Scientific Letter
Community-associated methicillin-resistant Staphylococcus aureus disease in two members of a household in Spain
Infección invasora por Staphylococcus aureus comunitario en dos miembros de una familia
J.R.. José Ramón Paño-Pardoa,
, Adela Garcíab, Francisco Aracilc, Antonio Martínezd
Corresponding author
a Infectious Disease Unit, Hospital Universitario La Paz - IDIPAZ, Madrid, Spain
b Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
c Department of Pediatrics Hospital Universitario La Paz - IDIPAZ, Madrid, Spain
d Department of Respiratory Medicine Hospital Universitario La Paz - IDIPAZ , Madrid, Spain
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"nombre" => "José Ramón" "apellidos" => "Paño-Pardo" "email" => array:1 [ 0 => "joserrapa@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Adela" "apellidos" => "García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff3" ] ] ] 2 => array:3 [ "nombre" => "Francisco" "apellidos" => "Aracil" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff4" ] ] ] 3 => array:3 [ "nombre" => "Antonio" "apellidos" => "Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff2" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Infectious Disease Unit, Hospital Universitario La Paz - IDIPAZ, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff3" ] 2 => array:3 [ "entidad" => "Department of Pediatrics Hospital Universitario La Paz - IDIPAZ, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff4" ] 3 => array:3 [ "entidad" => "Department of Respiratory Medicine Hospital Universitario La Paz - IDIPAZ , Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infección invasora por Staphylococcus aureus comunitario en dos miembros de una familia" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p class="elsevierStylePara elsevierViewall">We present 2 cases of community-associated methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> (CA-MRSA) pneumonia in a young, previously healthy woman and her newborn. To the best of our knowledge this is the first reported intra-family cluster of CA-MRSA pneumonia. If reported cases of household transmission of invasive CA-MRSA increase, stricter infection control measures might be needed in the management of these patients and their households.</p><p class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Patient 1 (PT1)</span>. A 38-year-old Filipino woman with a past medical history of mild asthma was admitted to our institution with severe community-acquired pneumonia. Bilateral alveolar infiltrates were observed on chest radiographs. She was admitted to the intensive care unit (ICU), and antimicrobial therapy with ceftriaxone and clarithromycin was started. She had migrated to Spain 4 years before and lived in a 3-bedroom flat with 8 other people, all adults except for her baby boy, who was born 3 months before through an uncomplicated vaginal delivery. Clinically, she remained intermittently febrile during her ICU stay. On hospital day (HD) 4, the 2 sets of blood cultures obtained on admission were reported to be positive for MRSA. The isolate was susceptible to all other non-beta-lactam antimicrobials routinely tested, including clindamycin, erythromycin, trimethoprim/sulfamethoxazole, doxycycline, aminoglycosides, and levofloxacin, among others. Antimicrobial therapy was then switched to vancomycin and levofloxacin, and the patient rapidly defervesced. New blood cultures were negative and a transesophageal echocardiogram was performed without evidence of infective endocarditis. On HD 10, vancomycin and levofloxacin were discontinued and linezolid 600<span class="elsevierStyleHsp" style=""></span>mg bid po was started to complete 4 weeks of therapy without further complications.</p><p class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Patient 2. (PT2)</span> Twelve days after admission of PT1, her 3-month-old baby boy was admitted to our hospital with a 24-hour history of irritability, somnolence, and fever. On chest radiography, a right lower lobe infiltrate was seen. Antimicrobial therapy with vancomycin and cefotaxime were started. The patient's condition remained mainly unchanged, with persistent fever and elevated inflammatory markers. A second chest radiograph showed significantly increased right pleural effusion. Culture of the pleural fluid yielded MRSA with the same susceptibility pattern as that observed in PT1. The pleural effusion was percutaneously aspirated and antimicrobial therapy was changed to linezolid and meropenem. Soon after, the patient became afebrile and received 4 weeks of antimicrobials without further complications.