{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T22:21:33Z","timestamp":1788560493594,"version":"build-2803163510"},"reference-count":38,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Carbapenem-resistant Enterobacterales (CRE) are designated by the World Health Organization as critical-priority pathogens. While global outcomes are well documented, regional data from the Middle East remain limited. Methods: We performed a retrospective cohort study of adults with confirmed CRE infections admitted to King Fahad Hospital of the University, Saudi Arabia, between 2019 and 2024. Clinical, microbiological, and therapeutic data were analyzed. Primary outcomes were infection recurrence, recurrence-related readmissions, and all-cause mortality at 14, 30, and 90 days. Predictors were assessed using univariate tests and multivariate Cox regression. Results: Among 101 patients (mean age 65 years, 57% female), Klebsiella pneumoniae predominated (94%), with OXA-48 detected in 70%. Most infections were hospital-acquired (78%). Recurrence occurred in 16.8% of cases, with 12.9% requiring readmission. Mortality reached 22.8% at 14 days, 30.7% at 30 days, and 42.6% at 90 days. Diabetes mellitus predicted recurrence (p = 0.024). Independent predictors of 90-day mortality were pneumonia (HR 2.39, 95% CI 1.23\u20134.64), critical care admission (HR 6.24, 95% CI 2.44\u201315.97), and hypotension (HR 4.10, 95% CI 1.84\u20139.15). Elevated Pitt bacteremia and INCREMENT-CPE scores also stratified risk. Conclusions: CRE infections in Saudi Arabia impose a heavy clinical burden, with high recurrence, frequent readmissions, and late mortality. Identifying drivers of recurrence and mortality highlights opportunities for targeted risk stratification. Beyond treatment choices, these findings emphasize the need for proactive surveillance, integrated stewardship, and early recognition of high-risk patients. Region-specific evidence such as this is critical to shaping infection control policies and guiding future multicenter research into novel therapeutic approaches.<\/jats:p>","DOI":"10.3390\/diagnostics15232957","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T17:28:07Z","timestamp":1763746087000},"page":"2957","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Recurrence, Readmission, and Key Mortality Predictors in Patients with Carbapenem-Resistant Enterobacterales Infections"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2372-9462","authenticated-orcid":false,"given":"Bashayer Mohammed","family":"Alshehail","sequence":"first","affiliation":[{"name":"Pharmacy Practice Department, College of Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4646-6717","authenticated-orcid":false,"given":"Marwan Jabr","family":"Alwezzeh","sequence":"additional","affiliation":[{"name":"Infectious Disease Division, Internal Medicine Department, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussain Humaid","family":"Almalki","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Care, Northern Area Armed Forces Hospital, Hafar Al Batin 31991, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5105-6002","authenticated-orcid":false,"given":"Amani","family":"Alnimr","sequence":"additional","affiliation":[{"name":"Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6279-3809","authenticated-orcid":false,"given":"Haytham","family":"Wali","sequence":"additional","affiliation":[{"name":"Pharmacy Practice Department, College of Clinical Pharmacy, King Faisal University, Alahsa 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4549-2638","authenticated-orcid":false,"given":"Zainab","family":"Al Jamea","sequence":"additional","affiliation":[{"name":"Pharmaceutical Care Department, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullatif S.","family":"Al Rashed","sequence":"additional","affiliation":[{"name":"Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mashael","family":"Alhajri","sequence":"additional","affiliation":[{"name":"Infectious Disease Division, Internal Medicine Department, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hawra Abdulwahab","family":"Abdulaal","sequence":"additional","affiliation":[{"name":"College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lujain Ali","family":"Alanbari","sequence":"additional","affiliation":[{"name":"College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0450-9846","authenticated-orcid":false,"given":"Yazed S.","family":"Alsowaida","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Clinical Pharmacy, Hail University, Hail 