Stratification by demographic and clinical data of the antibiotic susceptibility of Escherichia coli from urinary tract infections of the community

array:24 ["pii" => "S0212656718303469" "issn" => "02126567" "doi" => "10.1016/j.aprim.2018.06.004" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "1604" "copyright" => "The Authors" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Aten Primaria. 2019;51:494-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 769 "formatos" => array:3 [ "EPUB" => 53 "HTML" => 416 "PDF" => 300 ] ] "itemSiguiente" => array:19 [ "pii" => "S0212656718303470" "issn" => "02126567" "doi" => "10.1016/j.aprim.2018.07.006" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "1615" "copyright" => "The Authors" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Aten Primaria. 2019;51:499-505" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1481 "formatos" => array:3 [ "EPUB" => 49 "HTML" => 1000 "PDF" => 432 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "ORIGINAL" "titulo" => "Perfil sociodemográfico del usuario de la homeopatía en España" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "499" "paginaFinal" => "505" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Sociodemographic profile of the homeopathy user in Spain" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2454 "Ancho" => 1417 "Tamanyo" => 306337 ] ] "descripcion" => array:1 [ "es" => "Resumen gráfico del perfil del usuario de homeopatía." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lorena Cano-Orón, Isabel Mendoza-Poudereux, Carolina Moreno-Castro" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Lorena" "apellidos" => "Cano-Orón" ] 1 => array:2 [ "nombre" => "Isabel" "apellidos" => "Mendoza-Poudereux" ] 2 => array:2 [ "nombre" => "Carolina" "apellidos" => "Moreno-Castro" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0212656718303470?idApp=UINPBA00004N" "url" => "/02126567/0000005100000008/v1_201910110654/S0212656718303470/v1_201910110654/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0212656717303797" "issn" => "02126567" "doi" => "10.1016/j.aprim.2018.06.002" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "1602" "copyright" => "The Authors" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Aten Primaria. 2019;51:486-93" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2956 "formatos" => array:3 [ "EPUB" => 50 "HTML" => 1458 "PDF" => 1448 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Diseño y validación de la escala para valorar la fragilidad de los pacientes crónicos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "486" "paginaFinal" => "493" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Design and validation of the scale to assess the fragility of chronic patients" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1558 "Ancho" => 1630 "Tamanyo" => 147891 ] ] "descripcion" => array:1 [ "es" => "Área gráfica de la curva ROC de EPADI." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Antonio Jesús Núñez-Montenegro, Victoria Martín-Yañez, María Ángeles Roldan-Liébana, Francisca Dolores González-Ruiz, Rita Fernández-Romero, Cristina Narbona-Ríos" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Antonio Jesús" "apellidos" => "Núñez-Montenegro" ] 1 => array:2 [ "nombre" => "Victoria" "apellidos" => "Martín-Yañez" ] 2 => array:2 [ "nombre" => "María Ángeles" "apellidos" => "Roldan-Liébana" ] 3 => array:2 [ "nombre" => "Francisca Dolores" "apellidos" => "González-Ruiz" ] 4 => array:2 [ "nombre" => "Rita" "apellidos" => "Fernández-Romero" ] 5 => array:2 [ "nombre" => "Cristina" "apellidos" => "Narbona-Ríos" ] 6 => array:1 [ "colaborador" => "en representación del grupo EPADI" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0212656717303797?idApp=UINPBA00004N" "url" => "/02126567/0000005100000008/v1_201910110654/S0212656717303797/v1_201910110654/es/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Stratification by demographic and clinical data of the antibiotic susceptibility of Escherichia coli from urinary tract infections of the community" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "494" "paginaFinal" => "498" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Martín C. Grados, Israel J. Thuissard, Juan-Ignacio Alós" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Martín C." "apellidos" => "Grados" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Israel J." "apellidos" => "Thuissard" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Juan-Ignacio" "apellidos" => "Alós" "email" => array:1 [ 0 => "nachoalos@telefonica.net" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio Microbiología, Hospital Universitario de Getafe, Getafe, Carretera de Toledo km 12,500, 28905 Getafe, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad Europea, Villaviciosa de Odón, Calle Tajo s/n, 28670 Villaviciosa de Odón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estratificación por datos clínicos y demográficos de la sensibilidad antibiótica de Escherichia coli de infecciones del tracto urinario de origen comunitario" ] ] "textoCompleto" => "IntroductionUrinary tract infections (UTI) are common and contribute a significant burden to population health. In the United States, UTI account for approximately 10 million ambulatory visits and an estimated $2.000 in total cost each year.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> In Spain, one third of visits to primary care are due to infectious processes. Of these, 10% are urinary infections, most uncomplicated acute cistitis.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>UTI are one of the most common reasons for prescription of antimicrobials in primary care. Appropriate empirical therapy is important since treatment with an antimicrobial to which the uropathogen is resistant is associated with more clinical and microbiological failures, a longer median time to symptom resolution, higher re-consultation rates, and more subsequent antibiotics.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a>Acute uncomplicated UTI in women is generally managed effectively and safely by empirical antibiotic therapy without a urine culture, laboratory testing is undertaken when empirical therapy fails. In recurrent UTI and in complicated UTI, urine cultures and antimicrobial susceptibility tests are recommended. For these reasons laboratory-based surveillance suffers from requesting bias, and probably overestimate resistance rates.Antimicrobial resistance in common urinary pathogens is increasing at an alarming rate, as a result of overuse and misuse of antibiotics. Resistance patterns vary by geographic location, but are rising in Spain and globally.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a>Knowledge of local susceptibility patterns is important for the selection of appropriate empirical therapy of UTI. Reporting updated local susceptibility patterns<a class="elsevierStyleCrossRef" href="#bib0035">7</a> of the most frequently isolated microorganisms from urine samples influence physician decisions on therapeutic choices<a class="elsevierStyleCrossRef" href="#bib0040">8</a> allowing to choose more appropriate and effective treatments.Among outpatients, Escherichia coli is the main urinary tract pathogen, accounting for 60–85% of isolates. There are many studies in literature on the antibiotic susceptibility of E. coli and other uropathogens,<a class="elsevierStyleCrossRefs" href="#bib0025">5,9-12</a> but there are few studies, and less in primary care, evaluating the susceptibility of this microorganism considering some demographic and clinical data of patients such as sex, age and type of UTI.<a class="elsevierStyleCrossRefs" href="#bib0065">13-15</a> Our hypothesis is that if there were differences in the susceptibility patterns according to these characteristics of the patients, these last data would be more useful to guide clinicians to choose a more appropriate empirical treatment.Our goal was to determine the antibiotic susceptibility patterns of E. coli strains isolated from adult patients with UTI attended at primary care centers in Getafe (Madrid, Spain), to compare them with the global laboratory susceptibility data of adults with positive urine cultures in primary care, and to stratify the results by age, and type of UTI, determined by clinical data, to verify if there are statistically significant variations.Material and methodsDesign and study populationA cross-sectional prospective study was carried out. Inclusion criteria: Isolates of E. coli from urine (104–105cfu/ml) of adult patients, aged 18 and older, of all the primary care Centers in the Getafe area (Madrid, Spain); they were randomly selected from June 2016 to April 2017, one per patient; clinical and demographic data of the patients were obtained. Exclusion criteria: Isolates of E. coli from urine of patients aged less than 18 years, of hospital wards, and of the emergency department.The study protocol (17/82) was approved by the Comité Ético de Investigación con Medicamentos of Hospital Universitario de Getafe.Data and variablesClinical and demographic data (gender and age) were analyzed and, taking into account these features, the episodes were classified as complicated UTI, uncomplicated UTI or asymptomatic bacteriuria, according to the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) guidelines<a class="elsevierStyleCrossRef" href="#bib0080">16</a>; complicated UTI was considered in all men, and in patients with diabetes, indwelling catheter, neurogenic bladder, obstructive uropathy, history of pathologies or spinal surgeries, invasive urological procedure in the previous 3 months or immunosupresion.The antibiotic susceptibility of the strains of E. coli was determined by broth microdilution (MicroScan panels, California, USA) to the following antibiotics: amoxicillin, amoxicillin/clavulanic acid, fosfomycin, cotrimoxazole, nitrofurantoin, ciprofloxacin, gentamicin, cefotaxime, and imipenem. The results were interpreted according to the 2016 EUCAST guidelines<a class="elsevierStyleCrossRef" href="#bib0085">17</a> except for amoxicillin/clavulanic in which the 2016 CLSI guidelines were used.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>Global laboratory susceptibility data of adults of primary care with significant isolation of E. coli from urine cultures were obtained from our laboratory computer system.Statistical analysisFor the descriptive analysis, the absolute (n) and relative (%) frequencies were used to express the qualitative variables. Following the confirmation of the parametric behavior, mean±standard deviation (SD) or median [interquartile range; IQR] were used to express the quantitative variables. To test the statistically significant differences scenarios either the chi-square test or Fisher's exact test was performed for qualitative variables. Besides, either Student T test or U-Mann Whitney was used for quantitative variables according to the normality test. When the p-value was inferior to the alpha error (5%), a statistical significance was considered. The data analysis was performed with IBM SPSS statistics version 21.0 (IBM Corp; USA).ResultsIn our health care area 30,144 urine cultures were processed in 2016, of which 19,533 (64.8%) came from adult patients of primary care. E. coli was isolated in 2140 (61.4% of the considered positive cultures); its antibiotic susceptibility is represented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Of the 100 patients included, 15% were male and 85% female. The mean age was 58.3±18.8 years, 49 had complicated UTI, 44 uncomplicated UTI, and 7 had asymptomatic bacteriuria. Patients with uncomplicated UTI (44, all women) had a mean age of 54.1±18.0 years; Patients with complicated UTI (49 in total, 15 males and 34 females) had a mean age of 63.9±17.2 years, significantly higher (p=0.009).The overall analysis of antibiotic susceptibility of the 100 E. coli strains was: amoxicillin (47%), amoxicillin/clavulanic acid (86%), fosfomycin (99%), cotrimoxazole (73%), ciprofloxacin (74%), gentamicin (92%), nitrofurantoin (99%), cefotaxime (93%), and imipenem (100%) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The antibiotic susceptibility of part of these strains stratified in those with complicated UTI (n=49) and those with uncomplicated UTI (n=44) as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.When we compare the stratified antibiotic susceptibility, we found that strains isolated from patients with uncomplicated UTI showed significantly greater susceptibility than those of complicated UTI to amoxicillin (65.9% vs. 30.6%, p=0.001), amoxicillin/clavulanic acid (95.5% vs. 77.6%, p=0.013) and ciprofloxacin (81.8% vs. 63.3%, p=0.047).In complicated UTI, susceptibility to ciprofloxacin was significantly greater in the ≤65 years age group compared to the older age group (78.3% vs. 50%, respectively, p=0.041). In the rest of antibiotics, no statistically significant differences were obtained when comparing by age (≤65 years versus>65 years), both in uncomplicated and complicated UTI.DiscussionAntimicrobial resistance in common urinary pathogens is increasing at an alarming rate. Because of the predominance of E. coli as causative agent, resistance to this species is often of epidemiologic resistance studies.<a class="elsevierStyleCrossRefs" href="#bib0055">11,12,19</a>Laboratory-based surveillance suffers from requesting bias since primary care physicians are advised against urine sampling in cases of uncomplicated UTI in non-pregnant women at least at first presentation. Urine culture is recommended for patients with complicated infection, and to guide a change of antimicrobials for women who do not respond to initial therapy. Since patients who fail initial empirical therapy for UTI have more risk factors for antimicrobial resistance, complications or recurrence and are more likely to be tested, laboratory-based surveillance is likely to overestimate resistance rates.