The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes.LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January–December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien–Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141).A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% . The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively.This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives. HighlightsInternational snapshot study following the global surgery collaborative approach.Over 2000 patients were included from all continents.The 90-day mortality rate after liver surgery was 4%.The failure to rescue rate ranged from 5 to 35% among higher and lower Human Development Index (HDI) groups.There is a great need to develop quality improvement collaboratives worldwide.1. Liver cancer deaths were over 800 000 in 2020, with the highest rates observed in Eastern Asia and Northern Africa2. Furthermore, it has was shown that socioeconomic factors have a significant impact on liver cancer outcomes3. The Human Development Index (HDI) is a metric of life expectancy, education, and standard of living, developed to assess social and economic differences among countries4. This metric is therefore useful to compare outcomes after liver surgery in different regions across the world.The most common indications for liver surgery include primary cancer, such as hepatocellular and cholangiocarcinoma, liver metastases, mostly colorectal, and benign liver lesions, including hydatid liver disease. Asia and the Western Pacific have the highest liver malignancy mortality rates nearing 20%, especially in upper-middle-income areas, while the lowest rates are observed in South America, Europe, South-East Asia, as well as in low-middle-income regions5, hepatobiliary surgery is often a vital intervention in managing benign liver diseases, such as large symptomatic liver cysts, hepatic adenomas, and hydatid liver disease, among others6. Liver surgery ranges vastly in degrees of complexity and relies on strong cohesive multidisciplinary care. However, access to safe surgery of the liver worldwide is yet to be addressed. It is in this context that identifying the gaps in global surgery of the liver can help pinpoint modifiable domains in healthcare provision and perioperative care to improve the accessibility and safety of surgery worldwide. A light was shed on the gross inequality in surgery and anesthesia care in the world by the former President of the World Bank, Jim Yong Kim, in his statement to promote the inclusion of surgical care in the global health agenda that ʻsurgical care is an indivisible, indispensable part of healthcareʼ7. As the need to upscale healthcare systems, infrastructure, and education in underserved countries is increasingly evident, global surgery, a field of research and advocacy to improve surgical care outcomes not restricted to specific diseases, populations, or geographical regions, is of mounting significance today9. Thus, global surgery research should not only focus on ʻessentialʼ, cost-effective general surgical procedures10 but also on highly specialized surgery, such as hepatobiliary.Apart from being the only potentially curative approach for many liver malignancies13. A comprehensive understanding of the global necessity for surgical interventions is paramount to address the significant health challenges faced by populations worldwide. However, it is equally crucial to acknowledge and analyze the barriers to accessing surgical care, including workforce shortages and quality concerns, to effectively enhance global surgical standards. The importance of this endeavor lies in its potential to mitigate disparities and optimize hepatobiliary surgical outcomes across diverse healthcare settings14.Ultimately, the true demographics worldwide in terms of activity and outcomes of hepatobiliary surgery remain unknown and surgery of the liver as we know it reflects the activity of highly specialized academic centers. In addition, the true population-based outcomes are likely different to those vastly reported from high-volume academic centersIn this International Liver Surgery Outcomes Study, the primary objective was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe, committing to consecutive case registration and rigorous data validation. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes.15. Such research methodology provides a worldwide population-based overview of the current clinical practice and allows for hypothesis generating comparative analyses. The study protocol was registered in advanced at ClinicalTrials.gov (NCT03768141) and audit approval was obtained by the Royal Free Hospital London, UK. This work is reported in line with the strengthening the reporting of cohort, cross-sectional and case–control studies in surgery (STROCSS) criteria16 .LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach which was introduced in the UK in 201317.The project and study design were initiated in May 2017, center recruitment in September 2018, with a 3-month of prospective, consecutive patient enrollment within January to December 2019. Each patient was followed up for up to 90 days postoperatively. None of the participating centers were affected by the first peak of COVID-19 during the study periodAny surgeon performing liver surgery was eligible to participate and there were no exclusion criteria for center participation, to reflect the nature of this global surgery study. Centers were recruited through various methods, including: collaborative networks and partnerships with healthcare institutions, through national societies of surgical trainees, through different associations and societies by promoting our study to their members, through research collaborations with centers that had prior projects with the study investigators, through preselected country and regional leaders dedicated to recruit centers within their region, through dissemination of study information at conferences, through multiple emails and newsletters, social media, instant messaging groups, by utilizing personal contacts, and referrals within the global surgery community.18 for the purposes of liver parenchyma augmentation were excluded. It was predetermined at the beginning of the study design that data on two-stage liver resections would warrant separate examination and documentation. The purpose of the present study was to report the true morbidity and mortality associated with liver surgery. Only reason I would delete this is because it sounds like a bias introduced rather than a measure to minimise it (which I believe was the intention).All patients undergoing liver surgery at their respective centers were eligible for study inclusion. The inclusion criteria were patients of 18 years of age or older, any indication for surgery, including surgery for both benign and malignant disease, and all minimally invasive approaches. The exclusion criteria were patients undergoing liver transplantation, liver biopsies, or image-guided liver ablation alone. For this manuscript, only single-stage liver resections were included, two-stage liver resection19, the FABIB Liver Surgery-Specific Classification20 and the novel Comprehensive Complication Index (CCI)21 up to 90 days postoperatively. Major complications were defined as Clavien–Dindo grade ≥3a (any complication requiring an intervention or organ failure). High-volume centers were defined as those having submitted at least 30 cases over the 3-month recruitment period . The failure-to-rescue rate was calculated by dividing the number of patients that died after surgery over the total number of patients with complications22. All data were collected using the LiverGroup.org specially designed electronic Case Report Form (eCRF). Furthermore, country-based and hospital-based data were collected, including the Human Development Index (HDI)4, Gross National Income (GNI)23, Education Index23, Life Expectancy Index (LEI)23, and the Total Health Expenditure24. These parameters were used to compare the outcomes of liver surgery worldwide. Cost analysis was conducted using the validated AssesSurgery GmbH calculator25 only for European countries, including Switzerland and the United States of America. All values in Euro or Swiss Francs were converted to US Dollars for comparisons and uniform reporting purposes.Basic demographics, patient and operation characteristics were collected. The complexity of liver surgery was defined according to certain criteria and each criterion was given a single point (maximum 13) to create the Liver Surgery Complexity Score. Morbidity was recorded according to the Clavien–Dindo Classification of Surgical ComplicationsThis study aimed for the maximum number of patients able to recruit. Assuming a 90-day mortality rate of 5 and 50% reduction to 2.5%, an alpha error of 0.05, power of 80%, the sample size calculation revealed the need for 1828 patients to be recruited. When adjusting for 10% drop-out or missing data rate, the final sample size calculation was set at 2011 cases in total.t-test, the Mann–Whitney U test and the Kruskal–Wallis H test or one-way ANOVA where appropriate. Differences among proportions derived from categorical data were compared using the Fisher and the Pearson χ2-tests, where appropriate. The Complexity of Liver Surgery Score (maximum score 13) was internally validated using the intraclass collection coefficient and the Cronbach’s alpha test. ROC curve analysis was used to assess its predictive value and the Yuden’s index to identify the optimal score cut-off point. A multivariable, binary regression analysis was performed to identify independent factors of 90-day mortality. The nature of missingness and proportions of missing data per variable were assessed. Variables containing data missing completely at random and missing in fewer than 10% of observations were handled as complete case analysis26. Cases with missing outcome only  data were excluded and there were no attempts to perform multiple imputation calculations to replace them. All P-values were 2-sided and considered statistically significant if P<0.05. Statistical analysis was performed using R version 3.3.2 , R Studio version 1.0.44  with the graphical user interface (GUI) rBiostatistics.com .Continuous variables were compared with the Student A total of 2159 patients were included  rates were at 90 days postoperatively . Similarly, on multivariable analysis, the complexity of the liver sugary score, with a cut-off of 2 points , was identified as an independent predictor of mortality  . Figure Surgery was performed for cancer in 1785 82.7%) patients, of whom 296 (13.7%) had received a liver resection previously. In 914 (42.3%) patients the indication for resection was colorectal liver metastases (CRLM), while in 386 (17.9%) it was hepatocellular carcinoma (HCC) (Table .7% patieIn 211 (9.8%) patients, liver resection was performed together with a form of biliary and/or venous reconstruction. The median intraoperative and first 24 h postoperatively packed red blood cell (RBC) transfusion was 0 (10th–90th percentile: 0–1). Finally, a total of 1434 (80.1%) patients were successfully extubated in the operation room (Table http://links.lww.com/JS9/B126). Morbidity and mortality rates according to the different indications and types of operations are reported in Table P=0.483) and mortality  did not differ between benign and malignant indications for liver surgery .Outcomes were measured from the completion of surgery up until 90 days postoperatively. Of all patients, 912 42.2%) experienced a postoperative complication of any severity, while the major complication rate was 15.8% 341/2,159)  (dead/complications). The overall mean estimated cost of liver surgery in Europe and the USA was 14 034 (SD 7279) US