Eikenella corrodens causing deep-seated infections. Six-year experience in a University Hospital in Madrid | Enfermedades Infecciosas y Microbiología Clínica

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Six-year experience in a University Hospital in Madrid" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "76" "paginaFinal" => "78" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Lourdes Rodríguez-Rojas, Amaya Suarez-López, Rafael Cantón, Patricia Ruiz-Garbajosa" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Lourdes" "apellidos" => "Rodríguez-Rojas" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 1 => array:4 [ "nombre" => "Amaya" "apellidos" => "Suarez-López" "email" => array:1 [ 0 => "amayinsl@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Rafael" "apellidos" => "Cantón" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Patricia" "apellidos" => "Ruiz-Garbajosa" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infecciones por Eikenella corrodens en localizaciones profundas. Experiencia de 6 años en un hospital universitario de Madrid" ] ] "textoCompleto" => "IntroductionEikenella corrodens (EC) belongs to the family Neisseriaceae. It is a small, non-motile, non-spore-forming, facultatively anaerobic gramnegative rod. It grows slowly on blood or chocolate agar at 37°C. Colonies are greyish, sometimes surrounded by a greenish discoloration on the blood agar, and produce a bleach-like odour. About 50% of the strains pit or corrode the agar, and this characteristic gave the microorganism its name.<a class="elsevierStyleCrossRef" href="#bib0055">1</a> Nowadays, matrix-assisted laser desorption ionisation–time of flight (MALDI-TOF) mass spectrometry is a rapid and accurate tool for the identification of E. corrodens.<a class="elsevierStyleCrossRef" href="#bib0060">2</a>E. corrodens is a component of the normal microbiota of the oropharynx and is a common cause of periodontitis and opportunistic infections of the head and neck. It is also a typical pathogen of human bite wounds or clenched-fist injuries. Deep-seated infections such as pleuropulmonary and abdominal infections have been described. Pleuropulmonary infections are seen in patients with medical history of aspirative pneumonia and alcoholism, and abdominal infections are often preceded by surgery.<a class="elsevierStyleCrossRef" href="#bib0065">3</a> Intravenous drug users are at risk of bacteraemia and endocarditis. Osteomyelitis can occur following a puncture wound with objects such as forks, toothpicks and fish bones, or after a human bite or clenched-fist injury. Thyroid abscesses and central nervous system infections have been described in children.<a class="elsevierStyleCrossRef" href="#bib0070">4</a>Deep-seated infections caused by this micoorganism are unusual and its identification may raise some doubts regarding antibiotic choice and length of treatment. Despite appropriate antimicrobial therapy, E. corrodens infections tend to relapse if treatment is withhold too early and drainage may be necessary to achieve cure. We describe 9 cases of deep-seated infections located in anatomical regions different from the head and neck diagnosed at our hospital between 2010 and 2015. We decided to review these cases in order to describe the clinical characteristics, management, and outcomes of this infection these infections.Material and methodsE. corrodens isolates cultured from abscesses or usually sterile sites were identified preforming a restrospective review of the laboratory database and clinical and surgical records of these patients, during the years 2010–2015. Identification of E. corrodens was performed using conventional culture techniques and biochemical tests, and mass spectrometry (MALDI-TOF MS; Bruker Daltonics, Leipzig, Germany). Susceptibility testing was performed with MIC gradient strips (Etest, BioMerieux, France) and interpreted according to the Clinical and Laboratory Standards Institute (CLSI) criteria.ResultsE. corrodens was isolated from 39 clinical samples during the study period: 21 head and neck abscesses, 9 superficial wounds, and 9 deep-seated abscesses or usually sterile sites or fluids. These last nine cases were selected for the study.Case reportsPatient #1: 72-year-old man who presented with asymptomatic jaundice and was diagnosed of adenocarcinoma of the pancreatic head and underwent cephalic pancreaticoduodenectomy. Postoperatively, the patient was febrile and had elevated sepsis markers. An abdominal computed tomography (CT) scan showed a single suprahepatic collection that was drained percutaneously and grew E. corrodens in pure culture.Patient #2: 66-year-old man, admitted for urgent surgery due to acute abdomen secondary to a perforated tumoral mass on the transverse colon. Two weeks after surgery the patient was febrile and the CT scan showed a subphrenic collection, which was drained through a percutaneous catheter. E. corrodens was isolated in pure culture.Patient #3: 49-year-old man on peritoneal dialysis for 2 years, who noted suppuration around the insertion point of the catheter. The catheter was removed and samples of the discharge and peritoneal fluid were