Bacterial resistance in acne? A meta-analysis of the controversy

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] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Bacterial resistance in acne? A meta-analysis of the controversy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "190" "paginaFinal" => "195" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mariana Alvarez-Sánchez, Ernesto Rodríguez-Ayala, Rosa María Ponce-Olivera, Andrés Tirado-Sánchez, María Ivonne Arellano-Mendoza" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Mariana" "apellidos" => "Alvarez-Sánchez" "email" => array:1 [ 0 => "mariana.alvasa@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ernesto" "apellidos" => "Rodríguez-Ayala" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Rosa María" "apellidos" => "Ponce-Olivera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Andrés" "apellidos" => "Tirado-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "María Ivonne" "apellidos" => "Arellano-Mendoza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Huixquilucan, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General de México, México, D.F., Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding autor at: Av. Universidad Anáhuac 46, Col. Lomas Anáhuac, C.P. 52786, Huixquilucan, Mexico. Tel.: +52 55 5627 0210." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Resistencia en el acné? Un metaanálisis a propósito de la controversia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1307 "Ancho" => 2410 "Tamanyo" => 267904 ] ] "descripcion" => array:1 [ "en" => "Statistics of each study." ] ] ] "textoCompleto" => "BackgroundAcne is the second major cause for dermatology consultation, therefore it is important to know how to treat it appropriately.<a class="elsevierStyleCrossRef" href="#bib0105">1</a> The treatment guidelines for acne vulgaris establish as their criteria: (a) the clinical variety of acne, classified as comedonal, papulo-postular, nodulocystic and (b) severity.<a class="elsevierStyleCrossRef" href="#bib0110">2</a> The most frequently used treatment for acne, and especially for papulo-postular acne, are topical antibiotics.<a class="elsevierStyleCrossRefs" href="#bib0110">2,3</a> Because they have been used indiscriminately, an increased resistance to topical antibiotics<a class="elsevierStyleCrossRef" href="#bib0120">4</a> has been confirmed in Propionibacterium acnes (P. acnes), by means of cultures and antibiograms.<a class="elsevierStyleCrossRef" href="#bib0125">5</a>In order to evaluate whether there is sufficient evidence to consider P. acnes resistant to topical antibiotics, we performed a meta-analysis of the articles published on the subject, and our research covered the last 10 years (2004–2013).Material and methodsSearch strategyThe literature published from 1 January to 31 December 2013 on the topical treatment was reviewed. The metasearch engines we used were PubMed, Ovid, EBSCO, Cochrane, ScienceDirect and ClinicalKey.Searches were made using the following MeSH terms: “acne vulgaris”, “Propionibacterium acnes”, “topical administration”, “treatment”, “erythromycin”, “clindamycin”, “nadifloxacin”, “antibacterial agent”, “bacterial drug resistance”.Selection of studiesStudies published from 1 January 2004 until 31 December 2013 (10 years) and written in English and/or Spanish were chosen. Two authors (Alvarez-Sánchez and Arellano-Mendoza) independently reviewed, assessed and chose the studies for analysis.Microbiological analysisData relating to the method of handling samples, transport, cultures, isolation and identification of P. acnes were gathered and the antibiogram results of the antibiotics that are available for topical administration (clindamycin, erythromycin and nadifloxacin). They were assessed with results for: sensitivity and resistance, cut-off points of minimum inhibitory concentration or E-strip based on the standards of the European Committee on Antimicrobial Susceptibility Testing and the Clinical and Laboratory Standards Institute.<a class="elsevierStyleCrossRef" href="#bib0130">6</a>Data extractionThe data gathered from published studies were evaluated. The following information was extracted from each study: total number of patients, patients with identification of P. acnes and the abovementioned microbiological data. Any discrepancy between the observers was resolved by consensus or by including a third observer.Statistical analysisThe comprehensive meta-analysis (CMA version 2.2.064) software package was used for processing the data, the data was entered and the statistical analysis made, which can be seen in the forest plot (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The cut-off point for determining resistance or sensitivity is an odds ratio (OR) of 1, where less than 1 indicates sensitivity and greater than 1 indicates resistance; p-values<0.05 were considered statistically significant.ResultsAround 501 articles were found in the above mentioned search in the period selected (January 2004 to December 2013). We found no duplicated articles, and only 142 of the total met the criteria of identifying P. acnes, and the analysis of resistance and sensitivity with an antibiogram. However, only 24 studies were selected for methodological review and analysis, leaving only 13 which met all the microbiological and clinical data to be analysed; the remaining studies were excluded due to a lack of data or because their methodology was incomplete (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>It was established that 13 articles had a classification of cases and controls with a grade IIIB level of evidence and recommendation, without obtaining the clinical trial level, which is preferable for this statistical design (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0135">7–19</a><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The following data were extracted from the studies chosen: sample with P. acnes, sensitivity and resistance to clindamycin and erythromycin. Nadifloxacin was not found in any of the publications, only levofloxacin was tested, but its administration route meant it was ruled out for the study.<a class="elsevierStyleCrossRef" href="#bib0135">7</a>Once these data had been selected, the odd ratio OR was calculated for each, and the upper limit and the statistical p value in each article.<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows us how the mean OR is 1.24, with a 95% CI of 0.7048–2.3090. A total of 1770 patients was obtained from the 13 articles, with a range from 40 to 400 and a mean of 136.15; P. acnes was identified in 70% of the patients and resistance to treatment demonstrated in 43%, with sensitivity in 57%. Most of the articles were from different countries, except 2 from Chile (Schafer et al.<a class="elsevierStyleCrossRef" href="#bib0160">12</a> and Gübelin et al.<a class="elsevierStyleCrossRef" href="#bib0170">14</a>) and 2 from Korea (Moon et al.<a class="elsevierStyleCrossRef" href="#bib0140">8</a> and Song et al.<a class="elsevierStyleCrossRef" href="#bib0185">17</a>). The other countries were: México<a class="elsevierStyleCrossRef" href="#bib0135">7</a> (González et al.), Japan<a class="elsevierStyleCrossRef" href="#bib0145">9</a> (Ishida et al.), China<a class="elsevierStyleCrossRef" href="#bib0150">10</a> (Luk et al.), France<a class="elsevierStyleCrossRef" href="#bib0155">11</a> (Dumont-Wallon et al.), Sweden<a class="elsevierStyleCrossRef" href="#bib0165">13</a> (Oprica et al.), Singapore<a class="elsevierStyleCrossRef" href="#bib0175">15</a> (Tan et al.), Iran<a class="elsevierStyleCrossRef" href="#bib0180">16</a> (Zandi et al.), Colombia<a class="elsevierStyleCrossRef" href="#bib0190">18</a> (Mendoza et al.) and Turkey<a class="elsevierStyleCrossRef" href="#bib0195">19</a> (Ergin et al.). The greatest resistance was observed between 2010 and 2012 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).DiscussionAcne is a frequent reason for consultation in our clinical practice.<a class="elsevierStyleCrossRef" href="#bib0105">1</a> In recent years resistance to topical antibiotics has become evident in various publications, principally to topical erythromycin and clindamycin.<a class="elsevierStyleCrossRef" href="#bib0120">4</a> However, in practice its clinical significance has not been fully clarified and they are still used in routine practice to manage these patients, principally for patients with papulo-postular acne. In our review of the literature, we observed that there are few publications containing strict criteria for demonstrating the resistance of P. acnes to topical antibiotics; 7 articles presented an OR greater than 1, which shows a tendency to bacterial resistance. We also found 2 studies which presented excellent sensitivity to antibiotics.