</p><p class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Family environment</span>: PT1 and PT2 shared a 3-bedroom flat in the metropolitan area of Madrid with 7 more people, all of Filipino ethnicity. Nasal swabs for culture were obtained from all the household members. MRSA with an identical susceptibility pattern was isolated in one of them.</p><p class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Molecular typing of the isolates</span>: Clinical isolates from both patients and the one obtained from the healthy household member were analyzed by sequencing of the protein A gene polymorphic region (<span class="elsevierStyleItalic">spa</span>-typing). All isolates were found to belong to <span class="elsevierStyleItalic">spa-</span>type 019, which has been described only in clone ST30, also known as the South Pacific clone. Analysis by PCR showed that the 3 isolates carried the SCCmec element of type IV and the <span class="elsevierStyleItalic">lukPV</span> genes (coding for the Panton-Valentine leukocidin [PVL]).</p><p class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Discussion:</span> We herein report 2 cases of CA-MRSA pneumonia in a household setting of previously healthy young individuals of Filipino ethnicity in Spain. The epidemiology of CA-MRSA infections in the United States has been extensively investigated, and they known to account for most skin and soft tissue infections (SSTIs). There are fewer data on the magnitude of this problem in other areas of the world, although it appears that the incidence of CA-MRSA infection in countries other than USA is generally lower. For instance, in a prospective study conducted between 1999 and 2003 in a French 500-bed community hospital study including 197 patients with community-acquired staphylococcal SSTI, only 3% had criteria for CA-MRSA infection.<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> Figures in the United Kingdom and Scandinavian countries seem to be somewhat higher. In a recent nationwide point-prevalence study of all MRSA isolated in a single day in 149 Spanish hospitals, none of the isolates produced PVL.<a class="elsevierStyleCrossRef" href="#bib2"><span class="elsevierStyleSup">2</span></a> Nevertheless, there are recent reports of CA-MRSA infections, mainly SSTI, in the immigrant population in Spain.<a class="elsevierStyleCrossRefs" href="#bib3"><span class="elsevierStyleSup">3,4</span></a> Regarding the overall molecular epidemiology of CA-MRSA<span class="elsevierStyleBold">,</span> Vandenesch et al<a class="elsevierStyleCrossRef" href="#bib5"><span class="elsevierStyleSup">5</span></a> found that the CA-MRSA sequence type (ST) showed clear continent specificity: ST-1 in USA, ST-80 in Europe (European clone) and ST-30 in Oceania (Southwest Pacific clone) and suggested the possibility of simultaneous co-evolution of CA-MRSA organisms in different locations.</p><p class="elsevierStylePara elsevierViewall">Several authors have reported clustering of CA-MRSA colonization in households.<a class="elsevierStyleCrossRef" href="#bib6"><span class="elsevierStyleSup">6</span></a> Nevertheless documentation of intrafamilial clusters of CA-MRSA infections, mainly in the setting of SSTI, is relatively rare.<a class="elsevierStyleCrossRefs" href="#bib7"><span class="elsevierStyleSup">7–9</span></a> To the best of our knowledge, this is the first report of clustered invasive CA-MRSA infections within a household. Currently there are many uncertainties regarding the infection control measures to adopt in the household setting when CA-MRSA has been diagnosed.<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a> As opposed to the hospital setting, the association between nasal colonization and infection in the community is not so straight forward. Furthermore, colonization of different sites (pharynx, axilla, rectum, peritoneum) may also have an important role, and there are no studies that inconclusively support the benefit of decolonization. With this level of evidence, the CDC recommends clinicians to ask about similar cases of SSTI in household members and other close contacts and reinforce basic hygienic measures among them. Nasal decolonization with topical mupirocin and antiseptic body washes are recommended in patients with recurrent infection and when ongoing MRSA transmission is occurring in a well-defined, closely-associated cohort, such as a household.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Emergence of two populations of methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> with distinct epidemiological, clinical and biological features, isolated from patients with community-acquired skin infections" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Del Giudice" 1 => "V. Blanc" 2 => "F. Durupt" 3 => "M. Bes" 4 => "J.P. Martinez" 5 => "E. Counillon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2005.06910.