was read the article
array:23 [ "pii" => "S0213005X13000475" "issn" => "0213005X" "doi" => "10.1016/j.eimc.2013.02.004" "estado" => "S300" "fechaPublicacion" => "2014-02-01" "aid" => "906" "copyright" => "Elsevier España, S.L.. All rights reserved" "copyrightAnyo" => "2012" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Enferm Infecc Microbiol Clin. 2014;32:87-92" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2455 "formatos" => array:3 [ "EPUB" => 12 "HTML" => 1878 "PDF" => 565 ] ] "itemSiguiente" => array:18 [ "pii" => "S0213005X13002449" "issn" => "0213005X" "doi" => "10.1016/j.eimc.2013.08.002" "estado" => "S300" "fechaPublicacion" => "2014-02-01" "aid" => "1004" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Enferm Infecc Microbiol Clin. 2014;32:93-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2836 "formatos" => array:3 [ "EPUB" => 11 "HTML" => 2018 "PDF" => 807 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original breve</span>" "titulo" => "Tratamiento antirretroviral de inicio en pacientes infectados por el virus de la inmunodeficiencia humana en España: decisiones con relación a características inmunovirológicas específicas (estudio PERFIL-es)" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "93" "paginaFinal" => "95" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Initial antiretroviral treatment in human immunodeficiency virus-infected patients in Spain: Decisions made in relation to particular immunovirological characteristics (PERFIL-es study)" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 873 "Ancho" => 1607 "Tamanyo" => 90687 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Motivos de elección del régimen antirretroviral de inicio basado en un ITINAN o en un IP/r.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pompeyo Viciana, Antonio Ocampo, Henar Hevia, Marta Palazuelos, Francisco Ledesma" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Pompeyo" "apellidos" => "Viciana" ] 1 => array:2 [ "nombre" => "Antonio" "apellidos" => "Ocampo" ] 2 => array:2 [ "nombre" => "Henar" "apellidos" => "Hevia" ] 3 => array:2 [ "nombre" => "Marta" "apellidos" => "Palazuelos" ] 4 => array:2 [ "nombre" => "Francisco" "apellidos" => "Ledesma" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X13002449?idApp=UINPBA00004N" "url" => "/0213005X/0000003200000002/v1_201402060050/S0213005X13002449/v1_201402060050/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0213005X13000487" "issn" => "0213005X" "doi" => "10.1016/j.eimc.2013.02.005" "estado" => "S300" "fechaPublicacion" => "2014-02-01" "aid" => "907" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Enferm Infecc Microbiol Clin. 2014;32:82-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2350 "formatos" => array:3 [ "EPUB" => 13 "HTML" => 1761 "PDF" => 576 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Time devoted to pre- and post-HIV test counselling in different health services according to participants of a rapid testing program in Madrid, Spain" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "82" "paginaFinal" => "86" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tiempo dedicado al consejo antes y después de la prueba del VIH en los servicios sanitarios según los participantes de un programa de pruebas rápidas en Madrid, España" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1319 "Ancho" => 2490 "Tamanyo" => 168919 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Percentage of respondents who reported no counselling at last HIV test, by gender/sexual behaviour and testing place, Spain.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Hoyos Miller, Sonia Fernández-Balbuena, María José Belza Egozcue, Patricia García de Olalla, Jose Pulido Manzanero, Gemma Molist Señe, Luis de la Fuente de Hoz" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Juan" "apellidos" => "Hoyos Miller" ] 1 => array:2 [ "nombre" => "Sonia" "apellidos" => "Fernández-Balbuena" ] 2 => array:2 [ "nombre" => "María José" "apellidos" => "Belza Egozcue" ] 3 => array:2 [ "nombre" => "Patricia" "apellidos" => "García de Olalla" ] 4 => array:2 [ "nombre" => "Jose" "apellidos" => "Pulido Manzanero" ] 5 => array:2 [ "nombre" => "Gemma" "apellidos" => "Molist Señe" ] 6 => array:2 [ "nombre" => "Luis" "apellidos" => "de la Fuente de Hoz" ] 7 => array:1 [ "colaborador" => "Madrid Rapid HIV Testing Group" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X13000487?idApp=UINPBA00004N" "url" => "/0213005X/0000003200000002/v1_201402060050/S0213005X13000487/v1_201402060050/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Emergence of extended-spectrum β-lactamase producing <span class="elsevierStyleItalic">Enterobacter</span> spp. in patients with bacteremia in a tertiary hospital in southern Brazil" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "87" "paginaFinal" => "92" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Keite da Silva Nogueira, Maria Cristina Paganini, Andréia Conte, Laura Lúcia Cogo, Iara Taborda de Messias Reason, Márcio José da Silva, Libera Maria Dalla-Costa" "autores" => array:7 [ 0 => array:3 [ "nombre" => "Keite da Silva" "apellidos" => "Nogueira" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "Maria Cristina" "apellidos" => "Paganini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Andréia" "apellidos" => "Conte" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Laura Lúcia" "apellidos" => "Cogo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Iara" "apellidos" => "Taborda de Messias Reason" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Márcio José" "apellidos" => "da Silva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 6 => array:4 [ "nombre" => "Libera Maria" "apellidos" => "Dalla-Costa" "email" => array:1 [ 0 => "lmdc@ufpr.br" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Clinics Hospital, Federal University of Paraná (UFPR), Curitiba, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Postgraduate Program in Pharmaceutical Sciences of UFPR, Curitiba, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Medical Course of UFPR, Curitiba, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Plant Molecular Biology and Genomics of Campinas University (Unicamp), Campinas, Brazil" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Pelé Pequeno Príncipe Faculty and Research Institute (FPP/IPPPP), Curitiba, Brazil" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Emergencia de <span class="elsevierStyleItalic">Enterobacter</span> spp. productores de β-lactamasas de espectro extendido en pacientes con bacteriemia en un hospital terciário del sur del Brasil" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1386 "Ancho" => 3221 "Tamanyo" => 266874 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Genetic similarity among ESBL-producing <span class="elsevierStyleItalic">Enterobacter cloacae</span> by PFGE and ESBL type, unit, and year of microorganism isolation. Legend: HU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>hematology unit; CU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>chemotherapy unit; ICU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>intensive care unit; CTCV= Thoracic and Cardiovascular Surgery unit; THU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>transplant hepatic unit; P ICU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>pediatric intensive care unit; PU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>pediatric unit.