<a class="elsevierStyleCrossRefs" href="#bib0170">14,17</a> In Song et al. study<a class="elsevierStyleCrossRef" href="#bib0185">17</a> of 31 samples diagnosed with P. acnes, only one isolate was resistant to clindamycin, which moves the general mean of the studies towards sensitivity, and this is also demonstrated with the above mentioned analysis in all of the patients.Erythromycin and clindamycin are the 2 topical antibiotics which all the articles tested. In the case of erythromycin, the mean resistance percentage in all the publications is 30%, with a maximum of 73.6% in Dumont-Wallon et al. study<a class="elsevierStyleCrossRef" href="#bib0155">11</a> and nil resistance Song et al. study.<a class="elsevierStyleCrossRef" href="#bib0185">17</a> The case of clindamycin is similar, with a resistance mean of 25.5% and a maximum of 53% in Luk et al. study<a class="elsevierStyleCrossRef" href="#bib0150">10</a> with a minimum of 3% in the aforementioned study by Song et al.<a class="elsevierStyleCrossRef" href="#bib0185">17</a>We should highlight that despite the fact that there is a statistical tendency towards bacterial resistance, it is very weak and clinically the topical treatment might fail; however it should be remembered that the combination of topical antibiotics with benzoyl peroxide, as indicated in the treatment guidelines, reduces the incidence of resistance. Recent publications confirm that patients with resistant P. acnes have a clinical benefit if the area is washed with benzoyl peroxide at 6% for 20s before treatment with the topical antibiotic, this reduces bacterial resistance considerably (1 log after one week's treatment and at least 2 log after 3 weeks of treatment).<a class="elsevierStyleCrossRef" href="#bib0200">20</a> In our country, the commercial presentation of benzoyl peroxide at 5% can be found in combination with topical antibiotics, which helps dermatologists to achieve a good therapeutic response in their patients.We observed that there are few studies that would have made cultures of P. acnes, and those available had an evidence grade IIIB, therefore it is imperative to perform more rigorous clinical–microbiological studies with scientific evidence for a highly prevalent disease like acne vulgaris.The resistance indices observed in the studies might be lower, when short courses of antibiotics were used and in combination with benzoyl peroxide.In conclusion, a tendency towards P. acnes bacterial resistance has been found in patients with acne vulgaris. Monotherapy using clindamycin and erythromycin should not be the basis for treatment of this condition; these topical antibiotics can be used in very select cases, for short periods, and should always be used in combination with benzoyl peroxide to diminish, reduce inflammation and avoid P. acnes bacterial resistance in patients with acne vulgaris.We recommend that clinicians should use the evidence found in this meta-analysis in order to select the best treatment and obtain the best results for their patients with acne vulgaris.Conflict of interestsThe authors have no conflict of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres671268" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec677685" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres671269" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec677684" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Search strategy" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Selection of studies" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Microbiological analysis" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Data extraction" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-03-19" "fechaAceptado" => "2015-08-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec677685" "palabras" => array:4 [ 0 => "Acne vulgaris" 1 => "Bacterial resistance" 2 => "Propionibacterium acnes" 3 => "Meta-analysis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec677684" "palabras" => array:4 [ 0 => "Acne vulgaris" 1 => "Resistencia bacteriana" 2 => "Propionibacterium acnes" 3 => "Metaanálisis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundAcne is one of the dermatological pathologies with the highest incidence around the world. It is a multifactorial disease and its treatment can be complex. Propionibacterium acnes play a key role in the inflammation of this dermatosis. Topical antibiotics, including mainly erythromycin and clindamycin, have been used, but there is controversy over their use due to the widely documented bacterial resistance. For this reason a meta-analysis of the publications over the past 10 years is presented in order to confirm this hypothesis. Material and methodsA search was made of the publications over the past 10 years that included the results of antibiogams of patients with acne. MeSH type searches were performed with the terms “acne vulgaris”, “Propionibacterium acnes”, “topical administration”, “treatment”, “erythromycin”, “clindamycin”, “nadifloxacin”, “antibacterial agent”, “bacterial drug resistance” in PubMed, Ovid, EBSCO, Cochrane, ScienceDirect and ClinicalKey meta-searches. ResultsA total of 13 articles were found that met the inclusion criteria. The mean odds ratio (OR 1.24, 95% CI) of the articles showed a slight tendency towards resistance of P. acnes. ConclusionsAn increase in bacterial resistance to topical erythromycin and clindamycin can be confirmed, thus the use of these antibiotics is recommended in selective cases for short periods, and in combination with benzoyl peroxide for the best clinical outcome in patients with acne vulgaris." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "AntecedentesEl acné es una de las afecciones dermatológicas con mayor incidencia a nivel mundial; su origen es multifactorial y, por lo tanto, su tratamiento puede ser complejo. Propionibacterium acnes tiene un papel primordial en la inflamación de esta dermatosis y para su tratamiento se usan antibióticos tópicos; entre los principales se encuentran eritromicina y clindamicina, en los que se ha documentado una amplia resistencia bacteriana, lo que genera controversia respecto a su uso. Por este motivo se presenta un metaanálisis de las publicaciones de los últimos 10 años para confirmar esta hipótesis. Material y métodosEn la literatura de los últimos 10 años se buscaron artículos sobre resultados de cultivos con antibiograma de pacientes con acné. Se realizaron búsquedas tipo MeSH con los términos «acne vulgaris», «Propionibacterium acnes», «topical administration», «treatment», «erythromycin», «clindamycin», «nadifloxacin», «antibacterial agent», «bacterial drug resistance», en los metabuscadores PubMed, Ovid, EBSCO, Cochrane, ScienceDirect y ClinicalKey. ResultadosSe encontraron 13 artículos que cumplieron con los criterios de inclusión. La razón de momios promedio (OR 1.24, IC 95%) de los artículos demostró una ligera tendencia hacia la resistencia de Propionibacterium acnes. ConclusionesSe confirma el aumento en la resistencia bacteriana de Propionibacterium acnés a eritromicina y clindamicina tópica, por lo que recomendamos el uso de estos antibióticos combinados en casos selectos por periodos cortos y en combinación con peróxido de benzoilo, para obtener el mejor resultado clínico en los pacientes con Acne vulgaris." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Alvarez-Sánchez M, Rodríguez-Ayala E, Ponce-Olivera RM, Tirado-Sánchez A, Arellano-Mendoza MI. ¿Resistencia en el acné? Un metaanálisis a propósito de la controversia. Cirugía y Cirujanos. 2016;84:190–195." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1307 "Ancho" => 2410 "Tamanyo" => 267904 ] ] "descripcion" => array:1 [ "en" => "Statistics of each study." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2419 "Ancho" => 2197 "Tamanyo" => 328806 ] ] "descripcion" => array:1 [ "en" => "Process for selecting the articles." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CLN: clindamycin; ERY: erythromycin; NA: not assigned; P. acnes: Propionibacterium acnes." "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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Authors \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sample total \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Samples with P. acnes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Resistant \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensitive \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Resistance percentage \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensitivity percentage \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ERY percentage \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CLN percentage \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Schafer et al.