Dollars. Supplementary figure 2 Supplemental Digital Content 1, versus large (≥850 beds) hospitals was not significantly different in this cohort . Teaching or university affiliated hospitals; however, were associated with lower mortality rates when compared to nonteaching hospitals . There was a trend to higher mortality rate associated with private when compared to public hospitals 3.7 vs. 7.9%, OR 2.23, 95% CI: 0.84–5.03, P=0.081).The mortality rate in relatively small (<850 beds) http://links.lww.com/JS9/B126) is a summary measure of achievement in key dimensions of human development: Life Expectancy (LEI), Education (EI) and the Gross National Income (GNI) Indices23. All participating centers fell into three groups, the low- to medium- (0.550–0.699), high- (0.700–0.799) and very high- (≥0.800) HDI groups. Although sex and comorbidities did not differ significantly among the three HDI groups, patients from low- to middle HDI countries were younger, were more likely to suffer from a benign disease, had similar postoperative morbidity rates but despite that, a significantly higher mortality rate when compared to high- and very high-HDI groups , respectively (P=0.004). Figure http://links.lww.com/JS9/B126).The Human Development Index (HDI)  perform an increasing number of liver resections, while Sub-Saharan Africa is grossly underrepresented. Liver surgery today bears important morbidity overall, with as many as 4 in 10 patients experiencing at least one postoperative complication of any severity with an overall 90-day mortality rate of 4%.Across the represented HDI groups, there was an inverse relationship between increasing HDI and 90-day mortality rates with a four-fold higher mortality in the medium HDI group than in the very high-HDI group. Major morbidity, however, while also highest in the medium HDI group, was lowest in the high-HDI countries rather than in the very high-HDI countries. Interestingly, despite the very high-HDI countries owning the lowest mortality, the major morbidity was substantial. When evaluating the surgical complexity scores, it becomes apparent that the high morbidity is associated with higher complexity. The resulting relationship of these outcome metrics, particularly in the medium and very high-HDI group, rises further themes for discussion and research.27. This global snapshot study reveals a failure-to-rescue rate of over 10% in liver surgery worldwide. The stark contrast between the mortality rates between medium and very high-HDI groups, considering the relatively similar morbidity rates, is highly suggestive of higher preventable mortality in lower HDI groups. Similarly, in the African Surgical Outcomes Study (ASOS), a high incidence of preventable deaths in low-risk patients following surgery was identified and attributed to inadequate identification and treatment of life-threatening complications during the perioperative period28. Furthermore, several Global Surgery studies have emphasized the importance of failure to rescue as one of the few factors that are modifiable30. This has led to its use as a new quality indicator of surgical services31. Although the key modifiable domains that impact mortality following major complications in liver surgery remain hypothesis driven, the timely recognition and management of complications together with optimal infrastructure can hardly be disputed. Nationwide studies, albeit all from very high-HDI countries, have attributed interhospital differences in failure to rescue rates after liver surgery, at least in part, to hospital volume33. However, at an international level, there appears to be no significant association between the two, with hospital size and volume not being associated with postoperative outcomes.Failure-to-rescue, defined as death after a treatable complication, was described as an effective measure of preventable postoperative mortality34. Improving surgical care must embrace initiatives to reduce postoperative deaths as much as to address the disparities in surgical activity in underserved areas. While the present study reveals gaps in the field of liver surgery, failure to rescue encompasses the wider surgical ecosystem, including workforce and infrastructure factors. Identifying what drove the improved standards in the very high-HDI countries that have also allowed for resections of higher complexity will help address the high failure to rescue rates observed in the medium HDI group. In establishing an international collaborative group, LiverGroup.org members could now work together to develop quality improvement collaboratives.The burden of postoperative mortality after surgery, of any kind, is estimated to account for nearly 10% of all deaths each year worldwide, which makes it the third leading cause of deaths, preceded only by ischemic heart disease and stroke35. This may be attributed to improved surgical techniques and precision instruments, preoperative planning and advanced imaging technologies, inflow occlusion36, hemostatic agents and devices for effective bleeding control, optimized transfusion strategies and blood management protocols, as well as enhanced perioperative care practices. However, mortality rates reaching nearly 20% in patients that suffer from hilar cholangiocarcinoma, requiring complex liver surgery, biliary and/or venous reconstruction are unacceptable and twice as high when compared to the current literature37. Further research in this field is required to make surgery for cholangiocarcinoma safer, among others including risk stratification and patient selection scores, perioperative care optimization protocols, quality improvement initiatives, multicenter collaborations, and data registries.This study also revealed other important findings. Liver surgery is currently performed bloodless, with only about 1 out of 10 patients requiring a blood transfusion. This is in contrast with historic reports that associated liver surgery with significant blood loses38. Furthermore, minimally invasive surgery was attempted and/or performed in a quarter of the patients in this cohort, however the levels of surgical complexity in this group were lowest, which may explain superior outcomes. Interestingly, worse outcomes were associated with operations that were converted from minimally invasive to open surgery. This may reflect higher complexity as well as intraoperative complications affecting patient outcomes39.A third of the patients underwent parenchymal preserving operations . This is in contrast to previous reports with anatomical, nonparenchymal preserving operations performed due to the perceived oncological benefit and simplicity of liver surgery40. In-hospital cost appear to double for reinterventions and quadruple with organ failure. The highest costs were related to patients in whom failure-to-rescue occurred. Prevention and early identification of postoperative complications may help increase patient turnover as well as save cost, allowing to offer surgery to more patients and reduce the waiting time for surgery.Apart from the patient and family burden, postoperative complications also affect cost and hospital resourcesFirstly, selective reporting is an issue with any type of global surgery studies41 and there were no data monitors assigned to each center. However, with anonymous reporting and the high mortality rates associated with specific disease and operation characteristics, the writing committee members did not consider this as a significant issue. Secondly, the short time frame of three months for data capture by local investigators may risk selection bias, such as seasonal variation in local presentations. However, longer enrollment strategies, with a higher time burden, may have affected study participation. Thirdly, this study used several classifications and terminology that may not be familiar to local investigators, and this may have affected the correctness of data capture. However, the electronic Case Report Form (CRF) as well as the LiverGroup.org platform contained explanations for each classification and term used as well as online converters for laboratory values and other important calculators. Fourthly, the surgeon experience and learning curve was not assessed in this study, thus no associations could be made with regards to outcomes, especially among the different HDI country groups. Lastly, underrepresentation of certain regions in global surgery studies is a common phenomenon and this can be attributed to limited research infrastructure and funding opportunities in certain regions, lack of awareness and access to global surgery studies, language and cultural barriers that impact participation, variation in regulatory and ethical considerations across countries, as well as differences in surgical capacity and expertise among regions. Addressing these barriers requires initiatives to promote inclusivity and equity, such as capacity-building programs, targeted funding support, collaborations with regional partners, translation, and cultural adaptation of study materials, and active engagement with underrepresented regions to overcome specific challenges they may face42.The strengths of this study lie in the magnitude of the LiverGroup.org network, its geographic distribution, the prospective nature of this study, the duration of follow-up, and the liver surgery-specific details obtained. Nevertheless, a study of this scale has some inevitable limitations. In conclusion, to our knowledge, this is the first global surgery study specifically designed and conducted for specialized, liver surgery. We identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index (HDI) countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives, with the next obvious step being studying failure to rescue in lower HDI countries. We propose a strategy encompassing joint research on failure-to-rescue factors in lower HDI countries, skill-based training programs, technology transfer, infrastructure development, policy advocacy, and local capacity-buildingThis project obtained audit approval from the Royal Free Hospital Audit and Compliance, Quality Governance department with the registration ID: RFH TASS40_2016/17.This project, registered as an audit, did not require informed consent in the UK as it was truly observational with fully anonymised data.This study was supported by the University College London, UK Liver Fund Charity and BOWA AG, Germany. The sponsors how NO involvement in the collection, analysis and interpretation of data, in the writing of the manuscript, and in the decision to submit the manuscript for publication.DA.R., C.H.S., and M.M.: study conception and study design, data acquisition, data analysis and interpretation, article drafting and approval. All members of the Scientific Committee (see Appendix) revised and approved the manuscript for publication.The authors declare that they have no financial conflict of interest with regard to the content of this report.ClinicalTrials.gov NIH Protocol (NCT03768141).ISRCTN Registry Protocol (ISRCTN14071325).Dimitri Raptis and Massimo Malagò.The Scientific and Management Committees will decide about requests from LiverGroup.org Members regarding data sharing and will consider all such requests based on quality and the validity of the proposed project.Not commissioned, externally peer-reviewed.LiverGroup.org CommitteesChief Investigators:Co-Chief Investigator: Dimitri Aristotle Raptis, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi ArabiaMassimo Malagò, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia and Alejandro Serrablo, Hospital Universitario Miguel Servet, Spain. Scientific Committee:Christos Dervenis, Metropolitan Hospital Athens, Greece & University of Cyprus; Karl Jürgen Oldhafer, Asklepios Medical School, Germany; Marcel Autran Machado, Hospital Sirio