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Enterobacter</span> spp. has been recognized as nosocomial pathogens, mainly affecting patients in the intensive care unit (ICU). <span class="elsevierStyleItalic">E. cloacae</span> and <span class="elsevierStyleItalic">E. aerogenes</span> are the most common species found in human infections. The frequency of bacteremia has increased in the last decade, and the rate of infection is approximately 1/1000 admissions in university hospitals or tertiary-care centers.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In general, the mortality associated with bacteremia caused by <span class="elsevierStyleItalic">Enterobacter</span> spp. is as high as bacteremia caused by other enteric bacilli, with mean rates of 20–35%.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">β-Lactam resistance in <span class="elsevierStyleItalic">Enterobacter</span> spp. challenges the treatment of infections caused by this organism and is associated with unfavorable clinical outcomes.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The main resistance mechanism in these organisms is the expression of chromosomally encoded AmpC cephalosporinase,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> leading to treatment failure when third-generation cephalosporins are used.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Moreover, the frequency of extended-spectrum β-lactamase (ESBL) expression is increasing in these species as an important cause of broad-spectrum cephalosporin resistance.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">While AmpC cephalosporinase is chromosomally encoded, ESBLs are mediated by transferable plasmids. Therefore, detection of ESBL genes is recommended for the adoption of control measures to prevent spread of resistance.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Several reports have described the high mortality, time, and cost of hospitalization as well as delays in choosing the appropriate antibiotic therapy associated with infections caused by <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>, <span class="elsevierStyleItalic">Escherichia coli</span>, and <span class="elsevierStyleItalic">Proteus mirabilis</span> ESBL-producing microorganisms.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> However, studies evaluating the effects of ESBL production in <span class="elsevierStyleItalic">Enterobacter</span> spp. are rare. One report compared the clinical significance of ESBLs produced in <span class="elsevierStyleItalic">Enterobacter</span> spp., <span class="elsevierStyleItalic">Citrobacter</span> spp., <span class="elsevierStyleItalic">Serratia</span> spp., and <span class="elsevierStyleItalic">Morganella morganii</span> and found no differences in the outcome of bacteremia between those microorganisms.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> However, further clinical studies are hindered by the difficulty of detecting ESBLs in species that also express genes encoding inducible AmpC, since the latter may mask the detection of the former.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This study evaluated the prevalence, risk factors, and clinical outcomes of bacteremia caused by ESBL- and non-ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. strains.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study setting</span><p id="par0030" class="elsevierStylePara elsevierViewall">This study was conducted at the Clinics Hospital of Federal University of Paraná (HC/UFPR), a 643-bed teaching hospital located in Curitiba, Brazil, over a 5-year period (January 2004–December 2008). Over the past 10 years, HC/UFPR has had an average of 18,699 admissions per year, including 159 ICU admissions, per year. The Clinics Hospital offers a broad range of complex care including bone marrow transplants, liver transplants, cardiovascular surgery, chemotherapy, and other high-risk procedures.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study was approved by the Institutional Review Board of the HC/UFPR (project number 2288.182/2010-07). All patients received an individual identification number, and their names were not disclosed to maintain confidentiality.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study design and bacterial strains</span><p id="par0040" class="elsevierStylePara elsevierViewall">A retrospective comparative study was performed to assess risk factors and clinical outcomes of nosocomial infection by ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. vs. non-ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. strains. All patients included in this study developed bacteremia after 48<span class="elsevierStyleHsp" style=""></span>h of hospitalization and yielded positive blood culture for <span class="elsevierStyleItalic">Enterobacter</span> spp. (either ESBL-producing or non-producing strains). One isolate per patient was included in the study. The total number of patients with positive blood culture collected during the period of study was considered to assess prevalence.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Clinical data were obtained from medical records of the patients. The following clinical data were evaluated: age and sex, underlying disease (cancer, digestive tract diseases, respiratory diseases, heart diseases, central nervous system diseases, or kidney disease), invasive procedures (central venous catheter, mechanical ventilation, tracheotomy, surgery, transplant, or urinary catheter), ward and/or intensive care unit (ICU) admission, use of antimicrobial agents, immunosuppressant or chemotherapy prior to culture, primary focus of bacteremia, length of hospital stay (days), before and after blood culture results (with ESBL or non-ESBL producing <span class="elsevierStyleItalic">Enterobacter</span> spp.), changes in antimicrobial therapy after physicians were informed of the ESBL results, and clinical outcome (death, discharge, or related death).