submitted for culture, and pure growth of E. corrodens was obtained.Patient #4: 68-year old man who presented to the emergency room two weeks after laparoscopic cholecystectomy because of persistent fever and right upper quadrant pain. The CT scan showed a 10cm liver abscess. The sample obtained from the drainage of the abscess grew a pure culture of E. corrodens. Blood cultures were also positive for this organism.Patient #5: 83-year-old diabetic woman who complained of productive cough and right-sided chest pain. CT scan revealed a pleural effusion occupying the whole hemithorax, which was drained through a chest tube. The sample thus obtained was purulent and grew E. corrodens and Staphylococcus intermedius.Patient #6: 49-year-old woman with no relevant medical history, who consulted for chest pain and cough in the last 72h. She referred that 2 months ago she noted suppuration through the right inguinal region that ceased spontaneously. Physical examination revealed hypoventilation in the right lung. A thoracoabdominal CT scan showed a pleural effusion occupying two thirds of the lung, a pararenal fluid collection affecting the psoas muscle, and a liver abscess. The empyema and the psoas abscess were drained, whereas the liver abscess was monitored through imaging and resolved with antibiotic therapy alone. E. corrodens was found in both pleural fluid and psoas abscess samples. In addition, Prevotella spp. was isolated form the pleural fluid and Fusobacterium spp. from the psoas abscess sample.Patient #7: 47-year-old alcoholic man who complained of fever and purulent sputum. Poor oral hygiene was noted during physical examination. CT scan imaging revealed a lung cavitation with an air-fluid level in the left upper lobe. Drainage was performed through transthoracic puncture and grew E. corrodens, Corynebacterium spp., and Streptococcus spp.Patient #8: 54-year-old woman with a history of recent bariatric surgery and postoperative nosocomial pneumonia, presenting a month after discharge with dyspnoea and chest pain. Massive left empyema was diagnosed through CT scan and drainage. E. corrodens was identified in the sample.Patient #9: 66-year-old man presenting a worsening of the respiratory function and a bilious fluid drain from the chest tube on the postoperative phase of esophagectomy used to treat a locally advanced oesophageal cancer. The CT scan showed bilateral pleural effusion and the fluid sent for culture grew E. corrodens.The mean age was 61 years (±12.25 SD). Six of the 9 patients were male. E. corrodens grew in pure culture in 6 cases, whereas in 3 cases the infection was polymicrobial. E. corrodens isolates were susceptible to penicillin (85.7%), ampicillin (85.7%), amoxicillin-clavulanate (85.7%), cefotaxime (100%), imipenem (100%), ciprofloxacin (100%), tetracycline (100%), cotrimoxazole (77.7%) and rifampicin (75%).All patients were treated with antibiotics for at least 4 weeks, except the patient on peritoneal dialysis (patient #2), who recovered after 2 weeks of treatment. All infections resolved after antibiotics and draining if needed (see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>DiscussionE. corrodens is an opportunistic pathogen that shows a propensity towards the formation of abscesses in any location. Infections tend to be indolent and benign, but invasive infections and relapse have been described. This slow-growing, fastidious bacterium is often involved in polymicrobial infections and thus might be underdiagnosed because it is outgrown by coinfecting microorganisms in conventional culture media.It has been described that E. corrodens shows exponential growth in the presence of different strains of Streptotoccus spp.<a class="elsevierStyleCrossRef" href="#bib0075">5</a> Polymicrobial infections are in fact frequent and in some series account for up to 65% of cases,<a class="elsevierStyleCrossRefs" href="#bib0065">3,6</a> with Streptococcus spp. and anaerobes being the species usually involved.In the present study we have found that a break in mucocutaneous barriers (invasive procedures, surgery, peritoneal catheter) can lead to bacteraemia and deep-seated E. corrodens infections. Five of the patients in this series had undergone such a procedure. In a small series, several E. corrodens abdominal abscesses secondary to surgery have been reported.<a class="elsevierStyleCrossRef" href="#bib0085">7</a> Microaspiration could be a mechanism of respiratory infections.Most E. corrodens isolates are susceptible to penicillin, ampicillin, second- and third-generation cephalosporins, carbapenems, fluoroquinolones, and tetracyclines. All strains are resistant to clindamycin and metronidazole. Some strains are β-lactamase producers, and the β-lactamase is inhibited by clavulanic acid and sulbactam. The production of β-lactamase and the resistance to streptomycin and sulphonamides has been associated with a plasmid,<a class="elsevierStyleCrossRef" href="#bib0090">8</a> and with a transposon.<a class="elsevierStyleCrossRef" href="#bib0095">9</a> A non-inducible β-lactamase encoded by the chromosome has also been described in this organism.