Libanes, Brazil; Norihiro Kokudo, University of Tokyo Hospital, Japan, Pål-Dag Line, Oslo University Hospital, Norway; Roberto Hernandez-Alejandro, University of Rochester Medical Center, USA; Stefan Breitenstein, Cantonal Hospital Winterthur, Switzerland; Thomas van Gulik, Academic Medical Center, University of Amsterdam, Netherlands; Yaman Tokat, International Liver Center, Turkey and Ulf Peter Neumann, University Hospital Aachen, Germany.Management Committee:Aditya Borakati, Royal Free Hospital London, UK; Andrea Monaco, Royal Free Hospital London, UK; Andreas A. Schnitzbauer, University Hospital Frankfurt, Germany; Arthur Elfrink, University Medical Center Groningen, Netherlands; Carlijn Buis, University Medical Center Groningen, Netherlands; Camila Hidalgo Salinas, Royal Free Hospital London, UK; Charles Imber, Royal Free Hospital London, UK; Daniele Ferraro, Royal Free Hospital London, UK; Deniz Balci, Ankara University, Turkey; Dimitri Aristotle Raptis, Royal Free Hospital London, UK; Erik Schadde, Rush University Medical Center, Chicago, IL, United States; Fiammetta Soggiu, Royal Free Hospital London, UK; Georg Lurje, University Hospital Aachen, Germany; Gregor A. Stavrou, Klinikum Saarbruecken, Germany; Ioannis Passas, Metropolitan Hospital, Athens, Greece; James Pape, Johannesburg, South Africa; Marc Bemelmans, Maastricht University Medical Center, Netherlands; Marieke de Boer, University Medical Center Groningen, Netherlands; Omid Madadi-Sanjani, Royal Free Hospital London, UK; Pim Olthof, University of Amsterdam, Netherlands; Rahul Koti, Royal Free Hospital, UK; Stefen Gilg Karolinska Institutet, Stockholm, Sweden; Steven Olde Damink, Maastricht University, Netherlands; Sven Lang, University Hospital Freiburg, Germany; Theodora Pissanou, Royal Free Hospital London, UK; Thomas Hanna, Royal Free Hospital London, UK; Victoria Ardiles, Hospital Italiano de Buenos Aires, Argentina.Country Leaders:Algeria: Ahmed Belhadj Mostefa, Centre Hospitalo-Universitaire Constantine; Argentina: Jeremias Goransky, Hospital Italiano de Buenos Aires; Lucas McCormack, Hospital Aleman of Buenos Aires; Nicolas Resio, Unidad HPB Sur; Australia: George Petrou, Mid North Coast; Thomas Hugh, Royal North Shore Hospital; Vincent Lam, Norwest Private Hospital; Austria: Thomas Gruenberger, Social Medical Center South; Belarus: Aliaksei Shcherba, Minsk Medical Center for Surgery, Transplantation and Hematology; Belgium: Claude Bertrand, CHU UCL Namur, Godinne; Mathieu D'Hondt, Groeninge Hospital Kortrijk; Brazil: Claudemiro Quireze Junior, Universidade Federal de Goias; Lucio Lucas Pereira, Hospital Sirio Libanes. Felipe José Fernández Coimbra, AC Camargo Cancer Center. Bulgaria: Daniel Kostov, Military Medical Academy, Varna; Nikola Vladov, Military Medical Academy, Sofia; Nikolay Belev, UMBAL-Eurohospital; Canada: Gonzalo Sapisochin, UHN - Toronto General Hospital; Chile: Camila Hidalgo, Nicolas Jarufe, P. Universidad Carolica de Chile; China: An'an Gong, Yiwu Central Hospital; Chao Liu, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; Dachen Zhou, The Second Hospital of Anhui Medical University; Yiming Chen, The First Affiliated Hospital of Dali University; Fei Zhang, The First Affiliated Hospital of China Medical University, Zhang Wen, The first affiliated Hospital, Guangxi Medical University; Croatia: Mario Kopljar, University Hospital Center "Sestre milosrdnice"; Cyprus: Athanasios Petrou, American Institute of Minimal Invasive Surgery; Czech Republic: Vladislav Treska, University Hospital; Egypt: Ahmed Sherif, National Liver Institute - Menoufia University; Mahmoud El-Meteini, Faculty of Medicine, Ain Shams University; France: David Fuks, Institut Mutualiste Montsouris; Olivia Sgarbura, Cancer Institute Montpellier; Germany: Bettina M. Buchholz, University Medical Center Hamburg-Eppendorf; Jun Li, University Medical Center Hamburg-Eppendorf; Stefan Heinrich, University Hospital of Mainz; Greece: George Tzimas, Hygeia Hospital; Georgios Tsoulfas, Aristotle University of Thessaloniki; Ioannis Passas, Metropolitan Hospital; Panagiotis Petras, Ippokratio General Hospital of Thessaloniki; India: Soumil Vyas, Sir H N Reliance Foundation Hospital; Indonesia: Budi Irwan, RSUP H. Adam Malik; Erik Prabowo, Kariadi General Hospital / Diponegoro University; Ireland: Tom Gallagher, St. Vincent's University Hospital; Israel: Riad Haddad, Carmel Medical Center; Italy: Adelmo Antonucci, Policlinico of Monza; Elio Jovine, Sant’Orsola University hospital IRCCS; Francesca Ratti, San Raffaele Hospital; Francesco Saverio Papadia, Ospedale Policlinico San Martino; Marcello Maestri, Fondazione IRCCS Policlinico San Matteo, Pavia; Latvia: Arturs Ozolins, Pauls Stradins Clinical University Hospital; Lebanon: Mohamad Khalife, American University of Beirut; Libya: Muhammed Elhadi, University of Tripoli; Lithuania: Audrius Dulskas, National Cancer Institute; Marius Paskonis, Vilnius University hospital Santaros Klinikos; Tomas Vanagas, Lithuanian University of Health Sciences; Malaysia: Peng Soon Koh, University of Malaya; Maldives: Shahi Ghani, Tree Top Hospital; Mexico: Alejandro Ramirez Del Val, National Institute of Medical Science and Nutrition Salvador Zubiran; Alejandro Eduardo Padilla Rosciano, National Cancer Institute; Carlos Florez Zorrilla, Centro Médico Nacional 20 de noviembre; Javier Melchor-Ruan, Instituto Nacional de Cancerología; Netherlands: Carlijn Buis, UMCG; Marc Bemelmans, Maastricht University Medical Center+; New Zealand: Jonathan Koea, North Shore Hospital; Nigeria: Bose Ojo-Williams, Olusegun Alatise, Obafemi Awolowo University Teaching Hospitals Complex; Norway: Sheraz Yaqub, Oslo University Hospital; Peru: Eduardo Anchante Castillo, G. Almenara I. National Hospital Essalud; Peru: Victor Hugo Torres Cuevs, G. Almenara I. National Hospital Essalud; Philippines: Catherine Teh, St Luke's Medical Center; Poland: Andrzej Komorowski, University of Rzeszow; Krzysztof Jeziorski, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw; Krzysztof Zieniewicz, Medical University of Warsaw; Oskar Kornasiewicz, Medical University of Warsaw; Portugal: Vitor Nunes, Hospital Prof. Dr. Fernando Fonseca; Qatar: Hatem Khalaf, Hamad Medical Corporation; Romania: Anamaria Schipor, Iuliu Haţieganu University of Medicine and Pharmacy; Ionut Negoi, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest; Matei Bratu, Emergency Clinical Hospital of Bucharest; Octav Ginghina, Saint John Hospital Bucharest; Russia: Arkady Bedzhanyan, Russian Reserch Center of Surgery named after B.V.Petrovsky; Ivan Kozyrin, Clinical Hospital #1 MEDSI; Nikita Chardarov, Petrovsky Russian Research Center of Surgery; Nikolay Bagmet, Petrovsky National Research Centre of Surgery; Vladimir Zagainov, Volga District Medical Center of FMBA of Russia; Saudi Arabia: Ahmed Zidan, King Faisal Specialist Hospital and Research Centre; Serbia: Aleksandar Karamarkovic, Clinic for Surgery, University Clinical Center Zvezdara, Faculty of Medicine University of Belgrade; Daniel Galun, University Clinic for Digestive Surgery; Mladjan Protic, University of Novi Sad, Faculty of Medicine; Slovakia: Alexander Ferko, University Hospital Martin; Slovenia: Blaž Trotovšek, University Medical Centre Ljubljana; Slovenia: Peter Pipan, TBA; Spain: Benedetto Ielpo, University Hospital of Leon; Spain: Irene Ortega, Infanta Sofía University Hospital; JM Asencio, Hospital General Universitario Gregorio Marañón; Miguel-Angel Suarez-Muñoz, University Hospital "Virgen de la Victoria"; Roberto Brusadin, Virgen del Arrixaca Clinic and University Hospital; Vicenç Artigas, Universidad Autònoma Barcelona; Sri Lanka: Bulathsinhalage Bulathsinhala, Colombo North Teaching Hospital;Rohan Siriwardana, University of Kelaniya; Sweden: Ernesto Sparrelid, Karolinska Institutet; Per Sandström, Institution of Biomedical and Clinical Sciences; Switzerland: Andrea Peloso, HUG - Hôpitaux Universitaires de Genève; Erik Schadde, Cantonal Hospital Winterthur; Turkey: Ahmet Coker, Ender Dulundu, University of Istanbul, Cerrahpasa, School of Medicine; Mustafa Kerem, Gazi University Faculty of Medicine; United Kingdom: Francis Robertson, Royal Infirmary of Edinburgh; Moh'd Abu Hilal, Southampton University Hospital and Poliambulanza Foundation Hospital, Brescia, Italy; Rajiv Lahiri, Royal Free Hospital; Reena Ravikumar, Kings College Hospital; Robert Hutchins, Bart's Health NHS trust; Satheesh Iype, Royal Free Hospital; Stephanos Pericleous, The Royal Marsden NHS Trust; VM Bobby Dasari, Queen Elizabeth Hospital; United States: Alan Koffron, Beaumont Health System; Emmanouil Giorgakis, University of Arkansas for Medical Sciences; Hrishikesh Samant, Willis Knighton health system; Steven Curley, Christus Trinity Mother Frances. Yuri Genyk, University of Southern California, Uruguay: Daniel Czarnevicz, Servicio Medico Integral.LiverGroup.org Members:Argentina: HIGA Dr. O. Alende Hospital: Gabriela Delvalle; Hospital Aleman of Buenos Aires: Matias Balmer; Hospital Universitario Fundacion Favaloro: Diego Ramich; Gabriel Gondolesi; Pablo Barros Schelotto; Clinica Pasteur Rio Negro: Nicolas Resio; Unidad HPB Sur: Dario Abaca; Julio Lazarte; Australia: Norwest Private Hospital: Lawrence Yuen; Tony Pang; Royal North Shore Hospital: Nazim Bhimani; Austria: Community Hospital Horn: Andreas Hauer; Klaus Kirbes; Reinhold Klug; Medical University of Innsbruck: Eva Braunwarth; Florian Primavesi; Stefan Stättner; Belarus: Minsk Medical Center for Surgery, Transplantation and Hematology: Dmitry Fedaruk; Sergey Korotkov; Belgium: AZ Delta: Sébastien Strypstein; Bart Smet; Mehrdad Biglari; CHU UCL Namur, Godinne: Alexandra Dili; Ghent University Hospital: Aude Vanlander; Betsy Van Loo; Luís Filipe Abreu de Carvalho; Bart Hendrikx; Federico Tomassini; Xavier Rogiers; Groeninge Hospital Kortrijk: Celine De Meyere; Franky Vansteenkiste; Brazil: Santa Casa de Misericórdia do Pará: Fernanda Oliveira Barreto Garcia; Rafael José Romero Garcia; Universidade Federal do Pampa /Hospital Santa Casa de Caridade de Ururguaiana: Diego Kleinubing; Universidade Federal de São Paulo, Hospital São Paulo: Marcelo Moura Linhares; Leandro Dias Cezar; Daniel Kitayama Shiraiwa; Rachel Riera; Bulgaria: Military Medical Academy: Tsonka Lukanova; Vasil Kostov; UMBAL-Eurohospital: Panche Krastev; Radoslav Penkov; Chile: P. Universidad Carolica de Chile: Martin Dib; P. Universidad Católica de Chile: Carlo Marino; China: The Second Hospital of Anhui Medical University: Dachen Zhou, Jiong Gu, Bin Zhang; Yat-sen Memorial Hospital, Sun Yat-sen University: Lei-bo Xu; Rui Zhang; The First Affiliated Hospital of Dali University: Yunbo Tan; Ziting Su; The first affiliated Hospital, Guangxi Medical University: Banghao Xu; Jilong Wang; Yiwu Central Hospital: Ke Miao; Xuhang Luo; Yuebei Peopl’s Hospital: Haimin Chen; Jiafeng Zhao; Croatia: University Hospital Center "Sestre milosrdnice": Mario Zovak; Czech Republic: University Hospital: Jakub Fichtl; Egypt: Faculty of Medicine, Ain Shams University: Hany Dabbous; Mohamed Bahaa; National Liver Institute - Menoufia University: Islam Ayoub; Maher Osman; Estonia: University of Tartu: Jaan Soplepmann; Margus Kivisild; Olav Tammik; France: Cancer Institute Montpellier: François Quenet; Centre Hospitalier Régional Universitaire de Lille: Stéphanie Truant; Emmanuel Boleslawski; Hôpital Ambroise Paré - APHP: Renato M Lupinacci; Frédérique S Peschaud; Institut Mutualiste Montsouris: Ela Ekmekçigil; Ioannis Triantafyllidis; Germany: Asklepios Clinic Barmbek: Georgios Makridis; Alexandros Kantas; Tim Reese; Heinrich Heine University Hospital: Nadja Lehwald-Tywuschik; Paulina Shabes; Wolfram Knoefel; Medical Center Freiburg: Magdalena Menzel; Saarbruecken Hospital: Dimitrios Kardassis; Technical University Munich: Christian Stöß; Daniel Hartmann; Alexander Novotny; Helmut Friess; University Hospital Heidelberg: Arianeb Mehrabi; University Hospital of Mainz: Hauke Lang; Verena Tripke; University Hospital Regensburg: Hans Jürgen Schlitt; Jens M. Werner; Monika Diehl-Bein; Stefan M. Brunner; University Hospital RWTH Aachen: Isabella Lurje; Zoltan Czigany; Greece: Aretaieion Hospital, National and Kapodistrian University Medical School of Athents: Konstantinos Bramis; Manousos Konstadoulakis; Hippokration General Hospital, National and Kapodistrian University Medical School of Athents: Nikolaos Alexakis; Aristotle University of Thessaloniki: Dimitrios Giakoustidis; Vasileios Papadopoulos; Attikon University Hospital: Anna Paspala; Emmanuel Pikoulis; Nikolaos Arkadopoulos; Panagiotis Kokoropoulos; Paul Patapis; Theodoros Sidiropoulos; Evgenideio Hospital: Nikolaos Machairas; Paraskevas Stamopoulos; Hygeia Hospital: George Tzimas; Spiridon Pangratis, Ippokratio General Hospital of Thessaloniki: Apostolos Kambaroudis; Thomas Kanteres; Laiko General Hospital: Dimitrios Dimitroulis; Georgios Sotiropoulos; Michail Vailas; Zoe Garoufalia; Laiko General Hospital, Athens Medical School: Alexandros Papalampros; John Griniatsos; Metropolitan General: Emmanuil Zacharakis; Theo Tsirlis; Ioannis Sideris; National and Kapodistrian University of Athens: Athanasios Syllaios; Dimitrios Schizas; Konstantinos Toutouzas; Natasha Hasemaki; Olympion General Clinic: Apollon Zygomalas; Dionissios Karavias; Nikolaos Katsiakis; Saint Savvas Anticancer Hospital: Dimitrios Balalis; Dimitrios Korkolis; Dimitrios Manatakis; University Hospital of Ioannina and School of Medicine of Ioannina: Ioannis Kyrochristos; Georgios Glantzounis; University Hospital of Larissa: Alexandros Diamantis; Konstantinos Perivoliotis; Konstantinos Tepetes; University of Athens: Evangelos Felekouras; Dimitrios Moris; India: Amrita Institute of Medical Sciences: Biju Chandran; Christi Varghese; Surendran Sudhindran; Caritas Hospital: Arun Kumar; Murali Appukuttan; Vinitha Nair; Hindu Mission Hospital, Chennai: Anand Ramamurthy; Shalby Hospitals: Bhavin Vasavada; Hardik Patel; Indonesia: M.djamil Padang General Hospital: Irwan Rachman; Prof. Dr. R.D. Kandou General Hospital: Michael Tendean; Ireland: St. Vincent's University Hospital: Aidan O'Dowling; Emir Hoti; Patrick Kambakamba; Israel: Carmel Medical Center: Moneer Swaed; Riad Haddad; Rabin Medical Center: Eran Sadot; Hanoch Kashtan; Rambam Health Care Campus: Offir Ben-Ishay; Safi Khouri; Italy: AOUI Verona: Luca Bortolasi; ASST Papa Giovanni XXIII, Bergamo: Carolina Rubicondo; Mara Giovanelli; AUSL Bologna: Matteo Zanello; Michele Masetti; Raffaele Lombardi; Azienda Ospedaliera "Vito Fazzi": Marcello Spampinato; Stefano Garritano; Azienda Ospedaliera Papardo: Edoardo Saladino; Giuseppe Cuticone; Nino Gullà; Dell'Angelo Hospital: Alfonso Recordare; Fabrizio Cimino; Fondazione IRCCS Istituto Nazionale dei Tumori: Alessandro Germini; Vincenzo Mazzaferro; Claudia Piscitelli; Tommaso Dominioni; AOUI Verona: Alfredo Guglielmi; Andrea Ruzzenente; Tommaso Campagnaro; IRCCS - Regina Elena National Cancer Institute: Chiara Parrino; Gian Luca Grazi; Valerio De Peppo; La Maddalena: Marco Paci; Lucio Mandalà; Pietro Mezzatesta; Mauriziano Hospital: Alessandro Ferrero; Fabio Forchino; Nadia Russolillo; National Cancer Institute - Fondazione "G. Pascale" - IRCCS: Andrea Belli; Vincenza Granata; Francesco Izzo; Ospedale Centrale di Bolzano: Antonio Frena; Stefan Patauner; Giovanni Scotton; Francesca Notte; Ospedale Policlinico San Martino: Andrea Massobrio; Davide Pertile; Franco De Cian; Stefano Di Domenico; Stefano Scabini; Policlinico di Monza: Marco Mattioli; Ana Gonta; Sciannamea Ivano; Policlinico S.Orsola-Malpighi: Matteo Serenari; Policlinico San Pietro: Enrico Pinotti; Mauro Montuori; Mauro Zago; San Raffaele Hospital: Federica Cipriani; Luca Aldrighetti; Sant'Orsola Hospital: Margherita Binetti; Maurizio Cervellera; Valeria Tonini; Università Politecnica delle Marche: Federico Mocchegiani; Grazia Conte; Marco Vivarelli; University of Milan-Bicocca: Alessandro Giani; Fabrizio Romano; Simone Famularo; University of Sassari: Alberto Porcu; Claudio F. Feo; Giuseppe Cherchi; Lebanon: American University of Beirut: Walid Faraj; Libya: Alkhadra Hospital: Bushray Almiqlash; Libya: Tripoli University Hosptial: Hazem Ahmed; Zliten Teaching Hospital: Ahmad Alzedam; Lithuania: National Cancer Institute: Eugenijus Stratilatovas; Rimantas Bausys; Vilnius University hospital Santaros Klinikos: Kestutis Strupas; Rokas Rackauskas; Lithuanian University of Health Sciences: Giedrius Barauskas; Romualdas Riauka; Malaysia: University of Malaya: Boon Koon Yoong; Jun Kit Koong; Mexico: National Cancer Institute: Horacio Lopez Basave; National Institute of Medical Science and Nutrition Salvador Zubiran: Alan Contreras Saldívar; Ismael Dominguez Rosado; Mario Vilatobá Chapa; Miguel Mercado; Netherlands: Albert Schweitzer Hospital: Eric Belt; Gijs Musters; Joost Van der Hoeven; Amphia Ziekenhuis: Arjen Rijken; Jan Wijsman; Paul Gobardhan; Amsterdam University Medical Center: Joris Erdmann; Marc Besselink; Rutger-Jan Swijnenburg; Antoni van Leeuwenhoek Ziekenhuis: Koert Kuhlmann; Niels Kok; Theo Ruers; Deventer Ziekenhuis: A. Talsma;Dutch Institute for Clinical Auditing / UMCG: Arthur Elfrink; Erasmus Medical Center: Dirk Grünhagen; C. Verhoef; Michiel Rothbarth; Gelre Ziekenhuis: Peter van Duijvendijk; IJsselland Ziekenhuis: Elisabeth de Wijkerslooth; Maarten Vermaas; Pascal Doornebosch; Isala Klinieken: Gijs Patijn; V. Nieuwenhuis; Maastricht University Hospital: Marcel den Dulk; Maastricht University Medical Center+: Kees Dejong; Marielle Coolsen; Maxima Medical Center: Gerrit Slooter; Wouter Leclerq; Julie Sijmons; Medical Center Leeuwarden: Christiaan Hoff; Eric Manusama; Hasan Eker; Medisch Spectrum Twente: Daan Lips; Jorieke Nijhuis; Mike Liem; Onze Lieve Vrouwe Gasthuis: Fadi Rassam; Hendrik Marsman; Michael Gerhards; Radboud University Medical Center: Peter van den Boezem; Johannes de Wilt; Martijn Stommel; Regionaal Academisch Kankercentrum Utrecht: Jeroen Hagendoorn; Wouter te Riele; Spaarne Gasthuis: Ronald Vuylsteke; Steven Oosterling; University Medical Centre Groningen: Frederik Hoogwater; Marieke de Boer; Floris Poelmann; Deventer Ziekenhuis: H. Torrenga; K. Talsma, New Zealand: North Shore Hospital: Michael Rodgers; Universe Leung; Auckland City Hospital: Peter Johnston; John McCall; Waikato Hospital: Fraser Welch; Christchurch Hospital: Saxon Connor; Todd Hore; Dunedin Hospital: Andrew Audeau; Peru: G. Almenara I. National Hospital Essalud: Lilian Rebecs Mantilla Silva; Philippines: St Luke's Medical Center: Amornetta Jordan-Casupang; Poland: Medical University of Warsaw: Bartosz Cieslak; Bartosz Maczkowski; Dariusz Wasiak; Maciej Kosieradzki; Maciej Krasnodębski; Marcin Kotulski; Michał Grąt; Piotr Kalinowski; Piotr Malkowski; Piotr Smoter; Rafał Paluszkiewicz; Waclaw Hołówko; Waldemar Patkowski; Portugal: Centro Hospitalar Universitario Sao Joao - Porto: Renato de Melo; Hospital Prof. Dr. Fernando Fonseca: Antonio Gomes; Rui Marinho; Qatar: Hamad Medical Corporation: Ahmed Elaffandi; Walid El-Moghazy; Republic of Korea: Seoul National University Bundang Hospital, Seoul National University College of Medicine: Boram Lee, Jai Young Cho, Ho-Seong Han Reunion: CHU Réunion: Herve Fagot; Johanna Zemour; Romania: Emergency Clinical Hospital of Bucharest: Bogdan Diaconescu; Bogdan Stoica; Mircea Beuran, Valentina Madalina Negoita, Cezar Ciubotaru;; Saint John Hospital Bucharest: Andrada Spanu; Mara Mardare; Russia: Petrovsky National Research Centre of Surgery: Garnik Shatverian; Nikolay Bagmet; Konstantin Petrenko; Lilia Polishchuk; Volga District Medical Center of FMBA of Russia: Gleb Gorochov; Nikolay Bobrov; Saudi Arabia: King Faisal Specialist Hospital and Research Centre: Mark Sturdevant; Serbia: Clinic for Surgery, University Clinical Center Zvezdara, Faculty of Medicine University of Belgrade: Jovan Juloski; Ljiljana Milic; Vladica Ćuk. University Clinic for Digestive Surgery: Aleksandar Bogdanovic; Marko Zivanovic; University of Novi Sad, Faculty of Medicine, Oncology Institute of Vojvodina; Slovakia: University Hospital Martin: Ludovit Laca; Martin Vojtko; Slovenia: University Medical Centre Ljubljana: Miha Petrič; Mihajlo Djokić; Spain: Hospital Universitari de Girona Dr Josep Trueta: Maria Teresa Albiol; Ernest Castro; Santiago López-Ben; Hospital Torrecardenas: Maria del Mar Rico; Miguel Vargas; Orlando Porcel; Hospital Universitari Son Espases: Francesc Xavier Molina Romero; José Miguel Morón Canis; Natalia Pujol Cano; Hospital Universitario Central de Asturias: Alberto Miyar de León; Carmen García Bernardo; Lorena Solar-García; Hospital Universitario de Badajoz: Adela Rojas Holguín; Diego López Guerra; Gerardo Blanco Fernández; Hospital Universitario de Canarias: Ángel Pallares; Antonio Martín Malagón; Liliana Pezzetta Hernández; Hospital Universitario de Guadalajara: Alba Manuel; Jose Ramia; Raquel Latorre; Hospital Universitario de Torrejón: Enrique Esteban Agustí; Maria Gutiérrez Samaniego; Miguel-Angel Hernández Bartolomé; Hospital Universitario de Valme: Darío Martinez-Baena; José Lorente-Herce; Pablo Parra-Memrbives; Hospital Universitario Fundación Jiménez Díaz: Ángel Uriarte; Santiago Ayora; Hospital Universitario Insular de Gran Canaria: José López Fernández; Gabriel Garcia Plaza; Javier Alcalá Serrano; Hospital Universitario Puerta del Mar: Maria Jesús Castro Santiago; Infanta Sofía University Hospital: Ángel Cuadrado; Rocío Fernández; La Paz Hospital: Jose Castell; Nuria Boñar; Rula Sabbagh; Miguel Servet University Hospital Zaragoza: Mario Serradilla; Sandra Paterna; Teresa Gimenez-Maurel; Hospital Universitario del Mar: Fernando Burdío; Patricia Sánchez-Velázquez;: Manuel Rodriguez Blanco; Universidad Autònoma Barcelona: Manuel Rodriguez Blanco; Universitario la Fe: Eva Montalvá; Rafael López-Andújar; University Hospital "Virgen de la Victoria": Jorge Roldan de la Rua; Luis Hinojosa-Arco; University Hospital La Princesa: Elena Martin-Perez; Marcello Di Martino; Ángela de la Hoz Rodríguez. University Hospital San Juan de Alicante: Antonio F. Compañ Rosique, Rumyana Rumenova Smilevska; University Hospital Virgen del Rocio: Francisco Javier Padillo Ruiz; Miguel-Angel Gomez Bravo; Pablo Beltran Miranda; Virgen del Arrixaca Clinic and University Hospital: Ricardo Robles Campos; Víctor López-López; University Hospital of Tarragona Joan XXIII: Mihai Calin Pavel; Laia Estalella; Robert Memba; Rosa Jorba; Sri Lanka: University of Kelaniya: Nattashi Ranaweera; Nisansala Harshani; Sweden: Institution of Biomedical and Clinical Sciences: Bergthor Bjornsson; Linda Lundgren; Umeå University: Oskar Hemmingsson; Switzerland: Hôpitaux Universitaires de Genève: Nicola Colucci; Christian Toso; Kantonsspital St.Gallen: Antonia Loosen; Fariba Abbassi; Thomas Steffen; Kantonsspital Winterthur: Erik Schadde; Franziska Heid; University Hospital of Lausanne CHUV: Emmanuel Melloul; Ismail Labgaa; Nicolas Demartines; Régional Hospital Lugano: Alessandra Cristaudi; Raffaello Roesel; Pietro Majno; Taiwan: National Taiwan University/Fu Jen Catholic University Hospital: Po-Chih Yang; Turkey: Ankara University: Elvan Kirimker; Kaan Karayalcin; EGE University: Alper Uguz; Omer Unalp; Medical Park hospital & Sisli Etfal hospital: Ertan Emek; Pinar Yazici; Gazi University Faculty of Medicine: Ali Yalcinkaya; Hasan Bostanci; Kursat Dikmen; Ukraine: National Cancer Institute: Oleksandr Kvasivka; Kostiantyn Kopchak; Valeriya Sumarokova; Dmitry Cheverdiuk; Oleg Vasilev; Sergei Sikachov; United Kingdom: Kings College Hospital: Christina Boumpoureka; Diana Bogatu; Dimitra Intzepogazoglou; Parthi Srinivasan; Manchester Royal infirmary: Ajith K Siriwardena. LiverGroup.org Headquarters London: Eirini Liova; Plymouth NHS Trust: Urszula Donigiewicz; Princess Grace Hospital: Lisa Woodrow; Queen Elizabeth Hospital Birmingham: Andrea Schlegel; Buddhika Dassanayake; Royal Blackburn Hospital: Ambareen Kausar; Royal Free Hospital London: Andrea Tufo; Adam Framptonl; Alejandro Ramirez Del Var, Andrea Monaco; Dimitri A Raptis; Brian R Davidson; Charles Imber; David Nasralla; Danielle Ferraro; Dinesh Sharma; Giuseppe Kito Fusai; Helen Tzerbinis; Ioannis D. Kostakis; Joao Mestre de Costa; Joerg-Matthias Pollok; Nikolaos Dimitrokallis; Pascale Tinguely; Satheesh Iype, Stephanos Pericleous; Timothy Owen; Theodora Pissanou; Royal Infirmary of Edinburgh: Ewen Harrison; Southampton University Hospital: John Primrose; Thomas Armstrong; Christoph Kuemmerli; Christoph Tschuor; Raed Aljarrah; St james University Hospital: Peter Lodge; Philipp Kron; The Royal Marsden NHS Trust: Daniel Akhtar; Tania Policastro; Ricky H Bhogal. United States: Carolinas Medical Center - Atrium Health: Christoph Tschuor; Dionisios Vrochides; John Martinie; Rush University Medical Center: JJ Klein; Erik Schadde; Martin Hertl; Xavier Keutgen; Jennifer Kalil; University of Arkansas for Medical Sciences: Lyle Burdine; University of Rochester Medical Center: Katie Helbig; Uruguay: Servicio Medico Integral: Gustavo Andreoli; Santiago Cubas.Hans Torrenga; Stijn Vanlaarhoven;