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Definitions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Patients with ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. were defined as “group 1” and patients with non-ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. were defined as “group 2”. Death was considered related to infection when the cause of death was septic shock and the last microorganism isolated from blood cultures was identified as <span class="elsevierStyleItalic">Enterobacter</span> spp. Antimicrobial therapy with carbapenems for ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp., and carbapenem or fourth-generation cephalosporins for non-ESBL <span class="elsevierStyleItalic">Enterobacter</span> spp. was considered appropriate therapy. Third-generation cephalosporins were considered inadequate therapies for both groups, and other antibiotics were deemed appropriate or not according to the antimicrobial susceptibility test.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Microbiology studies</span><p id="par0055" class="elsevierStylePara elsevierViewall">Blood cultures were performed with the BactAlert<span class="elsevierStyleSup">®</span> system (bioMérieux, Hazelwood, MO). The Vitek system (bioMérieux) was used for species identification (ID 32 GN card) and antimicrobial sensitivity tests (AST N105 card). Isolates showing reduced sensitivity to cephalosporins were tested (ceftriaxone, ceftazidime, cefotaxime, or aztreonam), according to the Clinical Laboratory Standard Institute (CLSI) breakpoints for ESBL screening in <span class="elsevierStyleItalic">Klebsiella</span> spp. and <span class="elsevierStyleItalic">E. coli</span>,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> were tested for the presence of ESBL-encoding genes.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Molecular detection of ESBL genes</span><p id="par0060" class="elsevierStylePara elsevierViewall">All isolates of <span class="elsevierStyleItalic">Enterobacter</span> spp. with a positive phenotypic screening test were tested for the presence of <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV</span>, and <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">PER</span> genes by polymerase chain reaction (PCR) as previously described.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–12</span></a> Positive controls <span class="elsevierStyleItalic">K. pneumoniae</span> A30397 (<span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-2</span>), <span class="elsevierStyleItalic">E. coli</span> E27 (<span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM-9</span>), and <span class="elsevierStyleItalic">K. pneumoniae</span> A32048-3 (<span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV-5</span>), and the negative control <span class="elsevierStyleItalic">E. coli</span> ATCC 25922 were run simultaneously. Samples that were PCR-positive for <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M</span> were submitted to a second PCR using the primers: <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-1</span> 5′-TGTTAGGAAGTGTGCCGCTG-3′; 5′-GACGGCTTTCTGCCTTAGGTTG-3′ and <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M-2</span> 5′-ATGTTAACGGTGATGGCGAC-3′; 5′-GCATCAGAAACCGTGGGTTAC-3′. Amplicons from all isolates were purified using a GFX-TM PCR purification kit (Amersham Bioscience, NJ, USA) and sequenced using the same set of primers. The nucleotide sequences were identified using a BigDye terminator v3.1 Cycle Sequencing kit and an automated DNA capillary sequencer (ABI PRISM 3700 DNA Analyzer; PE Applied Biosystems, Hitachi), analyzed with ChromasPro version 1.33 (Technelysium Pty LTDA), and compared with the GenBank database sequences using the BLAST tool (<a id="intr0005" class="elsevierStyleInterRef" href="http://www.ncbi.nih.gov/BLAST">http://www.ncbi.nih.gov/BLAST</a>). Isolates with ESBL genes were classified as ESBL-producing.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Pulsed-field gel electrophoresis (PFGE)</span><p id="par0065" class="elsevierStylePara elsevierViewall">DNA of all ESBL-producing strains was extracted as described previously<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and digested with <span class="elsevierStyleItalic">Xba</span>I (10<span class="elsevierStyleHsp" style=""></span>U; Fermentas, Maryland, USA) at 37<span class="elsevierStyleHsp" style=""></span>°C. Electrophoresis was performed on a CHEF-DR III (Bio-Rad Laboratories, USA) instrument for 24<span class="elsevierStyleHsp" style=""></span>h at 6<span class="elsevierStyleHsp" style=""></span>V/cm and 12<span class="elsevierStyleHsp" style=""></span>°C and pulse times from 5 to 30<span class="elsevierStyleHsp" style=""></span>s. Gels were analyzed with the Gel-Pro Analyzer 4.0 and NTSYS 2.02 software. Clusters of possibly related isolates were identified using the Dice similarity coefficient and unweighted pair-group method with arithmetic averages (UPGMA). Identical isolates were assigned the same capital letter and different pulsed-field gel electrophoresis (PFGE) profiles were named with different capital letters. Isolates with more than 80% similarity were assigned as a subtype and given the same capital letter as the major type, followed by an Arabic number (e.g., A1, A2, A3, and A4).</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical analyses</span><p id="par0070" class="elsevierStylePara elsevierViewall">Epidemiological data were recorded and analyzed using Epi Info version 3.5.1. and Statistics v.8.0, using the following statistical parameters: Kruskal–Wallis test for nonparametric continuous variables and chi-square (degree of freedom<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) or Fisher's exact test (expected value less than 5) for categorical variables. A logistic regression for multivariate analyses was included for variables with <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 in univariate analyses. The results were considered statistically significant when the P value was less than 0.05.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">During the study period (2004–2008), 4907 patients had positive blood cultures, and <span class="elsevierStyleItalic">Enterobacter</span> spp. were isolated from 205 (4.1%) patients, showing an increasing prevalence of 2.7% in 2004 to 5.8% in 2008 (data not shown). The <span class="elsevierStyleItalic">Enterobacter</span> spp. species found were <span class="elsevierStyleItalic">E. cloacae</span> (109 cases, 53.2%), <span class="elsevierStyleItalic">E. aerogenes</span> (91, 44.4%), and <span class="elsevierStyleItalic">E. gergoviae</span> (5, 2.4%).</p><p id="par0080" class="elsevierStylePara elsevierViewall">Out of the 205 <span class="elsevierStyleItalic">Enterobacter</span> spp. isolated, 41 (20%) were ESBL-producing (20 were <span class="elsevierStyleItalic">E. cloacae</span> and 21 were <span class="elsevierStyleItalic">E. aerogenes</span>) while 164 (78%) were non-ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Patient age ranged between 15 days and 97 years old. We compared the ESBL- and non-ESBL groups and their distribution according to the following age strata <18 (pediatric, <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>22), 18–64 (adults, <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>119) and ≥65 (elderly, <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>64); ESBL-producing strains were observed in 22.7% of pediatric patients, 21% of adult patients and 17.2% of elderly patients. There was no significance difference between groups. There was also no gender difference between ESBL- and non-ESBL-producing groups.</p><p id="par0090" class="elsevierStylePara elsevierViewall">ESBL- and non-ESBL-producing strains showed similar distributions between different hospital wards, except in the ICU where the frequency of ESBL-producing strains was higher. Similarly, the length of hospital stay before infection was similar between the 2 groups, varying only in ICU, where a longer stay was a significant risk factor for ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. infection (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Among all underlying diseases and co-morbidities evaluated, none represented independent risk factors for infection by ESBL-producing strains (<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>). Moreover, invasive procedure during hospitalization was not a risk factor for infection by ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. On the other hand, the use of carbapenem and third-generation cephalosporins during hospitalization proved to be a risk factor for infections by non-ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. (<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Regarding the clinical outcome, the mortality among patients with bacteremia by ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. was 43.9%; among patients with bacteremia by non-ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp., mortality was 49.4%. ESBL- and non-ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp.-related mortality was 19.5% and 13.4%, with no significant difference between groups. The patients infected with ESBL-producing strains had a longer hospital stay after the culture results than patients with non-ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. bacteremia. The mean hospital stay in this study was 8 days in the ICU and 7 days in other wards. During the course of this study, bacteremia caused by <span class="elsevierStyleItalic">Enterobacter</span> spp. increased the mean length of hospital stay to 15 days and ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. increased the mean duration of hospitalization to 22 days (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Patients infected with ESBL-producing strains that were using empirically ceftriaxone or ceftazidime were considered to have received inappropriate therapy, and totaled 85.4% of the study population. The microbiological diagnostic results led to a change in antimicrobial therapy in 75.6% (31/41) of patients. In most of these cases (97%), the exchange occurred from cephalosporins to carbapenems. On the other hand, ineffective empirical treatment (third generation cephalosporin) was not a risk factor for death or related death in patients with bacteremia in both groups.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Three different groups of β-lactamases were identified from the total number of ESBL-producing strains: CTX-M (34 isolates), SHV (5 isolates), and PER (2 isolates). CTX-M-2 was the most prevalent type, accounting for 83% of all ESBL-producing strains, including 8 isolates of <span class="elsevierStyleItalic">E. aerogenes</span> and 15 isolates of <span class="elsevierStyleItalic">E. cloacae</span>. CTX-M-59 was detected in 10 isolates of <span class="elsevierStyleItalic">E. aerogenes</span> and CTX-M-15 in 1 isolate of <span class="elsevierStyleItalic">E. cloacae</span>. SHV-12 enzymes were found in 3 <span class="elsevierStyleItalic">E. cloacae</span> and 2 <span class="elsevierStyleItalic">E. aerogenes.</span> PER-2 was found in 2 <span class="elsevierStyleItalic">E. cloacae</span> strains.The high degree of genetic similarity of the <span class="elsevierStyleItalic">E. aerogenes</span> isolates identified in this study is reflected in the results of the PFGE profiling analysis. Out of eleven distinct PFGE types, a PFGE group with at least 80% similarity was identified (group C) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). This group included 85% (17/20) of the isolates and was divided in eight subgroups (C, C1, C2, C3, C4, C5, C6 and C7). For the subgroups C, C1 and C6, clones (100% identity on the basis of PFGE analysis) with four isolates were found. The other PFGE types (A, B and D) showed less than 80% similarity and represented unrelated isolates. CTX-M-59 and CTX-M-2-producing <span class="elsevierStyleItalic">E. aerogenes</span> were frequently found. ESBL groups comprised ten isolates of CTX-M-59 (50%), eight of CTX-M-2 (40%), and two of SHV-12 (10%).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Twenty distinct PFGE types were identified in <span class="elsevierStyleItalic">E. cloacae</span> isolates on the basis of dendrogram analysis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Two PFGE groups possessed above 80% similarity, group D that contained two isolates and group L that clustered four isolates. Furthermore, these groups included only CTX-M-2-producing <span class="elsevierStyleItalic">E. cloacae</span>. The other PFGE types showed to be unrelated isolates (<80% similarity), and also included CTX-M-2-producing <span class="elsevierStyleItalic">E. cloacae</span>, besides SHV-12, PER-2 and CTX-M-15-producing <span class="elsevierStyleItalic">E. cloacae.</span> Only a clonal group was observed (group C) that comprised two PER-2-producing <span class="elsevierStyleItalic">E. cloacae.</span> This ESBL group has never been described in previous Brazilian studies.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">The emergence of bacteremia caused by <span class="elsevierStyleItalic">Enterobacter</span> spp. has been described in recent years. In this study, <span class="elsevierStyleItalic">Enterobacter</span> spp. was isolated in 4.3% of patients with bacteremia in a teaching hospital in southern Brazil during the period 2004–2008, with an increased frequency (2.7–5.8%) of isolation over the 5-year study period. A previous study showed similar results,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and another reported an average of 2.2% (range, 1.4–3.4%).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> These results highlight <span class="elsevierStyleItalic">Enterobacter</span> spp. as a pathogen frequently present in nosocomial bacteremia.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The prevalence of <span class="elsevierStyleItalic">E. cloacae</span>, followed by <span class="elsevierStyleItalic">E. aerogenes</span>, and less participation from other species of this genus as agents of bacteremia, is consistent with the results obtained in other studies.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,15</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">ESBL production has been found with increased frequency in <span class="elsevierStyleItalic">Enterobacter</span> spp. The frequency of ESBL among <span class="elsevierStyleItalic">Enterobacter</span> spp. in this study was 20%. A study conducted in Korea found 43% of ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. isolated from blood cultures<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>; another study conducted in Hong Kong found a frequency of 6.5%.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> These data show that prevalence of ESBL in these species varies, and can be high in some countries.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Risk factors for infection by ESBL-producing strains include previous antibiotic therapy, severity of disease, cross transmission,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> longer hospital stays,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> advanced age, and chronic diseases,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> among others. When bacteremia caused by ESBL- and non-ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. was evaluated in this study, there were no major differences in the risk factors for infections between the 2 groups. These findings suggest that ESBL has less influence on the selection of resistant organisms in this species, probably because <span class="elsevierStyleItalic">Enterobacter</span> spp. harbored chromosomal AmpC, which confers resistance during therapy with third-generation cephalosporins.</p><p id="par0145" class="elsevierStylePara elsevierViewall">In this study, pneumonia was the main source of bacteremia by ESBL-producing strains, suggesting that ESBL strains have a hospital origin. Moreover, ESBL-producing strains presented mainly a clonal profile, and in 74% of cases, pneumonia was associated with mechanical ventilation. Likewise, ICU stay was relevant for the acquisition of ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. Furthermore, clonality of <span class="elsevierStyleItalic">E. aerogenes</span> isolated from ICU patients during the 5-year study suggested the hospital origin of the strains.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Studies have associated ESBL production with higher mortality, longer hospital stay, delay in appropriate therapy, and higher treatment costs. Most of these studies compared <span class="elsevierStyleItalic">E. coli</span>, <span class="elsevierStyleItalic">Klebsiella</span> spp., and <span class="elsevierStyleItalic">Proteus mirabilis</span> ESBL- and non-ESBL-producing strains.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6,15</span></a> The present study shows a similar risk of mortality in the group of patients harboring ESBL- and non-ESBL-producing strains. This finding may be explained by the high resistance of <span class="elsevierStyleItalic">Enterobacter</span> spp. to antibiotics, even in the absence of ESBL production. However, ESBL-producing infectious agents increased hospital stay, which typically leads to higher costs of patient care. Costs were not directly assessed, but they are higher because the average length of stay was 7 days longer in patients with ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. than in patients infected with non-ESBL-producing strains.</p><p id="par0155" class="elsevierStylePara elsevierViewall">The main cause of mortality in infections by <span class="elsevierStyleItalic">E. coli</span> and <span class="elsevierStyleItalic">Klebsiella</span> ESBL-producing strains is the delay in administration of appropriate antibiotic therapy.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,15,18</span></a> These data were not evaluated in infections by ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. in this study.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Beyond the epidemiological significance of ESBL detection, there is also the therapeutic importance. During this study, ESBL detection was used to adjust therapy in 75% of patients with ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. bacteremia. This action could have affected the association between ESBLs and outcome, suggesting that if ESBL was not detected, mortality might have been even greater.</p><p id="par0165" class="elsevierStylePara elsevierViewall">CTX-M is a type of ESBL widely prevalent in the world, mainly in South America.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> It was also the predominant type identified in this study. PER-2 represents another important type of ESBL, which is prevalent in South America,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> but has never been reported in Brazil and was found in 2 isolates from this study. Similarly, the SHV-12 type, which is commonly found in the USA<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> but not in Brazil, was detected in 5 strains.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Cross transmission was more prevalent in <span class="elsevierStyleItalic">E. aerogenes</span> than in <span class="elsevierStyleItalic">E. cloacae</span>. The same type of ESBL was detected in strains not genetically related and different ESBLs were detected in genetically related strains, indicating that transfer of plasmids is probably the most important mechanism of resistance dissemination by ESBLs in this study. ESBL detection in <span class="elsevierStyleItalic">Enterobacter</span> spp. is important to prevent increased frequency of ESBL in <span class="elsevierStyleItalic">Enterobacter</span> spp. as well as in other species of Gram-negative bacilli present in the hospital environment; moreover, the plasmid that carries ESBL genes often carries multiple genes for resistance to other antimicrobials.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Enterobacter</span> spp. is a pathogen with increasing importance in bacteremia. ESBL production is an important mechanism of resistance to broad-spectrum cephalosporins, reducing the therapeutic options for infection by this microorganism. The predominant type of ESBL was CTX-M, with minor participation of other types such as SHV and PER. The PFGE typing showed the occurrence of clonal and non-clonal spread of the strains, suggesting that the ESBL genes have been horizontally disseminated. ESBL detection in <span class="elsevierStyleItalic">Enterobacter</span> spp could help to control the spread of this kind of resistance. Moreover, the ESBL production had not contributed to mortality but increased the length of hospital stay.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0180" class="elsevierStylePara elsevierViewall">This study received no funding.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">Authors have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres310837" "titulo" => array:5 [ 0 => "Abstract" 1 => "Background" 2 => "Methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec294056" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres310836" "titulo" => array:5 [ 0 => "Resumen" 1 => "Antecedentes" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec294057" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study setting" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Study design and bacterial strains" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Definitions" ] 3 => array:2 [ "identificador" => "sec0025" "titulo" => "Microbiology studies" ] 4 => array:2 [ "identificador" => "sec0030" "titulo" => "Molecular detection of ESBL genes" ] 5 => array:2 [ "identificador" => "sec0035" "titulo" => "Pulsed-field gel electrophoresis (PFGE)" ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical analyses" ] ] ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-06-26" "fechaAceptado" => "2013-02-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec294056" "palabras" => array:4 [ 0 => "Bacteremia" 1 => "<span class="elsevierStyleItalic">Enterobacter</span>" 2 => "Extended-spectrum β-lactamase" 3 => "ESBL" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec294057" "palabras" => array:4 [ 0 => "Bacteriemia" 1 => "<span class="elsevierStyleItalic">Enterobacter</span>" 2 => "Beta-lactamasas de espectro extendido" 3 => "BLEE" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Extended-spectrum β-lactamases (ESBLs) are increasingly prevalent in <span class="elsevierStyleItalic">Enterobacter</span> spp., posing a challenge to the treatment of infections caused by this microorganism. The purpose of this retrospective study was to evaluate the prevalence, risk factors, and clinical outcomes of inpatients with bacteremia caused by ESBL and non ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. in a tertiary hospital over the period 2004–2008.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The presence of <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV</span>, and <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">PER</span> genes was detected by polymerase chain reaction (PCR) and nucleotide sequence analysis. Genetic similarity between strains was defined by pulsed-field gel electrophoresis (PFGE).</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Enterobacter</span> spp. was identified in 205 of 4907 of the patients who had positive blood cultures during hospitalization. Of those cases, 41 (20%) were ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. Nosocomial pneumonia was the main source of bacteremia caused by ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. The presence of this microorganism was associated with longer hospital stays. The ESBL genes detected were: CTX-M-2 (23), CTX-M-59 (10), CTX-M-15 (1), SHV-12 (5), and PER-2 (2). While <span class="elsevierStyleItalic">Enterobacter aerogenes</span> strains showed mainly a clonal profile, <span class="elsevierStyleItalic">Enterobacter cloacae</span> strains were polyclonal.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Although no difference in clinical outcomes was observed between patients with infections by ESBL-producing and non-ESBL-producing strains, the detection of ESBL in <span class="elsevierStyleItalic">Enterobacter</span> spp. resulted in the change of antimicrobials in 75% of cases, having important implications in the decision-making regarding adequate antimicrobial therapy.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las β-lactamasas de espectro extendido (BLEE) son cada vez más frecuentes en <span class="elsevierStyleItalic">Enterobacter</span> spp., lo que representa un desafío para el tratamiento de infecciones causadas por este microorganismo. El propósito de este estudio fue evaluar los factores de riesgo y los resultados clínicos de pacientes ingresados con bacteriemia causada por <span class="elsevierStyleItalic">Enterobacter</span> spp. productores de BLEE en un hospital terciario durante los años 2004-2008.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La presencia de los genes <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">CTX-M</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">TEM</span>, <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SHV</span>, e <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">PER</span> se detectó mediante la reacción en cadena de la polimerasa (PCR) y análisis de la secuencia de nucleótidos. La similitud genética entre las cepas fue definida por electroforesis en gel de campo pulsado (PFGE).</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Enterobacter</span> spp. fue identificado en 205 pacientes de un total de 4.907 que tenían cultivos positivos de sangre durante la hospitalización. De esos 205 casos, 41 (20%) eran <span class="elsevierStyleItalic">Enterobacter</span> spp. productores de BLEE. La neumonía nosocomial fue la principal fuente de bacteriemia causada por <span class="elsevierStyleItalic">Enterobacter</span> spp. productores de BLEE. La presencia de este microorganismo se asoció con una mayor estancia hospitalaria. Las BLEE detectadas fueron: CTX-M-2 (23), CTX-M-59 (10), CTX-M-15 (1), SHV-12 (5) y PER-2 (2). Mientras que las cepas de <span class="elsevierStyleItalic">Enterobacter aerogenes</span> presentaron un perfil principalmente clonal, <span class="elsevierStyleItalic">E. cloacae</span> fueron policlonales.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Si bien no fueron observadas diferencias en los resultados clínicos entre los pacientes con infecciones causadas por cepas productoras de BLEE y no productoras de BLEE, la detección de BLEE en <span class="elsevierStyleItalic">Enterobacter</span> spp., resultó en el cambio de los antimicrobianos en el 75% de los casos, habiendo implicaciones importantes en la toma de las decisiones con respecto a la terapia antimicrobiana adecuada.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1385 "Ancho" => 3229 "Tamanyo" => 249587 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Genetic similarity among ESBL-producing <span class="elsevierStyleItalic">Enterobacter aerogenes</span> by PFGE and ESBL type, unit, and year of microorganism isolation. Legend: ICU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>intensive care unit; SU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>surgical unit; NB ICU= newborn intensive care unit; MW<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>male ward.