Clinical features and microbiological in bacterial keratitis in a tertiary referral hospital | Archivos de la Sociedad Española de Oftalmología (English Edition)

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Broad range topical antibiotic therapy is applied initially<a class="elsevierStyleCrossRef" href="#bib0270">18</a> – and modified if necessary – on the basis of clinical response, severity, risk of perforation, culture results and antimicrobial sensitivity.<a class="elsevierStyleCrossRefs" href="#bib0275">19–21</a> It is important to emphasize sample taking and culture of patients with infectious keratitis, because this is crucial in the management, follow-up and evolution of the condition.<a class="elsevierStyleCrossRefs" href="#bib0265">17,22–25</a>Bacterial keratitis is a frequently diagnosed and treated disease in hospital environments, that can produce severe corneal alterations with loss of transparency and diminished visual acuity. The present study aims at describing the epidemiological pattern, the risk factors, symptomatology and antibiotic susceptibility in bacteria infectious keratitis at the Ophthalmology Department of the Fundación Jiménez Díaz University Hospital between 2009 and 2014, in order to contribute to the knowledge and management of this frequent disease.Subjects, material and methodsA descriptive, observational and retrospective study based on the review of clinical records of patients with a diagnostic of bacterial keratitis between 2009 and 2014 at the Ophthalmology and Ocular Emergency Department of the Fundación Jiménez Díaz University Hospital (HUFJD) (Madrid, Spain). The sample was obtained on the basis of the main inclusion criteria, i.e. all patients with positive culture who had the antibiotic susceptibility analysis, excluding patients with polymicrobial infectious keratitis, those with possible contamination report and with non-bacterial infectious keratitis.The approval and authorization of the HUFJD Ethics Committee was requested for managing clinic as well as laboratory data. The Helsinki declaration rules were adhered to, obtaining data from clinic records and lab reports of the Ophthalmological and Microbiology Departments respectively, that were collected on a data collection file.The microbiological reports were derived from corneal scrapings performed with “prior topical anesthesia” with spatula and subsequent extension of samples on glass slides for direct examination with Gram staining, culturing the samples in chocolate agar culture medium with CO2 and blood agar, as well as the respective study of the antibiotic and antibiogram with disk-plate, reported as microorganisms sensitive or resistant to specific antibiotics.The results were processed with a Microsoft Excel™ spreadsheet and the statistical application SPSS 19.0. Statistical chi square was applied for analysis, and data confidentiality was preserved at all times.ResultsConsidering the inclusion and exclusion criteria, of 180 patients with positive culture a sample of 160 patients was obtained (n=160): 93 females and 67 males. Overall, 51.3% of patients were over 65 years of age (82) and the most frequent age group was that between 76 and 85 years (34). One patient exhibited bilateral involvement. The year that presented the largest number of cases (38) was 2012, while 2009 was the year with the lowest number of patients (13). The most frequent symptom for the visit was eye reddening (n=100), with a statistically significant ratio only for coagulase-negative Staphylococcus (p=0.05). The next most frequent symptom was ocular pain (n=62) and the third most frequent symptom were secretions (n=40). The less frequent symptoms were blurred vision (n=9) and itching (n=8). Six patients referred no symptoms at all and were diagnosed casually. The most frequent risk factor was the use of contact lenses (n=58), followed by the presence of ocular surface diseases (n=51) and a history of previous ocular surgery (n=40). The ratio between the use of contact lenses and ocular disease as regards sex was not statistically significant (p=0.924; p=0.248, respectively, <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In contact lens users the most common germs were coagulase-negative Staphylococcus (n=17; p=0.04) and P. aeruginosa (n=12; p=0.018), with a statistically significant ratio for both microorganisms (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The most frequent microorganisms were coagulase-negative Staphylococcus (n=33), Staphylococcus aureus (n=31) and P. aeruginosa (n=20). Gram-positive bacteria were most common (n=103; 2/3), with the rest of being gram-negative (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>The antibiotics for which the bacteria were most sensitive were: gentamicin (n=114), cotrimoxazole (n=107), vancomycin (n=106), ciprofloxacin (n=97), rifampicin (n=96) and linezolid (n=91) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The antibiotics to which the bacteria were most resistant included ampicilin (n=59) and erythromycin (n=45), and those to which they were less resistant