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Wong, V. Galvis, A. Tello, D. Villareal, J.J. Rey" "autores" => array:5 [ 0 => array:2 [ "nombre" => "C.A." "apellidos" => "Wong" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Galvis" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Tello" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Villareal" ] 4 => array:2 [ "nombre" => "J.J." 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Wong, V. Galvis, A. Tello, D. Villareal, J.J. Rey" "autores" => array:5 [ 0 => array:4 [ "nombre" => "C.A." "apellidos" => "Wong" "email" => array:1 [ 0 => "cwongm@institutowong.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Galvis" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Tello" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Villareal" ] 4 => array:2 [ "nombre" => "J.J." "apellidos" => "Rey" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Fundación Oftalmológica de Santander–Clínica Carlos Ardila Lülle (FOSCAL), Universidad Industrial de Santander, Laboratorio Higuera Escalante–Centro de Diagnóstico Ocular OCULAB" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Susceptibilidad antibiótica <span class="elsevierStyleItalic">in vitro</span> a fluoroquinolonas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2107 "Ancho" => 1649 "Tamanyo" => 127194 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution of microorganisms in corneal samples in order of frequency.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The introduction of antimicrobial agents was one of the most significant developments in modern medicine, although it was soon found that microorganisms were able to develop resistance to said agents. In order to counteract the development and dissemination of resistant organisms, a rational use of antibiotics has been proposed as well as a call to discover and develop new antimicrobial agents.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The ophthalmologist must confront various types of infections, the most common of which are superficial infections such as conjunctivitis which fortunately do not lead to severe consequences. On the other hand, corneal or posterior segment infections such as endophthalmitis and retinitis can produce severe visual sequels. Endophthalmitis has been associated to severe visual loss in 20% of patients<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and frequently requires posterior vitrectomy and the application of intravitral antibiotics. Due to the severity of this type of infection, prevention is the most appropriate approach and prophylactic presurgery antibiotic treatments have become the norm.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Fluoroquinolones are bactericide agents frequently used in ophthalmology<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> due to their high effectiveness, broad range and specific activity on gram-negative pathogens. Fluoroquinolones prevent the synthesis of bacterial deoxyribonucleic acid (DNA) due to the inhibition of topoisomerases II and IV.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> According to their activity, they are divided in second generation fluoroquinolones such as ciprofloxacin; third-generation fluoroquinolones such as levofloxacin; and fourth generation such as moxifloxacin and gatifloxacin.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In general, fluoroquinolones are considered to be very good options for treating and preventing various ocular infections.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–9</span></a> This explains their increasing use in ophthalmology.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However, improper use of either systemic of topical antibiotics can lead to the appearance of bacterial resistance. In fact, some recent studies suggest that this resistance could be appearing even with fourth generation fluoroquinolones.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Accordingly, the aim of this paper is to analyze <span class="elsevierStyleItalic">in vitro</span> antibiotic susceptibility of the ocular pathogen flora in ocular infection cultures at the Ophthalmological Foundation of Santander–Carlos Ardila Lulle Clinic (FOSCAL), Floridablanca (Colombia). The collected information could be useful for an empirical selection of antibiotics in addition to providing a true picture of microbial resistance in our environment.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A descriptive and retrospective study of a series of records of ocular surface sample cultures (corneal or conjunctival) and intraocular liquids of the OCULAB–FOSCAL Lab (Floridablanca-Santander, Colombia), between January and December 2007.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The conjunctival surface samples were taken with a sterile cotton or calcium alginate cotton swab. For the cornea samples, a sterile Kimura spatula was used and additionally with clockmaker's tweezers for sampling tissue remains in the compromised area. In some cases, the corneal tissue obtained during the penetrating keratoplasty surgery was studied. Intraocular liquid was sampled with vitreal puncture (vitreous humor) or with paracentesis (aqueous humor).</p><p id="par0035" class="elsevierStylePara elsevierViewall">The direct study was made carrying out an extension in the glass plate, performing Gram and 10% potassium hydroxide (KOH) analysis. After doing the extension for the direct analysis, a sample was taken to place it in the culture and in a second step it was seeded with bacteriological matter in chocolate agar with CO<span class="elsevierStyleInf">2</span>, blood agar and McConkey agar. If anaerobics were suspected, the culture was made in phenylethyl alcohol, meat-liver agar, blood agar and chocolate agar in anaerobiosis.