Europe-wide expansion and eradication of multidrug-resistant Neisseria gonorrhoeae lineages: a genomic surveillance study

Detalhes bibliográficos
Autor(a) principal: Sánchez-Busó, Leonor
Data de Publicação: 2022
Outros Autores: Cole, Michelle J., Spiteri, Gianfranco, Day, Michaela, Jacobsson, Susanne, Golparian, Daniel, Sajedi, Noshin, Yeats, Corin A., Abudahab, Khalil, Underwood, Anthony, Bluemel, Benjamin, Aanensen, David M., Unemo, Magnus, Pleininger, Sonja, Indra, Alexander, De Baetselier, Irith, Vanden Berghe, Wim, Hunjak, Blaženka, Blažić, Tatjana Nemeth, Maikanti-Charalambous, Panayiota, Pieridou, Despo, Zákoucká, Hana, Žemličková, Helena, Hoffmann, Steen, Cowan, Susan, Schwartz, Lasse Jessen, Peetso, Rita, Epstein, Jevgenia, Viktorova, Jelena, Ndeikoundam, Ndeindo, Bercot, Beatrice, Bébéar, Cécile, Lot, Florence, Buder, Susanne, Jansen, Klaus, Miriagou, Vivi, Rigakos, Georgios, Raftopoulos, Vasilios, Balla, Eszter, Dudás, Mária, Ásmundsdóttir, Lena Rós, Sigmundsdóttir, Guðrún, Hauksdóttir, Guðrún Svanborg, Gudnason, Thorolfur, Colgan, Aoife, Crowley, Brendan, Saab, Sinéad, Stefanelli, Paola, Carannante, Anna, Parodi, Patrizia, Pakarna, Gatis, Nikiforova, Raina, Bormane, Antra, Dimina, Elina, Perrin, Monique, Abdelrahman, Tamir, Mossong, Joël, Schmit, Jean-Claude, Mühlschlegel, Friedrich, Barbara, Christopher, Mifsud, Francesca, Van Dam, Alje, Van Benthem, Birgit, Visser, Maartje, Linde, Ineke, Kløvstad, Hilde, Caugant, Dominique, Młynarczyk-Bonikowska, Beata, Azevedo, Jacinta, Borrego, Maria-José, Nascimento, Marina Lurdes Ramos, Pavlik, Peter, Klavs, Irena, Murnik, Andreja, Jeverica, Samo, Kustec, Tanja, Vázquez Moreno, Julio, Diaz, Asuncion, Abad, Raquel, Velicko, Inga, Fifer, Helen, Shepherd, Jill, Patterson, Lynsey
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10400.18/8605
Resumo: Centre for Genomic Pathogen Surveillance and the Euro-GASP study group: Sonja Pleininger, Alexander Indra, Irith De Baetselier, Wim Vanden Berghe, Blaženka Hunjak, Tatjana Nemeth Blažić, Panayiota Maikanti-Charalambous, Despo Pieridou, Hana Zákoucká, Helena Žemličková, Steen Hoffmann, Susan Cowan, Lasse Jessen Schwartz, Rita Peetso, Jevgenia Epstein, Jelena Viktorova, Ndeindo Ndeikoundam, Beatrice Bercot, Cécile Bébéar, Florence Lot, Susanne Buder, Klaus Jansen, Vivi Miriagou, Georgios Rigakos, Vasilios Raftopoulos, Eszter Balla, Mária Dudás, Lena Rós Ásmundsdóttir, Guðrún Sigmundsdóttir, Guðrún Svanborg Hauksdóttir, Thorolfur Gudnason, Aoife Colgan, Brendan Crowley, Sinéad Saab, Paola Stefanelli, Anna Carannante, Patrizia Parodi, Gatis Pakarna, Raina Nikiforova, Antra Bormane, Elina Dimina, Monique Perrin, Tamir Abdelrahman, Joël Mossong, Jean-Claude Schmit, Friedrich Mühlschlegel, Christopher Barbara, Francesca Mifsud, Alje Van Dam, Birgit Van Benthem, Maartje Visser, Ineke Linde, Hilde Kløvstad, Dominique Caugant, Beata Młynarczyk-Bonikowska, Jacinta Azevedo, Maria-José Borrego, Marina Lurdes Ramos Nascimento, Peter Pavlik, Irena Klavs, Andreja Murnik, Samo Jeverica, Tanja Kustec, Julio Vázquez Moreno, Asuncion Diaz, Raquel Abad, Inga Velicko, Magnus Unemo, Helen Fifer, Jill Shepherd, Lynsey Patterson