were vancomycin (n=2) and ceftazidime (n=1) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). S. aureus was mainly sensitive to amikacin and vancomycin, coagulase-negative Staphylococcus was sensitive to ciprofloxacin, gentamicin and vancomycin, while P. aeruginosa was sensitive to ciprofloxacin and amikacin (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>DiscussionThe objective of this study was to describe the tendencies in relation to age, sex, symptomatology, risk factors, sensitivity and resistance of bacteria causing keratitis, as well as the clinic characteristics and risk factors in HUFJD patients between 2009 and 2014. The 76–85 age group was the most numerous because they were patients with ocular surface disease (31.9%) and previous ocular surgery (25%). These 2 added factors turned said age group into the most affected one (to which we must add some patients who used therapeutic contact lenses which, despite monthly replacement and broad range antibiotic prophylaxis in the authors’ department, were still predisposed to infection). Said factors did not affect the population under 45 (finding reported by Bourcier et al.<a class="elsevierStyleCrossRef" href="#bib0310">26</a>), in which they were less frequent. In addition, the authors’ findings do not match those reported by Cibils et al.<a class="elsevierStyleCrossRef" href="#bib0315">27</a> and Laspina et al.,<a class="elsevierStyleCrossRef" href="#bib0320">28</a> in which patients over 70 were part of the group that exhibited keratitis with lower frequency. In the present study, the predominant sex was female, whereas in the studies by Cibils et al.<a class="elsevierStyleCrossRef" href="#bib0315">27</a> and Laspina et al.<a class="elsevierStyleCrossRef" href="#bib0320">28</a> it was male, being equal in the study by Bourcier et al.<a class="elsevierStyleCrossRef" href="#bib0310">26</a> In the present study, the most common risk factor was the use of contact lenses,<a class="elsevierStyleCrossRef" href="#bib0220">8</a> followed by ocular surface disease. The less frequent was previous keratitis, that was only preceded by ocular trauma (4.4%). However, the latter factor was more frequent in the paper by Ifeoma and Ezegwui<a class="elsevierStyleCrossRef" href="#bib0325">29</a> in Nigeria, and the third in frequency in the studies by Bourcier<a class="elsevierStyleCrossRef" href="#bib0320">28</a> and Jeng et al.<a class="elsevierStyleCrossRef" href="#bib0205">5</a> The last 2 studies were carried out in developing countries and support the study by Ifeoma and Ezegwui,<a class="elsevierStyleCrossRef" href="#bib0325">29</a> probably because protective measures as well as early healthcare are very deficient in said countries. In the present study, 67% of positive cultures were due to gram-positive bacteria comprising 2/3 of keratitis cases, with gram-negative bacteria being accountable for the remaining third. These findings are compatible with those reported by the American Ophthalmology Academy and by Pandita and Murphy.<a class="elsevierStyleCrossRefs" href="#bib0220">8,30</a> On the other hand, the high frequency of gram-positive bacteria is higher than the numbers reported by several authors in different studies.<a class="elsevierStyleCrossRefs" href="#bib0310">26–28</a> In what concerns the type of bacterian agent, coagulase-negative Staphylococcus (20.6%), S. aureus (19.4%) and P. aeruginosa (12.5%) were the most frequent bacteria, matching the results found in other studies.<a class="elsevierStyleCrossRefs" href="#bib0220">8,26–28</a>In the present study, the highest bacterian sensitivity was for gentamicin, vancomycin and ciprofloxacin. The latter finding differs from the results obtained by Galvis et al.,<a class="elsevierStyleCrossRefs" href="#bib0315">27,31</a> who concluded that ciprofloxacin exhibited low bacterian sensitivity. However, this could depend on the region.<a class="elsevierStyleCrossRef" href="#bib0220">8</a> The sensitivity findings for gentamicin of the present study match those of Sunilkumar.<a class="elsevierStyleCrossRef" href="#bib0355">35</a> Bacteria exhibited higher resistance to ampicillin, erythromycin and cotrimoxazol. On the other hand, ciprofloxacin, levofloxacin, vancomycin and gentamicin were the antibiotics against which bacteria exhibited lowest resistance, matching the results reported by Wong et al.<a class="elsevierStyleCrossRef" href="#bib0335">31</a> and Sunilkumar.