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1386 "Ancho" => 3221 "Tamanyo" => 266874 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Genetic similarity among ESBL-producing <span class="elsevierStyleItalic">Enterobacter cloacae</span> by PFGE and ESBL type, unit, and year of microorganism isolation. Legend: HU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>hematology unit; CU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>chemotherapy unit; ICU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>intensive care unit; CTCV= Thoracic and Cardiovascular Surgery unit; THU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>transplant hepatic unit; P ICU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>pediatric intensive care unit; PU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>pediatric unit.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">ICU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>intensive care unit; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>number of patients.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ESBL (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-ESBL (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>164) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Odds ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous ICU stay \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (65.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 (48.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.042 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gastrointestinal diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (19.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 (42.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (26.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 (22.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.506 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neoplasia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (29.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 (28.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.876 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neurological diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (22.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 (32.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.196 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kidney diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (12.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (19.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.369 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heart diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (43.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 (48.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.575 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urinary catheter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (35.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 (33.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.860 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central venous catheter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (41.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87 (53.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.184 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mechanical ventilation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (65.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82 (50.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.068 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tracheostomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (39.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 (25.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.088 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (14.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76 (46.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous infections \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (63.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91 (55.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.359 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pneumonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (56.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 (31.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urinary infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (25.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 (19.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.441 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abdominal infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (2.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (7.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.197 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgical wound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (5.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (9.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.309 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prior antibiotic use \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 (90.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">157 (96.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.117 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Quinolone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (22.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (16.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.371 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ceftriaxone or Ceftazidime \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (14.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 (34.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.021 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cefepime \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (46.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 (41.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.584 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Carbapenem \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (17.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 (38.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Piperacilin/tazobactam \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (12.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (19.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.308 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab455464.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Risk factors of ESBL- and non-ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. bacteremia.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">ICU<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>intensive care unit; n: number of patients.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ESBL (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-ESBL (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>164) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Odds ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Patient unit</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Previous ICU stay \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (65.