<a class="elsevierStyleCrossRef" href="#bib0160">12</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chile \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mendoza et al.<a class="elsevierStyleCrossRef" href="#bib0190">18</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Colombia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Luk et al.<a class="elsevierStyleCrossRef" href="#bib0150">10</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">China \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">111 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53.50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moon et al.<a class="elsevierStyleCrossRef" href="#bib0140">8</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Korea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Song et al.<a class="elsevierStyleCrossRef" href="#bib0185">17</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Korea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zandi et al.<a class="elsevierStyleCrossRef" href="#bib0180">16</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Iran \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dumont-Wallon et al.<a class="elsevierStyleCrossRef" href="#bib0155">11</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">France \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">273 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">273 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">205 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">González et al.<a class="elsevierStyleCrossRef" href="#bib0135">7</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mexico \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ishida et al.<a class="elsevierStyleCrossRef" href="#bib0145">9</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Japan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tan et al.<a class="elsevierStyleCrossRef" href="#bib0175">15</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Singapore \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">262 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">174 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">148 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gübelin et al.<a class="elsevierStyleCrossRef" href="#bib0170">14</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chile \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ergin et al.<a class="elsevierStyleCrossRef" href="#bib0195">19</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Turkey \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">120 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oprica et al.<a class="elsevierStyleCrossRef" href="#bib0165">13</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sweden \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">400 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">201 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">132 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1770 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1235 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">533 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">702 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.51 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1098138.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Selected studies." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of acne vulgaris" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Bhate" 1 => "H.C. Williams" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjd.12149" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2013" "volumen" => "168" "paginaInicial" => "474" "paginaFinal" => "485" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23210645" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0110" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Topical antimicrobial treatment of acne vulgaris. An evidence-based review article" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Gamble" 1 => "J. Dunn" 2 => "A. Dawson" 3 => "B. Petersen" 4 => "L. McLaughlin" 5 => "A. Small" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2165/11597880-000000000-00000" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Dermatol" "fecha" => "2012" "volumen" => "13" "paginaInicial" => "141" "paginaFinal" => "152" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22268388" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0115" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acné. Un enfoque global" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Kaminsky" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "edicion" => "1.a ed." "fecha" => "2007" "paginaInicial" => "181" "editorial" => "Colegio Ibero-Latinoamericano de Dermatologi¿a" "editorialLocalizacion" => "Buenos Aires" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0120" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A call to limit antibiotic use in acne" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Thiboutot" 1 => "B. Dreno" 2 => "H. Gollnick" 3 => "V. Bettoli" 4 => "S. Kang" 5 => "J.J. Leyden" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Drugs Dermatol" "fecha" => "2013" "volumen" => "12" "paginaInicial" => "1331" "paginaFinal" => "1332" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24301232" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0125" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bacterial resistance to antibiotics in acne vulgaris: an in vitro study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Hassanzadeh" 1 => "M. Bahmani" 2 => "D. Mehrabani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0019-5154.43213" "Revista" => array:6 [ "tituloSerie" => "Indian J Dermatol" "fecha" => "2008" "volumen" => "53" "paginaInicial" => "122" "paginaFinal" => "124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19882009" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0130" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sampling and detection of skin Propionibacterium acnes: current status" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "O.A. Alexeyev" 1 => "A.C. Jahns" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.anaerobe.2012.07.001" "Revista" => array:6 [ "tituloSerie" => "Anaerobe" "fecha" => "2012" "volumen" => "18" "paginaInicial" => "479" "paginaFinal" => "483" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22877737" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0135" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "In vitro antimicrobial susceptibility of Propionibacterium acnes isolated from acne patients in northern Mexico" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. González" 1 => "O. Welsh" 2 => "J. Ocampo" 3 => "R.M. Hinojosa-Robles" 4 => "L. Vera-Cabrera" 5 => "M.L. Delaney" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2010" "volumen" => "49" "paginaInicial" => "1003" "paginaFinal" => "1007" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20931669" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0140" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antibiotic resistance of microbial strains isolated from Korean acne patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.H. Moon" 1 => "H.S. Roh" 2 => "Y.H. Kim" 3 => "J.E. Kim" 4 => "J.Y. Ko" 5 => "Y.S. Ro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1346-8138.2012.01626.x" "Revista" => array:6 [ "tituloSerie" => "J Dermatol" "fecha" => "2012" "volumen" => "39" "paginaInicial" => "833" "paginaFinal" => "837" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22779738" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0145" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antimicrobial susceptibilities of Propionibacterium acnes isolated from patients with acne vulgaris" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Ishida" 1 => "H. Nakaminami" 2 => "N. Noguchi" 3 => "I. Kurokawa" 4 => "S. Nishijima" 5 => "M. Sasatsu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1348-0421.2008.00081.x" "Revista" => array:6 [ "tituloSerie" => "Microbiol Immunol" "fecha" => "2008" "volumen" => "52" "paginaInicial" => "621" "paginaFinal" => "624" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19120976" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0150" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antibiotic-resistant