Urinary infection in patients with neurogenic bladder: Patterns of resistance to the most frequent uropathogens | Actas Urológicas Españolas (English Edition)

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Urinary tract infections &#40;UTI&#41; in patients with indwelling urinary catheter &#40;IUC&#41; or undergoing intermittent catheterization constitute a public health problem because of their frequency and morbidity&#44; not only in in-patients&#44; but also in long-stay centers&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The nosocomial UTI is associated with the presence of one IUC in 80&#37; of the cases&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The microorganisms causing the UTI in the probed patient come from their own flora further modified by exogenous environmental pressure&#44; as well as from the potential pathogens carried by the health personnel&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The most common route of infection is the upward one initiated in the urethra&#46; The microorganisms reach the urinary bladder through several mechanisms&#58; during the insertion of the catheter&#44; intraluminally through the light of the probe and extaluminally through the space between the probe and the urethra&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Two factors are central in the pathogenesis&#58; the adhesion and the ability to form a film or biofilm&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Inside the biofilm&#44; bacterial growth is slower&#44; probably because of the lack of oxygen and nutrients&#44; and the bacteria become more resistant to antimicrobial action&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the intensive care units &#40;ICU&#41;&#44; several risk factors added to the IUC for developing a UTI&#44; the length of the hospital stay being a determining factor&#58; the increase of days of stay in the ICU for critically ill patients is associated with the development of a urinary tract infection&#44; although this does not involve an increase in mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In the group of neurological patients&#44; either in the population affected with neurogenic bladder secondary to a spinal cord injury&#44; multiple sclerosis&#44; brain injury&#44; or myelomeningocele&#44; the risk of urinary tract infection increases due to both structural factors of the urinary tract and physiological ones&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The method of urination&#44; mainly the use of IUC&#44; and the frequent invasive instrumentation also play a role&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The patients having a urinary catheter have infection by multiresistant microorganisms more often&#44; such as gram-negative bacilli strains producing in-patient and out-patient extended-spectrum beta-lactamases &#40;ESBL&#41;&#46; This leads to difficulties associated with the treatment of the UTI&#44; especially when prescribing empirical treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The UTI in the community is a common cause for consultation&#44; especially in women at ages of maximum sexual activity&#44; during menopause&#44; and after menopause&#44; and in men older than 50&#59; however&#44; the spectrum of pathogens in uncomplicated infections is limited&#44; <span class="elsevierStyleItalic">Escherichia coli</span> being the most frequently isolated microorganism&#46; The presence in these groups of patients of ESBL-producing strains is low&#44; although there has been a rising incidence of these isolates&#44; mainly of <span class="elsevierStyleItalic">E&#46; coli</span>&#44; being mostly of in-patient origin&#44; but also acquired in the community and in patients without IUC&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We performed an epidemiological and prospective study of a total of 284 patients from 4 different population groups at the Vall d&#8217;Hebron University Hospital&#46; The groups studied were&#58; &#40;a&#41; 106 patients with neurological injury randomly selected attending check-up in neuro-urology outpatient consultations for 4 consecutive months&#59; &#40;b&#41; 28 patients without neurological injury attending the Urology Department for routine control&#59; &#40;c&#41; 75 patients coming from the ICU of our hospital&#59; and &#40;d&#41; 75 patients attending casualty with symptoms of UTI&#59; in this group&#44; the patients with a previous hospitalization were discarded&#46; Of all the patients&#44; 129 were men and 155 women&#46; This sample is the same as that used to perform the first part of this study&#44; which examined the etiology of the UTI in patients with neurogenic bladder depending on the method of urination used&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In neurological patients&#44; the urination systems and the method of obtaining the sample were defined&#44; through spontaneous urination or sterile catheterization if they were not able to make a spontaneous urination&#46; The patients admitted to the ICU were all carriers of IUC and the urine of the patients in the latter two groups was obtained by spontaneous voiding&#46; In all samples&#44; conventional microscopic examination and quantitative urine culture in chromogenic medium were performed&#46; We conducted the identification and study of resistance of all the urine cultures&#44; which were considered positive as described by J&#46; Mensa Pueyo&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The isolated microorganisms were identified by the Vitek-2<span class="elsevierStyleSup">&#169;</span> system&#46; The <span