<a class="elsevierStyleCrossRef" href="#bib0100">20</a>Cumulative reports on antimicrobial susceptibility data provided by microbiological laboratories are important for selecting empiric treatments. There are many studies on antibiotic sensitivity of E. coli and other uropathogens.<a class="elsevierStyleCrossRefs" href="#bib0025">5,9-12</a> Weaknesses of these studies included a deficit of clinical data or even demographic data. A first or second episode of uncomplicated cystitis in a young woman is not the same as a UTI in a male with multiple episodes treated with antibiotics. Other methods of surveillance are required to provide unbiased estimates of antimicrobial resistance.To identify individual patient or clinical characteristics that predict antimicrobial resistance, culture results should be linked to patient demographics and clinical characteristics; however, urine samples are often submitted to the laboratory with insufficient supplementary clinical information. One strength of our study is that we have reviewed medical records (n=100). In fact, we have more patients with complicated UTI (n=49) than with uncomplicated UTI (n=44) because in many uncomplicated UTI, the most common type of urinary infection in primary care, urine cultures are not send to the laboratory.As expected, there were few differences in susceptibility between the global data of our laboratory (n=2140) and the data of the 100 strains included in this work (see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), but there were differences in some antibiotics between strains from uncomplicated UTI and complicated UTI, and depending on the age in ciprofloxacin in patients with complicated UTI. In cefotaxime, there was not a statistically significant difference due, in our opinion, to the restricted sample size.The data from the present study indicate that ciprofloxacin, ampicillin, and amoxicillin/clavulanic acid non-susceptibility in E. coli are associated mostly with isolates from complicated UTI. Explanation could be previous antibiotic treatments that would have selected resistant strains that colonize patients and cause infections in the next weeks/months. In a recent study,<a class="elsevierStyleCrossRef" href="#bib0075">15</a> an important variation in susceptibility to ciprofloxacin between cases of uncomplicated and complicated UTI were also observed.Reviewing the medical records of this study, we ascertain that amoxicillin/clavulanic acid and ciprofloxacin are frequently used for the empirical treatment of complicated UTIs (data not shown), which would explain the selection of resistances to these antibiotics and the differences with the strains isolated from uncomplicated UTI. We suggest not using these antibiotics in the empirical treatment of complicated UTI since susceptibility to both is less than 80%.It is important to note that the susceptibility to fosfomycin and nitrofurantoin remains high in all groups of patients analyzed. They would be an excellent option for the empirical treatment of cases of uncomplicated UTI, as it is stated in several guidelines.<a class="elsevierStyleCrossRefs" href="#bib0015">3,16</a> However, this is not the case of cotrimoxazole, 25% of strains are resistant. Although amoxicillin/clavulanic acid and ciprofloxacin are not considered appropriate empirical treatments for uncomplicated UTI, they would be an alternative as the rates of susceptibility are 95.5% and 81.8% respectively.A limitation of our study is that it was performed in a single-center (population 218,945 inhabitants), but in our opinion they warn of the convenience of stratify susceptibility data to obtain more usefulness of them. The subset of patients in some groups was of inadequate size to show statistical significances. Another limitation is that E. coli data underestimate resistance rates because they exclude bacteria like, for example, Enterobacter cloace and Pseudomonas aeruginosa with intrinsic resistance to various antibiotics, although these species are rare in UTI in primary care.In future it would be of interest to expand some group to obtain/to discard statistically differences in antibiotic susceptibility. Also, to evaluate the evolution over the time, as antibiotic resistance is dynamic.We conclude that clinical and demographic data are of great importance in the results of antibiotic susceptibility in E. coli causing UTI and would be more useful than global data in the choice of empirical treatments. Antibiograms stratified by patient characteristics may better facilitate empirical antibiotic selection for UTI in primary care.<elsevierMultimedia ident="tb0005"></elsevierMultimedia>Conflict of interestThe authors declare no conflict of interests." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1253684" "titulo" => "Abstract" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Aim" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Location" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Participants" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Main measurements" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Results" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1161763" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1253683" "titulo" => "Resumen" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "abst0040" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0045" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0050" "titulo" => "Emplazamiento" ] 3 => array:2 [ "identificador" => "abst0055" "titulo" => "Participantes" ] 4 => array:2 [ "identificador" => "abst0060" "titulo" => "Mediciones principales" ] 5 => array:2 [ "identificador" => "abst0065" "titulo" => "Resultados" ] 6 => array:2 [ "identificador" => "abst0070" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1161762" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design and study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Data and variables" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interest" ] 9 => array:2 [ "identificador" => "xack429573" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-05-16" "fechaAceptado" => "2018-06-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1161763" "palabras" => array:3 [ 0 => "Urinary tract infections" 1 => "Antimicrobial resistance" 2 => "Escherichia coli" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1161762" "palabras" => array:3 [ 0 => "Infecciones del tracto urinario" 1 => "Resistencia a antibióticos" 2 => "Escherichia coli" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "AimTo determine the patterns of antibiotic susceptibility of Escherichia coli strains isolated from adult patients with urinary tract infection (UTI), and to stratify the results by age and type of UTI to verify if there are statistically significant differences that can help physicians to prescribe better empirical antibiotherapy. DesignCross-sectional prospective study. LocationCommunity of Getafe (Madrid). Primary care level. Participants100 E. coli strains, randomly chosen, isolated from the urine (104–105cfu/ml) of different patients from primary care centers in the Getafe area. Main measurementsThe antibiotic susceptibility of the strains was evaluated and the results were stratified by age and type of UTI. The clinical and demographic data of the patients were analyzed, classifying each episode as complicated UTI or uncomplicated UTI. ResultsStrains isolated from patients with uncomplicated UTI showed significantly greater susceptibility than those of complicated UTI to amoxicillin (65.9% vs. 30.6%, p=0.001), amoxicillin/clavulanic acid (95.5% vs. 77.6%, p=0.013) and ciprofloxacin (81.8% vs. 63.3%, p=0.047). In complicated UTI, susceptibility to ciprofloxacin was significantly greater in the ≤65 years age group compared to the older age group (78.3% vs. 50%, respectively, p=0.041). In the rest of antibiotics, no statistically significant differences were obtained when comparing by age (≤65 years versus >65 years), both in uncomplicated and complicated UTI. ConclusionsClinical and demographic data of patients with UTI are of great importance in the results of the antibiotic susceptibility in E. coli. Antibiograms stratified by patient characteristics may better facilitate empirical antibiotic selection for UTI in primary care." "secciones" => array:7 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Aim" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Location" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Participants" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Main measurements" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Results" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoDeterminar los patrones de sensibilidad antibiótica de cepas de Escherichia coli aisladas de pacientes adultos con infección del tracto urinario (ITU), y estratificar los resultados por edad y tipo de ITU para verificar si existen diferencias estadísticamente significativas que puedan ayudar a los médicos a la prescripción de una mejor antibioterapia empírica. DiseñoEstudio transversal prospectivo. EmplazamientoComunidad de Getafe (Madrid). Nivel de atención primaria. Participantes100 cepas de E. coli, escogidas al azar, aisladas de orina (104 ->105ufc/ml) de diferentes pacientes de centros de atención primaria del área de Getafe. Mediciones principalesSe evaluó la sensibilidad antibiótica de las cepas y los resultados se estratificaron por edad y tipo de ITU. Se analizaron los datos clínicos y demográficos de los pacientes de los que provenían, clasificándose cada episodio como ITU complicada o ITU no complicada. ResultadosLas cepas aisladas de pacientes con ITU no complicada mostraron una sensibilidad antibiótica significativamente mayor que las de ITU complicada a amoxicilina (65,9% vs. 30,6%, p=0.001), amoxicilina/clavulánico (95,5% vs. 77,6%, p=0.013) y ciprofloxacino (81,8% vs. 63,3%, p=0.047). En la ITU complicada, la sensibilidad al ciprofloxacino fue significativamente mayor en el grupo de edad ≤65 años en comparación con el grupo de mayor edad (78,3% vs. 50%, p=0.041). Para el resto de antibióticos no se observaron diferencias significativas cuando se compararon por edad (≤65 versus>65), tanto en ITU no complicada como complicada. ConclusionesLos datos clínicos y demográficos de los pacientes con ITU son de gran importancia en los resultados de la sensibilidad antibiótica en E. coli. Los antibiogramas estratificados por características de los pacientes podrían facilitar una mejor selección de antibioterapia empírica para las ITU en atención primaria." "secciones" => array:7 [ 0 => array:2 [ "identificador" => "abst0040" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0045" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0050" "titulo" => "Emplazamiento" ] 3 => array:2 [ "identificador" => "abst0055" "titulo" => "Participantes" ] 4 => array:2 [ "identificador" => "abst0060" "titulo" => "Mediciones principales" ] 5 => array:2 [ "identificador" => "abst0065" "titulo" => "Resultados" ] 6 => array:2 [ "identificador" => "abst0070" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:2 [ 0 => 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:3 [ "leyenda" => "S, susceptible; cUTI, complicated urinary tract infections; uUTI, uncomplicated urinary tract infections." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">%S global \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">%S this study \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">%S cUTI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">%S uUTI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">P<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N=2140 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N=100<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N=49 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N=44 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ampicillin \t\t\t\t\t\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">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">47 \t\t\t\t\t\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">30.6 \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">65.9 \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">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amoxi/clav \t\t\t\t\t\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">83.4 \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">86 \t\t\t\t\t\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">77.6 \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">95.5 \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">0.013 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fosfomycin \t\t\t\t\t\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">97.8 \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">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\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">97.7 \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">0.473 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cotrimoxazole \t\t\t\t\t\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">70.7 \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">73 \t\t\t\t\t\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">67.3 \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">75.0 \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">0.417 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ciprofloxacin \t\t\t\t\t\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">76.1 \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">74 \t\t\t\t\t\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">63.3 \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">81.8 \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">0.047 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nitrofurantoin \t\t\t\t\t\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">99.0 \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">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\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">97.7 \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">0.473 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gentamicin \t\t\t\t\t\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">90.6 \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">92 \t\t\t\t\t\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">87.8 \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">95.5 \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">0.273 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cefotaxime \t\t\t\t\t\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">93.4 \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">93 \t\t\t\t\t\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">89.8 \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">97.7 \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">0.207 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Imipenem \t\t\t\t\t\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">99.9 \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">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">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">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">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2144307.