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Several culture media were utilized to provide various sample sources for agar plate culture. The media included standard low concentration nutritive culture (3<span class="elsevierStyleHsp" style=""></span>g/L yeast extract, ClNa 6<span class="elsevierStyleHsp" style=""></span>g/L, 15<span class="elsevierStyleHsp" style=""></span>g/L peptone base, 1<span class="elsevierStyleHsp" style=""></span>g/L glucose) and triptose medium (20<span class="elsevierStyleHsp" style=""></span>g/L triptose, 1<span class="elsevierStyleHsp" style=""></span>g/L glucose, 5<span class="elsevierStyleHsp" style=""></span>g/L ClNa, 0.005/L thiamin dichloride). After placing the sample in the culture at 37<span class="elsevierStyleHsp" style=""></span>°C, 24<span class="elsevierStyleHsp" style=""></span>hours were allowed to lapse before taking samples for a new evaluation under direct analysis for the solid agar cultures.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The cultures were checked at 24, 48 and 72<span class="elsevierStyleHsp" style=""></span>hours, reporting the microbial growth in each culture. In the absence of growth, the bacterial culture media were discarded at day 5.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Antibiogram was performed only for the positive culture bacteria, taking a sample of the culture over the agar and placing it in a brain–heart culture for approximately 12<span class="elsevierStyleHsp" style=""></span>hours. Subsequently, it was extended in a <span class="elsevierStyleItalic">Mueller Hinton</span> agar for antibiogram, seeding 3 times the entire surface of the plate rotating it 60° after each seeding to obtain uniform innoculation. The lid was left slightly open 5<span class="elsevierStyleHsp" style=""></span>min in order to absorb surface humidity, after which the antibiotic-impregnated discs were placed (Becton Dickinson-BBL™ Sensi-Disc™ Susceptibility Test Discs). Said discs were specifical for gram-positive or gram-negative (Kirby–Bauer method).</p><p id="par0055" class="elsevierStylePara elsevierViewall">The antibiotic sensidiscs had specific concentrations. The antibiograms were performed applying conventional diffusion methodology in <span class="elsevierStyleItalic">Mueller Hinton</span> agar. The agar plates were incubated 24<span class="elsevierStyleHsp" style=""></span>hours at 35<span class="elsevierStyleHsp" style=""></span>°C, studying the bacterial growth therein. The diameter of the inhibition area formed around each disc was measured. With this reference we were able to report whether the microorganism had sensitivity (S), intermediate sensitivity (I) or resistance (R) to each of the antibiotics assayed in the plates.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The variables were taken with an individual collection card for each sample, following the rules of the Helsinki Declaration and transferred to a Microsoft Excel database. The variables were analyzed with STATA and Epi Info 6.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Overall, 352 samples of conjunctival surface cultures were collected (conjunctival secretion), corneal surface (keratitis and corneal ulcers, corneal button sample, LASIK interface sample) and intraocular liquids (aqueous humor and vitreous humor samples). Of all the samples, 160 were of the conjunctiva (45.46%), 150 of the cornea (42.61%) and 42 of intraocular liquids (11.93%).</p><p id="par0070" class="elsevierStylePara elsevierViewall">Overall, the distribution was of 203 males and 149 females. A greater and statistically significant prevalence of cornea and intraocular liquids samples was found in males (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.10), matching the reports published by Serrano-Calderon et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> in our institution, possibly related to the higher risk of ocular trauma in males.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Of all the samples, 322 (91.42%) had positive cultures. More than one microorganism was recovered (polymicrobial infection) in 147 cultures (45.65% of the samples). This figure is significantly higher than those reported in other studies (21% found by Yeh et al.).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In order to determine whether the microorganisms present in the polymicrobial infections had different resistance than monomicrobial infections, analysis was made with cross infection tables with single microorganisms against polymicrobial infection both for gram-positive and gram-negative separately, without finding statistically significant differences.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The total number of identified bacteria was of 385: 303 gram-positive (78.7%), 71 gram-negative (18.4%), 1 anaerobic (0.3%), 2 <span class="elsevierStyleItalic">Mycobacterium</span> (0.5%) and in 8 cases <span class="elsevierStyleItalic">Chlamydia trachomatis</span> was suspected due to the presence of suggestive cytoplasmatic inclusions (2.1%); the remarkable predominance of gram-positive infections matches the findings of previous studies (Kunimoto et al. reported 71% of gram-positive germs in keratitis cultures).<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The total number of fungi was of 67 in all of the samples, with a predominance of <span class="elsevierStyleItalic">Aspergillus</span> sp. (46.3%), <span class="elsevierStyleItalic">Fusarium</span> sp. (26.9%) and <span class="elsevierStyleItalic">Candida</span> sp. (20.9%). The overall number of parasites was of 39, of which 94.9% were free-living amoebae of the <span class="elsevierStyleItalic">Acanthamoeba</span> sp. family.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Within the general group of gram-positive cultures, the most common were <span class="elsevierStyleItalic">Staphylococcus</span> nsp. (227 cases) including: 170 <span class="elsevierStyleItalic">Staphylococcus coagulase-negative</span> (including <span class="elsevierStyleItalic">Staphylococcus epidermidis</span>) and 57 <span class="elsevierStyleItalic">Staphylococcus aureus coagulase positive</span>, followed by siguieron <span class="elsevierStyleItalic">Corynebacterium</span> sp. (59 cases), <span class="elsevierStyleItalic">non-hemolytic Streptococcus type B</span> (7 cases), <span class="elsevierStyleItalic">Bacillus</span> sp. (6 cases), <span class="elsevierStyleItalic">Streptococcus viridans</span> (2 cases) and <span class="elsevierStyleItalic">Enterococcus</span> sp. (2 cases).