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spelling Europe-wide expansion and eradication of multidrug-resistant Neisseria gonorrhoeae lineages: a genomic surveillance studyEuropean Centre for Disease Prevention and ControlCentre for Genomic Pathogen SurveillanceÖrebro University HospitalWellcomeEuropeInfecções Sexualmente TransmissíveisResistência aos AntimicrobianosCentre for Genomic Pathogen Surveillance and the Euro-GASP study group: Sonja Pleininger, Alexander Indra, Irith De Baetselier, Wim Vanden Berghe, Blaženka Hunjak, Tatjana Nemeth Blažić, Panayiota Maikanti-Charalambous, Despo Pieridou, Hana Zákoucká, Helena Žemličková, Steen Hoffmann, Susan Cowan, Lasse Jessen Schwartz, Rita Peetso, Jevgenia Epstein, Jelena Viktorova, Ndeindo Ndeikoundam, Beatrice Bercot, Cécile Bébéar, Florence Lot, Susanne Buder, Klaus Jansen, Vivi Miriagou, Georgios Rigakos, Vasilios Raftopoulos, Eszter Balla, Mária Dudás, Lena Rós Ásmundsdóttir, Guðrún Sigmundsdóttir, Guðrún Svanborg Hauksdóttir, Thorolfur Gudnason, Aoife Colgan, Brendan Crowley, Sinéad Saab, Paola Stefanelli, Anna Carannante, Patrizia Parodi, Gatis Pakarna, Raina Nikiforova, Antra Bormane, Elina Dimina, Monique Perrin, Tamir Abdelrahman, Joël Mossong, Jean-Claude Schmit, Friedrich Mühlschlegel, Christopher Barbara, Francesca Mifsud, Alje Van Dam, Birgit Van Benthem, Maartje Visser, Ineke Linde, Hilde Kløvstad, Dominique Caugant, Beata Młynarczyk-Bonikowska, Jacinta Azevedo, Maria-José Borrego, Marina Lurdes Ramos Nascimento, Peter Pavlik, Irena Klavs, Andreja Murnik, Samo Jeverica, Tanja Kustec, Julio Vázquez Moreno, Asuncion Diaz, Raquel Abad, Inga Velicko, Magnus Unemo, Helen Fifer, Jill Shepherd, Lynsey PattersonBackground: Genomic surveillance using quality-assured whole-genome sequencing (WGS) together with epidemiological and antimicrobial resistance (AMR) data is essential to characterise the circulating Neisseria gonorrhoeae lineages and their association to patient groups (defined by demographic and epidemiological factors). In 2013, the European gonococcal population was characterised genomically for the first time. We describe the European gonococcal population in 2018 and identify emerging or vanishing lineages associated with AMR and epidemiological characteristics of patients, to elucidate recent changes in AMR and gonorrhoea epidemiology in Europe. Methods: We did WGS on 2375 gonococcal isolates from 2018 (mainly Sept 1-Nov 30) in 26 EU and EEA countries. Molecular typing and AMR determinants were extracted from quality-checked genomic data. Association analyses identified links between genomic lineages, AMR, and epidemiological data. Findings: Azithromycin-resistant N gonorrhoeae (8·0% [191/2375] in 2018) is rising in Europe due to the introduction or emergence and subsequent expansion of a novel N gonorrhoeae multi-antigen sequence typing (NG-MAST) genogroup, G12302 (132 [5·6%] of 2375; N gonorrhoeae sequence typing for antimicrobial resistance [NG-STAR] clonal complex [CC]168/63), carrying a mosaic mtrR promoter and mtrD sequence and found in 24 countries in 2018. CC63 was associated with pharyngeal infections in men who have sex