Important questions remain about the role of older adults in driving transmission of pneumococcus in the community. This is a critical question for understanding the potential indirect effects of using pneumococcal conjugate vaccines (PCVs) in older adults. For non-institutionalized individuals, the most likely source of adult-to-adult transmission is in the household. The goal of this study was to characterize the dynamics and risk factors for acquisition of pneumococcus in older adults.piaB and lytA.We designed a longitudinal study to sample adults > 60 years of age living in the same household , and without younger contacts residing in the household. Saliva samples and questionnaires regarding social behaviors and health status were obtained every 2 weeks for a period of 10 weeks. DNA extracted from culture-enriched saliva was tested using qPCR for pneumococcus genes piaB. Two individuals were colonized at 6/6 time points, and two others were colonized at 5/6 time points during the 10-week sampling period. In 7/93 (7.5%) households, both members were colonized, though not necessarily at the same time point. Pneumococcal colonization was substantially higher among individuals who had contact with children < 18 years as compared to those with no recent contact with children (9.4% vs 2.3%). Participants who reported recent contact with < 5 year olds and 5-9 year olds had particularly elevated prevalence .Across the two study seasons , 184 individuals from 93 households were sampled and completed all 6 visits. Overall, 31/184 (16.8%) individuals were colonized on at least one time point based on qPCR detection of Pneumococcal acquisition related to adult-to-adult transmission is low. Contact with pre-school and young school-aged children was the most important factor that influenced acquisition rates of pneumococcus among older adult households.Anne L. Wyllie, PhD, Co-Diagnostics: Board Member|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support Ronika Alexander-Parrish, RN, MAEd, Pfizer, Inc.: Employee|Pfizer, Inc.: Stocks/Bonds Adriano Arguedas, Medical director, Pfizer: Emplyee|Pfizer: Stocks/Bonds Bradford J. Gessner, M.D., M.P.H., Pfizer: I am an employee of Pfizer|Pfizer: Stocks/Bonds Daniel M. Weinberger, PhD, GSK: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support


This study describes clinical decisions on switching to B/F/TAF or DTG/3TC.Sequential explanatory design was used in this mixed methods study. Retrospective EMR analysis of Trio HIV Network data characterized people living with HIV (PWH) ≥18 yrs prescribed B/F/TAF or DTG/3TC (4/2019-6/2022). Informed by retrospective analyses, interviews among selected clinicians were summarized through thematic analyses. Qualitative responses were then quantified to describe regimen choice.In EMR analysis, of 6996 eligible PWH, 84% were prescribed B/F/TAF, 16% DTG/3TC. B/F/TAF prescription was associated with HIV clinical parameters  and substance use, while prescribing DTG/3TC was associated with renal toxicity and obesity.In qualitative analysis, 27 clinicians  participated in interviews. Factors influencing regimen switch endorsed by ≥50% of providers included resistance, HBV coinfection, eGFR, PWH views, VL, mental health, and weight [Figure 1]; only 22% felt CD4 count was relevant in decisions to switch.Over 89% of providers reported B/F/TAF or DTG/3TC switch discussions were related to development/anticipation of new symptoms or comorbidities. All providers had patient-initiated switch discussions motivated by individual concerns, advertisements, or social influences [Table 1].In differential choice analysis, PWH were more likely to be prescribed B/F/TAF if they were viremic, had HBV co-infection, inconsistent clinic attendance, non-adherence, or substance use; providers were more likely to prescribe DTG/3TC when there were concerns about weight or eGFR < 30 [Table 2].This mixed methods approach highlights discordance between beliefs and evidence in clinical decision making. CD4 count was not a consideration for ≥75% of providers in interviews, although CD4 < 200 cells/μL was significantly associated with prescribing B/F/TAF in EMR analysis. Provider beliefs surrounding B/F/TAF and DTG/3TC suggested general preferences for B/F/TAF for a broader population, including those with possible adherence challenges, substance use, or resistance, while DTG/3TC was preferred when weight gain or eGFR was a concern.Rick A. Elion, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Proteus: Grant/Research Support|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support Megan Dunbar, PhD, Gilead: Employment Joshua Gruber, PhD, Gilead Sciences, Inc: Employee|Gilead Sciences, Inc: Stocks/Bonds Grace A. McComsey, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Janssen: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support Peter Shalit, MD, PhD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support Janna Radtchenko, MBA, Trio Health: Employee


Fixed dose combination (FDC) dolutegravir (DTG) plus rilpivirine (RPV) is an approved antiretroviral treatment regimen for people with HIV. The steady-state PK of FDC DTG+RPV in those requiring hemodialysis (HD) has not been previously studied.We performed a single-center, prospective evaluation of the steady-state PK of FDC DTG (50mg)+RPV(25mg) in HIV-negative adults either requiring HD  or with normal renal function, defined as CrCl ≥ 75mL/min . All participants received DTG+RPV daily for 10-14 days with food before undergoing an intensive 24-hour PK evaluation . Plasma drug and metabolite concentrations were measured using a validated LC/MS/MS assay method (QTRAP 6500+LC-MS/MS system) with turboelectrospray source operating in both positive (confirmation) and negative (quantification) modes. We did not evaluate dialysis extraction of DTG+RPV. Descriptive PK parameters were calculated.2). The Table shows the PK parameters assessed in the study population for circulating plasma DTG, DTG-glucuronide (DTG’s primary metabolite), and RPV.No participant experienced serious or grade 3-4 adverse events; there were no study discontinuations. The 4 HD and 2 normal renal function participants were of similar ages  and BMI  and RPV (12ng/mL). These data suggest no dosing modifications are needed for the FDC DTG+RPV regimen in HD.In this study, HD did not lead to clinically appreciable differential exposures to DTG and RPV; the markedly increased exposure to DTG-glucoranide (which is considered inert) in HD suggests increased UGT1A1 activation. All participants maintained exposures throughout the dosing interval greater than the reported ICSamir K. Gupta, MD, Gilead Sciences: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support Allon Friedman, MD, Eli Lilly: Advisor/Consultant|Eli Lilly: Stocks/Bonds|GI Dynamics: Advisor/Consultant|Gila Therapeutics: Advisor/Consultant


Following the May 2019 approval of recombinant zoster vaccine (RZV) in China, there was a need for real-world information on the vaccine effectiveness (VE) of RZV in a Chinese population. We conducted a retrospective cohort study at Kaiser Permanente Southern California (KPSC) to estimate the VE of two doses of RZV in preventing herpes zoster (HZ) and chart-confirmed post-herpetic neuralgia (PHN) in Chinese adults.The study cohort consisted of Chinese KPSC members aged ≥50 years who received two doses of RZV 4 weeks to ≤6 months apart; second doses were accrued from 6/1/2018 to 12/31/2020. Chinese individuals were identified based on self-reported ethnicity or self-reported spoken/written language . RZV unvaccinated Chinese individuals were matched 4:1 to their vaccinated counterparts by age and sex, with follow-up through June 2022. The index date for vaccinated individuals was the date of the second dose; unvaccinated individuals had the same index date as their vaccinated match. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) comparing outcomes (HZ and PHN) in the vaccinated and unvaccinated groups. Adjusted VE (%) was calculated as (1−aHR) × 100.3978 RZV vaccinated Chinese individuals were matched to 15,912 RZV unvaccinated Chinese individuals. We identified 15 HZ cases in the vaccinated group and 344 in the unvaccinated group, with incidence rates per 1000 person-years (95% CI) of 1.5 (0.9–2.5) and 10.9 (9.8–12.1), respectively. There were 0 PHN cases in the vaccinated group and 19 in the unvaccinated group. The models were adjusted for heart disease, immunocompromised status, number of outpatient/virtual visits, history of zoster vaccine live vaccination, and length of continuous membership. Adjusted VE (95% CI) was 87.6% (78.9–92.7) against HZ; VE against PHN could not be estimated due to a lack of PHN cases. A sensitivity analysis excluding 30 days after index date from follow-up yielded similar results.Among Chinese adults aged ≥50 years, two doses of RZV provided substantial protection against HZ and PHN, supporting the real-world VE in this population.Ana Florea, PhD MPH, Gilead: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Lina S. Sy, MPH, Dynavax: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support Lei Qian, PhD, Dynavax: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support Bradley Ackerson, MD, Dynavax: Grant/Research Support|Genentech: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Yi Luo, PhD, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Jennifer H. Ku, PhD MPH, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support Leticia I. Vega Daily, MSW, GlaxoSmithKline: Grant/Research Support Jeannie Song, MPH, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Elizabeth Chmielewski-Yee, PhD, MPH, GSK: Employee|GSK: Stocks/Bonds OMareen Spence, PhD, GSK: Employee|GSK: Stocks/Bonds Harry Seifert, MD. MSCE, FISPE, GSK: Employee|GSK: Stocks/Bonds Driss Oraichi, PhD, GSK: Employee|GSK: Stocks/Bonds Hung Fu Tseng, PhD MPH, GSK: Grant/Research Support|Moderna: Grant/Research Support