Propionibacterium acnes among acne patients in a regional skin centre in Hong Kong" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.M. Luk" 1 => "M. Hui" 2 => "H.C. Lee" 3 => "L.H. Fu" 4 => "Z.H. Liu" 5 => "L.Y. Lam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2011.04351.x" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2013" "volumen" => "27" "paginaInicial" => "31" "paginaFinal" => "36" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22103749" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0155" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bacterial resistance in French acne patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Dumont-Wallon" 1 => "D. Moyse" 2 => "E. Blouin" 3 => "B. Dréno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2009.04270.x" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2010" "volumen" => "49" "paginaInicial" => "283" "paginaFinal" => "288" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20465665" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0160" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antimicrobial susceptibility and genetic characteristics of Propionibacterium acnes isolated from patients with acne" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F. Schafer" 1 => "F. Fich" 2 => "M. Lam" 3 => "C. Gárate" 4 => "A. Wozniak" 5 => "P. Garcia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2011.05371.x" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2013" "volumen" => "52" "paginaInicial" => "418" "paginaFinal" => "425" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23432195" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0165" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antibiotic-resistant Propionibacterium acnes on the skin of patients with moderate to severe acne in Stockholm" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Oprica" 1 => "L. Emtestam" 2 => "J. Lapins" 3 => "E. Borglund" 4 => "F. Nyberg" 5 => "K. Stenlund" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.anaerobe.2004.02.002" "Revista" => array:6 [ "tituloSerie" => "Anaerobe" "fecha" => "2004" "volumen" => "10" "paginaInicial" => "155" "paginaFinal" => "164" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16701513" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0170" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antimicrobial susceptibility of strains of Propionibacterium acnes isolated from inflammatory acne" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W. Gübelin" 1 => "M.A. Martínez" 2 => "M.T. Molina" 3 => "S. Zapata" 4 => "M.E. Valenzuela" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Latinoam Microbiol" "fecha" => "2006" "volumen" => "48" "paginaInicial" => "14" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17357569" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0175" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community-based study of acne vulgaris in adolescents in Singapore" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H.H. Tan" 1 => "A.W. Tan" 2 => "T. Barkham" 3 => "X.Y. Yan" 4 => "M. Zhu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2007.08087.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2007" "volumen" => "157" "paginaInicial" => "547" "paginaFinal" => "551" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17655737" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0180" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Determination of microbial agents of acne vulgaris and Propionibacterium acnes antibiotic resistance in patients referred to dermatology clinics in Kerman, Iran, 2008" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Zandi" 1 => "B. Vares" 2 => "H. 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Original article

¿Resistencia en el acné? Un metaanálisis a propósito de la controversia

Mariana Alvarez-Sáncheza,

Corresponding author

mariana.alvasa@gmail.com

Corresponding autor at: Av. Universidad Anáhuac 46, Col. Lomas Anáhuac, C.P. 52786, Huixquilucan, Mexico. Tel.: +52 55 5627 0210.

, Ernesto Rodríguez-Ayalaa, Rosa María Ponce-Oliverab, Andrés Tirado-Sánchezb, María Ivonne Arellano-Mendozab

a Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Huixquilucan, Mexico

b Servicio de Dermatología, Hospital General de México, México, D.F., Mexico

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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Statistics of each study&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Acne is the second major cause for dermatology consultation&#44; therefore it is important to know how to treat it appropriately&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> The treatment guidelines for <span class="elsevierStyleItalic">acne vulgaris</span> establish as their criteria&#58; &#40;a&#41; the clinical variety of acne&#44; classified as comedonal&#44; papulo-postular&#44; nodulocystic and &#40;b&#41; severity&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> The most frequently used treatment for acne&#44; and especially for papulo-postular acne&#44; are topical antibiotics&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#44;3</span></a> Because they have been used indiscriminately&#44; an increased resistance to topical antibiotics<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> has been confirmed in <span class="elsevierStyleItalic">Propionibacterium acnes</span> &#40;<span class="elsevierStyleItalic">P&#46; acnes</span>&#41;&#44; by means of cultures and antibiograms&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In order to evaluate whether there is sufficient evidence to consider <span class="elsevierStyleItalic">P&#46; acnes</span> resistant to topical antibiotics&#44; we performed a meta-analysis of the articles published on the subject&#44; and our research covered the last 10 years &#40;2004&#8211;2013&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Search strategy</span><p id="par0015" class="elsevierStylePara elsevierViewall">The literature published from 1 January to 31 December 2013 on the topical treatment was reviewed&#46; The metasearch engines we used were PubMed&#44; Ovid&#44; EBSCO&#44; Cochrane&#44; ScienceDirect and ClinicalKey&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Searches were made using the following MeSH terms&#58; &#8220;<span class="elsevierStyleItalic">acne vulgaris</span>&#8221;&#44; &#8220;<span class="elsevierStyleItalic">Propionibacterium acnes</span>&#8221;&#44; &#8220;topical administration&#8221;&#44; &#8220;treatment&#8221;&#44; &#8220;erythromycin&#8221;&#44; &#8220;clindamycin&#8221;&#44; &#8220;nadifloxacin&#8221;&#44; &#8220;antibacterial agent&#8221;&#44; &#8220;bacterial drug resistance&#8221;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Selection of studies</span><p id="par0025" class="elsevierStylePara elsevierViewall">Studies published from 1 January 2004 until 31 December 2013 &#40;10 years&#41; and written in English and&#47;or Spanish were chosen&#46; Two authors &#40;Alvarez-S&#225;nchez and Arellano-Mendoza&#41; independently reviewed&#44; assessed and chose the studies for analysis&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Microbiological analysis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Data relating to the method of handling samples&#44; transport&#44; cultures&#44; isolation and identification of <span class="elsevierStyleItalic">P&#46; acnes</span> were gathered and the antibiogram results of the antibiotics that are available for topical administration &#40;clindamycin&#44; erythromycin and nadifloxacin&#41;&#46; They were assessed with results for&#58; sensitivity and resistance&#44; cut-off points of minimum inhibitory concentration or <span class="elsevierStyleItalic">E-strip</span> based on the standards of the European Committee on Antimicrobial Susceptibility Testing and the Clinical and Laboratory Standards Institute&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Data extraction</span><p id="par0035" class="elsevierStylePara elsevierViewall">The data gathered from published studies were evaluated&#46; The following information was extracted from each study&#58; total number of patients&#44; patients with identification of <span class="elsevierStyleItalic">P&#46; acnes</span> and the abovementioned microbiological data&#46; Any discrepancy between the observers was resolved by consensus or by including a third observer&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">The comprehensive meta-analysis &#40;CMA version 2&#46;2&#46;064&#41; software