with men. Susceptibility to ceftriaxone and cefixime is increasing, as the resistance-associated lineage, NG-MAST G1407 (51 [2·1%] of 2375), is progressively vanishing since 2009-10. Interpretation: Enhanced gonococcal AMR surveillance is imperative worldwide. WGS, linked to epidemiological and AMR data, is essential to elucidate the dynamics in gonorrhoea epidemiology and gonococcal populations as well as to predict AMR. When feasible, WGS should supplement the national and international AMR surveillance programmes to elucidate AMR changes over time. In the EU and EEA, increasing low-level azithromycin resistance could threaten the recommended ceftriaxone-azithromycin dual therapy, and an evidence-based clinical azithromycin resistance breakpoint is needed. Nevertheless, increasing ceftriaxone susceptibility, declining cefixime resistance, and absence of known resistance mutations for new treatments (zoliflodacin, gepotidacin) are promising.This study was supported by the European Centre for Disease Prevention and Control, the Centre for Genomic Pathogen Surveillance, the Li Ka Shing Foundation (Big Data Institute, University of Oxford), the Wellcome Genome Campus, the Foundation for Medical Research at Örebro University Hospital, and grants from Wellcome (098051 and 099202). LSB was funded by Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana (Plan GenT CDEI-06/20-B), Valencia, Spain, and Ministry of Science, Innovation and Universities (PID2020–120113RA-I00), Spain, at the time of analysing and writing this manuscript.ElsevierRepositório Científico do Instituto Nacional de SaúdeSánchez-Busó, LeonorCole, Michelle J.Spiteri, GianfrancoDay, MichaelaJacobsson, SusanneGolparian, DanielSajedi, NoshinYeats, Corin A.Abudahab, KhalilUnderwood, AnthonyBluemel, BenjaminAanensen, David M.Unemo, MagnusPleininger, SonjaIndra, AlexanderDe Baetselier, IrithVanden Berghe, WimHunjak, BlaženkaBlažić, Tatjana NemethMaikanti-Charalambous, PanayiotaPieridou, DespoZákoucká, HanaŽemličková, HelenaHoffmann, SteenCowan, SusanSchwartz, Lasse JessenPeetso, RitaEpstein, JevgeniaViktorova, JelenaNdeikoundam, NdeindoBercot, BeatriceBébéar, CécileLot, FlorenceBuder, SusanneJansen, KlausMiriagou, ViviRigakos, GeorgiosRaftopoulos, VasiliosBalla, EszterDudás, MáriaÁsmundsdóttir, Lena RósSigmundsdóttir, GuðrúnHauksdóttir, Guðrún SvanborgGudnason, ThorolfurColgan, AoifeCrowley, BrendanSaab, SinéadStefanelli, PaolaCarannante, AnnaParodi, PatriziaPakarna, GatisNikiforova, RainaBormane, AntraDimina, ElinaPerrin, MoniqueAbdelrahman, TamirMossong, JoëlSchmit, Jean-ClaudeMühlschlegel, FriedrichBarbara, ChristopherMifsud, FrancescaVan Dam, AljeVan Benthem, BirgitVisser, MaartjeLinde, InekeKløvstad, HildeCaugant, DominiqueMłynarczyk-Bonikowska, BeataAzevedo, JacintaBorrego, Maria-JoséNascimento, Marina Lurdes RamosPavlik, PeterKlavs, IrenaMurnik, AndrejaJeverica, SamoKustec, TanjaVázquez Moreno, JulioDiaz, AsuncionAbad, RaquelVelicko, IngaUnemo, MagnusFifer, HelenShepherd, JillPatterson, Lynsey2023-03-24T12:06:56Z2022-062022-06-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.18/8605engLancet Microbe. 2022 Jun;3(6):e452-e463. doi: 10.1016/S2666-5247(22)00044-1. Epub 2022 May 10.2666-524710.1016/S2666-5247(22)00044-1info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-07-20T15:42:39Zoai:repositorio.insa.pt:10400.18/8605Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T18:43:14.973015Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Europe-wide expansion and eradication of multidrug-resistant Neisseria gonorrhoeae lineages: a genomic surveillance study
title Europe-wide expansion and eradication of multidrug-resistant Neisseria gonorrhoeae lineages: a genomic surveillance study
spellingShingle Europe-wide expansion and eradication of multidrug-resistant Neisseria gonorrhoeae lineages: a genomic surveillance study
Sánchez-Busó, Leonor
European Centre for Disease Prevention and Control
Centre for Genomic Pathogen Surveillance
Örebro University Hospital
Wellcome
Europe
Infecções Sexualmente Transmissíveis
Resistência aos Antimicrobianos
title_short Europe-wide expansion and eradication of multidrug-resistant Neisseria gonorrhoeae lineages: a genomic surveillance study
title_full Europe-wide expansion and eradication of multidrug-resistant Neisseria gonorrhoeae lineages: a genomic surveillance study
title_fullStr Europe-wide expansion and eradication of multidrug-resistant Neisseria gonorrhoeae lineages: a genomic surveillance study
title_full_unstemmed Europe-wide expansion and eradication of multidrug-resistant Neisseria gonorrhoeae lineages: a genomic surveillance study
title_sort Europe-wide expansion and eradication of multidrug-resistant Neisseria gonorrhoeae lineages: a genomic surveillance study
author Sánchez-Busó, Leonor
author_facet Sánchez-Busó, Leonor
Cole, Michelle J.
Spiteri, Gianfranco
Day, Michaela
Jacobsson, Susanne
Golparian, Daniel
Sajedi, Noshin
Yeats, Corin A.
Abudahab, Khalil
Underwood, Anthony
Bluemel, Benjamin
Aanensen, David M.
Unemo, Magnus
Pleininger, Sonja
Indra, Alexander
De Baetselier, Irith
Vanden Berghe, Wim
Hunjak, Blaženka
Blažić, Tatjana Nemeth
Maikanti-Charalambous, Panayiota
Pieridou, Despo
Zákoucká, Hana
Žemličková, Helena
Hoffmann, Steen
Cowan, Susan
Schwartz, Lasse Jessen
Peetso, Rita
Epstein, Jevgenia
Viktorova, Jelena
Ndeikoundam, Ndeindo
Bercot, Beatrice
Bébéar, Cécile
Lot, Florence
Buder, Susanne
Jansen, Klaus
Miriagou, Vivi
Rigakos, Georgios
Raftopoulos, Vasilios
Balla, Eszter
Dudás, Mária
Ásmundsdóttir, Lena Rós
Sigmundsdóttir, Guðrún
Hauksdóttir, Guðrún Svanborg
Gudnason, Thorolfur
Colgan, Aoife
Crowley, Brendan
Saab, Sinéad
Stefanelli, Paola
Carannante, Anna
Parodi, Patrizia
Pakarna, Gatis
Nikiforova, Raina
Bormane, Antra
Dimina, Elina
Perrin, Monique
Abdelrahman, Tamir
Mossong, Joël
Schmit, Jean-Claude
Mühlschlegel, Friedrich
Barbara, Christopher
Mifsud, Francesca
Van Dam, Alje
Van Benthem, Birgit
Visser, Maartje
Linde, Ineke
Kløvstad, Hilde
Caugant, Dominique
Młynarczyk-Bonikowska, Beata
Azevedo, Jacinta
Borrego, Maria-José
Nascimento, Marina Lurdes Ramos
Pavlik, Peter
Klavs, Irena
Murnik, Andreja
Jeverica, Samo
Kustec, Tanja
Vázquez Moreno, Julio
Diaz, Asuncion
Abad, Raquel
Velicko, Inga
Fifer, Helen
Shepherd, Jill
Patterson, Lynsey
author_role author
author2 Cole, Michelle J.