Achromobacter and Burkholderia species are opportunistic pathogens in individuals with an immunodeficiency, most notably cystic fibrosis. Cefiderocol (CFDC) is a siderophore-conjugated cephalosporin with broad activity against Gram-negative bacteria. In this study, the activity of CFDC and comparator agents was determined against isolates of Achromobacter and Burkholderia cepacia species complex, collected in 2020–2022 in Europe and the USA as part of the SENTRY antimicrobial surveillance program.Activity of cefiderocol and comparator agents against Achromobacter and Burkholderia IsolatesAchromobacter and 160 Burkholderia cepacia species complex isolates, using broth microdilution with cation-adjusted Mueller-Hinton broth (CAMHB) for comparator agents and iron-depleted CAMHB for CFDC. Comparator agents included β-lactam/β-lactamase inhibitor combinations ceftazidime-avibactam, ceftolozane-tazobactam, imipenem-relebactam, meropenem-vaborbactam, piperacillin-tazobactam, as well as meropenem, ceftazidime, levofloxacin, amikacin, trimethoprim-sulfamethoxazole, and minocycline. Susceptibility was assessed for agents with CLSI breakpoints. For agents without established CLSI breakpoints, only MIC50, MIC90 and MIC ranges were reported.Minimum inhibitory concentrations (MICs) were determined according to CLSI guidelines against 167 Achromobacter, showing MIC50 and MIC90 values of 0.03 and 0.25 µg/mL and all isolates were inhibited at ≤4 µg/mL (Table). Isolates from cystic fibrosis patients (n=15) showed higher MIC50 and MIC90 values for most agents, but CFDC MIC50 and MIC90 values remained low . Against Burkholderia cepacia species complex, CFDC was the most potent agent tested, with MIC50 and MIC90 values of 0.06 and 0.5 µg/mL, and 156 out of 160 isolates inhibited at ≤4 µg/mL. None of the comparator agents showed >90% susceptibility against these isolates (Table).CFDC was the most potent agent tested against Achromobacter and Burkholderia cepacia species complex isolates. These in vitro data suggest that CFDC could be an important treatment option for infections caused by these opportunistic pathogens.CFDC showed potent activity against a set of contemporary clinical Boudewijn L. DeJonge, PhD, Shionogi Inc.: Employee Sean T. Nguyen, PharmD, Shionogi: Employee|Shionogi, Inc: Employee Jason J. Bryowsky, PharmD, MS, Shionogi Inc.: Employee Christopher M. Longshaw, PhD, Shionogi BV: Employee Joshua Maher, PhD, AbbVie: Grant/Research Support|Affinity Biosensors: Grant/Research Support|AimMax Therapeutics, Inc: Grant/Research Support|Alterity Therapeutics: Grant/Research Support|Amicrobe, Inc: Grant/Research Support|Arietis Pharma: Grant/Research Support|Armata Pharmaceuticals, Inc: Grant/Research Support|Astrellas Pharma, Inc.: Grant/Research Support|Basilea Pharmaceutica AG: Grant/Research Support|Becton Dickinson And Company: Grant/Research Support|bioMerieux, Inc: Grant/Research Support|Boost Biomes: Grant/Research Support|Diamond V: Grant/Research Support|Fedora Pharmaceuticals, Inc: Grant/Research Support|Iterum Therapeutics plc: Grant/Research Support|Johnson & Johnson: Grant/Research Support|Kaleido Biosciences, Inc.: Grant/Research Support|Meiji Seika Pharma Co. Ltd.: Grant/Research Support|National Institutes of Health: Grant/Research Support|Pfizer Inc.: Grant/Research Support|Roche Holding AG: Grant/Research Support|Shionogi Inc.: Grant/Research Support|Summmit Therapeutics, Inc.: Grant/Research Support|Zoetis Inc: Grant/Research Support Rodrigo E. Mendes, PhD, AbbVie: Grant/Research Support|Basilea: Grant/Research Support|Cipla: Grant/Research Support|Entasis: Grant/Research Support|GSK: Grant/Research Support|Paratek: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support Miki Takemura, n/a, Shionogi & Co., Ltd.: Stocks/Bonds Yoshinori Yamano, PhD, Shionogi HQ: Employee


Neutralizing antibodies (nAbs) induced by authorized SARS-CoV-2 vaccines wane within months, requiring frequent boosters. Preliminary safety and immunogenicity of a samRNA-based SARS-CoV-2 vaccine candidate (GRT-R910) administered as a booster following AZD1222 primary series in older (≥ 60 years) adults  were previously reported. Updated results of GRT-R910 administered as a 2-dose booster in older (≥ 60 years) adults who received a primary series of either AZD1222 or mRNA vaccines (Cohorts 3 (C3) & 4 (C4)) are now reported.GRT-R910 encodes Wuhan Spike (S) and highly conserved non-S T cell epitopes, is being tested in this open-label phase I study, conducted in the UK. Two booster doses of 10µg GRT-R910 are assessed in older adults who have received (C3) or mRNA vaccines (C4) as primary series. Nine participants (C3) received an mRNA booster prior to enrollment. The primary objective is safety and secondary objectives include assessment of titers and durability of S-specific IgG (bAbs) and nAb responses of GRT-R910 boost vaccinations as well as T cell responses to S and non-S epitopes.nd booster compared to the 1st booster across all cohorts. All participants showed bAbs IgG > 500 ELU/mL and nAbs against to the vaccine-specific strain and nAbs > 500 ND50 at 6 months following GRT-R910 vaccination, regardless of age, primary vaccination series, or additional prior mRNA booster. T cell responses to S were boosted and maintained up to at least Day 57; analyses of non-S T cell responses are ongoing.Ten participants were enrolled in each cohort (C3 and C4). The majority of reactogenicity events were mild or moderate and transient in nature. Three subjects reported grade 3 solicited adverse events which resolved within 1-4 days. Local and systemic reactogenicities were milder with the 2nd booster was less reactogenic than the 1st and less reactogenicity was observed in the older population. High and sustainable antibody responses were observed for at least 6 months against Wuhan Spike across different age groups. Data on other variants will also be presented.GRT-R910 was well tolerated as a booster in older adults regardless of primary SARS-CoV-2 vaccination series. The 2Alison Uriel, MBBS, North Manchester General Hospital, UK. - Manchester (United Kingdom): Employee Pedro Garbes, MD, Gritstone bio, Inc.: Employee|Gritstone bio, Inc.: Employee|Gritstone bio, Inc.: Stocks/Bonds|Gritstone bio, Inc.: Stocks/Bonds A. Nagare, MBBS, Gritstone bio, Inc.: Employee|Gritstone bio, Inc.: Stocks/Bonds JC Kuan, PhD, Gritstone bio, Inc.: Employee|Gritstone bio, Inc.: Stocks/Bonds Christine Palmer, PhD, Gritstone bio, Inc.: Employee|Gritstone bio, Inc.: Stocks/Bonds K. Bae, PhD, Gritstone bio: Stocks/Bonds Karin Jooss, PhD, Gritstone bio: employee|Gritstone bio: Stocks/Bonds A. Rappaport, PhD, Gritstone bio, Inc.: Employee|Gritstone bio, Inc.: Stocks/Bonds Melissa Kachura, BS, Dynavax Technologies: WO2019040491A1|Dynavax Technologies: Stocks/Bonds|Gritstone bio, Inc.: Employee|Gritstone bio, Inc.: Stocks/Bonds L. Kraemer, PhD, Gritstone bio, Inc.: Employee|Gritstone bio, Inc.: Stocks/Bonds Harshni Venkatraman, MS, Gritstone bio, Inc.: Employee|Gritstone bio, Inc.: Stocks/Bonds Jason Jaroslavsky, MS, Gritstone bio, Inc.: Employee|Gritstone bio, Inc.: Stocks/Bonds Sonia Kounlavouth, BS, Gritstone bio, Inc.: Employee|Gritstone bio, Inc.: Stocks/Bonds M. Marrali, PhD, Gritstone bio, Inc.: Employee|Gritstone bio, Inc.: Stocks/Bonds Meghan Hart, ALM, Gritstone bio, Inc.: Employee|Gritstone bio, Inc.: Stocks/Bonds J. Betular, PhD, Gritstone bio, Inc.: Employee|Gritstone bio, Inc.: Stocks/Bonds A. Allen, MBBS, PhD, Gritstone bio, Inc.: Employee|Gritstone bio, Inc.: Ownership Interest|Gritstone bio, Inc.: Stocks/Bonds C. Green, MBBS, University Hospitals Birmingham NHS Foundation Trust - Birmingham (United Kingdom): Employee O. Osanlou, MBBS, North Wales Clinical Research Facility - North Wales (United Kingdom) and Bangor University – North Wales (United Kingdom): Employee Adrian Palfreeman, MBBS, University Hospital of Leicester NHS Trust. - Leicester (United Kingdom): Employee Tolga Turgut, MBBS, North Manchester General Hospital, UK. - Manchester (United Kingdom): Employee Andrew Ustianowski, MD, PhD, Gilead: Honoraria|Gilead: Advisory Board|GSK: Honoraria|Janssen: Honoraria|Merck: Honoraria|Merck: Advisory Board|Sanofi: Honoraria|ViiV Healthcare/GSK: Advisory Board


Respiratory syncytial virus (RSV) is a leading cause of pediatric hospitalizations. We aimed to describe the epidemiology and burden of RSV-associated hospitalizations among children in Canadian pediatric centers from 2017 to 2022, including changes during the COVID-19 pandemic.We performed active surveillance for hospitalized children 0 to 16 years of age with laboratory confirmed RSV at 13 Canadian Immunization Monitoring Program Active (IMPACT) pediatric hospitals during 5 seasons (2017-18 to 2021-22). Proportions of RSV hospitalizations over all-cause hospitalizations over time, and intensive care unit (ICU) admissions, prolonged admissions (≥ 7-days) and mortality proportions were calculated, overall and by age groups and regions. RSV hospitalization-associated burden was compared for 2021-22 to the pre-pandemic period of 2017-18 to 2019-20. Seasonality was described using epidemic curves.Among 11,014 RSV-associated hospitalizations 6,035 (54.8%) were male and 5,488 (50%) were aged < 6 months. Overall, 2,594 (23.6%) were admitted to ICU, of which 60.8% were aged < 6 months old. The median hospital stay was 4 days (interquartile range: 2-6). The mean number of hospitalizations during the pre-pandemic seasons was 2,522. Only 58 cases were reported in 2020-21, followed by 3,170 in 2021-22. The proportion of RSV hospitalizations over all-cause hospitalizations rose from 3.2% pre-pandemic to 4.5% in 2021-22 . One province, Quebec, had a significant increase in RSV-hospitalization proportion in 2021-22 . Age, sex, ICU admission, prolonged length of stay(≥7-days) and mortality proportions did not change in 2021-22 compared to the pre-pandemic period. Interregional differences in RSV seasonality were accentuated in 2021-22.Weekly RSV-associated hospital admissions in children aged 0 to 16 years at IMPACT centers, 2017-2022, by seasonMonthly RSV-associated hospital admissions in children aged 0 to 16 years at IMPACT centers, 2017-2022, by provinceRSV hospitalization burden in Canadian pediatric hospitals is substantial, especially in infants aged < 6 months. Following a near absence in 2020-21, RSV hospitalizations increased in the 2021-22 season, but severity of illness remained similar to the pre-pandemic period. These data will aid planning of RSV prevention strategies.Nirma K. Vadlamudi, MPH, PhD, Broadstreet HEOR: Personal fees outside of the submitted work Scott Halperin, MD, CanSino: Grant/Research Support|CanSino: served on ad hoc advisory board|GlaxoSmithKline: Grant/Research Support|GlaxoSmithKline: served on ad hoc advisory board|Merck: Grant/Research Support|Merck: served on ad hoc advisory board|Moderna: Grant/Research Support|Moderna: served on ad hoc advisory board|Pfizer,: Grant/Research Support|Pfizer,: served on ad hoc advisory board|Sanofi-Pasteur: Grant/Research Support|Sanofi-Pasteur: served on ad hoc advisory board|Seqirus: Grant/Research Support|Seqirus: served on ad hoc advisory board|VBI Vaccines: Grant/Research Support|VBI Vaccines: served on ad hoc advisory board Joanne M. Langley, MD, CanSino: Grant/Research Support|Entos: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Merck: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi-Pasteur: Grant/Research Support|Seqirus: Grant/Research Support|Symvivo: Grant/Research Support|VBI Vaccines: Grant/Research Support Shaun Morris, MD, MPH, DTM&H, FRCPC, FAAP, GlaxoSmithKline: Honoraria|JNJ China: Honoraria|Merck: served on ad hoc advisory board|Pfizer: Grant/Research Support|Pfizer: served on ad-hoc advisory board|Sanofi-Pasteur: served on ad-hoc advisory board Jeffrey Pernica, MD, MSc, FRCPC, DTMH, MedImmune: Grant/Research Support|Merck: Grant/Research Support Manish Sadarangani, BM BCh, FRCPC, DPhil, GlaxoSmithKline: Grant/Research Support|Merck: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi Pasteur: Grant/Research Support|Seqirus: Grant/Research Support|Symvivo: Grant/Research Support|VBI Vaccines: Grant/Research Support Jesse Papenburg, MD, AstraZeneca: Personal fees outside of the submitted work|MedImmune: Grant/Research Support|Merck: Grant/Research Support|Merck: Personal fees outside of the submitted work