<a class="elsevierStyleCrossRef" href="#bib0100">10</a> The 9 cases presented here were successfully treated with β-lactams or levofloxacin and 7 patients required surgical drainage. Incision and drainage of the abscesses and debridement of necrotic tissue have been found essential to achieve proper healing.<a class="elsevierStyleCrossRef" href="#bib0080">6</a>E. corrodens infections are prone to cause relapses even with appropriate therapy, so avoiding early cessation of antibiotic and assessing the necessity of new imaging are recommended in order to assess the development of collections when response to treatment is poor are recommended.<a class="elsevierStyleCrossRef" href="#bib0070">4</a>In conclusion, deep-seated infections in which E. corrodens is involved are often present in patients with comorbid conditions and subjected to invasive procedures that may serve as the route of entry for the pathogen. Despite being a bacterium susceptible to several antibiotics, patients are often treated with broad-spectrum antibiotics for a long period of time, even in the absence of no coinfecting microorganisms where cultured. This may be explained by the clinical suspicion of a polymicrobial infection or due to the characteristic torpid evolution of abscesses caused by E. corrodens, which tend to relapse if antibiotic therapy is stopped too early. Proper imaging to assess the evolution of the collections is important to monitor the response to therapy.FundingThe present investigation has not received specific subsidies from agencies of the public sector, commercial sector or non-profit entities.Conflict of interestsThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1297574" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1197697" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1297573" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1197698" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Case reports" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-01-07" "fechaAceptado" => "2019-04-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1197697" "palabras" => array:3 [ 0 => "Eikenella corrodens" 1 => "Deep-seated infections" 2 => "Abscess" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1197698" "palabras" => array:3 [ 0 => "Eikenella corrodens" 1 => "Infecciones en localizaciones profundas" 2 => "Absceso" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionEikenella corrodens (EC) is part of the normal microbiota of the oropharynx and a recognised opportunistic pathogen. It is mainly involved in head and neck infections, but it has also been identified as a cause of pleuropulmonary and intraabdominal infections. Its identification could be difficult due to its fastidious growth requirements, especially in the context of polymicrobial infection and is probably underreported. MethodsWe carried out a retrospective 5-year review of clinical charts and laboratory database. ResultsWe describe the clinical and microbiological characteristics of 9 deep-seated infections caused by EC, diagnosed in locations different from the head and neck. ConclusionEC deep-seated infections are often found in patients with comorbid conditions and a history of interventional procedures. Due to the characteristic torpid evolution of EC abscesses, imaging to assess the necessity of debridement and avoid early cessation of antibiotics is necessary." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEikenella corrodens (EC) es parte de la microbiota habitual orofaríngea y un conocido patógeno oportunista. Está involucrado principalmente en infecciones de cabeza y cuello, pero también causa de infecciones pleuropulmonares e intraabdominales. Su identificación podría ser difícil debido a sus exigentes requisitos de crecimiento, especialmente en el contexto de la infección polimicrobiana y probablemente sea un microorganismo infradiagnosticado. MétodosRealizamos una revisión retrospectiva de 5 años de las historias clínicas y la base de datos del laboratorio. ResultadosDescribimos las características clínicas y microbiológicas de 9 casos de infecciones en localizaciones profundas causadas por EC, diagnosticadas en localizaciones diferentes de la cabeza y el cuello. ConclusionesLas infecciones profundas por EC aparecen con frecuencia en pacientes con comorbilidades y antecedentes de procedimientos invasivos. Dada la evolución tórpida característica de los abscesos causados por EC, emplear técnicas de imagen para valorar la necesidad de desbridamiento y evitar la retirada prematura de los antimicrobianos." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Site of infection \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Underlying disease \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Possible route of entry \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Polymicrobial infection \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Drainage \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antibiotic treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intraabdominal abscess \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pancreatic adenocarcinoma \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="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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Piperacillin-tazobactam \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intraabdominal abscess \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perforated colonic adenocarcinoma \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="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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Piperacillin-tazobactam, gentamicin, metronidazole \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peritonitis \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chronic kidney disease \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peritoneal dyalisis 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Levofloxacin, vancomycin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liver abscess \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acute cholecystitis \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Laparoscopic colecistechtomy \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Piperacillin-tazobactam \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Empyema \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes mellitus \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">S. intermedius \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Piperacillin-tazobactam \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liver and psoas abscess, empyema \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="left" 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-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prevotella spp, Fusobacterium spp \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Meropenem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Empyema \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alcohol abuse, periodontal disease \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aspiration \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Streptococcus spp, Corynebacterium spp \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ertapenem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Empyema \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Morbid obesity, post-surgery 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="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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Piperacillin-tazobactam \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Empyema \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oesophageal cancer \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="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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Meropenem, linezolid \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2221812.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical characteristics and treatment of deep-seated Eikenella corrodens infections." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Eikenella corrodens]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Muhlhauser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4067/S0716-10182013000200007" "Revista" => array:7 [ "tituloSerie" => "Rev Chilena Infectol" "fecha" => "2013" "volumen" => "30" "paginaInicial" => "163" "paginaFinal" => "164" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23677155" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0967586812006510" "estado" => "S300" "issn" => "09675868" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identification of HACEK clinical isolates by matrix-assisted laser desorption ionization-time of flight mass spectrometry" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.R. Couturier" 1 => "E. Mehinovic" 2 => "A.C. 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Brief report

Eikenella corrodens causing deep-seated infections. Six-year experience in a University Hospital in Madrid

Infecciones por Eikenella corrodens en localizaciones profundas. Experiencia de 6 años en un hospital universitario de Madrid

Lourdes Rodríguez-Rojasa,b, Amaya Suarez-Lópeza,b,

Corresponding author

amayinsl@gmail.com

Corresponding author.

, Rafael Cantóna,b, Patricia Ruiz-Garbajosaa,b

a Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain

b Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain

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        "titulo" => "Infecciones por <span class="elsevierStyleItalic">Eikenella corrodens</span> en localizaciones profundas&#46; Experiencia de 6 a&#241;os en un hospital universitario de Madrid"