Spiteri, Gianfranco
Day, Michaela
Jacobsson, Susanne
Golparian, Daniel
Sajedi, Noshin
Yeats, Corin A.
Abudahab, Khalil
Underwood, Anthony
Bluemel, Benjamin
Aanensen, David M.
Unemo, Magnus
Pleininger, Sonja
Indra, Alexander
De Baetselier, Irith
Vanden Berghe, Wim
Hunjak, Blaženka
Blažić, Tatjana Nemeth
Maikanti-Charalambous, Panayiota
Pieridou, Despo
Zákoucká, Hana
Žemličková, Helena
Hoffmann, Steen
Cowan, Susan
Schwartz, Lasse Jessen
Peetso, Rita
Epstein, Jevgenia
Viktorova, Jelena
Ndeikoundam, Ndeindo
Bercot, Beatrice
Bébéar, Cécile
Lot, Florence
Buder, Susanne
Jansen, Klaus
Miriagou, Vivi
Rigakos, Georgios
Raftopoulos, Vasilios
Balla, Eszter
Dudás, Mária
Ásmundsdóttir, Lena Rós
Sigmundsdóttir, Guðrún
Hauksdóttir, Guðrún Svanborg
Gudnason, Thorolfur
Colgan, Aoife
Crowley, Brendan
Saab, Sinéad
Stefanelli, Paola
Carannante, Anna
Parodi, Patrizia
Pakarna, Gatis
Nikiforova, Raina
Bormane, Antra
Dimina, Elina
Perrin, Monique
Abdelrahman, Tamir
Mossong, Joël
Schmit, Jean-Claude
Mühlschlegel, Friedrich
Barbara, Christopher
Mifsud, Francesca
Van Dam, Alje
Van Benthem, Birgit
Visser, Maartje
Linde, Ineke
Kløvstad, Hilde
Caugant, Dominique
Młynarczyk-Bonikowska, Beata
Azevedo, Jacinta
Borrego, Maria-José
Nascimento, Marina Lurdes Ramos
Pavlik, Peter
Klavs, Irena
Murnik, Andreja
Jeverica, Samo
Kustec, Tanja
Vázquez Moreno, Julio
Diaz, Asuncion
Abad, Raquel
Velicko, Inga
Fifer, Helen
Shepherd, Jill
Patterson, Lynsey
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dc.contributor.none.fl_str_mv Repositório Científico do Instituto Nacional de Saúde
dc.contributor.author.fl_str_mv Sánchez-Busó, Leonor
Cole, Michelle J.
Spiteri, Gianfranco
Day, Michaela
Jacobsson, Susanne
Golparian, Daniel
Sajedi, Noshin
Yeats, Corin A.
Abudahab, Khalil
Underwood, Anthony
Bluemel, Benjamin
Aanensen, David M.
