{"key":"pone.0316492.ref014","first-page":"6669778","article-title":"Prevalence of Extended-Spectrum \u03b2-Lactamase-Producing Enterobacteriaceae in Ethiopia: A Systematic Review and Meta-Analysis","author":"T Kiros","year":"2021","journal-title":"Int J Microbiol"},{"issue":"3","key":"pone.0316492.ref015","doi-asserted-by":"crossref","first-page":"000195","DOI":"10.1099\/acmi.0.000195","article-title":"The magnitude of extended-spectrum beta-lactamase- producing Enterobacteriaceae from clinical samples in Ethiopia: a systematic review and meta-analysis","volume":"3","author":"K Diriba","year":"2021","journal-title":"Access Microbiol"},{"issue":"1","key":"pone.0316492.ref016","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1186\/s12879-023-08237-5","article-title":"Prevalence of carbapenemase-producing Enterobacteriaceae from human clinical samples in Ethiopia: a systematic review and meta-analysis","volume":"23","author":"E Alemayehu","year":"2023","journal-title":"BMC Infect Dis"},{"key":"pone.0316492.ref017","article-title":"JBI\u2019s critical appraisal tools assist in assessing the trustworthiness, relevance and results of published papers.","author":"Joanna Briggs Institute"},{"issue":"6","key":"pone.0316492.ref018","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/01.NAJ.0000450430.97383.64","article-title":"JBI\u2019s Systematic Reviews: Study selection and critical appraisal","volume":"114","author":"K Porritt","year":"2014","journal-title":"Am J Nurs"},{"issue":"2","key":"pone.0316492.ref019","first-page":"453","article-title":"Heterogeneity in meta-analysis","volume":"3","author":"M Borenstein","year":"2019","journal-title":"The handbook of research synthesis"},{"issue":"2","key":"pone.0316492.ref020","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1002\/jrsm.1468","article-title":"Investigating and dealing with publication bias and other reporting biases in meta-analyses of health research: A review","volume":"12","author":"MJ Page","year":"2021","journal-title":"Res Synth Methods"},{"issue":"1","key":"pone.0316492.ref021","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s12981-021-00347-x","article-title":"Fecal carriage of extended spectrum beta-lactamase producing Enterobacteriaceae among HIV infected children at the University of Gondar Comprehensive Specialized Hospital Gondar, Ethiopia","volume":"18","author":"B Bayleyegn","year":"2021","journal-title":"AIDS Res Ther"},{"key":"pone.0316492.ref022","doi-asserted-by":"crossref","first-page":"7041","DOI":"10.2147\/IDR.S432743","article-title":"Distribution of \u00df-Lactamase Genes Among Multidrug-Resistant and Extended-Spectrum \u00df-Lactamase-Producing Diarrheagenic Escherichia coli from Under-Five Children in Ethiopia","volume":"16","author":"T Zenebe","year":"2023","journal-title":"Infect Drug Resist"},{"key":"pone.0316492.ref023","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.2147\/CMAR.S422376","article-title":"Fecal Carriage of Extended-Spectrum \u03b2-Lactamase and Carbapenemase-Producing Enterobacteriaceae Among Oncology and Non-Oncology Patients at Jimma Medical Center in Ethiopia: A Comparative Cross-Sectional Study","volume":"15","author":"W Temsegen","year":"2023","journal-title":"Cancer Manag Res"},{"issue":"9","key":"pone.0316492.ref024","doi-asserted-by":"crossref","first-page":"e20072","DOI":"10.1016\/j.heliyon.2023.e20072","article-title":"Carriage of \u03b2-lactamase and carbapenemase-producing Enterobacteriaceae in hospitalized patients at debre tabor comprehensive specialized hospital","volume":"9","author":"T Kiros","year":"2023","journal-title":"Heliyon"},{"issue":"10","key":"pone.0316492.ref025","doi-asserted-by":"crossref","first-page":"e0258117","DOI":"10.1371\/journal.pone.0258117","article-title":"High prevalence of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae fecal carriage among children under five years in Addis Ababa, Ethiopia","volume":"16","author":"MA