<a class="elsevierStyleCrossRef" href="#bib0340">32</a> The finding for gentamicin is worthy of note because it is not frequently used due to its toxicity. The authors believe that for this reason gentamicin is reported in the antibiogram analysis as one of the antibiotics with higher sensitivity. This could be very useful against bacterial resistance to other more commonly used antibiotics. As ciprofloxacin was one of the antibiotics that reported lowest resistance in antibiograms, the authors would recommend rational use thereof, as well as reserving the application of fourth-generation quinolones such as moxifloxacin for non-responding and second line keratitis cases, or for severe keratitis<a class="elsevierStyleCrossRefs" href="#bib0345">33–36</a> (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>On the basis of the present findings, the authors would recommend deciding the baseline empirical treatment of bacterial keratitis on the basis of risk factor, clinic characteristics, severity and Gram report, preferably with aminoglycoside in addition to fluoroquinolone. In severe keratitis cases (with large central infiltrates extending to the deep stroma, chronic or with atypical appearance), or with risk factor history against resistance microorganisms, it is recommended to apply reinforced topical eyedrops with aminoglycoside or ceftazidime together with vancomycin. Culture results and antibiogram are critically important in all keratitis cases, even more so in the presence of resistant microorganisms or keratitis with poor evolution despite treatment.The present study demonstrates how the broad use of antibiotics in clinic practice has led to increased bacterian resistance, utilizing erythromycin by way of example. Accordingly, the authors insist on the need of an increasingly rational use of antibiotics in clinic practice.Conflict of interestsThe authors declare that they have no commercial interests and have not received financial support from any entity. In addition, the authors declare no conflict of interests." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres888067" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec874005" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres888066" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec874004" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Subjects, material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:2 [ "identificador" => "xack297016" "titulo" => "Acknowledgments" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-09-20" "fechaAceptado" => "2017-01-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec874005" "palabras" => array:3 [ 0 => "Antibiotic resistance" 1 => "Bacterial keratitis" 2 => "Clinical features" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec874004" "palabras" => array:3 [ 0 => "Resistencia antibiótica" 1 => "Queratitis bacteriana" 2 => "Características clínicas" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo describe the clinical features, bacterial agents, and antibiotic sensitivity of bacterial keratitis in the Ophthalmology Department at the University Hospital Fundación Jiménez Díaz (HUFJD) in Madrid. Materials and methodsA retrospective observational descriptive study using clinical records and reports of corneal scrapings in patients with bacterial keratitis at the HUFJD conducted between 2009 and 2014. ResultsIn a sample of 160 patients, gram-positive bacteria were the most prevalent with 64.3% (n=103). Coagulase negative Staphylococcus (20.6%), Staphylococcus aureus (19.4%), and Pseudomonas aeruginosa (12.5%) were the most frequent bacteria. The most common risk factor was the use of contact lenses, followed by disease of the ocular surface, and previous ocular surgeries. The antibiotics to which the bacteria were most commonly susceptible were gentamicin (n=114), cotrimoxazole (n=107), vancomycin (n=106), and ciprofloxacin (n=97). The antibiotics to which the bacteria were most commonly resistant were ampicillin (n=59) and erythromycin (n=45). ConclusionsIn the initial management of bacterial keratitis, the sensitivity and resistance of bacteria to antibiotics should be taken into account. Based on our findings, the use of aminoglycosides, vancomycin and fluoroquinolones is recommended, and, although widely used today, the discontinuation of erythromycin." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoDescribir las características clínicas, agentes bacterianos y sensibilidad antibiótica de las queratitis bacterianas en el Servicio de Oftalmología del Hospital Universitario Fundación Jiménez Díaz (HUFJD) de Madrid. Materiales y métodosEstudio observacional, descriptivo y retrospectivo de los registros clínicos e informes de los raspados corneales en pacientes con queratitis bacterianas en el HUFJD realizados entre los años 2009 y 2014. ResultadosSe tuvo una muestra de 160 pacientes. Las bacterias grampositivas fueron las más prevalentes con un 64,3% (n=103). Staphylococcus coagulasa negativo (20,6%), Staphylococcus aureus (19,4%) y Pseudomonas aeruginosa (12,5%) fueron las bacterias más frecuentes. El factor de riesgo más común fue el uso de lentes de contacto, seguido de enfermedad de la superficie ocular y cirugías oculares previas.Los antibióticos a los que las bacterias fueron más comúnmente sensibles fueron: gentamicina (n=114), cotrimoxazol (n=107), vancomicina (n=106) y ciprofloxacina (n=97) y los antibióticos a los que las bacterias fueron más comúnmente resistentes fueron ampicilina (n=59) y eritromicina (n=45). ConclusionesEn el manejo inicial de las queratitis bacterianas se debería tener en cuenta la sensibilidad y resistencia de las bacterias ante los antibióticos. Recomendamos, con base en nuestros hallazgos, el uso de aminoglucósidos, vancomicina y fluoroquinolonas, e interrumpir el uso de eritromicina, que es ampliamente usada actualmente." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Ruiz Caro JM, Cabrejas L, de Hoz MR, Mingo D, Duran SP. Características clínicas y microbiológicas en queratitis infecciosas bacterianas en un hospital de tercer nivel. Arch Soc Esp Oftalmol. 2017;92:419–425." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "Presented as a paper of the Master in Health Sciences Research." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1300 "Ancho" => 2102 "Tamanyo" => 133243 ] ] "descripcion" => array:1 [ "en" => "Risk factors." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1778 "Ancho" => 2660 "Tamanyo" => 292256 ] ] "descripcion" => array:1 [ "en" => "Frequency of bacterian agents." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1660 "Ancho" => 2640 "Tamanyo" => 268458 ] ] "descripcion" => array:1 [ "en" => "Distribution of antibiotics per sensitive cases." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1563 "Ancho" => 2214 "Tamanyo" => 168625 ] ] "descripcion" => array:1 [ "en" => "Distribution of antibiotics per resistance cases." ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "AP, ampicillin; CIP, ciprofloxacin; COT, cotrimoxazole; CTZ, ceftazidime; ERI, erythromycin; GEN, gentamicin; LEV, levofloxacin; RIF, rifampicin; TC, tetracycline; TO, tobramycin; VC, vancomycin." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Bacterian agent \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="11" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Antimicrobian (n=number of resistant cases)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">AP \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CTZ \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CIP \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">COT \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ERI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">GEN \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LEV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">RIF \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">TC \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">TO \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">VC \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Staphylococcus epidermidis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coagulase-negative Staphylococcus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Streptococcus pneumoniae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pseudomonas aeruginosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1500830.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Sensitive cases per antimicrobial and bacterian agent." ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "AK, amikacin; AP, ampicillin; CIP, ciprofloxacin; COT, cotrimoxazol; CTZ, ceftazidime; CZ, cefazoline; ERI, erythromycin; GEN, gentamicin; LEV, levofloxacin; RIF, rifampicin; TC, tetracycline; TO, tobramycin; VC, vancomycin." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Bacterian agent \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="13" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Antimicrobian (n=number of sensitive cases)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">AK \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">AP \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CZ \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CTZ \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CIP \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">COT \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ERI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">GEN \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LEV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">RIF \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">TC \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">TO \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">VC \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Staphylococcus epidermidis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coagulase-negative Staphylococcus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Streptococcus pneumoniae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pseudomonas aeruginosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1500829.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Resistance cases per antimicrobial and bacterial agent." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bib0185" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Keratitis: a clinical approach" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. 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Clinical features and microbiological in bacterial keratitis in a tertiary referral hospital

Características clínicas y microbiológicas en queratitis infecciosas bacterianas en un hospital de tercer nivel

J.M. Ruiz Caroa,

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drivertad@hotmail.com

Corresponding author.