package was used for processing the data&#44; the data was entered and the statistical analysis made&#44; which can be seen in the forest plot &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The cut-off point for determining resistance or sensitivity is an odds ratio &#40;OR&#41; of 1&#44; where less than 1 indicates sensitivity and greater than 1 indicates resistance&#59; <span class="elsevierStyleItalic">p</span>-values<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 were considered statistically significant&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Around 501 articles were found in the above mentioned search in the period selected &#40;January 2004 to December 2013&#41;&#46; We found no duplicated articles&#44; and only 142 of the total met the criteria of identifying <span class="elsevierStyleItalic">P&#46; acnes</span>&#44; and the analysis of resistance and sensitivity with an antibiogram&#46; However&#44; only 24 studies were selected for methodological review and analysis&#44; leaving only 13 which met all the microbiological and clinical data to be analysed&#59; the remaining studies were excluded due to a lack of data or because their methodology was incomplete &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">It was established that 13 articles had a classification of cases and controls with a grade IIIB level of evidence and recommendation&#44; without obtaining the clinical trial level&#44; which is preferable for this statistical design &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">7&#8211;19</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The following data were extracted from the studies chosen&#58; sample with <span class="elsevierStyleItalic">P&#46; acnes</span>&#44; sensitivity and resistance to clindamycin and erythromycin&#46; Nadifloxacin was not found in any of the publications&#44; only levofloxacin was tested&#44; but its administration route meant it was ruled out for the study&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Once these data had been selected&#44; the odd ratio OR was calculated for each&#44; and the upper limit and the statistical <span class="elsevierStyleItalic">p</span> value in each article&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows us how the mean OR is 1&#46;24&#44; with a 95&#37; CI of 0&#46;7048&#8211;2&#46;3090&#46; A total of 1770 patients was obtained from the 13 articles&#44; with a range from 40 to 400 and a mean of 136&#46;15&#59; <span class="elsevierStyleItalic">P&#46; acnes</span> was identified in 70&#37; of the patients and resistance to treatment demonstrated in 43&#37;&#44; with sensitivity in 57&#37;&#46; Most of the articles were from different countries&#44; except 2 from Chile &#40;Schafer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> and G&#252;belin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a>&#41; and 2 from Korea &#40;Moon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> and Song et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a>&#41;&#46; The other countries were&#58; M&#233;xico<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> &#40;Gonz&#225;lez et al&#46;&#41;&#44; Japan<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> &#40;Ishida et al&#46;&#41;&#44; China<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> &#40;Luk et al&#46;&#41;&#44; France<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> &#40;Dumont-Wallon et al&#46;&#41;&#44; Sweden<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> &#40;Oprica et al&#46;&#41;&#44; Singapore<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a> &#40;Tan et al&#46;&#41;&#44; Iran<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> &#40;Zandi et al&#46;&#41;&#44; Colombia<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> &#40;Mendoza et al&#46;&#41; and Turkey<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> &#40;Ergin et al&#46;&#41;&#46; The greatest resistance was observed between 2010 and 2012 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Acne is a frequent reason for consultation in our clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> In recent years resistance to topical antibiotics has become evident in various publications&#44; principally to topical erythromycin and clindamycin&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> However&#44; in practice its clinical significance has not been fully clarified and they are still used in routine practice to manage these patients&#44; principally for patients with papulo-postular acne&#46; In our review of the literature&#44; we observed that there are few publications containing strict criteria for demonstrating the resistance of <span class="elsevierStyleItalic">P&#46; acnes</span> to topical antibiotics&#59; 7 articles presented an OR greater than 1&#44; which shows a tendency to bacterial resistance&#46; We also found 2 studies which presented excellent sensitivity to antibiotics&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">14&#44;17</span></a> In Song et al&#46; study<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> of 31&#160;samples diagnosed with <span class="elsevierStyleItalic">P&#46; acnes</span>&#44; only one isolate was resistant to clindamycin&#44; which moves the general mean of the studies towards sensitivity&#44; and this is also demonstrated with the above mentioned analysis in all of the patients&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Erythromycin and clindamycin are the 2 topical antibiotics which all the articles tested&#46; In the case of erythromycin&#44; the mean resistance percentage in all the publications is 30&#37;&#44; with a maximum of 73&#46;6&#37; in Dumont-Wallon et al&#46; study<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> and nil resistance Song et al&#46; study&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> The case of clindamycin is similar&#44; with a resistance mean of 25&#46;5&#37; and a maximum of 53&#37; in Luk et al&#46; study<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> with a minimum of 3&#37; in the aforementioned study by Song et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">We should highlight that despite the fact that there is a statistical tendency towards bacterial resistance&#44; it is very weak and clinically the topical treatment might fail&#59; however it should be remembered that the combination of topical antibiotics with benzoyl peroxide&#44; as indicated in the treatment guidelines&#44; reduces the incidence of resistance&#46; Recent publications confirm that patients with resistant <span class="elsevierStyleItalic">P&#46; acnes</span> have a clinical benefit if the area is washed with benzoyl peroxide at 6&#37; for 20<span class="elsevierStyleHsp" style=""></span>s before treatment with the topical antibiotic&#44; this reduces bacterial resistance considerably &#40;1 log after one week&#39;s treatment and at least 2 log after 3 weeks of treatment&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> In our country&#44; the commercial presentation of benzoyl peroxide at 5&#37; can be found in combination with topical antibiotics&#44; which helps dermatologists to achieve a good therapeutic response in their patients&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">We observed that there are few studies that would have made cultures of <span class="elsevierStyleItalic">P&#46; acnes</span>&#44; and those available had an evidence grade IIIB&#44; therefore it is imperative to perform more rigorous clinical&#8211;microbiological studies with scientific evidence for a highly prevalent disease like acne vulgaris&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The resistance indices observed in the studies might be lower&#44; when short courses of antibiotics were used and in combination with benzoyl peroxide&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In conclusion&#44; a tendency towards <span class="elsevierStyleItalic">P&#46; acnes</span> bacterial resistance has been found in patients with <span class="elsevierStyleItalic">acne vulgaris</span>&#46; Monotherapy using clindamycin and erythromycin should not be the basis for treatment of this condition&#59; these topical antibiotics can be used in very select cases&#44; for short periods&#44; and should always be used in combination with benzoyl peroxide to diminish&#44; reduce inflammation and avoid <span class="elsevierStyleItalic">P&#46; acnes</span> bacterial resistance in patients with <span class="elsevierStyleItalic">acne vulgaris</span>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">We recommend that clinicians should use the evidence found in this meta-analysis in order to select the best treatment and obtain the best results for their patients with acne vulgaris&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interests</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
