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"apellidos" => "Martínez-Álvarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Laura" "apellidos" => "Ruiz-Ripa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Sara" "apellidos" => "Ceballos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Carmen" "apellidos" => "Torres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Microbiología, Hospital Royo Villanova, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Área de Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, La Rioja, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Enfermedades Infecciosas, Hospital Miguel Servet, Zaragoza, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bacteriemia por <span class="elsevierStyleItalic">Staphylococcus aureus</span> sensible a penicilina. Importancia epidemiológica, clínica y posibles implicaciones terapéuticas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Staphylococcus aureus</span> (SA) bacteraemia is an entity with special relevance due to its frequency, severity and high mortality. In the treatment of Methicillin-susceptible SA (MSSA) bacteraemia, the timeliness of suitable treatment is very important. In targeted therapy there is controversy about the use of different beta-lactams, with cloxacillin and cefazolin as first-line, and poorer results with second and third generation cephalosporins and beta-lactams with beta-lactamase inhibitors.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Regarding penicillin, due to its high resistance, it is not generally used for these treatments, especially in bacteraemia. However, in addition to the vast experience with this antibiotic over decades, recent works indicate that it still has points in its favour for even standing as a treatment of choice for SA infections susceptible to this antibiotic (SA-Pen<span class="elsevierStyleSup">S</span>).<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> These points include: 1) MIC values 10–50 times lower and a lower percentage of protein binding than cloxacillin; 2) the time above the MIC is longer than other antimicrobials, including cefazolin<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>; 3) narrower spectrum than other options, including first-generation cephalosporins (thus related to fewer infections by <span class="elsevierStyleItalic">Clostridium difficile</span>),<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and 4) less selection of <span class="elsevierStyleItalic">mecA</span> and <span class="elsevierStyleItalic">mecC</span>-mediated methicillin resistance.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In various countries around the world there is a growing trend in penicillin-sensitive SA, especially in invasive infections like bacteraemia. Data from the USA,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,8–10</span></a> Canada,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Europe (Sweden,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,11</span></a> Finland<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and Denmark<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>) or from Australia and New Zealand<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> exemplify this phenomenon, including penicillin in a kind of "second chance".<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Penicillin resistance in <span class="elsevierStyleItalic">mecA</span>-negative SA strains is due to the production of beta-lactamases encoded by the <span class="elsevierStyleItalic">bla</span>Z gene. There are several phenotypic methods for its detection, such as the nitrocefin test or the reading of the halo edge of penicillin on disk-diffusion, but compared with PCR detection of the <span class="elsevierStyleItalic">bla</span>Z gene they have less sensitivity.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,9,11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of this work was to understand the situation of penicillin sensitivity in cases of bacteriaemia caused by SA and its characteristics in our environment.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">During the study period (July 2015-December 2017) SA strains isolated from bacteraemia (both MSSA and methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> [MRSA]) were analysed, in adult patients at the Hospital Royo Villanova [Royo Villanova Hospital], Zaragoza. The blood cultures (Bactec, Becton, Dickinson®) and the sensitivity study (MicroScan, Beckman® Combo 31 panel) were performed following the usual <span class="elsevierStyleItalic">European Committe for Antimicrobial Susceptibility Testing</span> protocols and cut-off points.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In all the SA strains (one per patient) the presence of the <span class="elsevierStyleItalic">bla</span>Z and <span class="elsevierStyleItalic">mecA</span>genes was analysed, as well as the Panton-Valentine leukocidin (PVL) gene.