, L. Cabrejasa, M.R. de Hozb, D. Mingoa, S.P. Durana

a Departamento de Oftalmología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain

b Instituto de Investigación Ramón Castroviejo, Madrid, Spain

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Streptococcus</span> and <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; as well as gram-negative enteric bacteria&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;3&#44;6&#8211;8</span></a> It must be taken into account that bacterial keratitis is the most frequent suppurative corneal ulcer&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">9</span></a> It can exhibit symptoms such as pain&#44; foreign body feeling&#44; redeye&#44; photophobia&#44; tearing and secretion<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">10</span></a> and its risk factors include contact lens use&#44; ocular trauma&#44; previous ocular surgery &#40;including laser assisted in situ keratomileusis or Lasik&#41;&#44; ocular surface diseases &#40;dry eye syndrome&#44; blepharitis&#44; entropion&#44; corneal exposure and anesthesia&#41;&#44; previous herpetic or bacterial keratitis as well as local or systemic immunosuppression&#44; diabetes and vitamin A deficiency&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;3&#44;11&#44;12</span></a> Laboratory studies on infectious keratitis include corneal scraping for Gram staining and cultures to isolate the causing microorganism and determine antibiotic susceptibility&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">13&#8211;17</span></a> The sensitivity test is performed to determine the most effective available antimicrobial&#46; Broad range topical antibiotic therapy is applied initially<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a> &#8211; and modified if necessary &#8211; on the basis of clinical response&#44; severity&#44; risk of perforation&#44; culture results and antimicrobial sensitivity&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">19&#8211;21</span></a> It is important to emphasize sample taking and culture of patients with infectious keratitis&#44; 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that were collected on a data collection file&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The microbiological reports were derived from corneal scrapings performed with &#8220;prior topical anesthesia&#8221; with spatula and subsequent extension of samples on glass slides for direct examination with Gram staining&#44; culturing the samples in chocolate agar culture medium with CO<span class="elsevierStyleInf">2</span> and blood agar&#44; as well as the respective study of the antibiotic and antibiogram with disk-plate&#44; reported as microorganisms sensitive or resistant to specific antibiotics&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The results were processed with a Microsoft Excel&#8482; spreadsheet and the statistical application SPSS 19&#46;0&#46; Statistical chi square was applied for analysis&#44; and data confidentiality was preserved at all times&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Considering the inclusion and exclusion criteria&#44; of 180 patients with positive culture a sample of 160 patients was obtained &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>160&#41;&#58; 93 females and 67 males&#46; Overall&#44; 51&#46;3&#37; of patients were over 65 years of age &#40;82&#41; and the most frequent age group was that between 76 and 85 years &#40;34&#41;&#46; One patient exhibited bilateral involvement&#46; The year that presented the largest number of cases &#40;38&#41; was 2012&#44; while 2009 was the year with the lowest number of patients &#40;13&#41;&#46; The most frequent symptom for the visit was eye reddening &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#41;&#44; with a statistically significant ratio only for coagulase-negative <span class="elsevierStyleItalic">Staphylococcus</span> &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The next most frequent symptom was ocular pain &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>62&#41; and the third most frequent symptom were secretions &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;&#46; The less frequent symptoms were blurred vision &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41; and itching &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&#46; Six patients referred no symptoms at all and were diagnosed casually&#46; The most frequent risk factor was the use of contact lenses &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58&#41;&#44; followed by the presence of ocular surface diseases &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41; and a history of previous ocular surgery &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;&#46; The ratio between the use of contact lenses and ocular disease as regards sex was not statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;924&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;248&#44; respectively&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In contact lens users the most common germs were coagulase-negative <span class="elsevierStyleItalic">Staphylococcus</span> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41; and <span