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          "titulo" => "Resumen"
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            0 => "<span class="elsevierStyleItalic">Acne vulgaris</span>"
            1 => "Bacterial resistance"
            2 => "<span class="elsevierStyleItalic">Propionibacterium acnes</span>"
            3 => "Meta-analysis"
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            0 => "<span class="elsevierStyleItalic">Acne vulgaris</span>"
            1 => "Resistencia bacteriana"
            2 => "<span class="elsevierStyleItalic">Propionibacterium acnes</span>"
            3 => "Metaan&#225;lisis"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Acne is one of the dermatological pathologies with the highest incidence around the world&#46; It is a multifactorial disease and its treatment can be complex&#46; <span class="elsevierStyleItalic">Propionibacterium acnes</span> play a key role in the inflammation of this dermatosis&#46; Topical antibiotics&#44; including mainly erythromycin and clindamycin&#44; have been used&#44; but there is controversy over their use due to the widely documented bacterial resistance&#46; For this reason a meta-analysis of the publications over the past 10 years is presented in order to confirm this hypothesis&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A search was made of the publications over the past 10 years that included the results of antibiogams of patients with acne&#46; MeSH type searches were performed with the terms &#8220;<span class="elsevierStyleItalic">acne vulgaris</span>&#8221;&#44; &#8220;<span class="elsevierStyleItalic">Propionibacterium acnes</span>&#8221;&#44; &#8220;topical administration&#8221;&#44; &#8220;treatment&#8221;&#44; &#8220;erythromycin&#8221;&#44; &#8220;clindamycin&#8221;&#44; &#8220;nadifloxacin&#8221;&#44; &#8220;antibacterial agent&#8221;&#44; &#8220;bacterial drug resistance&#8221; in PubMed&#44; Ovid&#44; EBSCO&#44; Cochrane&#44; ScienceDirect and ClinicalKey meta-searches&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 13 articles were found that met the inclusion criteria&#46; The mean odds ratio &#40;OR 1&#46;24&#44; 95&#37; CI&#41; of the articles showed a slight tendency towards resistance of <span class="elsevierStyleItalic">P&#46; acnes</span>&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">An increase in bacterial resistance to topical erythromycin and clindamycin can be confirmed&#44; thus the use of these antibiotics is recommended in selective cases for short periods&#44; and in combination with benzoyl peroxide for the best clinical outcome in patients with acne vulgaris&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0005"
            "titulo" => "Background"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El acn&#233; es una de las afecciones dermatol&#243;gicas con mayor incidencia a nivel mundial&#59; su origen es multifactorial y&#44; por lo tanto&#44; su tratamiento puede ser complejo&#46; <span class="elsevierStyleItalic">Propionibacterium acnes</span> tiene un papel primordial en la inflamaci&#243;n de esta dermatosis y para su tratamiento se usan antibi&#243;ticos t&#243;picos&#59; entre los principales se encuentran eritromicina y clindamicina&#44; en los que se ha documentado una amplia resistencia bacteriana&#44; lo que genera controversia respecto a su uso&#46; Por este motivo se presenta un metaan&#225;lisis de las publicaciones de los &#250;ltimos 10&#160;a&#241;os para confirmar esta hip&#243;tesis&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En la literatura de los &#250;ltimos 10&#160;a&#241;os se buscaron art&#237;culos sobre resultados de cultivos con antibiograma de pacientes con acn&#233;&#46; Se realizaron b&#250;squedas tipo MeSH con los t&#233;rminos &#171;<span class="elsevierStyleItalic">acne vulgaris</span>&#187;&#44; &#171;<span class="elsevierStyleItalic">Propionibacterium acnes</span>&#187;&#44; &#171;topical administration&#187;&#44; &#171;treatment&#187;&#44; &#171;erythromycin&#187;&#44; &#171;clindamycin&#187;&#44; &#171;nadifloxacin&#187;&#44; &#171;antibacterial agent&#187;&#44; &#171;bacterial drug resistance&#187;&#44; en los metabuscadores PubMed&#44; Ovid&#44; EBSCO&#44; Cochrane&#44; ScienceDirect y ClinicalKey&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se encontraron 13 art&#237;culos que cumplieron con los criterios de inclusi&#243;n&#46; La raz&#243;n de momios promedio &#40;OR 1&#46;24&#44; IC 95&#37;&#41; de los art&#237;culos demostr&#243; una ligera tendencia hacia la resistencia de <span class="elsevierStyleItalic">Propionibacterium acnes</span>&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se confirma el aumento en la resistencia bacteriana de <span class="elsevierStyleItalic">Propionibacterium acn&#233;s</span> a eritromicina y clindamicina t&#243;pica&#44; por lo que recomendamos el uso de estos antibi&#243;ticos combinados en casos selectos por periodos cortos y en combinaci&#243;n con per&#243;xido de benzoilo&#44; para obtener el mejor resultado cl&#237;nico en los pacientes con <span class="elsevierStyleItalic">Acne vulgaris</span>&#46;</p></span>"
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          3 => array:2 [
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            "titulo" => "Conclusiones"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Alvarez-S&#225;nchez M&#44; Rodr&#237;guez-Ayala E&#44; Ponce-Olivera RM&#44; Tirado-S&#225;nchez A&#44; Arellano-Mendoza MI&#46; &#191;Resistencia en el acn&#233;&#63; Un metaan&#225;lisis a prop&#243;sito de la controversia&#46; Cirug&#237;a y Cirujanos&#46; 2016&#59;84&#58;190&#8211;195&#46;</p>"
      ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Statistics of each study&#46;</p>"
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      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Process for selecting the articles&#46;</p>"
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      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
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            "identificador" => "at1"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">CLN&#58; clindamycin&#59; ERY&#58; erythromycin&#59; NA&#58; not assigned&#59; <span class="elsevierStyleItalic">P&#46; acnes</span>&#58; <span class="elsevierStyleItalic">Propionibacterium acnes</span>&#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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Authors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sample total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Samples with <span class="elsevierStyleItalic">P&#46; acnes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Resistant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensitive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Resistance percentage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensitivity percentage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ERY percentage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CLN percentage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Schafer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mendoza et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Colombia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Luk et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Korea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Song et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Korea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zandi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Iran&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dumont-Wallon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">France&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">273&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">273&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">205&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gonz&#225;lez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mexico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ishida et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Japan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Singapore&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">262&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">174&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">148&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">G&#252;belin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ergin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Turkey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oprica et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sweden&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">201&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">132&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1770&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1235&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">533&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">702&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Selected studies&#46;</p>"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of acne vulgaris"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46; Bhate"