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Include cUTI, uUTI and 7 cases of asymptomatic bacteriuria." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "When comparing data of cUTI and uUTI." ] ] ] "descripcion" => array:1 [ "en" => "Global antibiotic susceptibility of Escherichia coli strains from urine cultures of adult outpatients in 2016, antibiotic susceptibility of the 100 isolates of the present study, and the same stratified by type of UTI, complicated versus uncomplicated." ] ] 1 => array:5 [ "identificador" => "tb0005" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "What is known about the subject<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•E. coli is the pathogen most frequently involved in UTI. Global data of the antibiotic susceptibility (antibiograms) provided by laboratories influence the choice of empirical treatments.</li><li class="elsevierStyleListItem" id="lsti0010">•Most studies report global data of laboratories without stratification.</li><li class="elsevierStyleListItem" id="lsti0015">•Few studies evaluate the influence of clinical and demographic data on the results of antibiotic susceptibility.</li></ul>What this study contributes<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020">•Clinical and demographic data are of great importance in the results of antibiotic susceptibility in E. coli causing UTI. Antibiograms stratified by patient characteristics may better facilitate empirical antibiotic selection for UTI in primary care.</li></ul>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Economic burden of uncomplicated urinary tract infections: direct, indirect and intangible costs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.N. Keating" 1 => "E.M. Perfetto" 2 => "P. Subedi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Expert Rev Pharmaeconomic Outcomes Res." "fecha" => "2005" "volumen" => "5" "paginaInicial" => "457" "paginaFinal" => "466" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedad infecciosa en atención primaria: estudio prospectivo efectuado durante todo un año" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Llor" 1 => "S. Hernández" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimc.2009.03.014" "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin." "fecha" => "2010" "volumen" => "28" "paginaInicial" => "222" "paginaFinal" => "226" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19720435" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011; 52:e103-e120." ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical relevance of laboratory reported antibiotic resistance in acute uncomplicated urinary tract infection in primary care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.A. McNulty" 1 => "J. Richards" 2 => "D.M. Livermore" 3 => "P. Little" 4 => "A. Charlett" 5 => "E. Freeman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Antimicrob Chemother." "fecha" => "2006" "volumen" => "58" "paginaInicial" => "1000" "paginaFinal" => "1008" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surveillance Study in Europe and Brazil on Clinical Aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): Implications for Empiric Therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K.G. Naber" 1 => "G. Schito" 2 => "H. Botto" 3 => "J. Palou" 4 => "T. Mazzei" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2008.05.010" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2008" "volumen" => "54" "paginaInicial" => "1164" "paginaFinal" => "1178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18511178" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Etiología y sensibilidad de los uropatógenos identificados en infecciones urinarias bajas no complicadas de la mujer (estudio ARESC): Implicaciones en la terapia empírica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Palou" 1 => "C. Pigrau" 2 => "I. Molina" 3 => "J.M. Ledesma" 4 => "J. Angulo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0025-7753(11)70001-X" "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)." "fecha" => "2011" "volumen" => "136" "paginaInicial" => "1" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21596179" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antibiotic resistance: location, location, location" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.M. Livermore" 1 => "A. Pearson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Infect." "fecha" => "2007" "volumen" => "13" "numero" => "suppl 2" "paginaInicial" => "7" "paginaFinal" => "16" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does laboratory antibiotic susceptibility reporting influence primary care prescribing in urinary tract infection and other infections?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.A. McNulty" 1 => "G.M. Lasseter" 2 => "A. Charlett" 3 => "A. Lovering" 4 => "R. Howell-Jones" 5 => "A. Macgowan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jac/dkr088" "Revista" => array:6 [ "tituloSerie" => "J Antimicrob Chemother." "fecha" => "2011" "volumen" => "66" "paginaInicial" => "1396" "paginaFinal" => "1404" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21398297" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surveillance of antibiotic susceptibility of urinary tract pathogens for a population of 5.6 million over 4 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Ironmonger" 1 => "O. Edeghere" 2 => "A. Bains" 3 => "R. Loy" 4 => "N. Woodford" 5 => "P.M. Hawkey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jac/dkv043" "Revista" => array:6 [ "tituloSerie" => "J Antimicrob Chemother." "fecha" => "2015" "volumen" => "70" "paginaInicial" => "1744" "paginaFinal" => "1750" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25733586" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology and antimicrobial susceptibility profile of pathogens causing urinary tract infections in the Asia–Pacific region: Results from the Study for Monitoring Antimicrobial Resistance Trends (SMART), 2010-2013" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.S. Jean" 1 => "G. Coombs" 2 => "T. Ling" 3 => "V. Balaji" 4 => "C. Rodrigues" 5 => "H. Mikamo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijantimicag.2016.01.008" "Revista" => array:6 [ "tituloSerie" => "Int J Antimicrob Agents." "fecha" => "2016" "volumen" => "47" "paginaInicial" => "328" "paginaFinal" => "334" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27005459" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparative in vitro activity of oral antimicrobial agents against enterobacteriaceae from patients with community – acquired urinary tract infections in three European countries" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Kresken" 1 => "B. Korber-Irrgang" 2 => "D.J. Biedenbach" 3 => "N. Batista" 4 => "V. Besard" 5 => "R. Cantón" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cmi.2015.08.026" "Revista" => array:7 [ "tituloSerie" => "Clin Microbiol Infect." "fecha" => "2016" "volumen" => "22" "numero" => "63." "paginaInicial" => "e1" "paginaFinal" => "5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26363405" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Susceptibility patterns and ESBLS rates of Escherichia coli from urinary tract infections in Canada and the United States" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.H. Lob" 1 => "L.E. Nicole" 2 => "D.J. Hoban" 3 => "K.M. Kazmierczak" 4 => "R.E. Badal" 5 => "D.F. Sahm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.diagmicrobio.2016.04.022" "Revista" => array:6 [ "tituloSerie" => "SMART 2010-2014. Diagn Microbiol Infect Dis." "fecha" => "2016" "volumen" => "85" "paginaInicial" => "459" "paginaFinal" => "465" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27306116" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The importance of Gender-stratified antibiotic resistance surveillance of unselected uropathogens: A Dutch nationwide extramural surveillance study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.D.J. den Heijer" 1 => "J. Penders" 2 => "G.A. Donker" 3 => "C.A. Bruggeman" 4 => "E.E. Stobberingh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0060497" "Revista" => array:5 [ "tituloSerie" => "PLoS One." "fecha" => "2013" "volumen" => "8" "paginaInicial" => "e60497" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23555983" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antibiotic resistance of urinary pathogens in female general practice patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Hummers-Pradier" 1 => "M. Koch" 2 => "A.M. Ohse" 3 => "W.R. Heizmann" 4 => "M.M. Kochen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Scand J Infect Dis." "fecha" => "2005" "volumen" => "37" "paginaInicial" => "256" "paginaFinal" => "261" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15871164" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Etiology and antibiotic susceptibility of bacterial pathogens responsible for community-acquired urinary tract infections in Poland" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Stefaniuk" 1 => "U. Suchocka" 2 => "K. Bosacka" 3 => "W. Hryniewics" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Clin Microbiol Infect." "fecha" => "2016" "volumen" => "35" "paginaInicial" => "1363" "paginaFinal" => "1369" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Executive summary of the diagnosis and treatment of urinary tract infection: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Cueto" 1 => "L. Aliaga" 2 => "J.I. Alós" 3 => "A. Canut" 4 => "I. Los-Arcos" 5 => "J.A. Martínez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimc.2016.11.005" "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin." "fecha" => "2017" "volumen" => "35" "paginaInicial" => "314" "paginaFinal" => "320" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28017477" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "The European Committee on Anti microbial Susceptibility Testing. European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 6.0, 2016. <a target="_blank" href="http://www.eucast.org/">http://www.eucast.org</a>.[accessed 30 Dec 2017]." ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 2016. 26th ed. CLSI supplement M100S. Wayne, PA: Clinical and Laboratory Standards Institute." ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of antibiotic susceptibility of Escherichia coli in urinary isolates from an emergency department with other institutional susceptibility data" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Zatorski" 1 => "J.A. Jordan" 2 => "S.E. Cosgrove" 3 => "M. Zocchi" 4 => "L. May" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2146/ajhp140832" "Revista" => array:6 [ "tituloSerie" => "Am J Health Syst Pharm." "fecha" => "2015" "volumen" => "72" "paginaInicial" => "2176" "paginaFinal" => "2180" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26637517" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antimicrobial resistance surveillance in urinary tract infections in primary care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T.L. Chin" 1 => "C. McNulty" 2 => "C. Beck" 3 => "A. MacGowan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jac/dkw223" "Revista" => array:6 [ "tituloSerie" => "J Antimicrob Chemother." "fecha" => "2016" "volumen" => "71" "paginaInicial" => "2723" "paginaFinal" => "2728" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27353470" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack429573" "titulo" => "Acknowledgements" "texto" => "None declared." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/02126567/0000005100000008/v1_201910110654/S0212656718303469/v1_201910110654/en/main.assets" "Apartado" => array:4 [ "identificador" => "7267" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02126567/0000005100000008/v1_201910110654/S0212656718303469/v1_201910110654/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0212656718303469?idApp=UINPBA00004N"]