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 (48.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Invasive procedures</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (14.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76 (46.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Previous antimicrobial therapy</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ceftriaxone/ceftazidime \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (14.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 (34.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Carbapenem \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (17.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 (38.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab455463.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Multivariate analysis of the risk factors of ESBL- and non-ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. bacteremia.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">n</span>: number of patients.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ESBL (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-ESBL (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>164) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Relative risk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Discharge \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (56.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83 (50.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.529 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (43.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81 (49.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.529 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Related mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (19.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (13.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.323 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab455465.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Clinical outcomes of ESBL- and non-ESBL-producing <span class="elsevierStyleItalic">Enterobacter</span> spp. bacteremia.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Enterobacter</span> spp.: pathogens poised to flourish at the turn of the century" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.E. Sanders Jr." 1 => "C.C. Sanders" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Rev" "fecha" => "1997" "volumen" => "10" "paginaInicial" => "220" "paginaFinal" => "241" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9105752" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Detection and characterization of extended-spectrum beta-lactamases among bloodstream isolates of <span class="elsevierStyleItalic">Enterobacter</span> spp. in Hong Kong, 2000-2002" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.L. Ho" 1 => "R.H. Shek" 2 => "K.H. Chow" 3 => "W.M. 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Year/Month | Html | Total | |
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2024 November | 1 | 0 | 1 |
2024 October | 31 | 4 | 35 |
2024 September | 50 | 15 | 65 |
2024 August | 39 | 18 | 57 |
2024 July | 45 | 11 | 56 |
2024 June | 20 | 4 | 24 |
2024 May | 30 | 8 | 38 |
2024 April | 27 | 5 | 32 |
2024 March | 44 | 10 | 54 |
2024 February | 52 | 8 | 60 |
2024 January | 37 | 10 | 47 |
2023 December | 41 | 5 | 46 |
2023 November | 24 | 8 | 32 |
2023 October | 44 | 9 | 53 |
2023 September | 31 | 0 | 31 |
2023 August | 25 | 8 | 33 |
2023 July | 19 | 3 | 22 |
2023 June | 25 | 5 | 30 |
2023 May | 49 | 6 | 55 |
2023 April | 19 | 3 | 22 |
2023 March | 28 | 3 | 31 |
2023 February | 36 | 3 | 39 |
2023 January | 20 | 6 | 26 |
2022 December | 35 | 13 | 48 |
2022 November | 46 | 11 | 57 |
2022 October | 36 | 13 | 49 |
2022 September | 40 | 15 | 55 |
2022 August | 37 | 7 | 44 |
2022 July | 42 | 10 | 52 |
2022 June | 25 | 7 | 32 |
2022 May | 40 | 13 | 53 |
2022 April | 28 | 8 | 36 |
2022 March | 20 | 13 | 33 |
2022 February | 45 | 5 | 50 |
2022 January | 45 | 12 | 57 |
2021 December | 26 | 18 | 44 |
2021 November | 21 | 6 | 27 |
2021 October | 27 | 12 | 39 |
2021 September | 31 | 15 | 46 |
2021 August | 38 | 6 | 44 |
2021 July | 38 | 9 | 47 |
2021 June | 35 | 13 | 48 |
2021 May | 36 | 5 | 41 |
2021 April | 63 | 21 | 84 |
2021 March | 54 | 17 | 71 |
2021 February | 31 | 9 | 40 |
2021 January | 24 | 11 | 35 |
2020 December | 22 | 9 | 31 |
2020 November | 22 | 15 | 37 |
2020 October | 25 | 5 | 30 |
2020 September | 46 | 11 | 57 |
2020 August | 41 | 13 | 54 |
2020 July | 26 | 14 | 40 |
2020 June | 24 | 16 | 40 |
2020 May | 33 | 10 | 43 |
2020 April | 17 | 2 | 19 |
2020 March | 23 | 8 | 31 |
2020 February | 27 | 5 | 32 |
2020 January | 30 | 8 | 38 |
2019 December | 46 | 18 | 64 |
2019 November | 17 | 12 | 29 |
2019 October | 17 | 5 | 22 |
2019 September | 19 | 7 | 26 |
2019 August | 22 | 6 | 28 |
2019 July | 35 | 21 | 56 |
2019 June | 56 | 15 | 71 |
2019 May | 138 | 37 | 175 |
2019 April | 64 | 5 | 69 |
2019 March | 20 | 4 | 24 |
2019 February | 22 | 5 | 27 |
2019 January | 13 | 4 | 17 |
2018 December | 16 | 8 | 24 |
2018 November | 27 | 6 | 33 |
2018 October | 33 | 5 | 38 |
2018 September | 26 | 11 | 37 |
2018 August | 10 | 1 | 11 |
2018 July | 15 | 0 | 15 |
2018 June | 15 | 1 | 16 |
2018 May | 6 | 4 | 10 |
2018 April | 9 | 5 | 14 |
2018 March | 7 | 0 | 7 |
2018 February | 4 | 1 | 5 |
2018 January | 10 | 2 | 12 |
2017 December | 4 | 0 | 4 |
2017 November | 17 | 1 | 18 |
2017 October | 6 | 4 | 10 |
2017 September | 13 | 1 | 14 |
2017 August | 18 | 2 | 20 |
2017 July | 13 | 4 | 17 |
2017 June | 19 | 13 | 32 |
2017 May | 18 | 1 | 19 |
2017 April | 28 | 6 | 34 |
2017 March | 50 | 30 | 80 |
2017 February | 36 | 5 | 41 |
2017 January | 21 | 0 | 21 |
2016 December | 26 | 5 | 31 |
2016 November | 22 | 0 | 22 |
2016 October | 72 | 11 | 83 |
2016 September | 42 | 4 | 46 |
2016 August | 33 | 5 | 38 |
2016 July | 29 | 4 | 33 |
2016 June | 44 | 8 | 52 |
2016 May | 10 | 3 | 13 |
2016 April | 21 | 9 | 30 |
2016 March | 23 | 5 | 28 |
2016 February | 25 | 7 | 32 |
2016 January | 29 | 11 | 40 |
2015 December | 22 | 9 | 31 |
2015 November | 21 | 2 | 23 |
2015 October | 24 | 7 | 31 |
2015 September | 29 | 4 | 33 |
2015 August | 31 | 6 | 37 |
2015 July | 25 | 9 | 34 |
2015 June | 13 | 2 | 15 |
2015 May | 13 | 5 | 18 |
2015 April | 33 | 8 | 41 |
2015 March | 29 | 6 | 35 |
2015 February | 20 | 3 | 23 |
2015 January | 23 | 3 | 26 |
2014 December | 28 | 4 | 32 |
2014 November | 21 | 4 | 25 |
2014 October | 18 | 5 | 23 |
2014 September | 12 | 5 | 17 |
2014 August | 19 | 9 | 28 |
2014 July | 16 | 7 | 23 |
2014 June | 20 | 5 | 25 |
2014 May | 21 | 6 | 27 |
2014 April | 24 | 11 | 35 |
2014 March | 51 | 35 | 86 |
2014 February | 55 | 78 | 133 |