</p><p id="par0090" class="elsevierStylePara elsevierViewall">Within the gram-negatives, the most common were <span class="elsevierStyleItalic">Haemophilus</span> sp. (24 cases), followed by <span class="elsevierStyleItalic">Klebsiella enterobacter</span> (18 cases), <span class="elsevierStyleItalic">Pseudomonas</span> sp. (11 cases), <span class="elsevierStyleItalic">Escherichia coli</span> (7 cases), <span class="elsevierStyleItalic">Enterobacter</span> sp. (3 cases), <span class="elsevierStyleItalic">Acinetobacter</span> sp. (2 cases), <span class="elsevierStyleItalic">Achromobacter</span> (2 cases); <span class="elsevierStyleItalic">Serratia marcescens</span>, <span class="elsevierStyleItalic">Proteus mirabilis</span>, <span class="elsevierStyleItalic">Salmonella typhi</span> and <span class="elsevierStyleItalic">Aeromona hydrophylla</span> (1 case each).</p><p id="par0095" class="elsevierStylePara elsevierViewall">In the conjunctive, 207 germs were identified, the most frequent being <span class="elsevierStyleItalic">Staphylococcus</span> sp. (mostly coagulase negative including <span class="elsevierStyleItalic">S. epidermidis</span>) and <span class="elsevierStyleItalic">Corynebacterium</span> sp. (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), matching previous studies.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14–16</span></a> Also gram-negative bacteria were evidenced but in a considerably lower percentage.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">In what concerns the cornea, the main isolated bacteria were <span class="elsevierStyleItalic">Staphylococcus</span> sp. (mostly coagulase-negative including <span class="elsevierStyleItalic">S. epidermidis</span>, <span class="elsevierStyleItalic">Acanthamoeba</span> sp., <span class="elsevierStyleItalic">Aspergillus</span> sp., <span class="elsevierStyleItalic">Corynebacterium</span> sp. and <span class="elsevierStyleItalic">Fusarium</span> sp.) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">From intraocular liquids the main bacteria were <span class="elsevierStyleItalic">Staphylococcus</span> coagulase-negative (including <span class="elsevierStyleItalic">S. epidermidis</span>) and <span class="elsevierStyleItalic">S. aureus</span> coagulase-positive (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">The antibiogram was performed in the cultures with positive sample for bacteria, placing sensidiscs with moxifloxacin (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), gatifloxacin (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), levofloxacin (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>) and ciprofloxacin (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comparison between resistance to fluoroquinolones</span><p id="par0115" class="elsevierStylePara elsevierViewall">The microorganisms exhibited lower resistance against fourth generation fluoroquinolones than against second and third-generation ones, with this difference being statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05).</p><p id="par0120" class="elsevierStylePara elsevierViewall">The overall bacterial resistance (gram-positive and gram-negative of any anatomic origin) to moxifloxacin was of 10.15% (33 out of 325) and gatifloxacin was of 6.46% (21 out of 325), with this difference being statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) by <span class="elsevierStyleItalic">x</span><span class="elsevierStyleSup">2</span> in SPSS 10 (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). The overall bacterial resistance to levofloxacin was of 30.77% (100 out of 325) and to ciprofloxacin of 32.0% (104 out of 325) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Bacterial resistance to fluoroquinolones for gram-positive bacteria, in growing order of resistance, was as follows: gatifloxacin 6.3% (17 out of 271), moxifloxacin 8.9% (24 out of 271), ciprofloxacin 33.2% (90 out of 271), levofloxacin 35.6% (91 out of 271) (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">In turn, resistance to fluoroquinolones for gram-negative in growing order of resistance was as follows: gatifloxacin 7.4% (4 out of 54), moxifloxacin 16.7% (9 out of 54), levofloxacin 16.7% (9 out of 54), ciprofloxacin 25.9% (14 out of 54) (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">The greater resistance to moxifloxacin than to gatifloxacin exhibited a statistically significant difference for positive as well as negative coagulase <span class="elsevierStyleItalic">S. aureus</span> (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.038 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.005 respectively); although it was not statistically significant for <span class="elsevierStyleItalic">Pseudomonae</span> sp. (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.737), probably due to the small amount of samples of these microorganisms.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">As described above, fluoroquinolones act on gyrase DNA (topoisomerase II) and on topoisomerase IV, with fourth generation fluoroquinolones exhibiting the highest action and the lowest probability of bacterial resistance as well as greater range of action because they act simultaneously on both enzymes. In order to develop resistance to second generation fluoroquinolones (ciprofloxacin, ofloxacin) bacteria only need one mutation whereas the newer fluoroquinolones such as moxifloxacin and gatifloxacin were specifically designed to be less affected by spontaneous mutations as generally two bacterial mutations are required to generate resistance.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> However, resistance to older generation fluoroquinolones has increased significantly in the last decade, and this may facilitate microorganisms developing resistance to fourth generation fluoroquinolones through mutation. The development of resistance to fourth generation fluoroquinolones has been evidenced <span class="elsevierStyleItalic">in vitro</span> in laboratories for over 5 years, although there are no final clinical studies confirming the lack of treatment effectiveness.