Statistics

Original article

Stratification by demographic and clinical data of the antibiotic susceptibility of Escherichia coli from urinary tract infections of the community

Estratificación por datos clínicos y demográficos de la sensibilidad antibiótica de Escherichia coli de infecciones del tracto urinario de origen comunitario

Martín C. Gradosa, Israel J. Thuissardb, Juan-Ignacio Alósa,b,

Corresponding author

nachoalos@telefonica.net

Corresponding author.

a Servicio Microbiología, Hospital Universitario de Getafe, Getafe, Carretera de Toledo km 12,500, 28905 Getafe, Madrid, Spain

b Universidad Europea, Villaviciosa de Odón, Calle Tajo s/n, 28670 Villaviciosa de Odón, Madrid, Spain

Read

3285

Times
was read the article

861

Total PDF

2424

Total HTML

Share statistics

 array:24 [
  "pii" => "S0212656718303469"
  "issn" => "02126567"
  "doi" => "10.1016/j.aprim.2018.06.004"
  "estado" => "S300"
  "fechaPublicacion" => "2019-10-01"
  "aid" => "1604"
  "copyright" => "The Authors"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Aten Primaria. 2019;51:494-8"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 769
    "formatos" => array:3 [
      "EPUB" => 53
      "HTML" => 416
      "PDF" => 300
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0212656718303470"
    "issn" => "02126567"
    "doi" => "10.1016/j.aprim.2018.07.006"
    "estado" => "S300"
    "fechaPublicacion" => "2019-10-01"
    "aid" => "1615"
    "copyright" => "The Authors"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Aten Primaria. 2019;51:499-505"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1481
      "formatos" => array:3 [
        "EPUB" => 49
        "HTML" => 1000
        "PDF" => 432
      ]
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
      "titulo" => "Perfil sociodemogr&#225;fico del usuario de la homeopat&#237;a en Espa&#241;a"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "499"
          "paginaFinal" => "505"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Sociodemographic profile of the homeopathy user in Spain"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figura 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 2454
              "Ancho" => 1417
              "Tamanyo" => 306337
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Resumen gr&#225;fico del perfil del usuario de homeopat&#237;a&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Lorena Cano-Or&#243;n, Isabel Mendoza-Poudereux, Carolina Moreno-Castro"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Lorena"
              "apellidos" => "Cano-Or&#243;n"
            ]
            1 => array:2 [
              "nombre" => "Isabel"
              "apellidos" => "Mendoza-Poudereux"
            ]
            2 => array:2 [
              "nombre" => "Carolina"
              "apellidos" => "Moreno-Castro"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0212656718303470?idApp=UINPBA00004N"
    "url" => "/02126567/0000005100000008/v1_201910110654/S0212656718303470/v1_201910110654/es/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0212656717303797"
    "issn" => "02126567"
    "doi" => "10.1016/j.aprim.2018.06.002"
    "estado" => "S300"
    "fechaPublicacion" => "2019-10-01"
    "aid" => "1602"
    "copyright" => "The Authors"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Aten Primaria. 2019;51:486-93"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2956
      "formatos" => array:3 [
        "EPUB" => 50
        "HTML" => 1458
        "PDF" => 1448
      ]
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
      "titulo" => "Dise&#241;o y validaci&#243;n de la escala para valorar la fragilidad de los pacientes cr&#243;nicos"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "486"
          "paginaFinal" => "493"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Design and validation of the scale to assess the fragility of chronic patients"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1558
              "Ancho" => 1630
              "Tamanyo" => 147891
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">&#193;rea gr&#225;fica de la curva ROC de EPADI&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Antonio Jes&#250;s N&#250;&#241;ez-Montenegro, Victoria Mart&#237;n-Ya&#241;ez, Mar&#237;a &#193;ngeles Roldan-Li&#233;bana, Francisca Dolores Gonz&#225;lez-Ruiz, Rita Fern&#225;ndez-Romero, Cristina Narbona-R&#237;os"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Antonio Jes&#250;s"
              "apellidos" => "N&#250;&#241;ez-Montenegro"
            ]
            1 => array:2 [
              "nombre" => "Victoria"
              "apellidos" => "Mart&#237;n-Ya&#241;ez"
            ]
            2 => array:2 [
              "nombre" => "Mar&#237;a &#193;ngeles"
              "apellidos" => "Roldan-Li&#233;bana"
            ]
            3 => array:2 [
              "nombre" => "Francisca Dolores"
              "apellidos" => "Gonz&#225;lez-Ruiz"
            ]
            4 => array:2 [
              "nombre" => "Rita"
              "apellidos" => "Fern&#225;ndez-Romero"
            ]
            5 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Narbona-R&#237;os"
            ]
            6 => array:1 [
              "colaborador" => "en representaci&#243;n del grupo EPADI"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0212656717303797?idApp=UINPBA00004N"
    "url" => "/02126567/0000005100000008/v1_201910110654/S0212656717303797/v1_201910110654/es/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Stratification by demographic and clinical data of the antibiotic susceptibility of <span class="elsevierStyleItalic">Escherichia coli</span> from urinary tract infections of the community"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "494"
        "paginaFinal" => "498"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Mart&#237;n C&#46; Grados, Israel J&#46; Thuissard, Juan-Ignacio Al&#243;s"
        "autores" => array:3 [
          0 => array:3 [
            "nombre" => "Mart&#237;n C&#46;"
            "apellidos" => "Grados"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Israel J&#46;"
            "apellidos" => "Thuissard"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:4 [
            "nombre" => "Juan-Ignacio"
            "apellidos" => "Al&#243;s"
            "email" => array:1 [
              0 => "nachoalos@telefonica.net"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio Microbiolog&#237;a&#44; Hospital Universitario de Getafe&#44; Getafe&#44; Carretera de Toledo km 12&#44;500&#44; 28905 Getafe&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Universidad Europea&#44; Villaviciosa de Od&#243;n&#44; Calle Tajo s&#47;n&#44; 28670 Villaviciosa de Od&#243;n&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Estratificaci&#243;n por datos cl&#237;nicos y demogr&#225;ficos de la sensibilidad antibi&#243;tica de <span class="elsevierStyleItalic">Escherichia coli</span> de infecciones del tracto urinario de origen comunitario"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Urinary tract infections &#40;UTI&#41; are common and contribute a significant burden to population health&#46; In the United States&#44; UTI account for approximately 10 million ambulatory visits and an estimated &#36;2&#46;000 in total cost each year&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In Spain&#44; one third of visits to primary care are due to infectious processes&#46; Of these&#44; 10&#37; are urinary infections&#44; most uncomplicated acute cistitis&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">UTI are one of the most common reasons for prescription of antimicrobials in primary care&#46; Appropriate empirical therapy is important since treatment with an antimicrobial to which the uropathogen is resistant is associated with more clinical and microbiological failures&#44; a longer median time to symptom resolution&#44; higher re-consultation rates&#44; and more subsequent antibiotics&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Acute uncomplicated UTI in women is generally managed effectively and safely by empirical antibiotic therapy without a urine culture&#44; laboratory testing is undertaken when empirical therapy fails&#46; In recurrent UTI and in complicated UTI&#44; urine cultures and antimicrobial susceptibility tests are recommended&#46; For these reasons laboratory-based surveillance suffers from requesting bias&#44; and probably overestimate resistance rates&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Antimicrobial resistance in common urinary pathogens is increasing at an alarming rate&#44; as a result of overuse and misuse of antibiotics&#46; Resistance patterns vary by geographic location&#44; but are rising in Spain and globally&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Knowledge of local susceptibility patterns is important for the selection of appropriate empirical therapy of UTI&#46; Reporting updated local susceptibility patterns<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> of the most frequently isolated microorganisms from urine samples influence physician decisions on therapeutic choices<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> allowing to choose more appropriate and effective treatments&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Among outpatients&#44; <span class="elsevierStyleItalic">Escherichia coli</span> is the main urinary tract pathogen&#44; accounting for 60&#8211;85&#37; of isolates&#46; There are many studies in literature on the antibiotic susceptibility of <span class="elsevierStyleItalic">E&#46; coli</span> and other uropathogens&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;9-12</span></a> but there are few studies&#44; and less in primary care&#44; evaluating the susceptibility of this microorganism considering some demographic and clinical data of patients such as sex&#44; age and type of UTI&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13-15</span></a> Our hypothesis is that if there were differences in the susceptibility patterns according to these characteristics of the patients&#44; these last data would be more useful to guide clinicians to choose a more appropriate empirical treatment&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Our goal was to determine the antibiotic susceptibility patterns of <span class="elsevierStyleItalic">E&#46; coli</span> strains isolated from adult patients with UTI attended at primary care centers in Getafe &#40;Madrid&#44; Spain&#41;&#44; to compare them with the global laboratory susceptibility data of adults with positive urine cultures in primary care&#44; and to stratify the results by age&#44; and type of UTI&#44; determined by clinical data&#44; to verify if there are statistically significant variations&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Design and study population</span><p id="par0040" class="elsevierStylePara elsevierViewall">A cross-sectional prospective study was carried out&#46; Inclusion criteria&#58; Isolates of <span class="elsevierStyleItalic">E&#46; coli</span> from urine &#40;10<span class="elsevierStyleSup">4</span>&#8211;10<span class="elsevierStyleSup">5</span><span class="elsevierStyleHsp" style=""></span>cfu&#47;ml&#41; of adult patients&#44; aged 18 and older&#44; of all the primary care Centers in the Getafe area &#40;Madrid&#44; Spain&#41;&#59; they were randomly selected from June 2016 to April 2017&#44; one per patient&#59; clinical and demographic data of the patients were obtained&#46; Exclusion criteria&#58; Isolates of <span class="elsevierStyleItalic">E&#46; coli</span> from urine of patients aged less than 18 years&#44; of hospital wards&#44; and of the emergency department&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study protocol &#40;17&#47;82&#41; was approved by the Comit&#233; &#201;tico de Investigaci&#243;n con Medicamentos of Hospital Universitario de Getafe&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Data and variables</span><p id="par0050" class="elsevierStylePara elsevierViewall">Clinical and demographic data &#40;gender and age&#41; were analyzed and&#44; taking into account these features&#44; the episodes were classified as complicated UTI&#44; uncomplicated UTI or asymptomatic bacteriuria&#44; according to the Spanish Society of Infectious Diseases and Clinical Microbiology &#40;SEIMC&#41; guidelines<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#59; complicated UTI was considered in all men&#44; and in patients with diabetes&#44; indwelling catheter&#44; neurogenic bladder&#44; obstructive uropathy&#44; history of pathologies or spinal surgeries&#44; invasive urological procedure in the previous 3 months or immunosupresion&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The antibiotic susceptibility of the strains of <span class="elsevierStyleItalic">E&#46; coli</span> was determined by broth microdilution &#40;MicroScan panels&#44; California&#44; USA&#41; to the following antibiotics&#58; amoxicillin&#44; amoxicillin&#47;clavulanic acid&#44; fosfomycin&#44; cotrimoxazole&#44; nitrofurantoin&#44; ciprofloxacin&#44; gentamicin&#44; cefotaxime&#44; and imipenem&#46; The results were interpreted according to the 2016 EUCAST guidelines<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> except for amoxicillin&#47;clavulanic in which the 2016 CLSI guidelines were used&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Global laboratory susceptibility data of adults of primary care