Editorial
Rapid tests for detection of carbapenemase producers in P. aeruginosa; what do we really need?
Pruebas rápidas para la detección de Pseudomonas aeruginosa productora de carbapenemasas. ¿Qué necesitamos realmente?
a INSERM U914 “Emerging Resistance to Antibiotics”, France
b Medical and Molecular Microbiology, Department of Medicine, Faculty of Science, University of Fribourg, Switzerland
c Centre National Associé - Centre de Référence des Résistances aux Antibiotiques, Le Kremlin-Bicêtre, France
d Hopital Fribourgeois-hôpital Cantonal, Fribourg, Switzerland
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MBL+ (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>93), isolates producing metallo-β-lactamases; MBL− (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">=</span><span class="elsevierStyleHsp" style=""></span>49), isolates not producing metallo-β-lactamases. AMI, amicacin; ATM, aztreonam; CAZ, ceftazidime; CPM, cefepime; CIP, ciprofloxacin; GEN, gentamicin; PTZ, piperacillin/tazobactam; POL, B polymyxin.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Andréa Lucena, Libera M. Dalla Costa, Keite da Silva Nogueira, Adriana P. Matos, Ana C. Gales, Sonia M. Raboni" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Andréa" "apellidos" => "Lucena" ] 1 => array:2 [ "nombre" => "Libera M. 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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "623" "paginaFinal" => "624" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Laurent Poirel, Patrice Nordmann" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Laurent" "apellidos" => "Poirel" "email" => array:1 [ 0 => "laurent.poirel@unifr.ch" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0005" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Patrice" "apellidos" => "Nordmann" "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0005" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "INSERM U914 “Emerging Resistance to Antibiotics”, France" "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Medical and Molecular Microbiology, Department of Medicine, Faculty of Science, University of Fribourg, Switzerland" "etiqueta" => "b" "identificador" => "aff0005" ] 2 => array:3 [ "entidad" => "Centre National Associé - Centre de Référence des Résistances aux Antibiotiques, Le Kremlin-Bicêtre, France" "etiqueta" => "c" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Hopital Fribourgeois-hôpital Cantonal, Fribourg, Switzerland" "etiqueta" => "d" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pruebas rápidas para la detección de <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> productora de carbapenemasas. ¿Qué necesitamos realmente?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Resistance to carbapenems in <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> is a major issue since that species is intrinsically resistant to many antibiotics and therefore, as soon as some acquired resistance traits occur, carbapenems become rapidly the ultimate therapeutic options.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Carbapenem resistance in <span class="elsevierStyleItalic">P. aeruginosa</span> may occur through the loss of an outer-membrane protein named OprD that results from mutations or truncations in the corresponding gene.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In Europe, that mechanism accounts for 15–20% of the imipenem-resistant <span class="elsevierStyleItalic">P. aeruginosa</span> isolates. It is not transmissible since it is chromosomally-encoded and interferes with imipenem susceptibility only, meropenem and doripenem as well as broad-spectrum cephalosporins remaining effective against OprD-deficient strains (if no additional acquired mechanism). However, the acquisition of carbapenemase genes is another mechanism of carbapenem resistance in <span class="elsevierStyleItalic">P. aeruginosa</span> that is increasingly identified wordwide.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> That resistance trait is more worrisome since it corresponds to genes acquired through horizontal gene transfers that may disseminate, and impacts all carbapenem molecules that are all hydrolyzed by those enzymes. In <span class="elsevierStyleItalic">P. aeruginosa</span>, carbapenemases are mainly metallo-β-lactamases (MBLs) that hydrolyze all carbapenems very efficiently.