Tola","year":"2021","journal-title":"PLoS One"},{"key":"pone.0316492.ref026","first-page":"3907","article-title":"Investigation of Extended-Spectrum \u03b2-Lactamase and Carbapenemase Producing Gram-Negative Bacilli in Rectal Swabs Collected from Neonates and Their Associated Factors in Neonatal Intensive Care Units of Southern Ethiopia","volume":"14","author":"A Zakir","year":"2021","journal-title":"Infect Drug Resist"},{"key":"pone.0316492.ref027","doi-asserted-by":"crossref","first-page":"2445","DOI":"10.2147\/IDR.S356807","article-title":"High Magnitude of Fecal Carriage of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae at Debre Berhan Comprehensive Specialized Hospital, Ethiopia","volume":"15","author":"D Shenkute","year":"2022","journal-title":"Infect Drug Resist"},{"issue":"3","key":"pone.0316492.ref028","doi-asserted-by":"crossref","first-page":"e0264818","DOI":"10.1371\/journal.pone.0264818","article-title":"High prevalence of fecal carriage of Extended-spectrum beta-lactamase and carbapenemase-producing Enterobacteriaceae among food handlers at the University of Gondar, Northwest Ethiopia","volume":"17","author":"A Amare","year":"2022","journal-title":"PLoS One"},{"key":"pone.0316492.ref029","doi-asserted-by":"crossref","first-page":"3791","DOI":"10.2147\/IDR.S269425","article-title":"Fecal Carriage Rate of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Among Apparently Health Food Handlers in Dilla University Student Cafeteria","volume":"13","author":"K Diriba","year":"2020","journal-title":"Infect Drug Resist"},{"key":"pone.0316492.ref030","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.2147\/IDR.S239092","article-title":"Gastrointestinal Tract Colonization Rate of Extended-Spectrum Beta-Lactamase- and Carbapenemase-Producing Enterobacteriaceae and Associated Factors Among Hospitalized Patients in Arba Minch General Hospital, Arba Minch, Ethiopia","volume":"13","author":"A Aklilu","year":"2020","journal-title":"Infect Drug Resist"},{"key":"pone.0316492.ref031","first-page":"7905350","article-title":"Extended-Spectrum Beta-Lactamase- and Carbapenemase-Producing Enterobacteriaceae Family of Bacteria from Diarrheal Stool Samples in Northwest Ethiopia","author":"M Worku","year":"2022","journal-title":"Interdiscip Perspect Infect Dis"},{"issue":"8","key":"pone.0316492.ref032","doi-asserted-by":"crossref","first-page":"e0161685","DOI":"10.1371\/journal.pone.0161685","article-title":"High Gastrointestinal Colonization Rate with Extended-Spectrum \u03b2-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Emergence of Carbapenemase-Producing K. pneumoniae in Ethiopia","volume":"11","author":"K Desta","year":"2016","journal-title":"PLoS One"},{"issue":"1","key":"pone.0316492.ref033","doi-asserted-by":"crossref","first-page":"93","DOI":"10.3390\/antibiotics13010093","article-title":"Antimicrobial Susceptibility and Characterization of Extended-Spectrum \u03b2-Lactamase-Producing Escherichia coli Isolated from Stools of Primary Healthcare Patients in Ethiopia","volume":"13","author":"D Wolde","year":"2024","journal-title":"Antibiotics (Basel)"},{"key":"pone.0316492.ref034","doi-asserted-by":"crossref","first-page":"107035","DOI":"10.1016\/j.ijid.2024.107035","article-title":"Carriage of antimicrobial-resistant Enterobacterales among pregnant women and newborns in Amhara, Ethiopia","volume":"143","author":"G Amsalu","year":"2024","journal-title":"Int J Infect Dis"},{"key":"pone.0316492.ref035","doi-asserted-by":"crossref","first-page":"6345","DOI":"10.2147\/IDR.S418066","article-title":"Fecal Carriage of Carbapenem Resistant Enterobacterales and Associated Factors Among Admitted Patients in Saint Paul\u2019s Hospital Millennium Medical College, Addis Ababa, Ethiopia","volume":"16","author":"Y Mekonnen","year":"2023","journal-title":"Infect Drug Resist"},{"key":"pone.0316492.ref036","doi-asserted-by":"crossref","first-page":"102508","DOI":"10.1016\/j.eclinm.2024.102508","article-title":"Carriage of