with significant isolation of <span class="elsevierStyleItalic">E&#46; coli</span> from urine cultures were obtained from our laboratory computer system&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">For the descriptive analysis&#44; the absolute &#40;<span class="elsevierStyleItalic">n</span>&#41; and relative &#40;&#37;&#41; frequencies were used to express the qualitative variables&#46; Following the confirmation of the parametric behavior&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation &#40;SD&#41; or median &#91;interquartile range&#59; IQR&#93; were used to express the quantitative variables&#46; To test the statistically significant differences scenarios either the chi-square test or Fisher&#39;s exact test was performed for qualitative variables&#46; Besides&#44; either Student <span class="elsevierStyleItalic">T</span> test or <span class="elsevierStyleItalic">U</span>-Mann Whitney was used for quantitative variables according to the normality test&#46; When the <span class="elsevierStyleItalic">p</span>-value was inferior to the alpha error &#40;5&#37;&#41;&#44; a statistical significance was considered&#46; The data analysis was performed with IBM SPSS statistics version 21&#46;0 &#40;IBM Corp&#59; USA&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">In our health care area 30&#44;144 urine cultures were processed in 2016&#44; of which 19&#44;533 &#40;64&#46;8&#37;&#41; came from adult patients of primary care&#46; <span class="elsevierStyleItalic">E&#46; coli</span> was isolated in 2140 &#40;61&#46;4&#37; of the considered positive cultures&#41;&#59; its antibiotic susceptibility is represented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Of the 100 patients included&#44; 15&#37; were male and 85&#37; female&#46; The mean age was 58&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;8 years&#44; 49 had complicated UTI&#44; 44 uncomplicated UTI&#44; and 7 had asymptomatic bacteriuria&#46; Patients with uncomplicated UTI &#40;44&#44; all women&#41; had a mean age of 54&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;0 years&#59; Patients with complicated UTI &#40;49 in total&#44; 15 males and 34 females&#41; had a mean age of 63&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;2 years&#44; significantly higher &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The overall analysis of antibiotic susceptibility of the 100 <span class="elsevierStyleItalic">E&#46; coli</span> strains was&#58; amoxicillin &#40;47&#37;&#41;&#44; amoxicillin&#47;clavulanic acid &#40;86&#37;&#41;&#44; fosfomycin &#40;99&#37;&#41;&#44; cotrimoxazole &#40;73&#37;&#41;&#44; ciprofloxacin &#40;74&#37;&#41;&#44; gentamicin &#40;92&#37;&#41;&#44; nitrofurantoin &#40;99&#37;&#41;&#44; cefotaxime &#40;93&#37;&#41;&#44; and imipenem &#40;100&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The antibiotic susceptibility of part of these strains stratified in those with complicated UTI &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>49&#41; and those with uncomplicated UTI &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>44&#41; as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">When we compare the stratified antibiotic susceptibility&#44; we found that strains isolated from patients with uncomplicated UTI showed significantly greater susceptibility than those of complicated UTI to amoxicillin &#40;65&#46;9&#37; <span class="elsevierStyleItalic">vs</span>&#46; 30&#46;6&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; amoxicillin&#47;clavulanic acid &#40;95&#46;5&#37; <span class="elsevierStyleItalic">vs</span>&#46; 77&#46;6&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;013&#41; and ciprofloxacin &#40;81&#46;8&#37; <span class="elsevierStyleItalic">vs</span>&#46; 63&#46;3&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;047&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In complicated UTI&#44; susceptibility to ciprofloxacin was significantly greater in the &#8804;65 years age group compared to the older age group &#40;78&#46;3&#37; <span class="elsevierStyleItalic">vs</span>&#46; 50&#37;&#44; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;041&#41;&#46; In the rest of antibiotics&#44; no statistically significant differences were obtained when comparing by age &#40;&#8804;65 years <span class="elsevierStyleItalic">versus</span><span class="elsevierStyleHsp" style=""></span>&#62;65 years&#41;&#44; both in uncomplicated and complicated UTI&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">Antimicrobial resistance in common urinary pathogens is increasing at an alarming rate&#46; Because of the predominance of <span class="elsevierStyleItalic">E&#46; coli</span> as causative agent&#44; resistance to this species is often of epidemiologic resistance studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12&#44;19</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Laboratory-based surveillance suffers from requesting bias since primary care physicians are advised against urine sampling in cases of uncomplicated UTI in non-pregnant women at least at first presentation&#46; Urine culture is recommended for patients with complicated infection&#44; and to guide a change of antimicrobials for women who do not respond to initial therapy&#46; Since patients who fail initial empirical therapy for UTI have more risk factors for antimicrobial resistance&#44; complications or recurrence and are more likely to be tested&#44; laboratory-based surveillance is likely to overestimate resistance rates&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Cumulative reports on antimicrobial susceptibility data provided by microbiological laboratories are important for selecting empiric treatments&#46; There are many studies on antibiotic sensitivity of <span class="elsevierStyleItalic">E&#46; coli</span> and other uropathogens&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;9-12</span></a> Weaknesses of these studies included a deficit of clinical data or even demographic data&#46; A first or second episode of uncomplicated cystitis in a young woman is not the same as a UTI in a male with multiple episodes treated with antibiotics&#46; Other methods of surveillance are required to provide unbiased estimates of antimicrobial resistance&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">To identify individual patient or clinical characteristics that predict antimicrobial resistance&#44; culture results should be linked to patient demographics and clinical characteristics&#59; however&#44; urine samples are often submitted to the laboratory with insufficient supplementary clinical information&#46; One strength of our study is that we have reviewed medical records &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46; In fact&#44; we have more patients with complicated UTI &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>49&#41; than with uncomplicated UTI &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>44&#41; because in many uncomplicated UTI&#44; the most common type of urinary infection in primary care&#44; urine cultures are not send to the laboratory&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">As expected&#44; there were few differences in susceptibility between the global data of our laboratory &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2140&#41; and the data of the 100 strains included in this work &#40;see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; but there were differences in some antibiotics between strains from uncomplicated UTI and complicated UTI&#44; and depending on the age in ciprofloxacin in patients with complicated UTI&#46; In cefotaxime&#44; there was not a statistically significant difference due&#44; in our opinion&#44; to the restricted sample size&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The data from the present study indicate that ciprofloxacin&#44; ampicillin&#44; and amoxicillin&#47;clavulanic acid non-susceptibility in <span class="elsevierStyleItalic">E&#46; coli</span> are associated mostly with isolates from complicated UTI&#46; Explanation could be previous antibiotic treatments that would have selected resistant strains that colonize patients and cause infections in the next weeks&#47;months&#46; In a recent study&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> an important variation in susceptibility to ciprofloxacin between cases of uncomplicated and complicated UTI were also observed&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Reviewing the medical records of this study&#44; we ascertain that amoxicillin&#47;clavulanic acid and ciprofloxacin are frequently used for the empirical treatment of complicated UTIs &#40;data not shown&#41;&#44; which would explain the selection of resistances to these antibiotics and the differences with the strains isolated from uncomplicated UTI&#46; We suggest not using these antibiotics in the empirical treatment of complicated UTI since susceptibility to both is less than 80&#37;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">It is important to note that the susceptibility to fosfomycin and nitrofurantoin remains high in all groups of patients analyzed&#46; They would be an excellent option for the empirical treatment of cases of uncomplicated UTI&#44; as it is stated in several guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;16</span></a> However&#44; this is not the case of cotrimoxazole&#44; 25&#37; of strains are resistant&#46; Although amoxicillin&#47;clavulanic acid and ciprofloxacin are not considered appropriate empirical treatments for uncomplicated UTI&#44; they would be an alternative as the rates of susceptibility are 95&#46;5&#37; and 81&#46;8&#37; respectively&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">A limitation of our study is that it was performed in a single-center &#40;population 218&#44;945 inhabitants&#41;&#44; but in our opinion they warn of the convenience of stratify susceptibility data to obtain more usefulness of them&#46; The subset of patients in some groups was of inadequate size to show statistical significances&#46; Another limitation is that <span class="elsevierStyleItalic">E&#46; coli</span> data underestimate resistance rates because they exclude bacteria like&#44; for example&#44; <span class="elsevierStyleItalic">Enterobacter cloace</span> and <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> with intrinsic resistance to various antibiotics&#44; although these species are rare in UTI in primary care&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In future it would be of interest to expand some group to obtain&#47;to discard statistically differences in antibiotic susceptibility&#46; Also&#44; to evaluate the evolution over the time&#44; as antibiotic resistance is dynamic&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">We conclude that clinical and demographic data are of great importance in the results of antibiotic susceptibility in <span class="elsevierStyleItalic">E&#46; coli</span> causing UTI and would be more useful than global data in the choice of empirical treatments&#46; Antibiograms stratified by patient characteristics may better facilitate empirical antibiotic selection for UTI in primary care&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflict of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres1253684"
          "titulo" => "Abstract"
          "secciones" => array:7 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Aim"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Design"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Location"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Participants"
            ]
            4 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Main measurements"
            ]
            5 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Results"
            ]
            6 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1161763"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1253683"
          "titulo" => "Resumen"
          "secciones" => array:7 [
            0 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0045"
              "titulo" => "Dise&#241;o"
            ]
            2 => array:2 [
              "identificador" => "abst0050"
              "titulo" => "Emplazamiento"
            ]
            3 => array:2 [
              "identificador" => "abst0055"
              "titulo" => "Participantes"
            ]
            4 => array:2 [
              "identificador" => "abst0060"
              "titulo" => "Mediciones principales"
            ]
            5 => array:2 [
              "identificador" => "abst0065"
              "titulo" => "Resultados"
            ]
            6 => array:2 [
              "identificador" => "abst0070"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1161762"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Material and methods"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Design and study population"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Data and variables"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conflict of interest"
        ]
        9 => array:2 [
          "identificador" => "xack429573"
          "titulo" => "Acknowledgements"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-05-16"
    "fechaAceptado" => "2018-06-06"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1161763"
          "palabras" => array:3 [
            0 => "Urinary tract infections"