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> They are not inhibited by β-lactamase inhibitors such as clavulanic acid and tazobactam and also confer resistance to other β-lactams such as broad-spectrum cephalosporins.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Therefore, an accurate and rapid detection of carbapenemase production in <span class="elsevierStyleItalic">P. aeruginosa</span> is extremely important. Such rapid detection may contribute to facilitate the antibiotic stewardship and treatment of infected patients and to prevent the further spread of those carbapenem-resistant isolates.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Therefore, in order to optimize infection control and antimicrobial therapy, advances in detection methods are crucial. Use of molecular biology and in particular PCR-based techniques is being the key-approach for rapid and accurate identification of those resistance traits. The main advantages of molecular techniques are sensitivity, specificity, and the relative rapidity of these methods. Without molecular techniques in routine laboratories, identification of resistance mechanisms is often fastidious and time-consuming.</p><p id="par0020" class="elsevierStylePara elsevierViewall">However, there are some drawbacks with those molecular techniques, the main ones are: (i) they are expensive, (ii) they do require some significant expertise, (iii) they do not fully replace the antibiogram since they only target some specific molecular determinants but do not evaluate the real susceptibility of the isolate to a large variety of drugs, (iv) the correlation between gene identification and resistance is not always observed (gene expression and modulation), and (v) by definition they do not identify the novel and emerging resistance genes.</p><p id="par0025" class="elsevierStylePara elsevierViewall">That is the reason why biochemical and phenotypical methods have still to be considered as interesting tools. In the study performed by Lucena et al. in this issue,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> phenotypic tests for detection of MBL production have been compared with an impressive collection of metallo-β-lactamase producers, mostly of the SPM type. The double-disk synergy test (DDST), the Combined-Disk (CD) assay, and the MBL E-test have been compared. They all show some advantages and disadvantages, but one main shortcoming is the lack of clear cut-off to accurately interpret the obtained results. Depending on the strain background (additional resistance mechanisms or not), and on the user's technical skills, variable results and interpretations may be observed.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We believe that those diagnostic techniques, in order to be used, must not only be affordable and rapid, but overall must be easy to perform and interpret. Routine laboratories cannot rely on complicated screening strategies that, in addition, may provide difficult-to-interpret results. Efforts must be placed in developing those tests that may be used in any clinical laboratory, and not only in those with advanced technologies or highly qualified personal.</p><p id="par0035" class="elsevierStylePara elsevierViewall">One recently developed technique aiming to rapidly identify carbapenemase producers, either in <span class="elsevierStyleItalic">Pseudomonas</span> spp. and in <span class="elsevierStyleItalic">Enterobacteriaceae</span>, is the Carba NP test that corresponds to an efficient and reliable diagnostic tool for identification of those enzymes.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The main advantages of this test are that it is extremely rapid and costless, by contrast to most of the other known techniques. It actually represents a breakthrough for detection of carbapenemase producers with results obtained in less than two hours, either directly from colonies but also from clinical samples such as blood cultures and urines.