81442, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Alamri","sequence":"additional","affiliation":[{"name":"Pharmaceutical Service Department, King Fahd Military Medical Complex, Dhahran 34313, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharifah","family":"Almuthen","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Specialty Internal Medicine, King Fahd Military Medical Complex, Dhahran 34313, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faten","family":"Azaiez","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Specialty Internal Medicine, King Fahd Military Medical Complex, Dhahran 34313, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"Department of Urology and Nephrology, King Fahd Military Medical Complex, Dhahran 34313, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nawaf","family":"Zakari","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, King Fahd Military Medical Complex, Dhahran 34313, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaber","family":"Asiri","sequence":"additional","affiliation":[{"name":"Pharmaceutical Service Department, King Fahd Military Medical Complex, Dhahran 34313, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wafa","family":"Alanazi","sequence":"additional","affiliation":[{"name":"Pharmaceutical Service Department, King Fahd Military Medical Complex, Dhahran 34313, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohanad","family":"Bakkar","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Specialty Internal Medicine, King Fahd Military Medical Complex, Dhahran 34313, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz","family":"Alfifi","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Specialty Internal Medicine, King Fahd Military Medical Complex, Dhahran 34313, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5416-9045","authenticated-orcid":false,"given":"Omar","family":"Alzuwayed","sequence":"additional","affiliation":[{"name":"Pharmaceutical Service Department, King Fahd Military Medical Complex, Dhahran 34313, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1781-2203","authenticated-orcid":false,"given":"Aiman","family":"El-Saed","sequence":"additional","affiliation":[{"name":"King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salma","family":"AlBahrani","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Specialty Internal Medicine, King Fahd Military Medical Complex, Dhahran 34313, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"key":"ref_1","unstructured":"WHO (2017). WHO Publishes List of Bacteria for Which New Antibiotics are Urgently Needed, WHO."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S28","DOI":"10.1093\/infdis\/jiw282","article-title":"The Epidemiology of Carbapenem-Resistant Enterobacteriaceae: The Impact and Evolution of a Global Menace","volume":"215","author":"Logan","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Villegas, M.V., Pallares, C.J., Escand\u00f3n-Vargas, K., Hern\u00e1ndez-G\u00f3mez, C., Correa, A., \u00c1lvarez, C., Rosso, F., Matta, L., Luna, C., and Zurita, J. (2016). Characterization and Clinical Impact of Bloodstream Infection Caused by Carbapenemase-Producing Enterobacteriaceae in Seven Latin American Countries. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0154092"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Garbati, M.A., Sakkijha, H., and Abushaheen, A. (2016). Infections due to Carbapenem Resistant Enterobacteriaceae among Saudi Arabian Hospitalized Patients: A Matched Case-Control Study. BioMed Res. Int., 2016.","DOI":"10.1155\/2016\/3961684"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"ofaa378","DOI":"10.1093\/ofid\/ofaa378","article-title":"Clinical and Microbiological Analysis of Risk Factors for Mortality in Patients With Carbapenem-Resistant Acinetobacter baumannii Bacteremia","volume":"7","author":"Son","year":"2020","journal-title":"Open Forum. Infect. Dis."},{"key":"ref_6","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":"Tischendorf","year":"2016","journal-title":"Am. J. Infect. Control"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Chen, H.Y., Jean, S.S., Lee, Y.L., Lu, M.C., Ko, W.C., Liu, P.Y., and Hsueh, P.R. (2021). Carbapenem-Resistant Enterobacterales in Long-Term Care Facilities: A Global and Narrative Review. Front. Cell. Infect. Microbiol., 11.","DOI":"10.3389\/fcimb.2021.601968"},{"key":"ref_8","first-page":"18","article-title":"Epidemiology of carbapenem resistance Enterobacterales in Saudi Arabia: A systematic review","volume":"8","author":"Aly","year":"2022","journal-title":"J. Contemp. Med. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Alshehri, A.A., Aldali, J.A., Abdelhamid, M.A., Alanazi, A.A., Alhuraiz, R.B., Alanazi, L.Z., Alshmrani, M.A., Alqahtani, A.M., Alrshoud, M.I., and Alharbi, R.F. (2025). Implementation of Antimicrobial Stewardship Programs in Saudi Arabia: A Systematic Review. Microorganisms, 13.","DOI":"10.3390\/microorganisms13020440"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1186\/s13756-022-01204-w","article-title":"Risk factors and mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection in a tertiary-care hospital in China: An eight-year retrospective study","volume":"11","author":"Chen","year":"2022","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"106126","DOI":"10.1016\/j.ijantimicag.2020.106126","article-title":"Clinical and Microbiological Analysis of Risk Factors for Mortality in Patients with Carbapenem-Resistant Enterobacteriaceae Bacteremia","volume":"56","author":"Seo","year":"2020","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.jiph.2018.08.002","article-title":"Treatment options and clinical outcomes for carbapenem-resistant Enterobacteriaceae bloodstream infection in a Chinese university hospital","volume":"12","author":"Li","year":"2019","journal-title":"J. Infect. Public Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/S1473-3099(19)30755-8","article-title":"Molecular and clinical epidemiology of carbapenem-resistant Enterobacterales in the USA (CRACKLE-2): A prospective cohort study","volume":"20","author":"Arias","year":"2020","journal-title":"Lancet Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s13756-024-01394-5","article-title":"Development of a risk prediction model for subsequent infection after colonization with carbapenem-resistant Enterobacterales: A retrospective cohort study","volume":"13","author":"Zheng","year":"2024","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1840","DOI":"10.1017\/ice.2022.4","article-title":"Poor outcomes in both infection and colonization with carbapenem-resistant Enterobacterales","volume":"43","author":"Earley","year":"2022","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Zilberberg, M.D., Nathanson, B.H., Sulham, K., Fan, W., and Shorr, A.F. (2017). Carbapenem resistance, inappropriate empiric treatment and outcomes among patients hospitalized with Enterobacteriaceae urinary tract infection, pneumonia and sepsis. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2383-z"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Huang, V., Ruhe, J.J., Lerner, P., and Fedorenko, M. (2018). Risk factors for readmission in patients discharged with outpatient parenteral antimicrobial therapy: A retrospective cohort study. BMC Pharmacol. Toxicol., 19.","DOI":"10.1186\/s40360-018-0240-3"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Lin, Q., Wu, M., Yu, H., Jia, X., Zou, H., Ma, D., Niu, S., and Huang, S. (2021). Clinical and Microbiological Characterization of Carbapenem-Resistant Enterobacteriales: A Prospective Cohort Study. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.716324"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1017\/ice.2015.278","article-title":"Predictors of Persistent Carbapenem-Resistant Enterobacteriaceae Carriage upon Readmission and Score Development","volume":"37","author":"Ciobotaro","year":"2016","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.ajic.2012.09.020","article-title":"Duration of carriage of carbapenem-resistant Enterobacteriaceae following hospital discharge","volume":"41","author":"Zimmerman","year":"2013","journal-title":"Am. J. Infect. Control"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Alraddadi, B.M., Heaphy, E.L.G., Aljishi, Y., Ahmed, W., Eljaaly, K., Al-Turkistani, H.H., Alshukairi, A.N., Qutub, M.O., Alodini, K., and Alosaimi, R. (2022). Molecular epidemiology and outcome of carbapenem-resistant Enterobacterales in Saudi Arabia. BMC Infect. Dis., 22.","DOI":"10.1186\/s12879-022-07507-y"},{"key":"ref_22","unstructured":"Barbara, W., Trautner, N.W.C.-P., Kalpana, G., Elizabeth, B.H., Molly, H., Gregory, J.M., Richard, C., John, C.O., Muhammad, S.A., and Shannon, C. (2025, September 25). Complicated Urinary Tract Infections (cUTI): Clinical Guidelines for Treatment and Management. IDSA 2025. Available online: https:\/\/www.idsociety.org\/practice-guideline\/complicated-urinary-tract-infections\/."