            1 => "Antimicrobial resistance"
            2 => "<span class="elsevierStyleItalic">Escherichia coli</span>"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1161762"
          "palabras" => array:3 [
            0 => "Infecciones del tracto urinario"
            1 => "Resistencia a antibi&#243;ticos"
            2 => "<span class="elsevierStyleItalic">Escherichia coli</span>"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Aim</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine the patterns of antibiotic susceptibility of <span class="elsevierStyleItalic">Escherichia coli</span> strains isolated from adult patients with urinary tract infection &#40;UTI&#41;&#44; and to stratify the results by age and type of UTI to verify if there are statistically significant differences that can help physicians to prescribe better empirical antibiotherapy&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional prospective study&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Location</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Community of Getafe &#40;Madrid&#41;&#46; Primary care level&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Participants</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">100 <span class="elsevierStyleItalic">E&#46; coli</span> strains&#44; randomly chosen&#44; isolated from the urine &#40;10<span class="elsevierStyleSup">4</span>&#8211;10<span class="elsevierStyleSup">5</span><span class="elsevierStyleHsp" style=""></span>cfu&#47;ml&#41; of different patients from primary care centers in the Getafe area&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Main measurements</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The antibiotic susceptibility of the strains was evaluated and the results were stratified by age and type of UTI&#46; The clinical and demographic data of the patients were analyzed&#44; classifying each episode as complicated UTI or uncomplicated UTI&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Strains isolated from patients with uncomplicated UTI showed significantly greater susceptibility than those of complicated UTI to amoxicillin &#40;65&#46;9&#37; <span class="elsevierStyleItalic">vs</span>&#46; 30&#46;6&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; amoxicillin&#47;clavulanic acid &#40;95&#46;5&#37; <span class="elsevierStyleItalic">vs</span>&#46; 77&#46;6&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;013&#41; and ciprofloxacin &#40;81&#46;8&#37; <span class="elsevierStyleItalic">vs</span>&#46; 63&#46;3&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;047&#41;&#46; In complicated UTI&#44; susceptibility to ciprofloxacin was significantly greater in the &#8804;65 years age group compared to the older age group &#40;78&#46;3&#37; <span class="elsevierStyleItalic">vs</span>&#46; 50&#37;&#44; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;041&#41;&#46; In the rest of antibiotics&#44; no statistically significant differences were obtained when comparing by age &#40;&#8804;65 years <span class="elsevierStyleItalic">versus</span> &#62;65 years&#41;&#44; both in uncomplicated and complicated UTI&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Clinical and demographic data of patients with UTI are of great importance in the results of the antibiotic susceptibility in <span class="elsevierStyleItalic">E&#46; coli</span>&#46; Antibiograms stratified by patient characteristics may better facilitate empirical antibiotic selection for UTI in primary care&#46;</p></span>"
        "secciones" => array:7 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Aim"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Design"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Location"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Participants"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Main measurements"
          ]
          5 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Results"
          ]
          6 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Determinar los patrones de sensibilidad antibi&#243;tica de cepas de <span class="elsevierStyleItalic">Escherichia coli</span> aisladas de pacientes adultos con infecci&#243;n del tracto urinario &#40;ITU&#41;&#44; y estratificar los resultados por edad y tipo de ITU para verificar si existen diferencias estad&#237;sticamente significativas que puedan ayudar a los m&#233;dicos a la prescripci&#243;n de una mejor antibioterapia emp&#237;rica&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Dise&#241;o</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal prospectivo&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Emplazamiento</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Comunidad de Getafe &#40;Madrid&#41;&#46; Nivel de atenci&#243;n primaria&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Participantes</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">100 cepas de <span class="elsevierStyleItalic">E&#46; coli</span>&#44; escogidas al azar&#44; aisladas de orina &#40;10<span class="elsevierStyleSup">4</span> -&#62;10<span class="elsevierStyleSup">5</span><span class="elsevierStyleHsp" style=""></span>ufc&#47;ml&#41; de diferentes pacientes de centros de atenci&#243;n primaria del &#225;rea de Getafe&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Mediciones principales</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se evalu&#243; la sensibilidad antibi&#243;tica de las cepas y los resultados se estratificaron por edad y tipo de ITU&#46; Se analizaron los datos cl&#237;nicos y demogr&#225;ficos de los pacientes de los que proven&#237;an&#44; clasific&#225;ndose cada episodio como ITU complicada o ITU no complicada&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Las cepas aisladas de pacientes con ITU no complicada mostraron una sensibilidad antibi&#243;tica significativamente mayor que las de ITU complicada a amoxicilina &#40;65&#44;9&#37; <span class="elsevierStyleItalic">vs</span>&#46; 30&#44;6&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; amoxicilina&#47;clavul&#225;nico &#40;95&#44;5&#37; <span class="elsevierStyleItalic">vs</span>&#46; 77&#44;6&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;013&#41; y ciprofloxacino &#40;81&#44;8&#37; <span class="elsevierStyleItalic">vs</span>&#46; 63&#44;3&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;047&#41;&#46; En la ITU complicada&#44; la sensibilidad al ciprofloxacino fue significativamente mayor en el grupo de edad &#8804;65 a&#241;os en comparaci&#243;n con el grupo de mayor edad &#40;78&#44;3&#37; <span class="elsevierStyleItalic">vs</span>&#46; 50&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;041&#41;&#46; Para el resto de antibi&#243;ticos no se observaron diferencias significativas cuando se compararon por edad &#40;&#8804;65 <span class="elsevierStyleItalic">versus</span><span class="elsevierStyleHsp" style=""></span>&#62;65&#41;&#44; tanto en ITU no complicada como complicada&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Los datos cl&#237;nicos y demogr&#225;ficos de los pacientes con ITU son de gran importancia en los resultados de la sensibilidad antibi&#243;tica en <span class="elsevierStyleItalic">E&#46; coli</span>&#46; Los antibiogramas estratificados por caracter&#237;sticas de los pacientes podr&#237;an facilitar una mejor selecci&#243;n de antibioterapia emp&#237;rica para las ITU en atenci&#243;n primaria&#46;</p></span>"
        "secciones" => array:7 [
          0 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Dise&#241;o"
          ]
          2 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Emplazamiento"
          ]
          3 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "Participantes"
          ]
          4 => array:2 [
            "identificador" => "abst0060"
            "titulo" => "Mediciones principales"
          ]
          5 => array:2 [
            "identificador" => "abst0065"
            "titulo" => "Resultados"
          ]
          6 => array:2 [
            "identificador" => "abst0070"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "multimedia" => array:2 [
      0 => 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:3 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">S&#44; susceptible&#59; cUTI&#44; complicated urinary tract infections&#59; uUTI&#44; uncomplicated urinary tract infections&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&#37;S global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&#37;S this study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&#37;S cUTI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&#37;S uUTI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col"><span class="elsevierStyleItalic">P</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ampicillin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amoxi&#47;clav&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fosfomycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;473&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cotrimoxazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;417&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ciprofloxacin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;047&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nitrofurantoin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;473&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gentamicin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;273&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cefotaxime&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;207&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imipenem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2144307.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Include cUTI&#44; uUTI and 7 cases of asymptomatic bacteriuria&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">When comparing data of cUTI and uUTI&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Global antibiotic susceptibility of <span class="elsevierStyleItalic">Escherichia coli</span> strains from urine cultures of adult outpatients in 2016&#44; antibiotic susceptibility of the 100 isolates of the present study&#44; and the same stratified by type of UTI&#44; complicated <span class="elsevierStyleItalic">versus</span> uncomplicated&#46;</p>"
        ]
      ]
      1 => array:5 [
        "identificador" => "tb0005"
        "tipo" => "MULTIMEDIATEXTO"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "texto" => array:1 [
          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">What is known about the subject</span><p id="par0150" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">E&#46; coli</span> is the pathogen most frequently involved in UTI&#46; Global data of the antibiotic susceptibility &#40;antibiograms&#41; provided by laboratories influence the choice of empirical treatments&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Most studies report global data of laboratories without stratification&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0165" class="elsevierStylePara elsevierViewall">Few studies evaluate the influence of clinical and demographic data on the results of antibiotic susceptibility&#46;</p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">What this study contributes</span><p id="par0170" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Clinical and demographic data are of great importance in the results of antibiotic susceptibility in <span class="elsevierStyleItalic">E&#46; coli</span> causing UTI&#46; Antibiograms stratified by patient characteristics may better facilitate empirical antibiotic selection for UTI in primary care&#46;</p></li></ul></p></span></span>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:20 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Economic burden of uncomplicated urinary tract infections&#58; direct&#44; indirect and intangible costs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46;N&#46; Keating"
                            1 => "E&#46;M&#46; Perfetto"
                            2 => "P&#46; Subedi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Expert Rev Pharmaeconomic Outcomes Res&#46;"
                        "fecha" => "2005"
                        "volumen" => "5"
                        "paginaInicial" => "457"
                        "paginaFinal" => "466"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Enfermedad infecciosa en atenci&#243;n primaria&#58; estudio prospectivo efectuado durante todo un a&#241;o"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Llor"
                            1 => "S&#46; Hern&#225;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eimc.2009.03.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Enferm Infecc Microbiol Clin&#46;"
                        "fecha" => "2010"
                        "volumen" => "28"
                        "paginaInicial" => "222"
                        "paginaFinal" => "226"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19720435"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Gupta K&#44; Hooton TM&#44; Naber KG&#44; Wullt B&#44; Colgan R&#44; Miller LG&#44; et al&#46; International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women&#58; a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases&#46; Clin Infect Dis 2011&#59; 52&#58;e103-e120&#46;"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical relevance of laboratory reported antibiotic resistance in acute uncomplicated urinary tract infection in primary care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;A&#46; McNulty"