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> Another major advantage of this test is that it can be implemented in any clinical laboratories due to its simplicity. It is therefore well adapted to the current needs, i.e. improving the hygiene control and the antimicrobial therapy. In a country such as Brazil where the study from Lucena et al. has been performed,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> it might really provide an added-value since not only its low price and low-expertise requirement will surely fit to the expectations, but also the current and very worrisome epidemiology (with huge dissemination of SPM-1-producing <span class="elsevierStyleItalic">P. aeruginosa</span> strains all over the country<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a>) will make it an essential tool.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Public health authorities around the world prompt to establish guidelines recommending strict and accurate monitoring of antimicrobial resistance should facilitate the development and dissemination of those kinds of methods that correspond to the needs in the “real” daily life.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Superbugs in the coming new decade; multidrug resistance and prospects for treatment of <span class="elsevierStyleItalic">Staphylococcus aureus</span>, <span class="elsevierStyleItalic">Enterococcus</span> spp. and <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> in 2010" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Nordmann" 1 => "T. Naas" 2 => "N. Fortineau" 3 => "L. Poirel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.mib.2007.07.004" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Microbiol" "fecha" => "2007" "volumen" => "10" "paginaInicial" => "436" "paginaFinal" => "440" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17765004" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gram-negative bacteria with resistance to carbapenems" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Nordmann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Sci (Paris)" "fecha" => "2010" "volumen" => "26" "paginaInicial" => "950" "paginaFinal" => "959" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carbapenemases: molecular diversity and clinical consequences" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Poirel" 1 => "J.D. Pitout" 2 => "P. Nordmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2217/17460913.2.5.501" "Revista" => array:6 [ "tituloSerie" => "Future Microbiol" "fecha" => "2007" "volumen" => "2" "paginaInicial" => "501" "paginaFinal" => "512" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17927473" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metallo-β-lactamases: the quiet before the storm?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T.R. Walsh" 1 => "M.A. Toleman" 2 => "L. Poirel" 3 => "P. Nordmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/CMR.18.2.306-325.2005" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Rev" "fecha" => "2005" "volumen" => "18" "paginaInicial" => "306" "paginaFinal" => "325" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15831827" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of phenotypic tests for the detection of metallo-β-lactamases in clinical isolates of <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Lucena" 1 => "L.M. Dalla Costa" 2 => "K. Da Silva Nogueira" 3 => "A.P. Matos" 4 => "A.C. Gales" 5 => "S.M. Raboni" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Enferm Infect Microbiol Clin" "fecha" => "2014" "volumen" => "32" "paginaInicial" => "625" "paginaFinal" => "630" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid detection of carbapenemase-producing <span class="elsevierStyleItalic">Enterobacteriaceae</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Nordmann" 1 => "L. Poirel" 2 => "L. Dortet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3201/eid1809.120355" "Revista" => array:6 [ "tituloSerie" => "Emerg Infect Dis" "fecha" => "2012" "volumen" => "18" "paginaInicial" => "1503" "paginaFinal" => "1507" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22932472" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Strategy for rapid detection of carbapenemase-producing <span class="elsevierStyleItalic">Enterobacteriaceae</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Dortet" 1 => "L. Bréchard" 2 => "G. Cuzon" 3 => "L. Poirel" 4 => "P. Nordmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/AAC.01239-13" "Revista" => array:6 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "2014" "volumen" => "58" "paginaInicial" => "2441" "paginaFinal" => "2445" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24468779" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid detection of carbapenemase-producing <span class="elsevierStyleItalic">Enterobacteriaceae</span> from blood cultures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Dortet" 1 => "L. Bréchard" 2 => "L. Poirel" 3 => "P. Nordmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1469-0691.12318" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "340" "paginaFinal" => "344" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23889766" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dissemination in distinct Brazilian regions of an epidemic carbapenem-resistant <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> producing SPM metallo-β-lactamase" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.C. Gales" 1 => "L.C. Menezes" 2 => "S. Silbert" 3 => "H.S. Sader" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jac/dkg416" "Revista" => array:6 [ "tituloSerie" => "J Antimicrob Chemother" "fecha" => "2003" "volumen" => "52" "paginaInicial" => "699" "paginaFinal" => "702" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12951331" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular analysis of metallo-β-lactamase gene <span class="elsevierStyleItalic">bla</span><span class="elsevierStyleInf">SPM-1</span>-surrounding sequences from disseminated <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> isolates in Recife, Brazil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Poirel" 1 => "M. Magalhaes" 2 => "M. Lopes" 3 => "P. 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| 2022 January | 12 | 13 | 25 |
| 2021 December | 15 | 16 | 31 |
| 2021 November | 14 | 25 | 39 |
| 2021 October | 22 | 13 | 35 |
| 2021 September | 15 | 13 | 28 |
| 2021 August | 14 | 9 | 23 |
| 2021 July | 20 | 13 | 33 |
| 2021 June | 26 | 11 | 37 |
| 2021 May | 17 | 10 | 27 |
| 2021 April | 32 | 46 | 78 |
| 2021 March | 17 | 11 | 28 |
| 2021 February | 20 | 6 | 26 |
| 2021 January | 13 | 13 | 26 |
| 2020 December | 18 | 10 | 28 |
| 2020 November | 12 | 15 | 27 |
| 2020 October | 24 | 12 | 36 |
| 2020 September | 29 | 6 | 35 |
| 2020 August | 11 | 21 | 32 |
| 2020 July | 10 | 17 | 27 |
| 2020 June | 10 | 5 | 15 |
| 2020 May | 22 | 12 | 34 |
| 2020 April | 11 | 9 | 20 |
| 2020 March | 14 | 7 | 21 |
| 2020 February | 11 | 8 | 19 |
| 2020 January | 8 | 9 | 17 |
| 2019 December | 40 | 12 | 52 |
| 2019 November | 10 | 5 | 15 |
| 2019 October | 19 | 11 | 30 |
| 2019 September | 11 | 22 | 33 |
| 2019 August | 22 | 9 | 31 |
| 2019 July | 21 | 27 | 48 |
| 2019 June | 17 | 33 | 50 |
| 2019 May | 92 | 27 | 119 |
| 2019 April | 34 | 31 | 65 |
| 2019 March | 9 | 1 | 10 |
| 2019 February | 8 | 14 | 22 |
| 2019 January | 10 | 16 | 26 |
| 2018 December | 8 | 11 | 19 |
| 2018 November | 11 | 10 | 21 |
| 2018 October | 19 | 15 | 34 |
| 2018 September | 12 | 7 | 19 |
| 2018 August | 4 | 10 | 14 |
| 2018 July | 4 | 8 | 12 |
| 2018 June | 10 | 6 | 16 |
| 2018 May | 4 | 4 | 8 |
| 2018 April | 4 | 10 | 14 |
| 2018 March | 10 | 8 | 18 |
| 2018 February | 6 | 5 | 11 |
| 2018 January | 11 | 3 | 14 |
| 2017 December | 17 | 5 | 22 |
| 2017 November | 7 | 9 | 16 |
| 2017 October | 18 | 5 | 23 |
| 2017 September | 9 | 8 | 17 |
| 2017 August | 25 | 12 | 37 |
| 2017 July | 10 | 5 | 15 |
| 2017 June | 25 | 35 | 60 |
| 2017 May | 21 | 23 | 44 |
| 2017 April | 18 | 23 | 41 |
| 2017 March | 29 | 35 | 64 |
| 2017 February | 18 | 9 | 27 |
| 2017 January | 17 | 3 | 20 |
| 2016 December | 28 | 8 | 36 |
| 2016 November | 28 | 8 | 36 |
| 2016 October | 63 | 13 | 76 |
| 2016 September | 39 | 7 | 46 |
| 2016 August | 41 | 10 | 51 |
| 2016 July | 21 | 2 | 23 |
| 2016 June | 42 | 1 | 43 |
| 2016 May | 33 | 5 | 38 |
| 2016 April | 22 | 1 | 23 |
| 2016 March | 29 | 26 | 55 |
| 2016 February | 32 | 20 | 52 |
| 2016 January | 38 | 26 | 64 |
| 2015 December | 31 | 19 | 50 |
| 2015 November | 32 | 17 | 49 |
| 2015 October | 42 | 20 | 62 |
| 2015 September | 44 | 17 | 61 |
| 2015 August | 22 | 14 | 36 |
| 2015 July | 21 | 10 | 31 |
| 2015 June | 29 | 8 | 37 |
| 2015 May | 37 | 19 | 56 |
| 2015 April | 38 | 26 | 64 |
| 2015 March | 59 | 27 | 86 |
| 2015 February | 81 | 53 | 134 |
| 2015 January | 222 | 79 | 301 |
| 2014 December | 289 | 95 | 384 |
| 2014 November | 108 | 68 | 176 |
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