class="elsevierStyleItalic">in vitro</span> sensitivity study was carried out by analyzing the inhibition zone diameters obtained by the disk-diffusion method&#46; The drugs tested for enterobacteriaceae were ampicillin&#44; amoxicillin&#47;clavulanic acid&#44; cefoxitin&#44; nitrofurantoin&#44; fosfomycin&#44; ciprofloxacin&#44; and trimetroprin&#46; For enterococci&#44; ampicillin&#44; fosfomycin&#44; vancomycin&#44; nitrofurantoin&#44; levofloxacin&#44; and tetracycline&#59; and piperacillin&#47;tazobactan&#44; ampicillin&#47;sulbactan&#44; ceftazidime&#44; cefepime&#44; and imipenem for non-fermentative gram-negative bacilli&#46; We studied the cloxacillin and cephalothin resistance to <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#46; The strains producing extended-spectrum beta-lactamase were detected by the agar diffusion method&#44; studying the synergy between the third-generation cephalosporins and clavulanic acid&#46; If necessary&#44; they were confirmed by the double-disk diffusion plate method &#40;E-test&#41;&#46; All the techniques of the study of sensitivity were performed according to the recommendations of the Clinical and Laboratory Standards Institute&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The incidence values of the germs identified and the sensitivity data are described by the numerical value obtained and frequency&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">287 uropathogens were obtained&#44; 155 belonging to men&#44; and 132 to women &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In the 106 patients with neurological injury&#44; 67&#37; of the cultures were positive&#58; <span class="elsevierStyleItalic">E&#46; coli</span> was the most frequently isolated &#40;34&#37;&#41;&#44; followed by <span class="elsevierStyleItalic">Enterococcus</span> spp&#46; &#40;15&#46;5&#37;&#41;&#44; <span class="elsevierStyleItalic">Proteus</span> spp&#46; &#40;11&#46;3&#37;&#41;&#44; <span class="elsevierStyleItalic">Klebsiella</span> spp&#46;&#44; and <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> &#40;9&#46;0&#37;&#41;&#46; In the ICU of the General Hospital&#44; the most frequently isolated microorganism was <span class="elsevierStyleItalic">Enterococcus</span> spp&#46; &#40;19&#46;4&#37;&#41;&#44; followed by <span class="elsevierStyleItalic">P&#46; aeruginosa</span> &#40;16&#46;5&#37;&#41;&#44; <span class="elsevierStyleItalic">Candida albicans</span>&#44; and <span class="elsevierStyleItalic">E&#46; coli</span> with 14&#46;6&#37;&#44; respectively&#46; In the patients from casualty and in the control group&#44; <span class="elsevierStyleItalic">E&#46; coli</span> was the predominant microorganism&#44; with prevalences of 75&#46;9&#37; and 42&#46;9&#37;&#44; respectively&#46; In the latter two groups&#44; no non-fermenting gram-negative bacilli or yeasts were isolated&#46; <span class="elsevierStyleItalic">Candida</span> spp&#46; was isolated exclusively in patients admitted to the ICU &#40;18&#46;8&#37;&#41;&#44; and in two patients with neurological injury &#40;1&#46;8&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">5 <span class="elsevierStyleItalic">E&#46; coli</span> and a <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> strains producing extended spectrum beta-lactamase &#40;ESBL&#41; were isolated&#46; The ESBL strains of <span class="elsevierStyleItalic">E&#46; coli</span> corresponded to a 26-year-old woman of the casualty group&#44; two women aged 29 and 82 admitted to the ICU&#44; and a 56-year-old woman and a 62-year-old man who belonged to the group of patients with neurological injury&#46; The strain of <span class="elsevierStyleItalic">K&#46; pneumoniae</span> was isolated in an 82-year-old woman admitted to the ICU&#46; Three methicillin-resistant <span class="elsevierStyleItalic">S&#46; aureus</span> strains were isolated&#46; Two belonged to patients of the group of neurogenic patients&#44; a woman aged 62 and a man aged 27&#44; and the third one was isolated in a 78-year-old woman of the ICU group &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The ESBL-producing strains were resistant to all the beta-lactams tested&#44; except to cefoxitin&#46; These strains showed no resistance to fosfomycin or nitrofurantoin&#46; However&#44; 50&#37; of the isolated strains from neurological patients showed resistance to ciprofloxacin <span class="elsevierStyleItalic">versus</span> 0&#37; in ICU patients&#46; The ESBL <span class="elsevierStyleItalic">Klebsiella</span> strain isolated in a patient in the ICU only showed sensitivity to nitrofurantoin and fosfomycin of all the antibiotics tested &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In the groups of neurological patients and ICU patients&#44; <span class="elsevierStyleItalic">E&#46; coli</span> resistance to ampicillin was 54&#46;5 and 100&#37;&#44; respectively&#44; to amoxicillin&#47;clavulanic acid 21&#46;2 and 13&#46;3&#37;&#44; and 9&#46;1 and 13&#46;3&#37; to cefoxitin&#46; The rate of resistance to nitrofurantoin was higher in ICU patients &#40;13&#46;3&#37;&#41; than among patients with neurogenic lesion &#40;6&#46;1&#37;&#41;&#44; 6&#46;7&#37; being to fosfomycin in the ICU&#44; and 12&#46;1&#37; in neurological patients&#46; Resistances to ciprofloxacin and trimethoprim were more prevalent in the patients admitted to the ICU &#40;40 and 46&#46;7&#37;&#41; <span class="elsevierStyleItalic">versus</span> 39&#46;4&#37; for both antibiotics in the patients with neurogenic lesion &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In the patients from casualty&#44; resistances to ampicillin &#40;66&#46;7&#37;&#41;&#44; ciprofloxacin &#40;15&#37;&#41;&#44; and trimethoprim &#40;31&#46;7&#37;&#41; stand out&#46; In the control group&#44; ampicillin resistances are 100&#37; and 33&#46;3&#37; to fosfomycin and ciprofloxacin&#44; respectively&#46; The samples assessed were sensitive to nitrofurantoin &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding the non-fermenting gram-negative bacilli&#44; of the 21 isolates in the ICU&#44; 17 were <span class="elsevierStyleItalic">P&#46; aeruginosa</span> and 3 <span class="elsevierStyleItalic">Acinetobacter baumannii</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; <span class="elsevierStyleItalic">P&#46; aeruginosa</span> was resistant to piperacillin&#47;tazobactan in an isolate &#40;5&#46;8&#37;&#41;&#44; and to imipenem in three &#40;17&#46;6&#37;&#41;&#44; being sensitive to the other drugs tested&#46; A strain of <span class="elsevierStyleItalic">A&#46; baumannii</span> was resistant to piperacillin&#47;tazobactan &#40;33&#46;3&#37;&#41;&#44; two to ceftazidime &#40;66&#46;6&#37;&#41;&#44; and three to aztreonam &#40;100&#37;&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Among the neurological patients of the 9 strains of <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#44; only one was resistant to cefepime &#40;11&#37;&#41;&#44; and another one to imipenem &#40;11&#37;&#41;&#46; All of them were resistant to ampicillin&#47;sulbactan&#44; since this resistance is associated with the species&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Of the enterococci isolated from the ICU&#44; 18 were <span class="elsevierStyleItalic">Enterococcus faecalis</span> and two <span class="elsevierStyleItalic">Enterococcus faecium&#46; E&#46; faecium</span> was resistant to ampicillin and levofloxacin in the two isolates and tetracycline in one&#46; Of the 18 isolates of <span class="elsevierStyleItalic">E&#46; faecalis</span>&#44; 16 were resistant to tetracycline &#40;89&#37;&#41;&#44; and 7 to levofloxacin &#40;39&#37;&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In the group of neurological patients&#44; all the isolates are <span class="elsevierStyleItalic">E&#46; faecalis</span>&#46; All of them were susceptible to ampicillin&#44; vancomycin&#44; and nitrofurantoin&#46; Twelve of these were resistant to tetracycline &#40;80&#37;&#41;&#44; three to levofloxacin &#40;20&#37;&#41;&#44; and one to fosfomycin &#40;6&#46;6&#37;&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">Among all the population groups in our series&#44; except in the patients admitted to the ICU&#44; the most frequently isolated microorganism is <span class="elsevierStyleItalic">E&#46; coli&#58;</span> it is a major cause of infection in humans&#44; both of nosocomial and community origin&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and the most common etiologic agent in the urinary tract infection&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> In our series&#44; the <span class="elsevierStyleItalic">E&#46; coli</span> isolates among the patients who consult in casualty reach 76&#37;&#44; a slightly higher figure than that found by Andreu and the Spanish Cooperative Group in out-patient infection&#58; 70&#46;8&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Gobernado&#44; in a study on uncomplicated cystitis in women in Spain for a year&#44; estimated the <span class="elsevierStyleItalic">E&#46; coli</span> isolates at approximately 90&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> It is likely that such a high figure is due to sex&#44; diagnosis&#44; and youth of the population studied&#44; since in the present study by Al&#243;s&#44; there is a percentage of isolates of 80&#8211;85&#37; in a similar population group&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The control group behaves like the casualty patients&#44; but the low number of positive urine cultures in this series makes its thorough comparison difficult&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In neurological patients&#44; the frequent hospitalization and the urination method&#44; mainly the use of IUC&#44; make them have similar characteristics to nosocomial patients&#44; although they are not admitted at the time of developing the urinary tract infection&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In a study 25 years ago in the same center as the current one&#44; the most frequent germs obtained in chronic spinal cord injured patients&#58; 35&#37; <span class="elsevierStyleItalic">E&#46; coli</span>&#44; 21&#37; <span class="elsevierStyleItalic">Enterococcus</span>&#44; and 9&#37; <span class="elsevierStyleItalic">Pseudomonas</span>&#44; with the lowest resistances by colistin and fosfomycin&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In our series&#44; the most frequently isolated microorganism in this group is <span class="elsevierStyleItalic">E&#46; coli</span>&#44; but other enterobacteria like <span class="elsevierStyleItalic">Citrobacter</span>&#44; <span class="elsevierStyleItalic">Enterobacter</span>&#44; or <span class="elsevierStyleItalic">Serratia</span>&#44; which do not appear in the population group consulting in casualty&#44; are isolated&#46; Additionally&#44; certain clearly in-patient microorganisms such as <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#44; <span class="elsevierStyleItalic">A&#46; baumannii</span>&#44; or <span class="elsevierStyleItalic">Candida</span> spp&#46; are only in the patients admitted to the ICU and in the neurological ones&#44; as it has been well documented in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#8211;20</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In