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The characterisation of the <span class="elsevierStyleItalic">bla</span>Z-negative (<span class="elsevierStyleItalic">bla</span>Z<span class="elsevierStyleSup">negative</span>) isolates was obtained through: 1) <span class="elsevierStyleItalic">spa</span> typing by PCR and sequencing<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>; 2) determination of the sequence type (ST) and clonal complex (CC) by the multilocus-sequence typing (MLST) technique from a representative isolate of each of the different <span class="elsevierStyleItalic">spa</span>-types detected, assuming the ST for all the isolates of the same<span class="elsevierStyleItalic">spa,</span><a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and 3) PCR study of non-beta-lactam antibiotic resistance genes: macrolides (<span class="elsevierStyleItalic">ermA</span>/<span class="elsevierStyleItalic">ermB</span>/<span class="elsevierStyleItalic">ermC/msrA/msrB</span> y <span class="elsevierStyleItalic">ermT</span>), tobramycin (<span class="elsevierStyleItalic">ant(4)’-Ia</span>) or mupirocin <span class="elsevierStyleItalic">(mupA)</span>.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Over the 30 months of study there were 84 patients with SA bacteraemia (30 with MRSA [35.7%] and 54 with MSSA [64.3%]). Of the MSSA isolates, 12 were susceptible to penicillin (MSSA-Pen<span class="elsevierStyleSup">S</span>), representing 22.2% of MSSA and 14.3% of SA.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Of the total of 84 SA, 77 isolates were recovered for characterisation (27 MRSA and 50 MSSA). The 27 MRSA isolates were resistant to penicillin (MIC: >0.12mcg/m), carried the <span class="elsevierStyleItalic">mecA</span> and <span class="elsevierStyleItalic">bla</span>Z genes, and were negative for the PVL gene.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The 50 MSSA isolates lacked <span class="elsevierStyleItalic">mecA</span>, and in relation to penicillin: a) 39 of them showed phenotypic resistance to penicillin (MIC: >0.25 μg/mL) and contained the <span class="elsevierStyleItalic">bla</span>Z gene (MSSA-Pen<span class="elsevierStyleSup">R</span>-<span class="elsevierStyleItalic">bla</span>Z<span class="elsevierStyleSup">positive</span>), and b) 11 were susceptible to penicillin and lacked the <span class="elsevierStyleItalic">bla</span>Z gene (MSSA-Pen<span class="elsevierStyleSup">S</span>-<span class="elsevierStyleItalic">bla</span>Z<span class="elsevierStyleSup">negative</span>), all of them showing an MIC-Pen≤0.3 μg/mL (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The 11 MSSA-Pen<span class="elsevierStyleSup">S</span>-<span class="elsevierStyleItalic">bla</span>Z<span class="elsevierStyleSup">negative</span> isolates were assigned to 8 different <span class="elsevierStyleItalic">spa</span> -types (t002 the most frequent), associated with 8 STs and 7 CCs (CC5, CC8, CC22, CC45, CC59, CC97 y CC398). Six of the 11 MSSA-Pen<span class="elsevierStyleSup">S</span>-<span class="elsevierStyleItalic">bla</span>Z<span class="elsevierStyleSup">negative</span> isolates were susceptible to all the antibiotics tested and the remaining 5 presented resistance to macrolides, lincosamides, tobramycin, mupirocin and/or fluoroquinolones (genes <span class="elsevierStyleItalic">ermA</span>, <span class="elsevierStyleItalic">ermT</span>, <span class="elsevierStyleItalic">msrA</span>, <span class="elsevierStyleItalic">msrB</span>, <span class="elsevierStyleItalic">ant(4)’-Ia</span> or <span class="elsevierStyleItalic">mupA</span>being detected). Lastly, one of the MSSA-Pen<span class="elsevierStyleSup">S</span>-<span class="elsevierStyleItalic">bla</span>Z<span class="elsevierStyleSup">negative</span> strains was a carrier of the PVL gene (t121-ST8/CC8), and only resistant to fluoroquinolones.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">In this study of SA bacteraemia, a MRSA prevalence of 35.7% was detected with 22.2% susceptibility to penicillin among MSSA isolates (14.3% of total SA). The percentage of MRSA is higher than that of other European countries and that of most Spanish hospitals (<a href="https://ecdc.europa.eu/en/about-us/partnerships-and-networks/disease-and-laboratory-networks/ears-net">https://ecdc.europa.eu/en/about-us/partnerships-and-networks/disease-and-laboratory-networks/ears-net</a>).</p><p id="par0065" class="elsevierStylePara elsevierViewall">Regarding the MSSA-Pen<span class="elsevierStyleSup">S</span>isolates, published figures are between 20 and 33% in northern European countries,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,11</span></a> USA<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,14</span></a> or Canada.