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Due to the high percentage of bacterial resistance to second and third generation fluoroquinolones, their efficacy has been questioned for treating and preventing ocular infections. Studies published in the last decade have reported bacterial resistance levels of 30% for ofloxacin<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>; keratitis-derived bacterial resistance levels to ciprofloxacin of 21.5% (gram-positives) and 2.7% (gram-negatives), and to ofloxacin of 18.5% and 2.7%, respectively.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Another publication<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> reported a resistance of 30.7% to ciprofloxacin <span class="elsevierStyleItalic">in vitro</span> samplings of bacterial keratitis, with higher percentages for gram-positive bacteria along the lines of our results (in cornea samples, a level of 27% was found for all the bacteria: 28.8% for gram-positives and 13.3% for gram-negatives), with increasing resistance in recent years. In 2002, Mather et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> reported <span class="elsevierStyleItalic">in vitro</span> superiority of fourth generation fluoroquinolones over ciprofloxacin, ofloxacin and levofloxacin, particularly over gram-positive bacteria. The efficacy of these fluoroquinolones is very similar with gram-negative bacteria, as confirmed in recent <span class="elsevierStyleItalic">in vitro</span> bacterial susceptibility studies which evidenced an increase of microorganism resistance to second and third generation fluoroquinolones (levofloxacin and tosufloxacin) in normal conjunctival flora. Said studies also warned of some <span class="elsevierStyleItalic">Staphylococcus</span> sp. strands with possible resistance mechanisms to fluoroquinolones, which is highly relevant for clinical practice.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,15</span></a> It has also been published that dry eye patients exhibit higher resistance to fluoroquinolones.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">In this study we have observed increased resistance in comparison to previous studies. A striking finding which is specific to fourth generation fluoroquinolones is that the bacterial resistance levels were higher in gram negative germs than in gram-positive germs. This tendency would justify a switch to antimicrobials with lower microbial resistance levels such as fourth generation fluoroquinolones, particularly in situations where the antibacterial action is critical such as in the treatment of corneal or intraocular infections and endophthalmitis prophylactic treatment.</p><p id="par0155" class="elsevierStylePara elsevierViewall">As regards specific pathogens, <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> continues to be a highly resistant bacterium. However, in our study and due to the small sample size it was difficult to determine the antibiotic sensitivity of this pathogen. <span class="elsevierStyleItalic">Staphylococcus</span> sp. exhibited low resistance to these 2 important antibiotics. However, resistance is on the increase when compared to previous studies, which means that caution must be exercised in the management of these antibiotics.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Our study evidenced an important amount of infections by <span class="elsevierStyleItalic">Acanthamoebas</span> sp. (37 out of 231 samples). This is an infrequent microorganism (under 1% of corneal ulcers) and is generally related to the use of contact lenses.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22–24</span></a> Our study correlates with the high prevalence described in a previous study carried out in our institution<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> which evidenced that 25% of infectious keratitis patients were infected by <span class="elsevierStyleItalic">Acanthamoeba</span> sp., although unrelated to the use of contact lenses. A prospective study is being arranged to determine risk factors for this type of amoeba keratitis in our environment.</p><p id="par0165" class="elsevierStylePara elsevierViewall">The development of bacterial resistance to all fluoroquinolones, including fourth-generation ones, is a fact. However, the resistance percentage for the fourth-generation fluoroquinolones is statistically significantly lower compared to third and second generation ones, particularly for gram-positive bacteria.</p><p id="par0170" class="elsevierStylePara elsevierViewall">When comparing gatifloxacin and moxifloxacin, the former exhibited lower <span class="elsevierStyleItalic">in vitro</span> microbial resistance levels in our study, with statistically significant differences. Even so, the interpretation of this superiority must be very prudent in the clinical field because other factors must be taken into account such as the tissue penetration of these 2 antibiotics (higher for moxifloxacin), which produces a greater intraocular concentration thereof.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25–27</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">To conclude, we found that second and third generation fluoroquinolones exhibit high microbial resistance levels in our environment. Fourth generation fluoroquinolones still exhibit low bacterial resistance level and for this reason their clinical effectiveness in treatment as well as it prophylaxis must be higher. We consider that indiscriminate use or poor dosage of these antibiotics can enhance the appearance of microbial resistance and therefore they must be reserved for treating resistant conjunctival infections, corneal infections and endophthalmitis.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors have not declared any conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres152701" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec140704" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres152702" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Materiales y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec140703" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Comparison between resistance to fluoroquinolones" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-11-04" "fechaAceptado" => "2011-06-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec140704" "palabras" => array:5 [ 0 => "Bacterial resistance" 1 => "Antibiotics" 2 => "Fluoroquinolones" 3 => "Moxifloxacin" 4 => "Gatifloxacin" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec140703" "palabras" => array:5 [ 0 => "Resistencia bacteriana" 1 => "Antibióticos" 2 => "Fluoroquinolonas" 3 => "Moxifloxacino" 4 => "Gatifloxacino" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine the antibiotic susceptibility of bacteria recovered from cultures of ocular infections in the Fundación Oftalmológica de Santander–Clínica Carlos Ardila Lulle (FOSCAL).