the out-patient <span class="elsevierStyleItalic">E&#46; coli</span> strains&#44; resistances to ampicillin &#40;66&#37;&#41;&#44; cotrimoxazole &#40;31&#46;6&#37;&#41;&#44; and ciprofloxacin &#40;15&#37;&#41; stand out&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In general&#44; the nosocomial strains are more resistant than those acquired in the community&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;21</span></a> In the <span class="elsevierStyleItalic">E&#46; coli</span> strains of the neurological patients&#44; ampicillin resistance is 51 and 100&#37; in the ICU&#46; Cotrimoxazole has 37&#37; resistance in neurological patients and 46&#37; in the ICU&#44; and 37 and 40&#37; ciprofloxacin&#44; respectively&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Regarding the isolated strains in the community&#44; the study by Gobernado reveals some resistance rates of 52&#37; to ampicillin&#44; 26&#37; to cotrimoxazole&#44; and 18&#37; to quinolones<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#59; that by Andreu 60&#46;7&#44; 32&#44; and 23&#46;9&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and that by Garc&#237;a 58&#46;2&#44; 30&#46;8&#44; and 30&#46;6&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> In the community of Madrid&#44; the quinolones &#40;44&#46;4&#37;&#41; and cotrimoxazole &#40;44&#46;8&#37;&#41; rates are higher&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> In neurological patients&#44; a 51&#37; resistance to ampicillin is surprising&#44; which&#44; in spite of being high&#44; is lower than in the series of community patients&#44; in which it ranges between 52 and 58&#46;2&#37;&#44; this fact not being explained due to the little use of the drug in this group&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The resistance to ampicillin has remained high and even increased significantly&#44; although in our area&#44; it has not been used in monotherapy to treat these infections for a long time&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> It may be due to the high consumption in Spain of broad spectrum beta-lactams&#44; as there is a statistically significant correlation between the consumption of these drugs and the resistance to ampicillin&#44; but not for amoxicillin&#47;clavulanic acid&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">E&#46; coli</span> resistances to cotrimoxazole are high&#44; but variable&#58; in our series&#44; they are 31&#46;6&#37;&#44; and in others performed in Spain in community patients they range between 26 and 32&#37;&#46; In neurological patients&#44; they are 37&#37;&#46; This also happens in other areas&#58; multicenter studies conducted in North America show that the resistance of outpatient strains in the U&#46;S&#46; has increased from 15&#37; in 1998<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> to 21&#46;3&#37; in 2004&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and from 10&#46;2 to 48&#46;5&#37; in Canada&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">It has also been observed that the empirical use of this drug in strains of resistant patients carries a worse clinical outcome than in sensitive strains&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> which discourages its use&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The resistance to quinolones in this study is 15&#37; in community strains&#44; which is a significantly lower rate than those described in Spanish series&#44; which range between 18 and 44&#37;&#44; and equally low compared to hospital strains&#44; where in the group of neurogenic patients&#44; the percentage is 37&#37;&#44; and 40&#37; in the ICU&#46; But the resistance to quinolones is linked to the geographical factor&#46; In Europe&#44; the rates of resistance to ciprofloxacin in 2000 were low in all the countries except Portugal and Spain&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> these having the highest consumption of this antibiotic&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> In the aforementioned American multicenter study&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> the resistance of uropathogenic <span class="elsevierStyleItalic">E&#46; coli</span> to ciprofloxacin was 6&#46;8&#37; in the U&#46;S&#46; and 1&#46;1&#37; in Canada&#46; In the series by Andreu&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> significant geographical differences were observed ranging between 12&#46;5 and 37&#46;3&#37;&#46; This situation is also contemplated in the U&#46;S&#46;&#44; where changes in the resistance between 2&#46;9&#37; in the Rocky Mountains and 20&#46;3&#37; in the Southwest are reflected&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Usually&#44; the resistance to quinolones in enterobacteriaceae is the result of the chromosomal mutation that causes alterations in the enzymatic target and the subsequent selection of the resistant strains induced by drug abuse&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> The reason for the gradual increase in resistance is the massive use of quinolones in both humans and animals&#44; with variations based on age &#40;the resistance increases with the age of the patient&#41; and on the geographic region&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Cephalosporins and amoxicillin&#47;clavulanic acid are maintained with low resistance rates in the community strains&#44; and even in neurological patients&#44; although resistance to amoxicillin&#47;clavulanic acid reaches 20&#37;&#44; lower in the ICU with 13&#37;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In this series&#44; the low rates