The most common organisms causing surgical site infection (SSI) are frequently found as part of the skin microbiota. Decolonization of the skin prior to a surgical procedure has been shown to be effective in reduction of SSI. The aim of this prospective study was to determine the organism profile of the skin and evaluate the effect of the application of an antiseptic solution on the skin microbiome.A total of 50 volunteers were recruited into this study. After randomization, one arm was treated with a pre-saturated wipe containing a benzalkonium chloride (BZK)-based antiseptic solution and the contralateral arm was wiped with a PBS-based pre-saturated wipe. Swab samples of each extremity were taken at baseline (prior to application of the agents) and at 4 different timepoints after application . Skin was protected between 5 min and 2 h after application with a sterile wrap to prevent environmental contamination between sampling. Microbiological analysis consisted of standard culture and Next-generation sequencing.Study designFifty volunteers were recruited for this double-blinded clinical trial. Randomization was performed to determine which arm will take the benzalkonium chloride (BZK) testing solution. We assessed bioburden and microbial diversity at 4 different timepoints after application .10 1.314 ± 0.086 and log10 1.308 ± 0.104, respectively; p< 0.01), compared to PBS. By 24 hours, the reduction in bacterial load was also higher in the BZK treated arm . The top species affected by the treatment were C. acnes, S. cohnii, E. cloacae, L. crispatus, among others. The relative abundance of all Staphylococcus species was significantly decreased after the application of BZK, from 34.50% to 20.48%, at the 2-hour timepoint (p< 0.01).The baseline skin bioburden varied greatly among individuals ; however, baseline bioburden within subjects did not differ between the arms (p=0.61). A higher effect of bioburden reduction was observed at 5 minutes and 2 hours after application of BZK .Bacterial composition.A) Relative abundance of the most prevalent bacterial genus and B) heatmap illustrating the mean relative abundance of bacteria detected to be differentially abundant by ANCOMBC procedure. A cell colored in black can be considered “true” zero, whereas there were no detections of a particular bacteria for that given cell.CFU log10 reduction, from baseline bioburden, at different timepoints after application of the testing solutions (BZK or PBS). Data is expressed as mean ± SEM.There was a wide difference in the skin microbiome between individuals but the organism profile was very similar in two arms of a given individual. Application of the BZK-based antiseptic solution led to a substantial reduction of the skin flora for up to 24 hours after application but the organism profile returned towards baseline rapidly. It appears that antiseptic solutions applied to skin are capable of transiently and markedly reduce the bioburden of skinJavad Parvizi, MD, FRCS, 3M: Grant/Research Support|Acumed, LLC: Stocks/Bonds|Aesculap: Grant/Research Support|Alphaeon: Stocks/Bonds|AO Spine: Stocks/Bonds|Becton Dickenson: Advisor/Consultant|Biomet: Grant/Research Support|Cardinal Health: Advisor/Consultant|Cempra: Grant/Research Support|CeramTec: Grant/Research Support|Ceribell: Stocks/Bonds|Coracoid: Stocks/Bonds|Corentec: Advisor/Consultant|Datatrace: Grant/Research Support|DePuy: Grant/Research Support|Elsevier: Grant/Research Support|Elute: Stocks/Bonds|Ethicon: Advisor/Consultant|Hip Innovation Technology: Stocks/Bonds|Illuminus: Stocks/Bonds|Integra: Grant/Research Support|Intellijoint: Stocks/Bonds|Jaypee Publishers: Grant/Research Support|KCI / 3M (Acelity): Advisor/Consultant|Lima: Grant/Research Support|MicroGenDx: Advisor/Consultant|Molecular Surface Technologies: Stocks/Bonds|Myoscience: Grant/Research Support|Nanooxygenic: Stocks/Bonds|National Institutes of Health (NIAMS & NICHD): Grant/Research Support|NDRI: Grant/Research Support|Novartis: Grant/Research Support|OREF: Grant/Research Support|Orthospace: Grant/Research Support|Osteal: Stocks/Bonds|Parvizi Surgical Innovations and Subsidiaries: Stocks/Bonds|Peptilogic: Stocks/Bonds|Peptilogics: Advisor/Consultant|Pfizer: Grant/Research Support|PRN-Veterinary: Grant/Research Support|Rotation Medical: Grant/Research Support|Simplify Medical: Grant/Research Support|SLACK Incorporated: Grant/Research Support|Smith & Nephew: Grant/Research Support|Sonata: Stocks/Bonds|Stelkast: Grant/Research Support|Stryker: Grant/Research Support|Synthes: Grant/Research Support|Tenor: Advisor/Consultant|TissueGene: Grant/Research Support|Tornier: Grant/Research Support|Wolters Kluwer Health - Lippincott Williams & Wilkins: Grant/Research Support|Zimmer Biomet: Advisor/Consultant|Zimmer Biomet: Grant/Research Support


Experimental & Molecular Medicine 10.1038/s12276-022-00865-2, published online 12 October 2022Correction to: After online publication of this article, the authors noticed an error in the Authors contributed section:“These authors jointly supervised this work: Yiyang Xu, Guping Mao, Dianbo Long”.The correct statement of this article should have read as below.“These authors contributed equally: Yiyang Xu, Guping Mao, Dianbo Long”.The authors apologize for any inconvenience caused.The original article has been corrected.


Postherpetic neuralgia (PHN) is a debilitating complication of herpes zoster (HZ). PHN diagnosis codes tend to be inaccurate or incomplete. The criterion standard for identifying PHN in electronic health records (EHR) is manual chart review, which can be costly and time-consuming. We developed and validated a method to automatically identify PHN from free-text EHR data using natural language processing (NLP).This study utilized EHR data of patients aged ≥50 years who had an incident HZ diagnosis and associated antiviral prescription between 2018-2022 at Kaiser Permanente Southern California. Among patients with ≥1 encounter during the 90-180 days after the incident HZ diagnosis, PHN was defined as pain/discomfort consistent with the HZ episode between 90-180 days after the initial HZ diagnosis; the symptoms were at the location of the initial HZ rash and were not due to other obvious causes. Trained research associates and an infectious disease physician manually reviewed and identified PHN cases from EHR. From these reviewed HZ cases, we randomly selected 500 and 800 cases for NLP development and validation, respectively. We developed and validated an NLP algorithm to identify PHN based on our case definition. Using chart-reviewed results as the criterion standard, the accuracy of NLP-based results was compared with that of diagnosis code-based results .Compared to the criterion standard, the NLP algorithm achieved 100% sensitivity (code-based 64.8%), 99.9% specificity (code-based 97.0%), 98.6% positive predictive value (code-based 67.7%), and 100% negative predictive value (code-based 96.6%) in identifying PHN cases. In the validation data, the prevalence of PHN was 8.9% based on manual chart review. Although the prevalence of PHN identified by the two methods was similar , the code-based method misclassified more than one-third of chart-confirmed PHN cases.Accuracy measurements of NLP and diagnosis codes in identifying PHN, as compared with chart-confirmed validation data.We developed and validated an automated method to identify PHN cases using the clinical text from EHR of HZ patients with high accuracy. This method can be a valuable tool to facilitate population-based studies of PHN.Bradley Ackerson, MD, Dynavax: Grant/Research Support|Genentech: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Leticia I. Vega Daily, MSW, GlaxoSmithKline: Grant/Research Support Jeannie Song, MPH, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Lina S. Sy, MPH, Dynavax: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support Lei Qian, PhD, Dynavax: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support Yi Luo, PhD, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Ana Florea, PhD MPH, Gilead: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Jennifer H. Ku, PhD MPH, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support Hung Fu Tseng, PhD MPH, GSK: Grant/Research Support|Moderna: Grant/Research Support


Correction: World J Surg Oncol 21, 55 (2023)https://doi.org/10.1186/s12957-023-02893-2Following publication of the original article , the autThe incorrect author names are:Li He, Wang Junzhu, Li Liwei, Zhao Luyang and Wang ZhiqiThe correct author names are:He Li, Junzhu Wang, Liwei Li, Luyang Zhao and Zhiqi WangThe author group has been updated above and the original article  has beenExample


Cryptosporidium is a parasitic protozoan that causes severe and potentially life-threatening diarrheal disease in immunocompromised patients. Infections can be asymptomatic, cause self-limited disease, or chronic diarrhea and in some cases result in biliary and pulmonary diseaseWe performed a detailed retrospective analysis of patients that presented with diarrheal illness, and Cryptosporidium infection diagnosed by GI multiplex (Biofire) at UT MD Anderson Cancer Center between January 2017 and March 2023.We identified 51 patients aged 24 to 89 years with cryptosporidiosis. Hematological malignancies (HM) were present in 44% of patients, while non-hematological malignancies (NHM) in 55%. Thirty-seven percent of patients had received hematopoietic stem cell transplantation (HSCT), 8% chimeric antigen receptor T-cell (CAR-T) therapy, 18% immunosuppressive therapy, and 65% received chemotherapy in the last 90 days. Two patients had human immunodeficiency virus (HIV). All patients presented with diarrhea, 39% with nausea, 43% with abdominal pain, and 51% had fever. The median duration of symptoms was 3 days. About 41% were severely neutropenic, and 61% had severe lymphopenia. Computed tomography (CT) abdomen was normal in 43% of patients, 16% had colitis, 12% had enteritis, and 4% had enterocolitis. All patients were treated with Nitazoxanide, with a median duration of therapy (DOT) of 14 days. The DOT was longer in HM than in NHM  and in HSCT/CAR-T patients than without HSCT/CAR-T . About 18% of patients had co-infections with other enteropathogens. Death from other causes occurred in 13 of 51 (23%) of patients. All cause mortality between HM and NHM (p=0.207), HSCT/CAR-T and non-HSCT/CAR-T (p=0.52), or chemotherapy vs. without chemotherapy (p=0.34) was similar. Most infections were encountered in the month of October.We observed a limited response to nitazoxanide at our center, contributing factors and confounders included co-infections with other pathogens, active chemotherapy, or HSCT/CAR-T induced intestinal epithelium injury. Controlled, double blinded studies with new agents are needed to determine the optimal management of cryptosporidiosis in this population.Pablo C. Okhuysen, M.D., FACP, FIDSA, Astra Zeneca: Stocks/Bonds|Beam Therapeutics: Stocks/Bonds|Biontech: Stocks/Bonds|Deinove Pharmaceutucals: Grant/Research Support|Ferring: Advisor/Consultant|GSK PLC: Stocks/Bonds|Haleon: Stocks/Bonds|Johnson and Johnson: Stocks/Bonds|Melinta Pharmaceuticals: Grant/Research Support|Merk Sharp and Dohme: Grant/Research Support|Moderna: Stocks/Bonds|Napo Pharmaceuticals: Advisor/Consultant|Napo Pharmaceuticals: Grant/Research Support|Novavax: Stocks/Bonds|Pfizer: Stocks/Bonds|SNIPR Biome: Advisor/Consultant|Summit Pharmaceuticals: Grant/Research Support