</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective descriptive study of a series of registries of cultures of samples from ocular surfaces and intraocular fluids from the OCULAB-FOSCAL laboratory in Floridablanca (Colombia) made between January and December of 2007. Antibiotic sensitivity screening by the method of Kirby–Bauer with impregnated Sensi-Discs™ of determined antibiotic concentrations was performed.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 352 samples were studied: 160 from conjunctiva, 150 from cornea and 42 from intraocular fluids. Of the total of the samples more than one microorganism was recovered 45.65% of the samples. Gram-positive and gram-negative bacteria were identified in 78.7 and 18.4%, respectively. Resistance to gatifloxacin, moxifloxacin, ciprofloxacin and levofloxacin was observed in 6.3, 8.9, 33.2 and 35.6%, respectively, of gram-positive bacteria. Resistance to gatifloxacin, moxifloxacin, ciprofloxacin and levofloxacin was also observed in 7.4, 16.7, 16.7% and 25.9%, respectively, of gram-negative bacteria. The overall bacterial resistance (gram-positive and gram-negative) to moxifloxacin was 10.15%, and to gatifloxacin it was 6.46%, being which showed a statistically significant difference (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In our study the development of bacterial resistance to fourth generation fluoroquinolones was demonstrated in ocular samples. However, lower levels of resistance to fourth generation fluoroquinolones compared with that of third and second generation were found, particularly to gram-positive. Gatifloxacin showed lower resistance levels than moxifloxacin. Nevertheless, interpretation of this superiority must be made with caution in the clinical field, since other factors, such as tissue penetration and <span class="elsevierStyleItalic">in vivo</span> activity, must be taken into account.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Determinar la susceptibilidad antibiótica de la bacterias obtenidas en cultivos de infecciones oculares en la Fundación Oftalmológica de Santander - Clínica Carlos Ardila Lulle (FOSCAL).</p> <span class="elsevierStyleSectionTitle">Materiales y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo retrospectivo de una serie de registros de cultivos de muestras de superficie ocular y líquidos intraoculares del laboratorio OCULAB-FOSCAL en Floridablanca (Colombia) realizados entreenero y diciembre de 2007. Se realizó antibiograma por el método de Kirby-Bauer con sensidiscos impregnados de concentraciones determinadas de antibiótico.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se recogieron un total de 352 muestras de los cuales 160 fueron de conjuntiva, 150 fueron de córnea y 42 de líquidos intraoculares. Se recuperó más de un microorganismo en el 45,65% del total de las muestras. El 78,7 y el 18,4% de las bacterias identificadas correspondieron a Gram positivos y a Gram negativos, respectivamente. El 6,3, 8,9, 33,2 y 35,6% de las bacterias Gram positivas fueron resistentes a gatifloxacino, moxifloxacino, ciprofloxacino y levofloxacino, respectivamente. El 7,4, 16,7, 16,7 y 25,9% de las bacterias Gram negativas fueron resistentes a gatifloxacino, moxifloxacino, ciprofloxacino y levofloxacino, respectivamente. La resistencia bacteriana global (tanto Gram positivos como Gram negativos) a moxifloxacino fue del 10,15% y a gatifloxacino del 6,46%, siendo esta diferencia estadísticamente significativa (p < 0,05).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En nuestro estudio, se evidenció el desarrollo de resistencia bacteriana en muestras oculares incluso con las fluoroquinolonas de cuarta generación. Sin embargo se encontraron menores niveles de resistencia para las fluoroquinolonas de cuarta generación que para las de tercera y segunda generación, especialmente entre Gram positivos. Gatifloxacino mostró menores niveles de resistencia que la moxifloxacino. La interpretación de esta superioridad debe, sin embargo, hacerse con cuidado en el campo clínico, ya que se deben tener en cuenta otros factores como la penetración tisular y la actividad <span class="elsevierStyleItalic">in vivo</span>.</p>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Wong CA, et al. Susceptibilidad antibiótica <span class="elsevierStyleItalic">in vitro</span> a fluoroquinolonas. Arch Soc Esp Oftalmol. 2012;87:72–8.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara">Presented in part and winner of first place to free labor in the XXXIV National and International Congress of Ophthalmology held in Bogota, Colombia from 10 to 14 August 2010.</p>" ] ] "multimedia" => array:10 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2093 "Ancho" => 1632 "Tamanyo" => 152779 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of microorganisms in conjunctival samples in order of frequency.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2107 "Ancho" => 1649 "Tamanyo" => 127194 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution of microorganisms in corneal samples in order of frequency.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1928 "Ancho" => 1607 "Tamanyo" => 112547 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Distribution of microorganisms in intraocular liquid samples in order of frequency.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 884 "Ancho" => 1447 "Tamanyo" => 72074 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Overall bacterial resistance to fluoroquinolones: gatifloxacin, moxifloxacin, levofloxacin and ciprofloxacin.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 845 "Ancho" => 1444 "Tamanyo" => 59178 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Bacterial resistance to fluoroquinolones for gram-positives: gatifloxacin, moxifloxacin, levofloxacin and ciprofloxacin.