of resistance to fosfomycin and nitrofurantoin&#44; widely documented in the literature&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;22</span></a> stand out&#44; but nitrofurantoin&#44; despite its proven efficacy&#44; is rarely used due to its potential pulmonary toxicity&#44; and&#44; especially&#44; due to its difficult therapeutic compliance&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In our series&#44; resistance to fosfomycin is 3&#46;3&#37; in the patients from casualty&#44; 6&#46;6&#37; in the ICU&#44; and 11&#37; in neurological patients&#44; a figure that although it is still relatively low&#44; it is higher than what is reflected by multicenter series&#46; Its high sensitivity is due to its special pharmacokinetics&#44; the acquisition of its resistance mechanisms through chromosomal mutation&#44; and its lack of use in human food and animal feed&#46; This makes it the ideal drug for the treatment of uncomplicated cystitis&#44; the comfort of its dosage&#44; 3<span class="elsevierStyleHsp" style=""></span>g of single-dose or every two days fosfomycin trometamol&#44; being a non-negligible advantage&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In recent years&#44; studies are being conducted on the effectiveness of fosfomycin in the strains producing extended-spectrum beta-lactamases&#44; provided they are isolated in patients with uncomplicated cystitis&#44; with favorable results&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> Such strains confer resistance to all beta-lactams except carbapenems&#44; and they frequently are cross-resistant to cotrimoxazole&#44; quinolones&#44; and fluoroquinolones&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> This is associated with a serious therapeutic problem in the treatment of urinary tract infections&#46; The efficacy of fosfomycin trometamol&#44; if confirmed&#44; would mean a major progress in the infections caused by these strains&#44; and it would avoid the intravenous treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">All the strains of <span class="elsevierStyleItalic">P&#46; aeruginosa</span> and <span class="elsevierStyleItalic">A&#46; baumannii</span> isolated in neurological patients in the ICU were sensitive to imipenem&#44; and all the enterococci isolated in these population groups were sensitive to vancomycin&#44; so no multiresistant strains were isolated among them&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In conclusion&#44; in neurological patients&#44; we must take into account the wide variety of microorganisms that can cause urinary tract infection&#46; Of the 5 ESBL <span class="elsevierStyleItalic">E&#46; coli</span> isolates&#44; two belong to this group &#40;2&#37;&#41;&#44; as well as two of the three strains of methicillin-resistant <span class="elsevierStyleItalic">S&#46; aureus</span> &#40;2&#37;&#41;&#46; The non-fermenting gram-negative bacilli &#40;10&#46;5&#37;&#41; also have prevalence&#44; and&#44; among the gram-positive ones&#44; the enterococci stand out with 15&#46;8&#37;&#46; To this we must add the presence of enterobacteria described above&#44; only isolated in this group and in patients admitted to the ICU&#44; who present very distant susceptibility profiles from the <span class="elsevierStyleItalic">E&#46; coli</span> strains isolated in the community&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The high resistances of cotrimoxazole and quinolones in the group of neurological patients do not recommend their use as empirical treatment&#44; perhaps reserving the latter for uncomplicated lower tract infections in young patients after antimicrobial susceptibility testing&#46; The cephalosporins remain stable&#44; so they are a good alternative&#44; but it is difficult to assess the use of amoxicillin&#47;clavulanic acid with 20&#37; resistance&#46; Nitrofurantoin&#44; and especially fosfomycin trometamol&#44; seem to offer a wide range of therapeutic possibilities&#44; particularly if their effectiveness in ESBL producing strains is confirmed&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">All this must be taken into account when prescribing empirical treatment&#44; being recommended whenever possible to perform a urine culture and study of resistances to establish a correct treatment or change it if necessary&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec89163"
          "palabras" => array:4 [
            0 => "Urinary tract infection"
            1 => "Resistances"
            2 => "Neurogenic bladder"
            3 => "Urethral cultures"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec89162"
          "palabras" => array:4 [
            0 => "Infecci&#243;n urinaria"
            1 => "Resistencias"
            2 => "Vejiga neur&#243;gena"
            3 => "Urinocultivos"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Purpose</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the most frequent causes and resistances of the uropathogens in patients affected by neurogenic bladder&#46;</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 284 patients&#44; in whom a total of 284 urinary cultures were performed&#44; were included&#46; Of these&#44; 106 came from patients with neurological injuries&#44; 28 from a non-neurogenic control group&#44; 75 from patients admitted to the intensive care unit &#40;ICU&#41; of our Hospital and 75 patients who came into the emergency room with the symptoms of an acute urinary tract infection&#46; A quantitative urine culture was performed in a chromogenic media and the resistances of all urine cultures that were positive for one or two micro-organisms were