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,10</span></a> In Spain we have not found any recent data, but in a multicentre study<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> with 20-year evolution data (1986–2006) the results of 6 prevalence studies in Spanish hospitals were analysed and it was observed that there was an increase in global susceptibility to penicillin in SA isolates from different clinical samples, with the lowest figures in 1991 (2.9%) and a sustained increase up to 2006 (11.0%). The data of our series of 14.3% global and 22.2% in MSSA would be in line with an increase in global susceptibility to penicillin in SA.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Of all the Pen<span class="elsevierStyleSup">S</span> strains characterised, (n = 11), all presented MIC-Pen≤0.3 μg/mL values and lacked the <span class="elsevierStyleItalic">bla</span>Z gene. This observation contributes to simplifying the microbiological diagnosis of penicillin susceptibility determination, since PCR detection of the <span class="elsevierStyleItalic">bla</span>Z gene is not available in most laboratories, the interpretation of susceptibility by disk-diffusion is not very objective and other tests such as nitrocefin are not recommended. Our data coincide with other authors that demonstrate that in strains with high susceptibility to penicillin (<0.03 μg/mL) the presence of beta-lactamases mediated by <span class="elsevierStyleItalic">bla</span>Z<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,9</span></a> can be reliably ruled out. Clonal complexes CC5, CC8, CC45 y CC22 associated with our MSSA-Pen<span class="elsevierStyleSup">S</span>-<span class="elsevierStyleItalic">bla</span>Z<span class="elsevierStyleSup">negative</span> were also detected in a similar study in Sweden, with CC5-t002<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> also predominant.</p><p id="par0075" class="elsevierStylePara elsevierViewall">An explanation for the increased susceptibility to penicillin in SA could be attributed to a lower selective pressure due to its lower use. In fact, there is a trend in this regard in the first years of the 21 st century compared to previous years, which is especially marked in the USA and Canada.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,10</span></a> The only country reporting a downward trend is Sweden,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> a country with an antibiotic policy that has prioritised narrow-spectrum antibiotics for years, which went from 57% susceptibility in 2008−09 to 29% in 2014−15. Perhaps it could be interpreted as an increasing phenomenon in countries where penicillin is not consumed and decreasing in those where it is used, with both situations coinciding with figures of 20-30% at the present time. Another possible explanation is that new, more epidemiologically successful SA clones are coming in to replace the previous ones, and among these some lack <span class="elsevierStyleItalic">bla</span>Z. This aspect should be monitored in the future.</p><p id="par0080" class="elsevierStylePara elsevierViewall">One of the limitations of our study is that of being single-centre. It would be interesting to see if this prevalence of penicillin susceptibility (with absence of <span class="elsevierStyleItalic">bla</span>Z) in SA exists in other hospitals in our country.</p><p id="par0085" class="elsevierStylePara elsevierViewall">There are no randomised studies comparing benzylpenicillin with other antistaphylococcal penicillins (cloxacillin) or with cefazolin, and its use has been so low since the end of the last century (due to increased resistance) that sufficient data has not been collected in retrospective studies. In some studies that analyse the use of penicillin, a higher mortality has not been observed compared with comparators such as dicloxacillin.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6</span></a> In one study,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> the use of penicillin went from 0 to 50% of susceptible cases, with good results. Another recent article<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> shows a slightly higher mortality of flucloxacillin compared to benzylpenicillin, although with methodological limitations.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Pencillin susceptibility in MSSA expands targeted treatment options. The limited data on its usefulness is favourable, but randomised studies are needed to determine the most appropriate treatment. The narrowest of spectrums is one of the aspects that must take precedence in the treatment of infections, without ruling out other aspects such as administration dosage difficulties.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0100" class="elsevierStylePara elsevierViewall">This work was funded in part by the <span class="elsevierStyleGrantSponsor" id="gs0005">Agencia Estatal de Investigación (AEI) [State Bureau of Investigation] of Spain</span> and <span class="elsevierStyleGrantSponsor" id="gs0010">the EU European Regional Development Fund</span><span class="elsevierStyleGrantNumber" refid="gs0010">SAF2016-76571-R</span> project.</p><p id="par0105" class="elsevierStylePara elsevierViewall">O.M. Mama has a predoctoral scholarship from Mujeres por África [Women for Africa]-Universidad de La Rioja [La Rioja University] and L. Ruiz-Ripa has a predoctoral scholarship from the Universidad de La Rioja.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1409808" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1289720" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1409807" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1289719" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-07-24" "fechaAceptado" => "2019-12-05" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1289720" "palabras" => array:4 [ 0 => "Penicillin" 1 => "<span class="elsevierStyleItalic">bla</span>Z" 2 => "<span class="elsevierStyleItalic">Staphylococcus aureus</span>" 3 => "Bacteremia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1289719" "palabras" => array:4 [ 0 => "Penicilina" 1 => "<span class="elsevierStyleItalic">bla</span>Z" 2 => "<span class="elsevierStyleItalic">Staphylococcus aureus</span>" 3 => "Bacteriemia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The increase in penicillin susceptibility among <span class="elsevierStyleItalic">Staphylococcus aureus</span> (SA-Pen<span class="elsevierStyleSup">S</span>) might have therapeutic relevance. We aimed to study the current situation in our environment.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Over a 2.5 years period, all SA isolates from bacteraemia were analysed. For all isolates, antimicrobial susceptibility profile, beta-lactam resistance genes (<span class="elsevierStyleItalic">blaZ, mecA</span>) and Panton-Valentine leucocidine encoding-genes were studied. For SA-Pen<span class="elsevierStyleSup">S</span>-<span class="elsevierStyleItalic">blaZ</span><span class="elsevierStyleSup">negative</span> isolates, <span class="elsevierStyleItalic">spa</span>-type, MLST and the presence of other resistance genes were studied.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Among 84 patients with SA bacteraemia (35.7% MRSA and 64.3% MSSA), 77 were analysed; 22.2% of MSSA isolates were Pen<span class="elsevierStyleSup">S</span> and <span class="elsevierStyleItalic">blaZ</span><span class="elsevierStyleSup">negative</span> (Pen-MIC ≤0.03 µg/mL) corresponding to 14.3% of the total SA. In MSSA-Pen<span class="elsevierStyleSup">S</span>-<span class="elsevierStyleItalic">bla</span>Z<span class="elsevierStyleSup">negative</span> isolates, eight <span class="elsevierStyleItalic">spa</span>-types corresponding to seven clonal complexes were detected.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A high prevalence of MRSA/SA and MSSA-Pen<span class="elsevierStyleSup">S</span>-<span class="elsevierStyleItalic">bla</span>Z<span class="elsevierStyleSup">negative</span>/MSSA was detected in blood cultures. Pen-MIC ≤0,3 µg/mL corresponded to MSSA-Pen<span class="elsevierStyleSup">S</span>-<span class="elsevierStyleItalic">bla</span>Z<span class="elsevierStyleSup">negative</span>. This situation raises therapeutic options which should be further evaluated in larger studies and clinical trials.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El aumento de la sensibilidad a penicilina en <span class="elsevierStyleItalic">Staphylococcus aureus</span> (SA-Pen<span class="elsevierStyleSup">S</span>) podría tener relevancia terapéutica. Pretendemos conocer esta situación en nuestro medio.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se analizaron bacteriemias por SA durante 2,5 años (2015–2017). Estudiamos la sensibilidad a antimicrobianos, genes de resistencia a beta-lactámicos (<span class="elsevierStyleItalic">blaZ, mecA</span>) y presencia de leucocidina de Panton-Valentine. En aislados SA-Pen<span class="elsevierStyleSup">S</span>-<span class="elsevierStyleItalic">bla</span>Z<span class="elsevierStyleSup">negativo</span> se determinó el tipo de <span class="elsevierStyleItalic">spa</span>, MLST y genes de resistencia a antimicrobianos no-beta-lactámicos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Hubo 84 pacientes con bacteriemia por SA (35,7% SARM y 64,3% SASM), se analizaron 77. El 22% de los SASM estudiados (n = 11) fueron Pen<span class="elsevierStyleSup">S</span>- <span class="elsevierStyleItalic">bla</span>Z<span class="elsevierStyleSup">negativo</span> (CMI-Pen ≤0,3 µg/mL), correspondiendo a 14,3% del total de SA. En SASM-Pen<span class="elsevierStyleSup">S</span>-<span class="elsevierStyleItalic">bla</span>Z<span class="elsevierStyleSup">negativo</span> se detectaron ocho tipos de <span class="elsevierStyleItalic">spa</span> asociados a siete complejos clonales.