class="elsevierStyleItalic">P&#46; aeruginosa</span> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;018&#41;&#44; with a statistically significant ratio for both microorganisms &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The most frequent microorganisms were coagulase-negative <span class="elsevierStyleItalic">Staphylococcus</span> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#41;&#44; <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#41; and <span class="elsevierStyleItalic">P&#46; aeruginosa</span> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46; Gram-positive bacteria were most common &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>103&#59; 2&#47;3&#41;&#44; with the rest of being gram-negative &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The antibiotics for which the bacteria were most sensitive were&#58; gentamicin &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>114&#41;&#44; cotrimoxazole &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>107&#41;&#44; vancomycin &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>106&#41;&#44; ciprofloxacin &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>97&#41;&#44; rifampicin &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>96&#41; and linezolid &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>91&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The antibiotics to which the bacteria were most resistant included ampicilin &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&#41; and erythromycin &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>45&#41;&#44; and those to which they were less resistant were vancomycin &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41; and ceftazidime &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; <span class="elsevierStyleItalic">S&#46; aureus</span> was mainly sensitive to amikacin and vancomycin&#44; coagulase-negative <span class="elsevierStyleItalic">Staphylococcus</span> was sensitive to ciprofloxacin&#44; gentamicin and vancomycin&#44; while <span class="elsevierStyleItalic">P&#46; aeruginosa</span> was sensitive to ciprofloxacin and amikacin &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">The objective of this study was to describe the tendencies in relation to age&#44; sex&#44; symptomatology&#44; risk factors&#44; sensitivity and resistance of bacteria causing keratitis&#44; as well as the clinic characteristics and risk factors in HUFJD patients between 2009 and 2014&#46; The 76&#8211;85 age group was the most numerous because they were patients with ocular surface disease &#40;31&#46;9&#37;&#41; and previous ocular surgery &#40;25&#37;&#41;&#46; These 2 added factors turned said age group into the most affected one &#40;to which we must add some patients who used therapeutic contact lenses which&#44; despite monthly replacement and broad range antibiotic prophylaxis in the authors&#8217; department&#44; were still predisposed to infection&#41;&#46; Said factors did not affect the population under 45 &#40;finding reported by Bourcier et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a>&#41;&#44; in which they were less frequent&#46; In addition&#44; the authors&#8217; findings do not match those reported by Cibils et al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a> and Laspina et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a> in which patients over 70 were part of the group that exhibited keratitis with lower frequency&#46; In the present study&#44; the predominant sex was female&#44; whereas in the studies by Cibils et al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a> and Laspina et al&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a> it was male&#44; being equal in the study by Bourcier et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a> In the present study&#44; the most common risk factor was the use of contact lenses&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a> followed by ocular surface disease&#46; The less frequent was previous keratitis&#44; that was only preceded by ocular trauma &#40;4&#46;4&#37;&#41;&#46; However&#44; the latter factor was more frequent in the paper by Ifeoma and Ezegwui<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">29</span></a> in Nigeria&#44; and the third in frequency in the studies by Bourcier<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a> and Jeng et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">5</span></a> The last 2 studies were carried out in developing countries and support the study by Ifeoma and Ezegwui&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">29</span></a> probably because protective measures as well as early healthcare are very deficient in said countries&#46; In the present study&#44; 67&#37; of positive cultures were due to gram-positive bacteria comprising 2&#47;3 of keratitis cases&#44; with gram-negative bacteria being accountable for the remaining third&#46; These findings are compatible with those reported by the American Ophthalmology Academy and by Pandita and Murphy&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">8&#44;30</span></a> On the other hand&#44; the high frequency of gram-positive bacteria is higher than the numbers reported by several authors in different studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">26&#8211;28</span></a> In