                            1 => "H&#46;C&#46; Williams"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.12149"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2013"
                        "volumen" => "168"
                        "paginaInicial" => "474"
                        "paginaFinal" => "485"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23210645"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Topical antimicrobial treatment of acne vulgaris&#46; An evidence-based review article"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Gamble"
                            1 => "J&#46; Dunn"
                            2 => "A&#46; Dawson"
                            3 => "B&#46; Petersen"
                            4 => "L&#46; McLaughlin"
                            5 => "A&#46; Small"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2165/11597880-000000000-00000"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Dermatol"
                        "fecha" => "2012"
                        "volumen" => "13"
                        "paginaInicial" => "141"
                        "paginaFinal" => "152"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22268388"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acn&#233;&#46; Un enfoque global"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Kaminsky"
                          ]
                        ]
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                    ]
                  ]
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                    0 => array:1 [
                      "Libro" => array:5 [
                        "edicion" => "1&#46;<span class="elsevierStyleSup">a</span> ed&#46;"
                        "fecha" => "2007"
                        "paginaInicial" => "181"
                        "editorial" => "Colegio Ibero-Latinoamericano de Dermatologi¿a"
                        "editorialLocalizacion" => "Buenos Aires"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A call to limit antibiotic use in acne"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Thiboutot"
                            1 => "B&#46; Dreno"
                            2 => "H&#46; Gollnick"
                            3 => "V&#46; Bettoli"
                            4 => "S&#46; Kang"
                            5 => "J&#46;J&#46; Leyden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Drugs Dermatol"
                        "fecha" => "2013"
                        "volumen" => "12"
                        "paginaInicial" => "1331"
                        "paginaFinal" => "1332"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24301232"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bacterial resistance to antibiotics in acne vulgaris&#58; an in vitro study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Hassanzadeh"
                            1 => "M&#46; Bahmani"
                            2 => "D&#46; Mehrabani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0019-5154.43213"
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian J Dermatol"
                        "fecha" => "2008"
                        "volumen" => "53"
                        "paginaInicial" => "122"
                        "paginaFinal" => "124"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19882009"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sampling and detection of skin <span class="elsevierStyleItalic">Propionibacterium acnes</span>&#58; current status"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "O&#46;A&#46; Alexeyev"
                            1 => "A&#46;C&#46; Jahns"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.anaerobe.2012.07.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anaerobe"
                        "fecha" => "2012"
                        "volumen" => "18"
                        "paginaInicial" => "479"
                        "paginaFinal" => "483"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22877737"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">In vitro</span> antimicrobial susceptibility of <span class="elsevierStyleItalic">Propionibacterium acnes</span> isolated from acne patients in northern Mexico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Gonz&#225;lez"
                            1 => "O&#46; Welsh"
                            2 => "J&#46; Ocampo"
                            3 => "R&#46;M&#46; Hinojosa-Robles"
                            4 => "L&#46; Vera-Cabrera"
                            5 => "M&#46;L&#46; Delaney"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol"
                        "fecha" => "2010"
                        "volumen" => "49"
                        "paginaInicial" => "1003"
                        "paginaFinal" => "1007"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20931669"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antibiotic resistance of microbial strains isolated from Korean acne patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;H&#46; Moon"
                            1 => "H&#46;S&#46; Roh"
                            2 => "Y&#46;H&#46; Kim"
                            3 => "J&#46;E&#46; Kim"
                            4 => "J&#46;Y&#46; Ko"
                            5 => "Y&#46;S&#46; Ro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1346-8138.2012.01626.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatol"
                        "fecha" => "2012"
                        "volumen" => "39"
                        "paginaInicial" => "833"
                        "paginaFinal" => "837"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22779738"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antimicrobial susceptibilities of <span class="elsevierStyleItalic">Propionibacterium acnes</span> isolated from patients with acne vulgaris"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46; Ishida"
                            1 => "H&#46; Nakaminami"
                            2 => "N&#46; Noguchi"
                            3 => "I&#46; Kurokawa"
                            4 => "S&#46; Nishijima"
                            5 => "M&#46; Sasatsu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1348-0421.2008.00081.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Microbiol Immunol"
                        "fecha" => "2008"
                        "volumen" => "52"
                        "paginaInicial" => "621"
                        "paginaFinal" => "624"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19120976"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antibiotic-resistant <span class="elsevierStyleItalic">Propionibacterium acnes</span> among acne patients in a regional skin centre in Hong Kong"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;M&#46; Luk"
                            1 => "M&#46; Hui"
                            2 => "H&#46;C&#46; Lee"
                            3 => "L&#46;H&#46; Fu"
                            4 => "Z&#46;H&#46; Liu"
                            5 => "L&#46;Y&#46; Lam"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-3083.2011.04351.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2013"
                        "volumen" => "27"
                        "paginaInicial" => "31"
                        "paginaFinal" => "36"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22103749"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bacterial resistance in French acne patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Dumont-Wallon"
                            1 => "D&#46; Moyse"
                            2 => "E&#46; Blouin"
                            3 => "B&#46; Dr&#233;no"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-4632.2009.04270.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol"
                        "fecha" => "2010"
                        "volumen" => "49"
                        "paginaInicial" => "283"
                        "paginaFinal" => "288"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20465665"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antimicrobial susceptibility and genetic characteristics of <span class="elsevierStyleItalic">Propionibacterium acnes</span> isolated from patients with acne"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Schafer"
                            1 => "F&#46; Fich"
                            2 => "M&#46; Lam"
                            3 => "C&#46; G&#225;rate"
                            4 => "A&#46; Wozniak"
                            5 => "P&#46; Garcia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-4632.2011.05371.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol"
                        "fecha" => "2013"
                        "volumen" => "52"
                        "paginaInicial" => "418"
                        "paginaFinal" => "425"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23432195"
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                    0 => array:2 [
                      "titulo" => "Antibiotic-resistant <span class="elsevierStyleItalic">Propionibacterium acnes</span> on the skin of patients with moderate to severe acne in Stockholm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Oprica"
                            1 => "L&#46; Emtestam"
                            2 => "J&#46; Lapins"
                            3 => "E&#46; Borglund"
                            4 => "F&#46; Nyberg"
                            5 => "K&#46; Stenlund"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.anaerobe.2004.02.002"
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                        "tituloSerie" => "Anaerobe"
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                        "paginaInicial" => "155"
                        "paginaFinal" => "164"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16701513"
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                  ]
                ]
              ]
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                      "titulo" => "Antimicrobial susceptibility of strains of <span class="elsevierStyleItalic">Propionibacterium acnes</span> isolated from inflammatory acne"
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                        0 => array:2 [
                          "etal" => false
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                            3 => "S&#46; Zapata"
                            4 => "M&#46;E&#46; Valenzuela"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "paginaInicial" => "14"
                        "paginaFinal" => "16"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17357569"
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                  ]
                ]
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                      "titulo" => "Community-based study of acne vulgaris in adolescents in Singapore"
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                            3 => "X&#46;Y&#46; Yan"
                            4 => "M&#46; Zhu"
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                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
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                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2007"
                        "volumen" => "157"
                        "paginaInicial" => "547"
                        "paginaFinal" => "551"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17655737"
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                ]
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                      "titulo" => "Determination of microbial agents of acne vulgaris and <span class="elsevierStyleItalic">Propionibacterium acnes</span> antibiotic resistance in patients referred to dermatology clinics in Kerman&#44; Iran&#44; 2008"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Jundishapur J Microbiol"
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                        "volumen" => "4"
                        "paginaInicial" => "17"
                        "paginaFinal" => "22"
                      ]
                    ]
                  ]
                ]
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                    0 => array:2 [
                      "titulo" => "Antibiotic susceptibility of <span class="elsevierStyleItalic">Propionibacterium acnes</span> isolated from acne vulgaris in Korea"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            4 => "K&#46;S&#46; Kwon"
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                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1111/j.1346-8138.2010.01109.x"
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                        "tituloSerie" => "J Dermatol"
                        "fecha" => "2011"
                        "volumen" => "38"
                        "paginaInicial" => "667"
                        "paginaFinal" => "673"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21352337"
                            "web" => "Medline"
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                  ]
                ]
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                      "titulo" => "Antimicrobial susceptibility of <span class="elsevierStyleItalic">Propionibacterium acnes</span> isolates from acne patients in Colombia"
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                          "etal" => false
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                        "tituloSerie" => "Int J Dermatol"
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                        "paginaInicial" => "688"
                        "paginaFinal" => "692"
                        "link" => array:1 [
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                        "link" => array:1 [
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Article information

ISSN: 24440507
Original language: English

DOI:10.1016/j.circen.2016.04.003

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	41	4	45
2024 September	62	10	72
2024 August	52	8	60
2024 July	60	14	74
2024 June	49	9	58
2024 May	49	8	57
2024 April	53	7	60
2024 March	52	8	60
2024 February	64	12	76
2024 January	120	14	134
2023 December	77	9	86
2023 November	68	11	79
2023 October	84	17	101
2023 September	63	8	71
2023 August	71	9	80
2023 July	63	14	77
2023 June	98	14	112
2023 May	126	10	136
2023 April	77	0	77
2023 March	97	6	103
2023 February	94	5	99
2023 January	63	6	69
2022 December	43	8	51
2022 November	64	10	74
2022 October	58	19	77
2022 September	61	12	73
2022 August	68	16	84
2022 July	70	10	80
2022 June	59	16	75
2022 May	56	10	66
2022 April	52	11	63
2022 March	87	5	92
2022 February	54	8	62
2022 January	99	4	103
2021 December	33	9	42
2021 November	55	11	66
2021 October	59	8	67
2021 September	28	10	38
2021 August	19	11	30
2021 July	24	4	28
2021 June	17	14	31
2021 May	33	11	44
2021 April	103	33	136
2021 March	47	22	69
2021 February	48	12	60
2021 January	27	11	38
2020 December	28	17	45
2020 November	20	4	24
2020 October	26	6	32
2020 September	14	26	40
2020 August	32	35	67
2020 July	29	17	46
2020 June	18	15	33
2020 May	18	18	36
2020 April	16	3	19
2020 March	29	2	31
2020 February	14	6	20
2020 January	22	9	31
2019 December	20	12	32
2019 November	14	7	21
2019 October	15	3	18
2019 September	24	4	28
2019 August	3	4	7
2019 July	17	10	27
2019 June	29	21	50
2019 May	112	67	179
2019 April	62	28	90
2019 March	9	4	13
2019 February	12	9	21
2019 January	8	3	11
2018 December	9	10	19
2018 November	13	9	22
2018 October	20	2	22
2018 September	10	6	16
2018 August	7	1	8
2018 July	8	14	22
2018 June	5	1	6
2018 May	8	11	19
2018 April	8	3	11
2018 March	10	2	12
2018 February	2	0	2
2018 January	7	3	10
2017 December	5	3	8
2017 November	5	2	7
2017 October	10	11	21
2017 September	5	6	11
2017 August	8	9	17
2017 July	11	11	22
2017 June	8	11	19
2017 May	5	4	9
2017 April	7	11	18
2017 March	8	37	45
2017 February	4	9	13
2017 January	3	5	8
2016 December	15	2	17
2016 November	18	3	21
2016 October	26	11	37
2016 September	29	6	35
2016 August	24	6	30
2016 July	40	4	44
2016 June	46	24	70

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