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    "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">Eikenella corrodens</span> &#40;EC&#41; belongs to the family <span class="elsevierStyleItalic">Neisseriaceae</span>&#46; It is a small&#44; non-motile&#44; non-spore-forming&#44; facultatively anaerobic gramnegative rod&#46; It grows slowly on blood or chocolate agar at 37<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Colonies are greyish&#44; sometimes surrounded by a greenish discoloration on the blood agar&#44; and produce a bleach-like odour&#46; About 50&#37; of the strains pit or corrode the agar&#44; and this characteristic gave the microorganism its name&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Nowadays&#44; matrix-assisted laser desorption ionisation&#8211;time of flight &#40;MALDI-TOF&#41; mass spectrometry is a rapid and accurate tool for the identification of <span class="elsevierStyleItalic">E&#46; corrodens</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">E&#46; corrodens</span> is a component of the normal microbiota of the oropharynx and is a common cause of periodontitis and opportunistic infections of the head and neck&#46; It is also a typical pathogen of human bite wounds or clenched-fist injuries&#46; Deep-seated infections such as pleuropulmonary and abdominal infections have been described&#46; Pleuropulmonary infections are seen in patients with medical history of aspirative pneumonia and alcoholism&#44; and abdominal infections are often preceded by surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Intravenous drug users are at risk of bacteraemia and endocarditis&#46; Osteomyelitis can occur following a puncture wound with objects such as forks&#44; toothpicks and fish bones&#44; or after a human bite or clenched-fist injury&#46; Thyroid abscesses and central nervous system infections have been described in children&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Deep-seated infections caused by this micoorganism are unusual and its identification may raise some doubts regarding antibiotic choice and length of treatment&#46; Despite appropriate antimicrobial therapy&#44; <span class="elsevierStyleItalic">E&#46; corrodens</span> infections tend to relapse if treatment is withhold too early and drainage may be necessary to achieve cure&#46; We describe 9 cases of deep-seated infections located in anatomical regions different from the head and neck diagnosed at our hospital between 2010 and 2015&#46; We decided to review these cases in order to describe the clinical characteristics&#44; management&#44; and outcomes of this infection these infections&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">E&#46; corrodens</span> isolates cultured from abscesses or usually sterile sites were identified preforming a restrospective review of the laboratory database and clinical and surgical records of these patients&#44; during the years 2010&#8211;2015&#46; Identification of <span class="elsevierStyleItalic">E&#46; corrodens</span> was performed using conventional culture techniques and biochemical tests&#44; and mass spectrometry &#40;MALDI-TOF MS&#59; Bruker Daltonics&#44; Leipzig&#44; Germany&#41;&#46; Susceptibility testing was performed with MIC gradient strips &#40;Etest&#44; BioMerieux&#44; France&#41; and interpreted according to the Clinical and Laboratory Standards Institute &#40;CLSI&#41; criteria&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">E&#46; corrodens</span> was isolated from 39 clinical samples during the study period&#58; 21 head and neck abscesses&#44; 9 superficial wounds&#44; and 9 deep-seated abscesses or usually sterile sites or fluids&#46; These last nine cases were selected for the study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Case reports</span><p id="par0035" class="elsevierStylePara elsevierViewall">Patient &#35;1&#58; 72-year-old man who presented with asymptomatic jaundice and was diagnosed of adenocarcinoma of the pancreatic head and underwent cephalic pancreaticoduodenectomy&#46; Postoperatively&#44; the patient was febrile and had elevated sepsis markers&#46; An abdominal computed tomography &#40;CT&#41; scan showed a single suprahepatic collection that was drained percutaneously and grew <span class="elsevierStyleItalic">E&#46; corrodens</span> in pure culture&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patient &#35;2&#58; 66-year-old man&#44; admitted for urgent surgery due to acute abdomen secondary to a perforated tumoral mass on the transverse colon&#46; Two weeks after surgery the patient was febrile and the CT scan showed a subphrenic collection&#44; which was drained through a percutaneous catheter&#46; <span class="elsevierStyleItalic">E&#46; corrodens</span> was isolated in pure culture&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patient &#35;3&#58; 49-year-old man on peritoneal dialysis for 2 years&#44; who noted suppuration around the insertion point of the catheter&#46; The catheter was removed and samples of the discharge and peritoneal fluid were submitted for culture&#44; and pure growth of <span class="elsevierStyleItalic">E&#46; corrodens</span> was obtained&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Patient &#35;4&#58; 68-year old man who presented to the emergency room two weeks after laparoscopic cholecystectomy because of persistent fever and right upper quadrant pain&#46; The CT scan showed a 10<span class="elsevierStyleHsp" style=""></span>cm liver abscess&#46; The sample obtained from the drainage of the abscess grew a pure culture of <span class="elsevierStyleItalic">E&#46; corrodens</span>&#46; Blood cultures were also positive for this organism&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Patient &#35;5&#58; 83-year-old diabetic woman who complained of productive cough and right-sided chest pain&#46; CT scan revealed a pleural effusion occupying the whole hemithorax&#44; which was drained through a chest tube&#46; The sample thus obtained was purulent and grew <span class="elsevierStyleItalic">E&#46; corrodens</span> and <span class="elsevierStyleItalic">Staphylococcus intermedius</span>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Patient &#35;6&#58; 49-year-old woman with no relevant medical history&#44; who consulted for chest pain and cough in the last 72<span class="elsevierStyleHsp" style=""></span>h&#46; She referred that 2 months ago she noted suppuration through the right inguinal region that ceased spontaneously&#46; Physical examination revealed hypoventilation in the right lung&#46; A thoracoabdominal CT scan showed a pleural effusion occupying two thirds of the lung&#44; a pararenal fluid collection affecting the psoas muscle&#44; and a liver abscess&#46; The empyema and the psoas abscess were drained&#44; whereas the liver abscess was monitored through imaging and resolved with antibiotic therapy alone&#46; <span class="elsevierStyleItalic">E&#46; corrodens</span> was found in both pleural fluid and psoas abscess samples&#46; In addition&#44; <span class="elsevierStyleItalic">Prevotella</span> spp&#46; was isolated form the pleural fluid and <span class="elsevierStyleItalic">Fusobacterium spp&#46;</span> from the psoas abscess sample&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Patient &#35;7&#58; 47-year-old alcoholic man who complained of fever and purulent sputum&#46; Poor oral hygiene was noted during physical examination&#46; CT scan imaging revealed a lung cavitation with an air-fluid level in the left upper lobe&#46; Drainage was performed through transthoracic puncture and grew <span class="elsevierStyleItalic">E&#46; corrodens</span>&#44; <span class="elsevierStyleItalic">Corynebacterium</span> spp&#46;&#44; and <span class="elsevierStyleItalic">Streptococcus</span> spp&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Patient &#35;8&#58; 54-year-old woman with a history of recent bariatric surgery and postoperative nosocomial pneumonia&#44; presenting a month after discharge with dyspnoea and chest pain&#46; Massive left empyema was diagnosed through CT scan and drainage&#46; <span class="elsevierStyleItalic">E&#46; corrodens</span> was identified in the sample&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Patient &#35;9&#58; 66-year-old man presenting a worsening of the respiratory function and a bilious fluid drain from the chest tube on the postoperative phase of esophagectomy used to treat a locally advanced oesophageal cancer&#46; The CT scan showed bilateral pleural effusion and the fluid sent for culture grew <span class="elsevierStyleItalic">E&#46; corrodens</span>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The mean age was 61 years &#40;&#177;12&#46;25 SD&#41;&#46; Six of the 9 patients were male&#46; <span class="elsevierStyleItalic">E&#46; corrodens</span> grew in pure culture in 6 cases&#44; whereas in 3 cases the infection was polymicrobial&#46; <span class="elsevierStyleItalic">E&#46; corrodens</span> isolates were susceptible to penicillin &#40;85&#46;7&#37;&#41;&#44; ampicillin &#40;85&#46;7&#37;&#41;&#44; amoxicillin-clavulanate &#40;85&#46;7&#37;&#41;&#44; cefotaxime &#40;100&#37;&#41;&#44; imipenem &#40;100&#37;&#41;&#44; ciprofloxacin &#40;100&#37;&#41;&#44; tetracycline &#40;100&#37;&#41;&#44; cotrimoxazole &#40;77&#46;7&#37;&#41; and rifampicin &#40;75&#37;&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">All patients were treated with antibiotics for at least 4 weeks&#44; except the patient on peritoneal dialysis &#40;patient &#35;2&#41;&#44; who recovered after 2 weeks of treatment&#46; All infections resolved after antibiotics and draining if needed &#40;see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">E&#46; corrodens</span> is an opportunistic pathogen that shows a propensity towards the formation of abscesses in any location&#46; Infections tend to be indolent and benign&#44; but invasive infections and relapse have been described&#46; This slow-growing&#44; fastidious bacterium is often involved in polymicrobial infections and thus might be underdiagnosed because it is outgrown by coinfecting microorganisms in conventional culture media&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">It has been described that <span class="elsevierStyleItalic">E&#46; corrodens</span> shows exponential growth in the presence of different strains of <span class="elsevierStyleItalic">Streptotoccus</span> spp&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Polymicrobial infections are in fact frequent and in some series account for up to 65&#37; of cases&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;6</span></a> with <span class="elsevierStyleItalic">Streptococcus</span> spp&#46; and anaerobes being the species usually involved&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In the present study we have found that a break in mucocutaneous barriers &#40;invasive