</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 842 "Ancho" => 1446 "Tamanyo" => 52509 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Bacterial resistance to fluoroquinolones for gram-negatives: gatifloxacin, moxifloxacin, levofloxacin and ciprofloxacin.</p>" ] ] 6 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Sensitivity to moxifloxacin for bacteria from corneal, conjunctival and intraocular liquid samples.</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">I: intermediate sensitivity; R: resistant; S: sensitive; T: total.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">Mox \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 " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Gram-positive</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Gram-negative</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">S \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">I \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">R \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">T \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">S \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">I \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">R \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">T \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">Conjuntiva \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">68 (52.7%) \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">49 (38.0%) \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"><span class="elsevierStyleBold">12 (9.3%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">129 (100%) \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 (53.3%) \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 (30.0%) \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"><span class="elsevierStyleBold">5 (16.7%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (100%) \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">Cornea \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">58 (52.3%) \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">43 (38.7%) \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"><span class="elsevierStyleBold">10 (9.0%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">111 (100%) \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">8 (53.3%) \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">4 (26.7%) \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"><span class="elsevierStyleBold">3 (20.0%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (100%) \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">Intraocular liquids \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 (35.5%) \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 (58.1%) \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"><span class="elsevierStyleBold">2 (6.4%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (100%) \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">4 (44.4%) \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">4 (44.4%) \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"><span class="elsevierStyleBold">1 (11.2%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab246900.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Antibiotic sensitivity to moxifloxacin.</p>" ] ] 7 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Sensitivity to gatifloxacin for bacteria from corneal, conjunctival and intraocular liquid samples.</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">I: intermediate sensitivity; R: resistant; S: sensitive; T: total.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">Gat \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 " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Gram-positives</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Gram-negatives</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">S \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">I \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">R \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">T \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">S \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">I \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">R \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">T \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">Conjuntiva \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">80 (62.0%) \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">41 (31.8%) \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"><span class="elsevierStyleBold">8 (6.2%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">129 (100%) \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">21 (70.0%) \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">8 (26.7%) \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"><span class="elsevierStyleBold">1 (3.3%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (100%) \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">Cornea \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">65 (58.6%) \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 (33.3%) \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"><span class="elsevierStyleBold">9 (8.1%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">111 (100%) \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 (60.0%) \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">4 (26.7%) \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"><span class="elsevierStyleBold">2 (13.3%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (100%) \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">Intraocular liquids \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 (58.1%) \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">13 (41.9%) \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"><span class="elsevierStyleBold">0 (0.0%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (100%) \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 (55.6%) \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 (33.3%) \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"><span class="elsevierStyleBold">1 (11.1%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab246901.