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2006" "volumen" => "154" "paginaInicial" => "118" "paginaFinal" => "124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16403104" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular epidemiology of methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> in Spain: a multicentre prevalence study (2002)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Cuevas" 1 => "E. Cercenado" 2 => "E. Bouza" 3 => "C. Castellares" 4 => "P. Trincado" 5 => "R. Cabrera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1469-0691.2006.01672.x" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2007" "volumen" => "13" "paginaInicial" => "250" "paginaFinal" => "256" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17391378" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community-acquired methicillin-resistant Staphylococcus aureus in Madrid, Spain: transcontinental importation and polyclonal emergence of Panton–Valentine leukocidin-positive isolates" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Cercenado" 1 => "O. Cuevas" 2 => "M. Marín" 3 => "E. Bouza" 4 => "P. Trincado" 5 => "T. Boquete" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.diagmicrobio.2008.01.001" "Revista" => array:7 [ "tituloSerie" => "Diagn Microbiol Infect Dis" "fecha" => "2008" "volumen" => "61" "paginaInicial" => "143" "paginaFinal" => "149" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18280081" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673603125093" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community-acquired methicillin-resistant Staphylococcus aureus infections: an emerging threat in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Manzur" 1 => "A.M. Dominguez" 2 => "M. Pujol" 3 => "M.P. González" 4 => "E. Limon" 5 => "A. Hornero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1469-0691.2007.01934.x" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "377" "paginaFinal" => "380" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18190565" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community-acquired methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> carrying Panton-Valentine leukocidin genes: worldwide emergence" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Vandenesch" 1 => "T. Naimi" 2 => "M.C. Enright" 3 => "G. Lina" 4 => "G.R. Nimmo" 5 => "H. Heffernan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3201/eid0908.030089" "Revista" => array:6 [ "tituloSerie" => "Emerg Infect Dis" "fecha" => "2003" "volumen" => "9" "paginaInicial" => "978" "paginaFinal" => "984" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12967497" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community-acquired methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> and intrafamilial spread of pustular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Faden" 1 => "S. Ferguson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Infect Dis J" "fecha" => "2001" "volumen" => "20" "paginaInicial" => "554" "paginaFinal" => "555" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11368124" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "First case of intrafamily transmission of a new MRSA clone with toxic shock syndrome toxin-1" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X. Lemaire" 1 => "L. Legout" 2 => "C. François" 3 => "G. Lina" 4 => "E. Beltrand" 5 => "E. Senneville" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/00365540701827499" "Revista" => array:6 [ "tituloSerie" => "Scand J Infect Dis" "fecha" => "2008" "volumen" => "40" "paginaInicial" => "675" "paginaFinal" => "676" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18642160" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High prevalence of MRSA in household contacts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.J. Hugo Johansson" 1 => "E.B. Gustafsson" 2 => "H. Ringberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/00365540701302501" "Revista" => array:6 [ "tituloSerie" => "Scandinavian Journal of Infectious Diseases" "fecha" => "2007" "volumen" => "39" "paginaInicial" => "764" "paginaFinal" => "768" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17701713" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intrafamilial Spread of Methicillin-Resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> Infections. Reply" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.C. Moellering Jr" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.299.21.2511-a" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2008" "volumen" => "299" "paginaInicial" => "2511" "paginaFinal" => "2512" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18523216" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Gorwitz RJ, Jernigan DB, Powers JH, Jernigan JA, and Participants in the CDCConvened Experts’ Meeting on Management of MRSA in the Community. Strategies for clinical management of MRSA in the community: Summary of an experts’ meeting convened by the Centers for Disease Control and Prevention. 2006. 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| 2024 July | 15 | 9 | 24 |