Unemo, Magnus
Pleininger, Sonja
Indra, Alexander
De Baetselier, Irith
Vanden Berghe, Wim
Hunjak, Blaženka
Blažić, Tatjana Nemeth
Maikanti-Charalambous, Panayiota
Pieridou, Despo
Zákoucká, Hana
Žemličková, Helena
Hoffmann, Steen
Cowan, Susan
Schwartz, Lasse Jessen
Peetso, Rita
Epstein, Jevgenia
Viktorova, Jelena
Ndeikoundam, Ndeindo
Bercot, Beatrice
Bébéar, Cécile
Lot, Florence
Buder, Susanne
Jansen, Klaus
Miriagou, Vivi
Rigakos, Georgios
Raftopoulos, Vasilios
Balla, Eszter
Dudás, Mária
Ásmundsdóttir, Lena Rós
Sigmundsdóttir, Guðrún
Hauksdóttir, Guðrún Svanborg
Gudnason, Thorolfur
Colgan, Aoife
Crowley, Brendan
Saab, Sinéad
Stefanelli, Paola
Carannante, Anna
Parodi, Patrizia
Pakarna, Gatis
Nikiforova, Raina
Bormane, Antra
Dimina, Elina
Perrin, Monique
Abdelrahman, Tamir
Mossong, Joël
Schmit, Jean-Claude
Mühlschlegel, Friedrich
Barbara, Christopher
Mifsud, Francesca
Van Dam, Alje
Van Benthem, Birgit
Visser, Maartje
Linde, Ineke
Kløvstad, Hilde
Caugant, Dominique
Młynarczyk-Bonikowska, Beata
Azevedo, Jacinta
Borrego, Maria-José
Nascimento, Marina Lurdes Ramos
Pavlik, Peter
Klavs, Irena
Murnik, Andreja
Jeverica, Samo
Kustec, Tanja
Vázquez Moreno, Julio
Diaz, Asuncion
Abad, Raquel
Velicko, Inga
Unemo, Magnus
Fifer, Helen
Shepherd, Jill
Patterson, Lynsey
dc.subject.por.fl_str_mv European Centre for Disease Prevention and Control
Centre for Genomic Pathogen Surveillance
Örebro University Hospital
Wellcome
Europe
Infecções Sexualmente Transmissíveis
Resistência aos Antimicrobianos
topic European Centre for Disease Prevention and Control
Centre for Genomic Pathogen Surveillance
Örebro University Hospital
Wellcome
Europe
Infecções Sexualmente Transmissíveis
Resistência aos Antimicrobianos
description Centre for Genomic Pathogen Surveillance and the Euro-GASP study group: Sonja Pleininger, Alexander Indra, Irith De Baetselier, Wim Vanden Berghe, Blaženka Hunjak, Tatjana Nemeth Blažić, Panayiota Maikanti-Charalambous, Despo Pieridou, Hana Zákoucká, Helena Žemličková, Steen Hoffmann, Susan Cowan, Lasse Jessen Schwartz, Rita Peetso, Jevgenia Epstein, Jelena Viktorova, Ndeindo Ndeikoundam, Beatrice Bercot, Cécile Bébéar, Florence Lot, Susanne Buder, Klaus Jansen, Vivi Miriagou, Georgios Rigakos, Vasilios Raftopoulos, Eszter Balla, Mária Dudás, Lena Rós Ásmundsdóttir, Guðrún Sigmundsdóttir, Guðrún Svanborg Hauksdóttir, Thorolfur Gudnason, Aoife Colgan, Brendan Crowley, Sinéad Saab, Paola Stefanelli, Anna Carannante, Patrizia Parodi, Gatis Pakarna, Raina Nikiforova, Antra Bormane, Elina Dimina, Monique Perrin, Tamir Abdelrahman, Joël Mossong, Jean-Claude Schmit, Friedrich Mühlschlegel, Christopher Barbara, Francesca Mifsud, Alje Van Dam, Birgit Van Benthem, Maartje Visser, Ineke Linde, Hilde Kløvstad, Dominique Caugant, Beata Młynarczyk-Bonikowska, Jacinta Azevedo, Maria-José Borrego, Marina Lurdes Ramos Nascimento, Peter Pavlik, Irena Klavs, Andreja Murnik, Samo Jeverica, Tanja Kustec, Julio Vázquez Moreno, Asuncion Diaz, Raquel Abad, Inga Velicko, Magnus Unemo, Helen Fifer, Jill Shepherd, Lynsey Patterson
publishDate 2022
dc.date.none.fl_str_mv 2022-06
2022-06-01T00:00:00Z
2023-03-24T12:06:56Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10400.18/8605
url http://hdl.handle.net/10400.18/8605
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Lancet Microbe. 2022 Jun;3(6):e452-e463. doi: 10.1016/S2666-5247(22)00044-1. Epub 2022 May 10.
2666-5247
10.1016/S2666-5247(22)00044-1
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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institution RCAAP
reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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