Ceftobiprole medocaril is being developed for the treatment of patients with ABSSSI and CABP. PK-PD target attainment analyses were performed to support the dosing regimens selected for these indications.Ceftobiprole medocaril is an intravenously (IV) administered cephalosporin that is rapidly converted in vitro surveillance data, percent probabilities of PK-PD target attainment were evaluated among simulated patients with ABSSSI and CABP resembling each clinical trial population. Dosing regimens were adjusted by CLcr group to match exposures among simulated patients with normal renal function administered ceftobiprole 500 mg IV every 8 hours. Randomly assigned ceftobiprole free-drug plasma %T > MIC (%fT >MIC) targets associated with net bacterial stasis and 1- and/or 2-log10 CFU reductions from baseline for S. aureus (SA), Streptococcus species, and Enterobacterales (ENT) based on data from a neutropenic murine-thigh infection model were assessed.Using a population PK model developed for ceftobiprole, PK-PD targets for efficacy, and Table 1. For ABSSSI, the highest MIC values at which percent probabilities of PK-PD target attainment were ≥ 90% based on randomly assigned %fT > MIC targets associated with net bacterial stasis were ≥ 4 µg/mL for SA and Streptococcus species (inhibiting 100% of isolates) and ≥ 2 µg/mL for ENT (inhibiting 86.5% of isolates) (Table 2). For CABP, the highest MIC values at which percent probabilities of PK-PD target attainment were ≥ 90% based on %fT >MIC targets associated with a 1-log10 CFU reduction from baseline were ≥ 4 µg/mL for S. pneumoniae (inhibiting 100% of isolates) and SA and ≥ 2 µg/mL for ENT (Table 3). Using the same PK-PD target endpoints for each indication, overall percent probabilities of PK-PD target attainment  were > 99.9% for SA and Streptococcus species or S. pneumoniae and ≥ 98.7% for non-ESBL-producing ENT subsets.Selected ceftobiprole dosing regimens by CLcr group are shown in These data provided support for a dosing regimen of ceftobiprole 500 mg IV every 8 hours for patients with ABSSSI or CABP. Dosing regimens should be adjusted for moderate and severe renal impairment including patients with ESRD.Sujata M. Bhavnani, PharmD; MS; FIDSA, Adagio Therapeutics, Inc.: Grant/Research Support|Albany Medical Center: Grant/Research Support|Amplyx Pharmaceuticals, Inc.: Grant/Research Support|AN2 Therapeutics: Grant/Research Support|Antabio SAS: Grant/Research Support|Arcutis Biotherapeutics, Inc.: Grant/Research Support|B. Braun Medical Inc.: Grant/Research Support|Basilea Pharmaceutica: Grant/Research Support|BioFire Diagnostics LLC: Grant/Research Support|Boston Pharmaceuticals: Grant/Research Support|Cidara Therapeutics Inc.: Grant/Research Support|Cipla USA: Grant/Research Support|Crestone Inc.: Grant/Research Support|CXC: Grant/Research Support|Debiopharm International SA: Grant/Research Support|Entasis Therapeutics: Grant/Research Support|Genentech: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Hoffmann-La Roche: Grant/Research Support|ICPD: Ownership Interest|Inotrem: Grant/Research Support|Insmed Inc.: Grant/Research Support|Iterum Therapeutics Limited: Grant/Research Support|Kaizen Bioscience, Co.: Grant/Research Support|KBP Biosciences USA: Grant/Research Support|Matinas Biopharma: Grant/Research Support|Meiji Seika Pharma Co., Ltd.: Grant/Research Support|Melinta Therapeutics: Grant/Research Support|Menarini Ricerche S.p.A.: Grant/Research Support|Mutabilis: Grant/Research Support|Nabriva Therapeutics AG: Grant/Research Support|Paratek Pharmaceuticals, Inc.: Grant/Research Support|Qpex Biopharma: Grant/Research Support|Sfunga Therapeutics: Grant/Research Support|Spero Therapeutics: Grant/Research Support|Suzhou Sinovent Pharmaceuticals Co.: Grant/Research Support|Theravance: Grant/Research Support|tranScrip Partners: Grant/Research Support|University of Wisconsin: Grant/Research Support|Utility Therapeutics: Grant/Research Support|ValanBio Therapeutics Inc.: Grant/Research Support|VenatoRx: Grant/Research Support Jeffrey P. Hammel, MS, Adagio Therapeutics, Inc.: Grant/Research Support|Albany Medical Center: Grant/Research Support|Amplyx Pharmaceuticals, Inc.: Grant/Research Support|AN2 Therapeutics: Grant/Research Support|Antabio SAS: Grant/Research Support|Arcutis Biotherapeutics, Inc.: Grant/Research Support|B. Braun Medical Inc.: Grant/Research Support|Basilea Pharmaceutica: Grant/Research Support|BioFire Diagnostics LLC: Grant/Research Support|Boston Pharmaceuticals: Grant/Research Support|Cidara Therapeutics Inc.: Grant/Research Support|Cipla USA: Grant/Research Support|Crestone Inc.: Grant/Research Support|CXC: Grant/Research Support|Debiopharm International SA: Grant/Research Support|Entasis Therapeutics: Grant/Research Support|Genentech: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Hoffmann-La Roche: Grant/Research Support|ICPD: Employee|Inotrem: Grant/Research Support|Insmed Inc.: Grant/Research Support|Iterum Therapeutics Limited: Grant/Research Support|Kaizen Bioscience, Co.: Grant/Research Support|KBP Biosciences USA: Grant/Research Support|Matinas Biopharma: Grant/Research Support|Meiji Seika Pharma Co., Ltd.: Grant/Research Support|Melinta Therapeutics: Grant/Research Support|Menarini Ricerche S.p.A.: Grant/Research Support|Mutabilis: Grant/Research Support|Nabriva Therapeutics AG: Grant/Research Support|Paratek Pharmaceuticals, Inc.: Grant/Research Support|Qpex Biopharma: Grant/Research Support|Sfunga Therapeutics: Grant/Research Support|Spero Therapeutics: Grant/Research Support|Suzhou Sinovent Pharmaceuticals Co.: Grant/Research Support|Theravance: Grant/Research Support|tranScrip Partners: Grant/Research Support|University of Wisconsin: Grant/Research Support|Utility Therapeutics: Grant/Research Support|ValanBio Therapeutics Inc.: Grant/Research Support|VenatoRx: Grant/Research Support Anthony J. Rinaldo, B.S., Adagio Therapeutics, Inc.: Grant/Research Support|Albany Medical Center: Grant/Research Support|Amplyx Pharmaceuticals, Inc.: Grant/Research Support|AN2 Therapeutics: Grant/Research Support|Antabio SAS: Grant/Research Support|Arcutis Biotherapeutics, Inc.: Grant/Research Support|B. Braun Medical Inc.: Grant/Research Support|Basilea Pharmaceutica: Grant/Research Support|BioFire Diagnostics LLC: Grant/Research Support|Boston Pharmaceuticals: Grant/Research Support|Cidara Therapeutics Inc.: Grant/Research Support|Cipla USA: Grant/Research Support|Crestone Inc.: Grant/Research Support|CXC: Grant/Research Support|Debiopharm International SA: Grant/Research Support|Entasis Therapeutics: Grant/Research Support|Genentech: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Hoffmann-La Roche: Grant/Research Support|ICPD: Employee|Inotrem: Grant/Research Support|Insmed Inc.: Grant/Research Support|Iterum Therapeutics Limited: Grant/Research Support|Kaizen Bioscience, Co.: Grant/Research Support|KBP Biosciences USA: Grant/Research Support|Matinas Biopharma: Grant/Research Support|Meiji Seika Pharma Co., Ltd.: Grant/Research Support|Melinta Therapeutics: Grant/Research Support|Menarini Ricerche S.p.A.: Grant/Research Support|Mutabilis: Grant/Research Support|Nabriva Therapeutics AG: Grant/Research Support|Paratek Pharmaceuticals, Inc.: Grant/Research Support|Qpex Biopharma: Grant/Research Support|Sfunga Therapeutics: Grant/Research Support|Spero Therapeutics: Grant/Research Support|Suzhou Sinovent Pharmaceuticals Co.: Grant/Research Support|Theravance: Grant/Research Support|tranScrip Partners: Grant/Research Support|University of Wisconsin: Grant/Research Support|Utility Therapeutics: Grant/Research Support|ValanBio Therapeutics Inc.: Grant/Research Support|VenatoRx: Grant/Research Support Jennifer Smart, PhD, Basilea Pharmaceutica International Ltd, Allschwil, Switzerland: Stocks/Bonds Karine Litherland, Ph.D., Basilea Pharmaceutica International Ltd, Allschwil, Switzerland: Full time employee|Basilea Pharmaceutica International Ltd, Allschwil, Switzerland: Stocks/Bonds Leonard R. Duncan, PhD, AbbVie: Grant/Research Support|Basilea: Grant/Research Support|CorMedix: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support Mark E. Jones, PhD, Astellas Pharma Global Development, Inc: Support for the present publication|Basilea Pharmaceutica International Ltd: Employee of Basilea Pharmaceutica International Ltd|Basilea Pharmaceutica International Ltd: Stocks/Bonds Marc Engelhardt, MD, Astellas Pharma Global Development, Inc.: Support for the present publication|Basilea Pharmaceutica International Ltd: Employee of Basilea Pharmaceutica International Ltd|Basilea Pharmaceutica International Ltd: Stocks/Bonds Paul G. Ambrose, PharmD; MS; FIDSA, Adagio Therapeutics, Inc.: Grant/Research Support|Albany Medical Center: Grant/Research Support|Amplyx Pharmaceuticals, Inc.: Grant/Research Support|AN2 Therapeutics: Grant/Research Support|Antabio SAS: Grant/Research Support|Arcutis Biotherapeutics, Inc.: Grant/Research Support|B. Braun Medical Inc.: Grant/Research Support|Basilea Pharmaceutica: Grant/Research Support|BioFire Diagnostics LLC: Grant/Research Support|Boston Pharmaceuticals: Grant/Research Support|Cidara Therapeutics Inc.: Grant/Research Support|Cipla USA: Grant/Research Support|Crestone Inc.: Grant/Research Support|CXC: Grant/Research Support|Debiopharm International SA: Grant/Research Support|Entasis Therapeutics: Grant/Research Support|Genentech: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Hoffmann-La Roche: Grant/Research Support|ICPD: Ownership Interest|Inotrem: Grant/Research Support|Insmed Inc.: Grant/Research Support|Iterum Therapeutics Limited: Grant/Research Support|Kaizen Bioscience, Co.: Grant/Research Support|KBP Biosciences USA: Grant/Research Support|Matinas Biopharma: Grant/Research Support|Meiji Seika Pharma Co., Ltd.: Grant/Research Support|Melinta Therapeutics: Grant/Research Support|Menarini Ricerche S.p.A.: Grant/Research Support|Mutabilis: Grant/Research Support|Nabriva Therapeutics AG: Grant/Research Support|Paratek Pharmaceuticals, Inc.: Grant/Research Support|Qpex Biopharma: Grant/Research Support|Sfunga Therapeutics: Grant/Research Support|Spero Therapeutics: Grant/Research Support|Suzhou Sinovent Pharmaceuticals Co.: Grant/Research Support|Theravance: Grant/Research Support|tranScrip Partners: Grant/Research Support|University of Wisconsin: Grant/Research Support|Utility Therapeutics: Grant/Research Support|ValanBio Therapeutics Inc.: Grant/Research Support|VenatoRx: Grant/Research Support Christopher M. Rubino, PharmD, Adagio Therapeutics, Inc.: Grant/Research Support|Albany Medical Center: Grant/Research Support|Amplyx Pharmaceuticals, Inc.: Grant/Research Support|AN2 Therapeutics: Grant/Research Support|Antabio SAS: Grant/Research Support|Arcutis Biotherapeutics, Inc.: Grant/Research Support|B. Braun Medical Inc.: Grant/Research Support|Basilea Pharmaceutica: Grant/Research Support|BioFire Diagnostics LLC: Grant/Research Support|Boston Pharmaceuticals: Grant/Research Support|Cidara Therapeutics Inc.: Grant/Research Support|Cipla USA: Grant/Research Support|Crestone Inc.: Grant/Research Support|CXC: Grant/Research Support|Debiopharm International SA: Grant/Research Support|Entasis Therapeutics: Grant/Research Support|Genentech: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Hoffmann-La Roche: Grant/Research Support|ICPD: Ownership Interest|Inotrem: Grant/Research Support|Insmed Inc.: Grant/Research Support|Iterum Therapeutics Limited: Grant/Research Support|Kaizen Bioscience, Co.: Grant/Research Support|KBP Biosciences USA: Grant/Research Support|Matinas Biopharma: Grant/Research Support|Meiji Seika Pharma Co., Ltd.: Grant/Research Support|Melinta Therapeutics: Grant/Research Support|Menarini Ricerche S.p.A.: Grant/Research Support|Mutabilis: Grant/Research Support|Nabriva Therapeutics AG: Grant/Research Support|Paratek Pharmaceuticals, Inc.: Grant/Research Support|Qpex Biopharma: Grant/Research Support|Sfunga Therapeutics: Grant/Research Support|Spero Therapeutics: Grant/Research Support|Suzhou Sinovent Pharmaceuticals Co.: Grant/Research Support|Theravance: Grant/Research Support|tranScrip Partners: Grant/Research Support|University of Wisconsin: Grant/Research Support|Utility Therapeutics: Grant/Research Support|ValanBio Therapeutics Inc.: Grant/Research Support|VenatoRx: Grant/Research Support