| 2024 June | 11 | 11 | 22 |
| 2024 May | 11 | 12 | 23 |
| 2024 April | 12 | 23 | 35 |
| 2024 March | 20 | 24 | 44 |
| 2024 February | 22 | 16 | 38 |
| 2024 January | 20 | 7 | 27 |
| 2023 December | 16 | 30 | 46 |
| 2023 November | 10 | 31 | 41 |
| 2023 October | 22 | 49 | 71 |
| 2023 September | 8 | 12 | 20 |
| 2023 August | 10 | 8 | 18 |
| 2023 July | 13 | 24 | 37 |
| 2023 June | 10 | 8 | 18 |
| 2023 May | 9 | 8 | 17 |
| 2023 April | 15 | 5 | 20 |
| 2023 March | 14 | 5 | 19 |
| 2023 February | 19 | 1 | 20 |
| 2023 January | 18 | 9 | 27 |
| 2022 December | 10 | 9 | 19 |
| 2022 November | 43 | 34 | 77 |
| 2022 October | 11 | 11 | 22 |
| 2022 September | 19 | 25 | 44 |
| 2022 August | 15 | 24 | 39 |
| 2022 July | 8 | 13 | 21 |
| 2022 June | 11 | 14 | 25 |
| 2022 May | 13 | 13 | 26 |
| 2022 April | 21 | 12 | 33 |
| 2022 March | 20 | 11 | 31 |
| 2022 February | 21 | 8 | 29 |
| 2022 January | 7 | 4 | 11 |
| 2021 December | 12 | 13 | 25 |
| 2021 November | 39 | 15 | 54 |
| 2021 October | 39 | 21 | 60 |
| 2021 September | 26 | 9 | 35 |
| 2021 August | 11 | 6 | 17 |
| 2021 July | 20 | 7 | 27 |
| 2021 June | 14 | 10 | 24 |
| 2021 May | 12 | 5 | 17 |
| 2021 April | 22 | 17 | 39 |
| 2021 March | 22 | 12 | 34 |
| 2021 February | 20 | 13 | 33 |
| 2021 January | 22 | 14 | 36 |
| 2020 December | 10 | 14 | 24 |
| 2020 November | 10 | 7 | 17 |
| 2020 October | 10 | 3 | 13 |
| 2020 September | 19 | 18 | 37 |
| 2020 August | 20 | 13 | 33 |
| 2020 July | 22 | 15 | 37 |
| 2020 June | 20 | 8 | 28 |
| 2020 May | 16 | 10 | 26 |
| 2020 April | 12 | 7 | 19 |
| 2020 March | 18 | 10 | 28 |
| 2020 February | 22 | 10 | 32 |
| 2020 January | 12 | 14 | 26 |
| 2019 December | 21 | 24 | 45 |
| 2019 November | 9 | 6 | 15 |
| 2019 October | 10 | 15 | 25 |
| 2019 September | 11 | 16 | 27 |
| 2019 August | 7 | 14 | 21 |
| 2019 July | 18 | 16 | 34 |
| 2019 June | 31 | 26 | 57 |
| 2019 May | 100 | 60 | 160 |
| 2019 April | 33 | 21 | 54 |
| 2019 March | 10 | 3 | 13 |
| 2019 February | 4 | 10 | 14 |
| 2019 January | 8 | 3 | 11 |
| 2018 December | 2 | 9 | 11 |
| 2018 November | 14 | 7 | 21 |
| 2018 October | 23 | 19 | 42 |
| 2018 September | 6 | 2 | 8 |
| 2018 August | 19 | 1 | 20 |
| 2018 July | 14 | 3 | 17 |
| 2018 June | 4 | 4 | 8 |
| 2018 May | 1 | 10 | 11 |
| 2018 April | 10 | 4 | 14 |
| 2018 March | 3 | 1 | 4 |
| 2018 February | 9 | 1 | 10 |
| 2018 January | 7 | 1 | 8 |
| 2017 December | 10 | 1 | 11 |
| 2017 November | 6 | 4 | 10 |
| 2017 October | 12 | 2 | 14 |
| 2017 September | 15 | 13 | 28 |
| 2017 August | 8 | 3 | 11 |
| 2017 July | 8 | 4 | 12 |
| 2017 June | 12 | 8 | 20 |
| 2017 May | 15 | 5 | 20 |
| 2017 April | 21 | 1 | 22 |
| 2017 March | 11 | 17 | 28 |
| 2017 February | 18 | 2 | 20 |
| 2017 January | 5 | 2 | 7 |
| 2016 December | 20 | 2 | 22 |
| 2016 November | 20 | 3 | 23 |
| 2016 October | 35 | 9 | 44 |
| 2016 September | 33 | 6 | 39 |
| 2016 August | 21 | 2 | 23 |
| 2016 July | 12 | 1 | 13 |
| 2016 June | 16 | 4 | 20 |
| 2016 May | 13 | 1 | 14 |
| 2016 April | 9 | 5 | 14 |
| 2016 March | 13 | 7 | 20 |
| 2016 February | 11 | 6 | 17 |
| 2016 January | 18 | 6 | 24 |
| 2015 December | 16 | 9 | 25 |
| 2015 November | 19 | 7 | 26 |
| 2015 October | 17 | 9 | 26 |
| 2015 September | 17 | 4 | 21 |
| 2015 August | 7 | 3 | 10 |
| 2015 July | 15 | 4 | 19 |
| 2015 June | 1 | 1 | 2 |
| 2015 May | 8 | 1 | 9 |
| 2015 April | 12 | 11 | 23 |
| 2015 March | 12 | 13 | 25 |
| 2015 February | 8 | 4 | 12 |
| 2015 January | 16 | 1 | 17 |
| 2014 December | 25 | 5 | 30 |
| 2014 November | 15 | 2 | 17 |
| 2014 October | 18 | 4 | 22 |
| 2014 September | 19 | 1 | 20 |
| 2014 August | 12 | 0 | 12 |
| 2014 July | 11 | 2 | 13 |
| 2014 June | 12 | 2 | 14 |
| 2014 May | 10 | 1 | 11 |
| 2014 April | 13 | 0 | 13 |
| 2014 March | 28 | 9 | 37 |
| 2014 February | 24 | 7 | 31 |
| 2014 January | 18 | 5 | 23 |
| 2013 December | 18 | 14 | 32 |
| 2013 November | 31 | 9 | 40 |
| 2013 October | 27 | 14 | 41 |
| 2013 September | 31 | 10 | 41 |
| 2013 August | 37 | 14 | 51 |
| 2013 July | 26 | 20 | 46 |
| 2013 June | 9 | 14 | 23 |
| 2013 May | 21 | 14 | 35 |
| 2013 April | 11 | 22 | 33 |
| 2013 March | 7 | 4 | 11 |
| 2013 February | 2 | 1 | 3 |
| 2013 January | 4 | 6 | 10 |
| 2012 December | 2 | 5 | 7 |
| 2012 November | 1 | 5 | 6 |
| 2012 October | 2 | 1 | 3 |
| 2010 July | 459 | 0 | 459 |
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