                            1 => "J&#46; Richards"
                            2 => "D&#46;M&#46; Livermore"
                            3 => "P&#46; Little"
                            4 => "A&#46; Charlett"
                            5 => "E&#46; Freeman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Antimicrob Chemother&#46;"
                        "fecha" => "2006"
                        "volumen" => "58"
                        "paginaInicial" => "1000"
                        "paginaFinal" => "1008"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surveillance Study in Europe and Brazil on Clinical Aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis &#40;ARESC&#41;&#58; Implications for Empiric Therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46;G&#46; Naber"
                            1 => "G&#46; Schito"
                            2 => "H&#46; Botto"
                            3 => "J&#46; Palou"
                            4 => "T&#46; Mazzei"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2008.05.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2008"
                        "volumen" => "54"
                        "paginaInicial" => "1164"
                        "paginaFinal" => "1178"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18511178"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etiolog&#237;a y sensibilidad de los uropat&#243;genos identificados en infecciones urinarias bajas no complicadas de la mujer &#40;estudio ARESC&#41;&#58; Implicaciones en la terapia emp&#237;rica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Palou"
                            1 => "C&#46; Pigrau"
                            2 => "I&#46; Molina"
                            3 => "J&#46;M&#46; Ledesma"
                            4 => "J&#46; Angulo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0025-7753(11)70001-X"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;&#46;"
                        "fecha" => "2011"
                        "volumen" => "136"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21596179"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antibiotic resistance&#58; location&#44; location&#44; location"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;M&#46; Livermore"
                            1 => "A&#46; Pearson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Infect&#46;"
                        "fecha" => "2007"
                        "volumen" => "13"
                        "numero" => "suppl 2"
                        "paginaInicial" => "7"
                        "paginaFinal" => "16"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does laboratory antibiotic susceptibility reporting influence primary care prescribing in urinary tract infection and other infections&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;A&#46; McNulty"
                            1 => "G&#46;M&#46; Lasseter"
                            2 => "A&#46; Charlett"
                            3 => "A&#46; Lovering"
                            4 => "R&#46; Howell-Jones"
                            5 => "A&#46; Macgowan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jac/dkr088"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Antimicrob Chemother&#46;"
                        "fecha" => "2011"
                        "volumen" => "66"
                        "paginaInicial" => "1396"
                        "paginaFinal" => "1404"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21398297"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surveillance of antibiotic susceptibility of urinary tract pathogens for a population of 5&#46;6 million over 4 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Ironmonger"
                            1 => "O&#46; Edeghere"
                            2 => "A&#46; Bains"
                            3 => "R&#46; Loy"
                            4 => "N&#46; Woodford"
                            5 => "P&#46;M&#46; Hawkey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jac/dkv043"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Antimicrob Chemother&#46;"
                        "fecha" => "2015"
                        "volumen" => "70"
                        "paginaInicial" => "1744"
                        "paginaFinal" => "1750"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25733586"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology and antimicrobial susceptibility profile of pathogens causing urinary tract infections in the Asia&#8211;Pacific region&#58; Results from the Study for Monitoring Antimicrobial Resistance Trends &#40;SMART&#41;&#44; 2010-2013"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;S&#46; Jean"
                            1 => "G&#46; Coombs"
                            2 => "T&#46; Ling"
                            3 => "V&#46; Balaji"
                            4 => "C&#46; Rodrigues"
                            5 => "H&#46; Mikamo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijantimicag.2016.01.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Antimicrob Agents&#46;"
                        "fecha" => "2016"
                        "volumen" => "47"
                        "paginaInicial" => "328"
                        "paginaFinal" => "334"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27005459"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparative in vitro activity of oral antimicrobial agents against enterobacteriaceae from patients with community &#8211; acquired urinary tract infections in three European countries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Kresken"
                            1 => "B&#46; Korber-Irrgang"
                            2 => "D&#46;J&#46; Biedenbach"
                            3 => "N&#46; Batista"
                            4 => "V&#46; Besard"
                            5 => "R&#46; Cant&#243;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cmi.2015.08.026"
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Microbiol Infect&#46;"
                        "fecha" => "2016"
                        "volumen" => "22"
                        "numero" => "63&#46;"
                        "paginaInicial" => "e1"
                        "paginaFinal" => "5"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26363405"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Susceptibility patterns and ESBLS rates of <span class="elsevierStyleItalic">Escherichia coli</span> from urinary tract infections in Canada and the United States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;H&#46; Lob"
                            1 => "L&#46;E&#46; Nicole"
                            2 => "D&#46;J&#46; Hoban"
                            3 => "K&#46;M&#46; Kazmierczak"
                            4 => "R&#46;E&#46; Badal"
                            5 => "D&#46;F&#46; Sahm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.diagmicrobio.2016.04.022"
                      "Revista" => array:6 [
                        "tituloSerie" => "SMART 2010-2014&#46; Diagn Microbiol Infect Dis&#46;"
                        "fecha" => "2016"
                        "volumen" => "85"
                        "paginaInicial" => "459"
                        "paginaFinal" => "465"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27306116"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The importance of Gender-stratified antibiotic resistance surveillance of unselected uropathogens&#58; A Dutch nationwide extramural surveillance study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;D&#46;J&#46; den Heijer"
                            1 => "J&#46; Penders"
                            2 => "G&#46;A&#46; Donker"
                            3 => "C&#46;A&#46; Bruggeman"
                            4 => "E&#46;E&#46; Stobberingh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0060497"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS One&#46;"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "e60497"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23555983"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antibiotic resistance of urinary pathogens in female general practice patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Hummers-Pradier"
                            1 => "M&#46; Koch"
                            2 => "A&#46;M&#46; Ohse"
                            3 => "W&#46;R&#46; Heizmann"
                            4 => "M&#46;M&#46; Kochen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Scand J Infect Dis&#46;"
                        "fecha" => "2005"
                        "volumen" => "37"
                        "paginaInicial" => "256"
                        "paginaFinal" => "261"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15871164"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etiology and antibiotic susceptibility of bacterial pathogens responsible for community-acquired urinary tract infections in Poland"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Stefaniuk"
                            1 => "U&#46; Suchocka"
                            2 => "K&#46; Bosacka"
                            3 => "W&#46; Hryniewics"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Clin Microbiol Infect&#46;"
                        "fecha" => "2016"
                        "volumen" => "35"
                        "paginaInicial" => "1363"
                        "paginaFinal" => "1369"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Executive summary of the diagnosis and treatment of urinary tract infection&#58; Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases &#40;SEIMC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Cueto"
                            1 => "L&#46; Aliaga"
                            2 => "J&#46;I&#46; Al&#243;s"
                            3 => "A&#46; Canut"
                            4 => "I&#46; Los-Arcos"
                            5 => "J&#46;A&#46; Mart&#237;nez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eimc.2016.11.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Enferm Infecc Microbiol Clin&#46;"
                        "fecha" => "2017"
                        "volumen" => "35"
                        "paginaInicial" => "314"
                        "paginaFinal" => "320"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28017477"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "The European Committee on Anti microbial Susceptibility Testing&#46; European Committee on Antimicrobial Susceptibility Testing&#46; Breakpoint tables for interpretation of MICs and zone diameters&#46; Version 6&#46;0&#44; 2016&#46; <a target="_blank" href="http://www.eucast.org/">http&#58;&#47;&#47;www&#46;eucast&#46;org</a>&#46;&#91;accessed 30 Dec 2017&#93;&#46;"
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "CLSI&#46; Performance Standards for Antimicrobial Susceptibility Testing&#46; 2016&#46; 26th ed&#46; CLSI supplement M100S&#46; Wayne&#44; PA&#58; Clinical and Laboratory Standards Institute&#46;"
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of antibiotic susceptibility of <span class="elsevierStyleItalic">Escherichia coli</span> in urinary isolates from an emergency department with other institutional susceptibility data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Zatorski"
                            1 => "J&#46;A&#46; Jordan"
                            2 => "S&#46;E&#46; Cosgrove"
                            3 => "M&#46; Zocchi"
                            4 => "L&#46; May"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2146/ajhp140832"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Health Syst Pharm&#46;"
                        "fecha" => "2015"
                        "volumen" => "72"
                        "paginaInicial" => "2176"
                        "paginaFinal" => "2180"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26637517"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antimicrobial resistance surveillance in urinary tract infections in primary care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46;L&#46; Chin"
                            1 => "C&#46; McNulty"
                            2 => "C&#46; Beck"
                            3 => "A&#46; MacGowan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jac/dkw223"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Antimicrob Chemother&#46;"
                        "fecha" => "2016"
                        "volumen" => "71"
                        "paginaInicial" => "2723"
                        "paginaFinal" => "2728"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27353470"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack429573"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0185" class="elsevierStylePara elsevierViewall">None declared&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/02126567/0000005100000008/v1_201910110654/S0212656718303469/v1_201910110654/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "7267"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Originales"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/02126567/0000005100000008/v1_201910110654/S0212656718303469/v1_201910110654/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0212656718303469?idApp=UINPBA00004N"
]