identified and studied&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 67&#37; of the patients with neurological injuries had positive urine cultures compared to 25&#37; of control group patients&#46; The urine cultures of patients admitted into the ICU and those of the Emergency Room group were 100&#37; positive&#44; since the first 75 positive urine cultures were selected for the study&#46; <span class="elsevierStyleItalic">Escherichia coli</span> was the most-frequently microorganism isolated in the group of neurological patients&#44; as well as among the patients from the Emergency Room and from the control group&#46; In the ICU&#44; the most-frequently isolated micro-organism was <span class="elsevierStyleItalic">Enterococcus</span> spp&#46; &#40;19&#46;4&#37;&#41;&#44; followed by <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> &#40;16&#46;5&#37;&#41;&#46; The study of resistances in general <span class="elsevierStyleItalic">E&#46; coli</span> has high rates of resistance to ampicillin and co-trimoxazole and&#44; although to a lesser degree to ciprofloxacin&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">E&#46; coli</span> is the micro-organism most frequently isolated among all of the groups except in the ICU&#44; where it is surpassed by <span class="elsevierStyleItalic">Enterococcus</span> spp&#46; and <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#46; The resistances among the four population groups studied have different features&#44; overall showing a low rate of resistance to nitrofurantoin and especially to fosfomycin&#44; observed in patients from the Emergency Room or admitted to the ICU and neurological patients&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar la etiolog&#237;a y resistencias de los uropat&#243;genos m&#225;s frecuentes en una pobla-ci&#243;n con vejiga neur&#243;gena&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 284 pacientes a los que se practicaron un total de 284 uro-cultivos&#46; De estos&#44; 106 proced&#237;an de pacientes con lesi&#243;n neurol&#243;gica&#44; 28 de grupo control no neur&#243;geno&#44; 75 de pacientes ingresados en la Unidad de Cuidados Intensivos &#40;UCI&#41; y 75 de pacientes que acudieron a Urgencias por sintomatolog&#237;a de infecci&#243;n aguda del tracto urinario&#46; Se realiz&#243; urocultivo cuantitativo en medio cromog&#233;nico&#44; as&#237; como identificaci&#243;n y estudio de resistencias de todos los urocultivos positivos para uno o dos microorganismos&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El 67&#37; de los pacientes neurol&#243;gicos presentaron urocultivos positivos&#44; frente al 25&#37; de los pacientes control&#46; Los urocultivos de pacientes ingresados en UCI y los del grupo Urgencias fueron positivos al 100&#37;&#44; ya que se seleccionaron los primeros 75 urocultivos positivos&#46; <span class="elsevierStyleItalic">E&#46; coli</span> fue el microorganismo m&#225;s frecuentemente aislado en el grupo de neurol&#243;gicos&#44; al igual que en enfermos procedentes de Urgencias y del grupo control&#46; En UCI fue <span class="elsevierStyleItalic">Enterococcus</span> spp&#46; &#40;19&#44;4&#37;&#41;&#44; seguido de <span class="elsevierStyleItalic">P&#46; aeruginosa</span> &#40;16&#44;5&#37;&#41;&#46; En el estudio de resistencias <span class="elsevierStyleItalic">E&#46; coli</span> present&#243; altas tasas de resistencia a ampicilina y cotrimoxazol y&#44; aunque en menor grado&#44; a ciprofloxacino&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">E&#46; coli</span> es el microorganismo m&#225;s frecuentemente aislado entre todos los grupos&#44; excepto en UCI&#44; en el que es superado por <span class="elsevierStyleItalic">Enterococcus</span> spp&#46; y <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#46; Las resisten-cias entre los 4 grupos de poblaci&#243;n estudiada tienen caracter&#237;sticas diferentes&#44; mostrando globalmente un bajo &#237;ndice de resistencias a nitrofuranto&#237;na y especialmente a fosfomicina&#44; observado en pacientes que provienen de Urgencias o ingresados en UCI y neurol&#243;gicos&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Romero-Culler&#233;s G&#44; et al&#46; Infecci&#243;n urinaria en pacientes con vejiga neur&#243;gena&#58; patrones de resistencias de los uropat&#243;genos m&#225;s frecuentes&#46; Actas Urol Esp&#46; 2012&#59;36&#58;474-81&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1152
            "Ancho" => 1499
            "Tamanyo" => 69078
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Prevalences of the most common isolated microorganisms compared in patients with neurogenic lesion &#40;NL&#41;&#44; intensive care unit &#40;ICU&#41;&#44; and casualty &#40;C&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 877
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            "Tamanyo" => 67385
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Percentage of <span class="elsevierStyleItalic">E&#46; coli</span> resistances to beta-lactams&#44; ciprofloxacin&#44; and fosfomycin&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">A patient may have more than one microorganism&#46; The percentages always refer to the total number&#46; ESBL&#58; extended-spectrum beta-lactamases&#59; PCNS&#58; Plasmacoagulase-negative Staphylococcus&#59; MARSA&#58; <span class="elsevierStyleItalic">S&#46; aureus</span> resistant cloxacillin&#46;</p>"
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                  \t\t\t\t">Number of isolates&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Male isolates&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Female isolates&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Total&#47;&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Total&#47;&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Total&#47;&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">111&#47;38&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41&#47;14&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">70&#47;24&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#47;1&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Klebsiella</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20&#47;7&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#47;2&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#47;0&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ESBL <span class="elsevierStyleItalic">Klebsiella</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#47;0&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#47;0&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">24&#47;8&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13&#47;4&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&#47;4&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Citrobacter</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#47;2&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Enterobacter</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#47;2&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#47;1&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#47;1&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">S&#46; marcescens</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#47;0&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#47;0&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#47;0&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">P&#46; aeruginosa</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#47;9&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&#47;6&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38&#47;13&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20&#47;7&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#47;6&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">S&#46; agalactiae</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#47;2&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#47;0&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#47;0&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">C&#46; parapsilosis</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#47;0&#46;3&#37;&nbsp;\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">1&#47;0&#46;3&#37;&nbsp;\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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \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">Candida</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
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                  \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">1&#47;0&#46;3&#37;&nbsp;\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">1&#47;0&#46;3&#37;&nbsp;\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="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
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                  \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">287&nbsp;\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
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                  \t\t\t\t">132&nbsp;\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
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                  \t\t\t\t">155&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t">Number of isolates&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Isolates&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Isolates&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Total&#47;&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">NL &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">ICU &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">C &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Control &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">111&#47;38&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">42&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">ESBL <span class="elsevierStyleItalic">E&#46; coli</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#47;1&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Klebsiella</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">20&#47;7&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">7&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ESBL <span class="elsevierStyleItalic">Klebsiella</span>&nbsp;\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
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \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">Proteus</span> spp&#46;&nbsp;\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">24&#47;8&#46;4&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;3&#37;&nbsp;\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="char" valign="\n
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                  \t\t\t\t">7&#46;8&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8&#37;&nbsp;\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="char" valign="\n
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                  \t\t\t\t">28&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Citrobacter</span> spp&#46;&nbsp;\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
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                  \t\t\t\t">6&#47;2&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Enterobacter</span> spp&#46;&nbsp;\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
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                  \t\t\t\t">8&#47;2&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">S&#46; marcescens</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#47;0&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;9&#37;&nbsp;\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="" valign="\n
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                  \t\t\t\t">&nbsp;\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="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">P&#46; aeruginosa</span>&nbsp;\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">26&#47;9&#46;1&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;3&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \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">A&#46; baumannii</span>&nbsp;\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">4&#47;1&#46;4&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><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">Other gram-negative bacilli</span>&nbsp;\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">5&#47;1&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Enterococci</span>&nbsp;\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">38&#47;13&#46;2&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;5&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;4&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">S&#46; agalactiae</span>&nbsp;\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">6&#47;2&#46;1&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">CEFOX&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;1&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;2&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">NITRO&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;1&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">FOSFO&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;1&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CIPRO&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">9&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">TRIM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">39&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">20&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab184384.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CEFOX&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NITRO&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">FOSFO&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;7&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;5&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">CIPRO&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;5&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">TRIM&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;7&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;5&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab184383.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Resistances of the most frequently isolated enterobacteriaceae in the group of patients with neurological lesions &#40;NL&#41; and those from the intensive care unit &#40;ICU&#41;&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">AMC&#58; amoxicillin-clavulanic&#59; AMP&#58; ampicillin&#59; CEFOX&#58; cefoxitin&#59; CIPRO&#58; ciprofloxacin&#59; FOSFO&#58; fosfomycin&#59; NITRO&#58; nitrofurantoin&#59; TRIM&#58; cotrimoxazole&#46;</p>"
          "tablatextoimagen" => array:2 [
            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"><td 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" style="border-bottom: 2px solid black">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">E&#46; coli</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">ESBL <span class="elsevierStyleItalic">E&#46; coli</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Proteus</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Klebsiella</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">ESBL <span class="elsevierStyleItalic">Klebsiella</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">AMP&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;7&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">125&#46;0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">180&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">AMC&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;5&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">CEFOX&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;5&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">NITRO&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">FOSFO&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;3&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;5&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">CIPRO&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;5&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">TRIM&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;7&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;5&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab184387.png"
              ]
            ]
            1 => 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"><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Control&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">E&#46; coli</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Proteus</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">AMC&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">CEFOX&nbsp;\t\t\t\t\t\t\n
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