what concerns the type of bacterian agent&#44; coagulase-negative <span class="elsevierStyleItalic">Staphylococcus</span> &#40;20&#46;6&#37;&#41;&#44; <span class="elsevierStyleItalic">S&#46; aureus</span> &#40;19&#46;4&#37;&#41; and <span class="elsevierStyleItalic">P&#46; aeruginosa</span> &#40;12&#46;5&#37;&#41; were the most frequent bacteria&#44; matching the results found in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">8&#44;26&#8211;28</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In the present study&#44; the highest bacterian sensitivity was for gentamicin&#44; vancomycin and ciprofloxacin&#46; The latter finding differs from the results obtained by Galvis et al&#46;&#44;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">27&#44;31</span></a> who concluded that ciprofloxacin exhibited low bacterian sensitivity&#46; However&#44; this could depend on the region&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a> The sensitivity findings for gentamicin of the present study match those of Sunilkumar&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">35</span></a> Bacteria exhibited higher resistance to ampicillin&#44; erythromycin and cotrimoxazol&#46; On the other hand&#44; ciprofloxacin&#44; levofloxacin&#44; vancomycin and gentamicin were the antibiotics against which bacteria exhibited lowest resistance&#44; matching the results reported by Wong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">31</span></a> and Sunilkumar&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a> The finding for gentamicin is worthy of note because it is not frequently used due to its toxicity&#46; The authors believe that for this reason gentamicin is reported in the antibiogram analysis as one of the antibiotics with higher sensitivity&#46; This could be very useful against bacterial resistance to other more commonly used antibiotics&#46; As ciprofloxacin was one of the antibiotics that reported lowest resistance in antibiograms&#44; the authors would recommend rational use thereof&#44; as well as reserving the application of fourth-generation quinolones such as moxifloxacin for non-responding and second line keratitis cases&#44; or for severe keratitis<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">33&#8211;36</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">On the basis of the present findings&#44; the authors would recommend deciding the baseline empirical treatment of bacterial keratitis on the basis of risk factor&#44; clinic characteristics&#44; severity and Gram report&#44; preferably with aminoglycoside in addition to fluoroquinolone&#46; In severe keratitis cases &#40;with large central infiltrates extending to the deep stroma&#44; chronic or with atypical appearance&#41;&#44; or with risk factor history against resistance microorganisms&#44; it is recommended to apply reinforced topical eyedrops with aminoglycoside or ceftazidime together with vancomycin&#46; Culture results and antibiogram are critically important in all keratitis cases&#44; even more so in the presence of resistant microorganisms or keratitis with poor evolution despite treatment&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The present study demonstrates how the broad use of antibiotics in clinic practice has led to increased bacterian resistance&#44; utilizing erythromycin by way of example&#46; Accordingly&#44; the authors insist on the need of an increasingly rational use of antibiotics in clinic practice&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no commercial interests and have not received financial support from any entity&#46; In addition&#44; the authors declare no conflict of interests&#46;</p></span></span>"
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    "fechaRecibido" => "2016-09-20"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the clinical features&#44; bacterial agents&#44; and antibiotic sensitivity of bacterial keratitis in the Ophthalmology Department at the University Hospital Fundaci&#243;n Jim&#233;nez D&#237;az &#40;HUFJD&#41; in Madrid&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective observational descriptive study using clinical records and reports of corneal scrapings in patients with bacterial keratitis at the HUFJD conducted between 2009 and 2014&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In a sample of 160 patients&#44; gram-positive bacteria were the most prevalent with 64&#46;3&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>103&#41;&#46; Coagulase negative <span class="elsevierStyleItalic">Staphylococcus</span> &#40;20&#46;6&#37;&#41;&#44; <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;19&#46;4&#37;&#41;&#44; and <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> &#40;12&#46;5&#37;&#41; were the most frequent bacteria&#46; The most common risk factor was the use of contact lenses&#44; followed by disease of the ocular surface&#44; and previous ocular surgeries&#46; The antibiotics to which the bacteria were most commonly susceptible were gentamicin &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>114&#41;&#44; cotrimoxazole &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>107&#41;&#44; vancomycin &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>106&#41;&#44; and ciprofloxacin &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>97&#41;&#46; The antibiotics to which the bacteria were most commonly resistant were ampicillin &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&#41; and erythromycin &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>45&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In the initial management of bacterial keratitis&#44; the sensitivity and resistance of bacteria to antibiotics should be taken into account&#46; Based on our findings&#44; the use of aminoglycosides&#44; vancomycin and fluoroquinolones is recommended&#44; and&#44; although widely used today&#44; the discontinuation of erythromycin&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Describir las caracter&#237;sticas cl&#237;nicas&#44; agentes bacterianos y sensibilidad antibi&#243;tica de las queratitis bacterianas en el Servicio de Oftalmolog&#237;a del Hospital Universitario Fundaci&#243;n Jim&#233;nez D&#237;az &#40;HUFJD&#41; de Madrid&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; descriptivo y retrospectivo de los registros cl&#237;nicos e informes de los raspados corneales en pacientes con queratitis bacterianas en el HUFJD realizados entre los a&#241;os 2009 y 2014&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se tuvo una muestra de 160 pacientes&#46; Las bacterias grampositivas fueron las m&#225;s prevalentes con un 64&#44;3&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>103&#41;&#46; <span class="elsevierStyleItalic">Staphylococcus</span> coagulasa negativo &#40;20&#44;6&#37;&#41;&#44; <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;19&#44;4&#37;&#41; y <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> &#40;12&#44;5&#37;&#41; fueron las bacterias m&#225;s frecuentes&#46; El factor de riesgo m&#225;s com&#250;n fue el uso de lentes de contacto&#44; seguido de enfermedad de la superficie ocular y cirug&#237;as oculares previas&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los antibi&#243;ticos a los que las bacterias fueron m&#225;s com&#250;nmente sensibles fueron&#58; gentamicina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>114&#41;&#44; cotrimoxazol &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>107&#41;&#44; vancomicina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>106&#41; y ciprofloxacina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>97&#41; y los antibi&#243;ticos a los que las bacterias fueron m&#225;s com&#250;nmente resistentes fueron ampicilina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&#41; y eritromicina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>45&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">En el manejo inicial de las queratitis bacterianas se deber&#237;a tener en cuenta la sensibilidad y resistencia de las bacterias ante los antibi&#243;ticos&#46; Recomendamos&#44; con base en nuestros hallazgos&#44; el uso de aminogluc&#243;sidos&#44; vancomicina y fluoroquinolonas&#44; e interrumpir el uso de eritromicina&#44; que es ampliamente usada actualmente&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ruiz Caro JM&#44; Cabrejas L&#44; de Hoz MR&#44; Mingo D&#44; Duran SP&#46; Caracter&#237;sticas cl&#237;nicas y microbiol&#243;gicas en queratitis infecciosas bacterianas en un hospital de tercer nivel&#46; Arch Soc Esp Oftalmol&#46; 2017&#59;92&#58;419&#8211;425&#46;</p>"
      ]
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Presented as a paper of the Master in Health Sciences Research&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Risk factors&#46;</p>"
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      1 => array:7 [
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        "etiqueta" => "Fig&#46; 2"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Bacterian agent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="11" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Antimicrobian &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>number of resistant cases&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">AP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CTZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CIP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">COT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ERI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">GEN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LEV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">RIF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">TC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">TO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">VC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus epidermidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Coagulase-negative Staphylococcus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Streptococcus pneumoniae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Bacterian agent&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ERI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">GEN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LEV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">TC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">VC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
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