third-generation cephalosporin-resistant and carbapenem-resistant Enterobacterales among children in sub-Saharan Africa: a systematic review and meta-analysis","volume":"70","author":"M Ruef","year":"2024","journal-title":"EClinicalMedicine"},{"issue":"6","key":"pone.0316492.ref037","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.ijantimicag.2016.08.021","article-title":"Colonisation with extended-spectrum \u03b2-lactamase-producing Enterobacteriaceae and risk for infection among patients with solid or haematological malignancy: a systematic review and meta-analysis","volume":"48","author":"M Alevizakos","year":"2016","journal-title":"Int J Antimicrob Agents"},{"key":"pone.0316492.ref038","first-page":"5153237","article-title":"Genetic Determinants of Resistance among ESBL-Producing Enterobacteriaceae in Community and Hospital Settings in East, Central, and Southern Africa: A Systematic Review and Meta-Analysis of Prevalence","author":"OG Onduru","year":"2021","journal-title":"Can J Infect Dis Med Microbiol"},{"issue":"4","key":"pone.0316492.ref039","doi-asserted-by":"crossref","first-page":"e0284038","DOI":"10.1371\/journal.pone.0284038","article-title":"A three years antimicrobials consumption in Ethiopia from 2017 to 2019: A cross- sectional study","volume":"18","author":"M Tirfe","year":"2023","journal-title":"PLoS One"},{"issue":"1","key":"pone.0316492.ref040","doi-asserted-by":"crossref","first-page":"21211","DOI":"10.1038\/s41598-021-00617-8","article-title":"Knowledge, attitudes and practices of animal farm owners\/workers on antibiotic use and resistance in Amhara region, north western Ethiopia","volume":"11","author":"K Geta","year":"2021","journal-title":"Sci Rep"},{"issue":"Suppl 1","key":"pone.0316492.ref041","doi-asserted-by":"crossref","first-page":"S82","DOI":"10.1093\/cid\/ciad222","article-title":"Colonization With Antibiotic-Resistant Bacteria in a Hospital and Associated Communities in Guatemala: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study","volume":"77","author":"BM Ramay","year":"2023","journal-title":"Clin Infect Dis"},{"issue":"4","key":"pone.0316492.ref042","doi-asserted-by":"crossref","first-page":"408","DOI":"10.3855\/jidc.4052","article-title":"Comparative evaluation of six phenotypic methods for detecting extended-spectrum beta-lactamase-producing Enterobacteriaceae","volume":"8","author":"RM Singh","year":"2014","journal-title":"J Infect Dev Ctries"},{"issue":"3","key":"pone.0316492.ref043","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.22207\/JPAM.17.3.31","article-title":"A Guide Towards the Phenotypic Detection of Extended-spectrum \u03b2-lactamases Production in Enterobacteriaceae: Alone or in Presence of Other Interfering Enzymes","volume":"17","author":"P Das","year":"2023","journal-title":"J Pure Appl Microbiol"},{"issue":"2","key":"pone.0316492.ref044","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1093\/jac\/dkl483","article-title":"CTX-M: changing the face of ESBLs in Europe","volume":"59","author":"DM Livermore","year":"2007","journal-title":"J Antimicrob Chemother"},{"issue":"3","key":"pone.0316492.ref045","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1093\/jac\/dkl309","article-title":"Molecular characterization of plasmids encoding CTX-M-15 beta-lactamases from Escherichia coli strains in the United Kingdom","volume":"58","author":"E Karisik","year":"2006","journal-title":"J Antimicrob Chemother"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0316492","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T21:38:20Z","timestamp":1743543500000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0316492"}},"subtitle":[],"editor":[{"given":"Lorenzo","family":"Righi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,4,1]]},"references-count":45,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,1]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0316492","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,1]]}}}