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Detectamos alta prevalencia de SARM/SA y de SASM-Pen<span class="elsevierStyleSup">S</span>-<span class="elsevierStyleItalic">bla</span>Z<span class="elsevierStyleSup">negativo</span>/SASM en hemocultivos. Una CMI-Pen ≤0,3 µg/mL se correspondió con SASM-Pen<span class="elsevierStyleSup">S</span>-<span class="elsevierStyleItalic">bla</span>Z<span class="elsevierStyleSup">negativo</span>. Esta situación plantea opciones terapéuticas que deberán reevaluarse con estudios más amplios y ensayos clínicos.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Aspiroz C, Mama OM, Martínez-Álvarez RM, Ruiz-Ripa L, Ceballos S, Torres C. Bacteriemia por <span class="elsevierStyleItalic">Staphylococcus aureus</span> sensible a penicilina. Importancia epidemiológica, clínica y posibles implicaciones terapéuticas. Enferm Infecc Microbiol Clin. 2020;38:434–437.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">?: probable, unproven infection; BAC: catheter-related bacteriaemia; CIP: ciprofloxacin; CLI: clindamycin; ERI: erythromycin; SSTI: skin and soft tissue infections; HAI: health care-associated infections; RTI: respiratory tract infection; UTI: urinary tract infection; LEVO: levofloxacin; MUP: mupirocin; TOB: tobramycin; PUI: pressure ulcer infection.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antibiotic resistance</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Isolate code \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ST/CC \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Spa</span> -type \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resistance phenotype \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resistance genes \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Virulence genes \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical picture/focus \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Origin of the infection \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X797 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST5/CC5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">t002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ERI-CLI<span class="elsevierStyleSup">a</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">msrA/msrB, ermA</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RTI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HAI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X748 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST5/CC5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">t002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ERI-CIP-LEVO-MUP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">msrA/msrB</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SSTI. Cellulitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Community \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X728 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST5/CC5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">t002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pansusceptible<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">UTI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HAI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X770 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST1099/CC5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">t2450 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ERI-CIP-LEVO-MUP-TOB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">msrA/msrB, mupA, ant(4́)-Ia</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">UTI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HAI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X737 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST8/CC8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">t121 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CIP-LEVO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">lukF/lukS-PV</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SSTI. Abscesses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Community \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X749 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST22/CC22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">t2816 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pansusceptible<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SSTI? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HAI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X727 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST45/CC45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-identifiable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pansusceptible<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BAC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nosocomial \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X756 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST59/CC59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">t216 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pansusceptible<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fever without a focus. SSTI-PUI? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HAI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X766 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST97/CC97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">t359 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pansusceptible<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fever without a focus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HAI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X787 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST97/CC97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">t1236 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pansusceptible<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RTI? SSTI-PUI? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HAI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X746 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST398/CC398 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">t571 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ERI-CLI<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">msrA/msrB, ermT</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">—</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BAC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nosocomial \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2417669.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Inducible resistance phenotype.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Susceptible to the following antimicrobials: cefoxitin, oxacillin, penicillin, phosphomycin, rifampin, mupirocin, fusidic acid, gentamicin, tobramycin, amikacin, ciprofloxacin, levofloxacin, cotrimoxazole, vancomycin, teicoplanin, daptomycin, linezolid, and tetracycline.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Phenotypic and genetic characteristics of 11 strains of <span class="elsevierStyleItalic">Staphylococcus aureus</span> Pen<span class="elsevierStyleSup">−S</span><span class="elsevierStyleItalic">-blaZ</span><span class="elsevierStyleSup">negative</span> isolated from blood cultures.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Are all beta-lactams similarly effective in the treatment of methicillin-sensitive <span class="elsevierStyleItalic">Staphylococcus aureus</span> bacteraemia?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Paul" 1 => "N. Zemer-Wassercug" 2 => "O. Talker" 3 => "Y. Lishtzinsky" 4 => "B. Lev" 5 => "Z. Samra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1469-0691.2010.03425.x" "Revista" => array:5 [ "tituloSerie" => "Clin Microbiol Infect." "fecha" => "2011" "volumen" => "17" "paginaInicial" => "1581" "paginaFinal" => "1586" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of penicillin, dicloxacillin and cefuroxime for penicillin-susceptible <span class="elsevierStyleItalic">Staphylococcus aureus</span> bacteraemia: a retrospective, propensity-score-adjusted case-control and cohort analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Nissen" 1 => "R. Skov" 2 => "J.D. Knudsen" 3 => "C. Ostergaard" 4 => "H.C. 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Year/Month | Html | Total | |
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2024 October | 39 | 6 | 45 |
2024 September | 75 | 8 | 83 |
2024 August | 45 | 12 | 57 |
2024 July | 38 | 4 | 42 |
2024 June | 35 | 6 | 41 |
2024 May | 30 | 6 | 36 |
2024 April | 43 | 4 | 47 |
2024 March | 45 | 6 | 51 |
2024 February | 30 | 12 | 42 |
2024 January | 43 | 17 | 60 |
2023 December | 40 | 8 | 48 |
2023 November | 48 | 10 | 58 |
2023 October | 50 | 6 | 56 |
2023 September | 36 | 4 | 40 |
2023 August | 22 | 3 | 25 |
2023 July | 25 | 6 | 31 |
2023 June | 21 | 4 | 25 |
2023 May | 26 | 1 | 27 |
2023 April | 18 | 9 | 27 |
2023 March | 27 | 7 | 34 |
2023 February | 27 | 7 | 34 |
2023 January | 71 | 48 | 119 |
2022 December | 33 | 5 | 38 |
2022 November | 50 | 12 | 62 |
2022 October | 38 | 9 | 47 |
2022 September | 40 | 9 | 49 |
2022 August | 47 | 16 | 63 |
2022 July | 21 | 9 | 30 |
2022 June | 29 | 4 | 33 |
2022 May | 22 | 5 | 27 |
2022 April | 33 | 10 | 43 |
2022 March | 40 | 10 | 50 |
2022 February | 29 | 9 | 38 |
2022 January | 39 | 5 | 44 |
2021 December | 53 | 9 | 62 |
2021 November | 49 | 11 | 60 |
2021 October | 34 | 13 | 47 |
2021 September | 15 | 8 | 23 |
2021 August | 14 | 6 | 20 |
2021 July | 14 | 3 | 17 |
2021 June | 22 | 3 | 25 |
2021 May | 23 | 7 | 30 |
2021 March | 8 | 0 | 8 |
2020 December | 1 | 0 | 1 |
2020 November | 8 | 0 | 8 |