Article information

ISSN: 02126567
Original language: English

DOI:10.1016/j.aprim.2018.06.004

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	2	1	3
2024 October	28	7	35
2024 September	39	8	47
2024 August	40	5	45
2024 July	62	5	67
2024 June	38	4	42
2024 May	32	5	37
2024 April	39	8	47
2024 March	69	8	77
2024 February	42	4	46
2024 January	50	8	58
2023 December	49	7	56
2023 November	55	10	65
2023 October	81	7	88
2023 September	46	6	52
2023 August	31	12	43
2023 July	58	23	81
2023 June	56	19	75
2023 May	79	15	94
2023 April	48	10	58
2023 March	34	6	40
2023 February	22	2	24
2023 January	18	1	19
2022 December	32	5	37
2022 November	50	7	57
2022 October	29	9	38
2022 September	42	16	58
2022 August	28	8	36
2022 July	35	7	42
2022 June	24	22	46
2022 May	26	12	38
2022 April	53	16	69
2022 March	42	16	58
2022 February	19	6	25
2022 January	18	9	27
2021 December	27	10	37
2021 November	40	9	49
2021 October	39	18	57
2021 September	17	7	24
2021 August	23	9	32
2021 July	25	9	34
2021 June	15	10	25
2021 May	17	10	27
2021 April	44	18	62
2021 March	27	9	36
2021 February	38	15	53
2021 January	38	18	56
2020 December	32	12	44
2020 November	20	7	27
2020 October	16	7	23
2020 September	39	13	52
2020 August	23	9	32
2020 July	31	11	42
2020 June	18	8	26
2020 May	16	10	26
2020 April	16	9	25
2020 March	22	12	34
2020 February	20	13	33
2020 January	23	12	35
2019 December	52	14	66
2019 November	52	24	76
2019 October	95	47	142
2019 September	12	6	18
2019 August	11	11	22
2019 July	16	10	26
2019 June	27	32	59
2019 May	53	33	86
2019 April	23	17	40
2019 March	2	6	8
2019 February	9	8	17
2019 January	3	10	13
2018 December	4	7	11
2018 November	4	8	12
2018 October	9	14	23
2018 September	9	17	26
2018 August	1	18	19

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter