{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T18:07:52Z","timestamp":1788977272295,"version":"build-2803163510"},"reference-count":45,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Background: Acute Respiratory Infections are a common reason for Pediatric Emergency Department (PED) visits. Differentiating bacterial and viral infections may be challenging and might result in incorrect antibiotic prescriptions and exacerbation of antimicrobial resistance. This study evaluated the impact of new diagnostic tests in PED. Methods: A retrospective cohort of 4882 acute febrile respiratory infection cases presenting to the PED was analyzed, comparing two periods: Period 1 (October 2016\u2013March 2017, n = 2181) and Period 2 (October 2023\u2013March 2024, n = 2701). During Period 1, Group A Streptococcus and Respiratory Syncytial Virus rapid antigen detection tests were available. During Period 2, new point-of-care tests (POCTs), including rapid C-reactive protein and rapid antigen detection for Influenza A, Influenza B, and SARS-CoV-2, and a multiplex PCR nasal swab, were introduced. Results: In Period 2, antibiotic prescriptions decreased by 28.4%, along with a reduction in broad-spectrum antibiotic use. A significant correlation was observed between reduced antibiotic prescription and the use of new POCTs and multiplex PCR tests. Performance of blood tests and chest radiographs also decreased. Conclusions: Implementing novel diagnostic tests in PED helps clinicians select more appropriate management options with an impact on reduced stress and radiation exposure and antibiotic prescription.<\/jats:p>","DOI":"10.3390\/pathogens14121284","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T09:36:39Z","timestamp":1765791399000},"page":"1284","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Use of Point-of-Care Tests and Multiplex PCR Tests in the Pediatric Emergency Department Reduces Antibiotic Prescription in Patients with Febrile Acute Respiratory Infections"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8175-5488","authenticated-orcid":false,"given":"Luca","family":"Pierantoni","sequence":"first","affiliation":[{"name":"Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7516-243X","authenticated-orcid":false,"given":"Arianna","family":"Dondi","sequence":"additional","affiliation":[{"name":"Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5994-4749","authenticated-orcid":false,"given":"Liliana","family":"Gabrielli","sequence":"additional","affiliation":[{"name":"Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Lasala","sequence":"additional","affiliation":[{"name":"Speciality School of Paediatrics, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Andreozzi","sequence":"additional","affiliation":[{"name":"Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8807-6373","authenticated-orcid":false,"given":"Laura","family":"Bruni","sequence":"additional","affiliation":[{"name":"Speciality School of Paediatrics, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1727-5372","authenticated-orcid":false,"given":"Fiorentina","family":"Guida","sequence":"additional","affiliation":[{"name":"Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Battelli","sequence":"additional","affiliation":[{"name":"Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2596-2367","authenticated-orcid":false,"given":"Giulia","family":"Piccirilli","sequence":"additional","affiliation":[{"name":"Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Corsini","sequence":"additional","affiliation":[{"name":"Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3093-363X","authenticated-orcid":false,"given":"Tiziana","family":"Lazzarotto","sequence":"additional","affiliation":[{"name":"Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"},{"name":"Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello","family":"Lanari","sequence":"additional","affiliation":[{"name":"Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy"},{"name":"Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9895-5942","authenticated-orcid":false,"given":"Daniele","family":"Zama","sequence":"additional","affiliation":[{"name":"Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy"},{"name":"Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1136\/emj.2010.106229","article-title":"Medical Problems Presenting to Paediatric Emergency Departments: 10 Years On","volume":"29","author":"Sands","year":"2012","journal-title":"Emerg. Med. J."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Hagedoorn, N.N., Borensztajn, D.M., Nijman, R., Balode, A., Von Both, U., Carrol, E.D., Eleftheriou, I., Emonts, M., Van Der Flier, M., and De Groot, R. (2020). Variation in Antibiotic Prescription Rates in Febrile Children Presenting to Emergency Departments across Europe (MOFICHE): A Multicentre Observational Study. PLoS Med., 17.","DOI":"10.1371\/journal.pmed.1003208"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1097\/INF.0b013e31829b7e43","article-title":"Viral Etiologies of Infant Bronchiolitis, Croup and Upper Respiratory Illness During 4 Consecutive Years","volume":"32","author":"Miller","year":"2013","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Lei, C., Yang, L., Lou, C.T., Yang, F., SiTou, K.I., Hu, H., Io, K., Cheok, K.T., Pan, B., and Ung, C.O.L. (2021). Viral Etiology and Epidemiology of Pediatric Patients Hospitalized for Acute Respiratory Tract Infections in Macao: A Retrospective Study from 2014 to 2017. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-05996-x"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1007\/s00431-023-05366-6","article-title":"Childhood Community-Acquired Pneumonia","volume":"183","year":"2023","journal-title":"Eur. J. Pediatr."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Bezerra, P.G.M., Britto, M.C.A., Correia, J.B., Duarte, M.D.C.M.B., Fonceca, A.M., Rose, K., Hopkins, M.J., Cuevas, L.E., and McNamara, P.S. (2011). Viral and Atypical Bacterial Detection in Acute Respiratory Infection in Children Under Five Years. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0018928"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Zeng, L., Zhang, L., Hu, Z., Ehle, E.A., Chen, Y., Liu, L., and Chen, M. (2014). Systematic Review of Evidence-Based Guidelines on Medication Therapy for Upper Respiratory Tract Infection in Children with AGREE Instrument. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0087711"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.1093\/cid\/cir531","article-title":"The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America","volume":"53","author":"Bradley","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global Burden of Bacterial Antimicrobial Resistance in 2019: A Systematic Analysis","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/S1473-3099(18)30605-4","article-title":"Attributable Deaths and Disability-Adjusted Life-Years Caused by Infections with Antibiotic-Resistant Bacteria in the EU and the European Economic Area in 2015: A Population-Level Modelling Analysis","volume":"19","author":"Cassini","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Don\u00e0, D., Barbieri, E., Brigadoi, G., Liberati, C., Bosis, S., Castagnola, E., Colomba, C., Galli, L., Lancella, L., and Lo Vecchio, A. (2025). State of the Art of Antimicrobial and Diagnostic Stewardship in Pediatric Setting. Antibiotics, 14.","DOI":"10.3390\/antibiotics14020132"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1086\/510393","article-title":"Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship","volume":"44","author":"Dellit","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Meesters, K., and Buonsenso, D. (2024). Antimicrobial Stewardship in Pediatric Emergency Medicine: A Narrative Exploration of Antibiotic Overprescribing, Stewardship Interventions, and Performance Metrics. Children, 11.","DOI":"10.3390\/children11030276"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1128\/CMR.00090-15","article-title":"The Point-of-Care Laboratory in Clinical Microbiology","volume":"29","author":"Drancourt","year":"2016","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Brigadoi, G., Gastaldi, A., Moi, M., Barbieri, E., Rossin, S., Biffi, A., Cantarutti, A., Giaquinto, C., Da Dalt, L., and Don\u00e0, D. (2022). Point-of-Care and Rapid Tests for the Etiological Diagnosis of Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis. Antibiotics, 11.","DOI":"10.3390\/antibiotics11091192"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E2214153","DOI":"10.1001\/jamanetworkopen.2022.14153","article-title":"Association of Inappropriate Outpatient Pediatric Antibiotic Prescriptions with Adverse Drug Events and Health Care Expenditures","volume":"5","author":"Butler","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.cll.2020.08.006","article-title":"Point-of-Care Testing in Microbiology","volume":"40","author":"Samuel","year":"2020","journal-title":"Clin. Lab. Med."},{"key":"ref_18","first-page":"CD012252","article-title":"Clinician-Targeted Interventions to Influence Antibiotic Prescribing Behaviour for Acute Respiratory Infections in Primary Care: An Overview of Systematic Reviews","volume":"2019","author":"Tan","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.jhin.2010.11.019","article-title":"Rapid Testing for Respiratory Syncytial Virus in a Paediatric Emergency Department: Benefits for Infection Control and Bed Management","volume":"77","author":"Mills","year":"2011","journal-title":"J. Hosp. Infect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1900430","DOI":"10.2807\/1560-7917.ES.2020.25.44.1900430","article-title":"Point-of-Care Tests for Influenza A and B Viruses and RSV in Emergency Departments\u2014Indications, Impact on Patient Management and Possible Gains by Syndromic Respiratory Testing, Capital Region, Denmark, 2018","volume":"25","author":"Schneider","year":"2020","journal-title":"Eurosurveillance"},{"key":"ref_21","first-page":"CD010130","article-title":"Biomarkers as Point-of-Care Tests to Guide Prescription of Antibiotics in People with Acute Respiratory Infections in Primary Care","volume":"2022","author":"Smedemark","year":"2022","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1097\/PEC.0000000000002250","article-title":"Point-of-Care Influenza Testing in the Pediatric Emergency Department","volume":"36","author":"Patel","year":"2020","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e2216162","DOI":"10.1001\/jamanetworkopen.2022.16162","article-title":"Effect of Point-of-Care Testing for Respiratory Pathogens on Antibiotic Use in Children: A Randomized Clinical Trial","volume":"5","author":"Mattila","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_24","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences., Lawrence Earlbaum Associates."},{"key":"ref_25","unstructured":"National Institute for Health and Care Excellence (2021). Bronchiolitis in Children: Diagnosis and Management, National Institute for Health and Care Excellence."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1093\/pch\/pxx019","article-title":"Acute Management of Croup in the Emergency Department","volume":"22","year":"2017","journal-title":"Paediatr. Child Health"},{"key":"ref_27","unstructured":"Rossella, B., Gagliotti, C., and Ricchizzi, E. (2024). Uso di Antibiotici e Resistenze Antimicrobiche in et\u00e0 Pediatrica, Rapporto Emilia-Romagna."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Puntoni, M., Caminiti, C., Maglietta, G., Lanari, M., Biasucci, G., Suppiej, A., Marchetti, F., De Fanti, A., Caramelli, F., and Iughetti, L. (2025). Pediatric Healthcare Service Utilization after the End of COVID-19 State of Emergency in Northern Italy: A 6-Year Quasi-Experimental Study Using Interrupted Time-Series Analysis. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1575047"},{"key":"ref_29","first-page":"19","article-title":"La sorveglianza integrata dei virus respiratori \u201cRespiVirNet\u201d in Italia: I risultati della stagione 2023\u20132024","volume":"5","author":"Bella","year":"2025","journal-title":"Boll. Epidemiol. Naz."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Pierantoni, L., Lasala, V., Dondi, A., Cifaldi, M., Corsini, I., Lanari, M., and Zama, D. (2023). Antibiotic Prescribing for Lower Respiratory Tract Infections and Community-Acquired Pneumonia: An Italian Pediatric Emergency Department\u2019s Real-Life Experience. Life, 13.","DOI":"10.3390\/life13091922"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/S1473-3099(18)30672-8","article-title":"Antibiotic Prescription for Febrile Children in European Emergency Departments: A Cross-Sectional, Observational Study","volume":"19","author":"Mintegi","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2017","DOI":"10.1007\/s00431-022-04386-y","article-title":"Determinants of Antibiotic Prescriptions in a Large Cohort of Children Discharged from a Pediatric Emergency Department","volume":"181","author":"Covino","year":"2022","journal-title":"Eur. J. Pediatr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1186\/s12985-024-02441-8","article-title":"Epidemiological Study of Post-Pandemic Pediatric Common Respiratory Pathogens Using Multiplex Detection","volume":"21","author":"Wu","year":"2024","journal-title":"Virol. J."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Barbieri, E., Di Chiara, C., Costenaro, P., Cantarutti, A., Giaquinto, C., Hsia, Y., and Don\u00e1, D. (2021). Antibiotic Prescribing Patterns in Paediatric Primary Care in Italy: Findings from 2012\u20132018. Antibiotics, 11.","DOI":"10.3390\/antibiotics11010018"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Di Martino, M., Lallo, A., Kirchmayer, U., Davoli, M., and Fusco, D. (2017). Prevalence of Antibiotic Prescription in Pediatric Outpatients in Italy: The Role of Local Health Districts and Primary Care Physicians in Determining Variation. A Multilevel Design for Healthcare Decision Support. BMC Public Health, 17.","DOI":"10.1186\/s12889-017-4905-4"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1177\/0009922819834278","article-title":"Antibiotic Prescribing in Outpatient Children: A Cohort From a Clinical Data Warehouse","volume":"58","author":"Shea","year":"2019","journal-title":"Clin. Pediatr."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Esposito, S., Mencacci, A., Cenci, E., Camilloni, B., Silvestri, E., and Principi, N. (2019). Multiplex Platforms for the Identification of Respiratory Pathogens: Are They Useful in Pediatric Clinical Practice?. Front. Cell. Infect. Microbiol., 9.","DOI":"10.3389\/fcimb.2019.00196"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e2111836","DOI":"10.1001\/jamanetworkopen.2021.11836","article-title":"Effect of Rapid Respiratory Virus Testing on Antibiotic Prescribing Among Children Presenting to the Emergency Department With Acute Respiratory Illness: A Randomized Clinical Trial","volume":"4","author":"Rao","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_39","first-page":"539","article-title":"Impact of Nested Multiplex Polymerase Chain Reaction Assay in the Management of Pediatric Patients with Acute Respiratory Tract Infections: A Single Center Experience","volume":"31","author":"Sherif","year":"2023","journal-title":"Infez. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1093\/jpids\/piab043","article-title":"Systematic Review and Meta-Analysis of Diagnostic Biomarkers for Pediatric Pneumonia","volume":"10","author":"Gunaratnam","year":"2021","journal-title":"J. Pediatr. Infect. Dis. Soc."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Gonz\u00e1lez, N.A., Keizer, E., Plate, A., Coenen, S., Valeri, F., Verbakel, J.Y.J., Rosemann, T., Neuner-Jehle, S., and Senn, O. (2020). Point-of-Care C-Reactive Protein Testing to Reduce Antibiotic Prescribing for Respiratory Tract Infections in Primary Care: Systematic Review and Meta-Analysis of Randomised Controlled Trials. Antibiotics, 9.","DOI":"10.3390\/antibiotics9090610"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.arcped.2018.10.004","article-title":"Impact of the Sofia\u00ae Influenza A+B FIA Rapid Diagnostic Test in a Pediatric Emergency Department","volume":"26","author":"Diallo","year":"2019","journal-title":"Arch. P\u00e9diatr."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Bellini, T., Fueri, E., Formigoni, C., Mariani, M., Villa, G., Finetti, M., Marin, M., De Chiara, E., Bratta, A., and Vanorio, B. (2024). Usefulness of Point-of-Care Testing for Respiratory Viruses in a Pediatric Emergency Department Setting. J. Clin. Med., 13.","DOI":"10.3390\/jcm13237368"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e044510","DOI":"10.1136\/bmjopen-2020-044510","article-title":"Role of Point-of-Care Tests in the Management of Febrile Children: A Qualitative Study of Hospital-Based Doctors and Nurses in England","volume":"11","author":"Li","year":"2021","journal-title":"BMJ Open"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"366","DOI":"10.3390\/pediatric14030043","article-title":"Activity of a Pediatric Emergency Department of a Tertiary Center in Bologna, Italy, during SARS-CoV-2 Pandemic","volume":"14","author":"Zama","year":"2022","journal-title":"Pediatr. Rep."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/12\/1284\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T10:05:19Z","timestamp":1765793119000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/12\/1284"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,13]]},"references-count":45,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["pathogens14121284"],"URL":"https:\/\/doi.org\/10.3390\/pathogens14121284","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,13]]}}}