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1093\/cid\/ciw353","article-title":"Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society","volume":"63","author":"Kalil","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1093\/cid\/ciu296","article-title":"Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1128\/AAC.01882-17","article-title":"Epidemiology of Carbapenem-Resistant Enterobacteriaceae Infections: Report from the China CRE Network","volume":"62","author":"Zhang","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Rebold, N., Lagnf, A.M., Alosaimy, S., Holger, D.J., Witucki, P., Mannino, A., Dierker, M., Lucas, K., Kunz Coyne, A.J., and El Ghali, A. (2023). Risk Factors for Carbapenem-Resistant Enterobacterales Clinical Treatment Failure. Microbiol. Spectr., 11.","DOI":"10.1128\/spectrum.02647-22"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s13756-018-0346-9","article-title":"A systematic review of the epidemiology of carbapenem-resistant Enterobacteriaceae in the United States","volume":"7","author":"Livorsi","year":"2018","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.jgar.2021.12.011","article-title":"Antimicrobial stewardship programme associated with earlier prescription of in vitro susceptible therapy and lower 14-day mortality in patients with carbapenem-resistant Enterobacterales bacteraemia: A cohort study","volume":"28","author":"Barros","year":"2022","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Dickstein, Y., Yahav, D., Tiseo, G., Mussini, C., Franceschini, E., Santoro, A., Rahav, G., Elinav, H., Potruch, A., and Nutman, A. (2025). Carbapenemase type and mortality in blood-stream infections caused by carbapenemase-producing enterobacterales: A multicenter retrospective cohort study. Infection, 1\u201311.","DOI":"10.1007\/s15010-025-02584-y"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e24880","DOI":"10.1097\/MD.0000000000024880","article-title":"Mortality-related factors in patients with OXA-48 carbapenemase-producing Klebsiella pneumoniae bacteremia","volume":"100","author":"Sousa","year":"2021","journal-title":"Medicine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.jiph.2019.03.024","article-title":"Carbapenem-Resistant Enterobacteriaceae: An update narrative review from Saudi Arabia","volume":"12","author":"Alotaibi","year":"2019","journal-title":"J. Infect. Public Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1016\/j.mayocp.2016.06.024","article-title":"A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae","volume":"91","author":"Salamanca","year":"2016","journal-title":"Mayo Clin. Proc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1128\/mSphere.00052-19","article-title":"A Cohort Study of the Impact of Carbapenem-Resistant Enterobacteriaceae Infections on Mortality of Patients Presenting with Sepsis","volume":"4","author":"Sabino","year":"2019","journal-title":"mSphere"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1016\/j.mayocp.2016.08.016","article-title":"Potential Impact of Burnout on the US Physician Workforce","volume":"91","author":"Shanafelt","year":"2016","journal-title":"Mayo Clin. Proc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/j.ijantimicag.2019.03.011","article-title":"Risk factors and outcomes associated with the isolation of polymyxin B and carbapenem-resistant Enterobacteriaceae spp.: A case-control study","volume":"53","author":"Teo","year":"2019","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1007\/s40121-020-00288-4","article-title":"Evaluation of the INCREMENT-CPE, Pitt Bacteremia and qPitt Scores in Patients with Carbapenem-Resistant Enterobacteriaceae Infections Treated with Ceftazidime-Avibactam","volume":"9","author":"Jorgensen","year":"2020","journal-title":"Infect. Dis. Ther."},{"key":"ref_37","first-page":"e911","article-title":"External validation of INCREMENT-CPE score in a retrospective cohort of carbapenemase-producing Klebsiella pneumoniae bloodstream infections in critically ill patients","volume":"27","author":"Bartzavali","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_38","first-page":"e27094","article-title":"Carbapenem-Resistant Enterobacteriaceae: A Retrospective Review of Presentation, Treatment, and Clinical Outcomes in a Tertiary Care Referral Hospital","volume":"14","author":"AlMusa","year":"2022","journal-title":"Cureus"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/23\/2957\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T17:29:02Z","timestamp":1763746142000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/23\/2957"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,21]]},"references-count":38,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["diagnostics15232957"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15232957","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,21]]}}}