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Antibiotic sensitivity to gatifloxacin.</p>" ] ] 8 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Sensitivity to levofloxacin for bacteria from corneal, conjunctival and intraocular liquid samples.</p><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">I: intermediate sensitivity; R: resistant; S: sensitive; T: total.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">Lev \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 " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Gram-positives</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Gram-negatives</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">S \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">I \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">R \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">T \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">S \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">I \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">R</span> \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">T \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">Conjuntiva \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">38 (29.5%) \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">48 (37.2%) \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"><span class="elsevierStyleBold">43 (33.3%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">129 (100%) \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">13 (43.3%) \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 (36.7%) \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"><span class="elsevierStyleBold">6 (20.0%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (100%) \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">Cornea \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">27 (24.3%) \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">47 (42.4%) \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"><span class="elsevierStyleBold">37 (33.3%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120 (100%) \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 (33.3%) \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 (60.0%) \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"><span class="elsevierStyleBold">1 (6.7%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (100%) \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">Intraocular liquids \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 (16.1%) \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 (48.4%) \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"><span class="elsevierStyleBold">11 (35.5%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 (100%) \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 (33.3%) \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">4 (44.5%) \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"><span class="elsevierStyleBold">2 (22.2%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab246903.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Antibiotic sensitivity to levofloxacin.</p>" ] ] 9 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Sensitivity to ciprofloxacin for bacteria from corneal, conjunctival and intraocular liquid samples.</p><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">I: intermediate sensitivity; R: resistant; S: sensitive; T: total.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">Cip \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 " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Gram-positives</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Gram-negatives</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">S \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">I \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">R \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">T \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">S \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">I \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">R \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">T \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">Conjuntiva \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 (31.0%) \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">42 (32.6%) \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"><span class="elsevierStyleBold">47 (36.4%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">129 (100%) \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">10 (33.3%) \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 (40.0%) \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"><span class="elsevierStyleBold">8 (26.7%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (100%) \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">Cornea \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">34 (30.6%) \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">45 (40.6%) \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"><span class="elsevierStyleBold">32 (28.8%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">111 (100%) \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">4 (26.7%) \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 (60.0%) \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"><span class="elsevierStyleBold">2 (13.3%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (100%) \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">Intraocular liquids \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 (20.0%) \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">13 (43.3%) \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"><span class="elsevierStyleBold">11 (36.7%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (100%) \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">4 (44.4%) \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 (11.2%) \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"><span class="elsevierStyleBold">4 (44.4%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab246902.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Antibiotic sensitivity to ciprofloxacin.</p>" ] ] 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