procedures&#44; surgery&#44; peritoneal catheter&#41; can lead to bacteraemia and deep-seated <span class="elsevierStyleItalic">E&#46; corrodens</span> infections&#46; Five of the patients in this series had undergone such a procedure&#46; In a small series&#44; several <span class="elsevierStyleItalic">E&#46; corrodens</span> abdominal abscesses secondary to surgery have been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Microaspiration could be a mechanism of respiratory infections&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Most <span class="elsevierStyleItalic">E&#46; corrodens</span> isolates are susceptible to penicillin&#44; ampicillin&#44; second- and third-generation cephalosporins&#44; carbapenems&#44; fluoroquinolones&#44; and tetracyclines&#46; All strains are resistant to clindamycin and metronidazole&#46; Some strains are &#946;-lactamase producers&#44; and the &#946;-lactamase is inhibited by clavulanic acid and sulbactam&#46; The production of &#946;-lactamase and the resistance to streptomycin and sulphonamides has been associated with a plasmid&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> and with a transposon&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> A non-inducible &#946;-lactamase encoded by the chromosome has also been described in this organism&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> The 9 cases presented here were successfully treated with &#946;-lactams or levofloxacin and 7 patients required surgical drainage&#46; Incision and drainage of the abscesses and debridement of necrotic tissue have been found essential to achieve proper healing&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleItalic">E&#46; corrodens</span> infections are prone to cause relapses even with appropriate therapy&#44; so avoiding early cessation of antibiotic and assessing the necessity of new imaging are recommended in order to assess the development of collections when response to treatment is poor are recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In conclusion&#44; deep-seated infections in which <span class="elsevierStyleItalic">E&#46; corrodens</span> is involved are often present in patients with comorbid conditions and subjected to invasive procedures that may serve as the route of entry for the pathogen&#46; Despite being a bacterium susceptible to several antibiotics&#44; patients are often treated with broad-spectrum antibiotics for a long period of time&#44; even in the absence of no coinfecting microorganisms where cultured&#46; This may be explained by the clinical suspicion of a polymicrobial infection or due to the characteristic torpid evolution of abscesses caused by <span class="elsevierStyleItalic">E&#46; corrodens</span>&#44; which tend to relapse if antibiotic therapy is stopped too early&#46; Proper imaging to assess the evolution of the collections is important to monitor the response to therapy&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0115" class="elsevierStylePara elsevierViewall">The present investigation has not received specific subsidies from agencies of the public sector&#44; commercial sector or non-profit entities&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Eikenella corrodens</span> &#40;EC&#41; is part of the normal microbiota of the oropharynx and a recognised opportunistic pathogen&#46; It is mainly involved in head and neck infections&#44; but it has also been identified as a cause of pleuropulmonary and intraabdominal infections&#46; Its identification could be difficult due to its fastidious growth requirements&#44; especially in the context of polymicrobial infection and is probably underreported&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We carried out a retrospective 5-year review of clinical charts and laboratory database&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We describe the clinical and microbiological characteristics of 9 deep-seated infections caused by EC&#44; diagnosed in locations different from the head and neck&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">EC deep-seated infections are often found in patients with comorbid conditions and a history of interventional procedures&#46; Due to the characteristic torpid evolution of EC abscesses&#44; imaging to assess the necessity of debridement and avoid early cessation of antibiotics is necessary&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Eikenella corrodens</span> &#40;EC&#41; es parte de la microbiota habitual orofar&#237;ngea y un conocido pat&#243;geno oportunista&#46; Est&#225; involucrado principalmente en infecciones de cabeza y cuello&#44; pero tambi&#233;n causa de infecciones pleuropulmonares e intraabdominales&#46; Su identificaci&#243;n podr&#237;a ser dif&#237;cil debido a sus exigentes requisitos de crecimiento&#44; especialmente en el contexto de la infecci&#243;n polimicrobiana y probablemente sea un microorganismo infradiagnosticado&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Realizamos una revisi&#243;n retrospectiva de 5 a&#241;os de las historias cl&#237;nicas y la base de datos del laboratorio&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Describimos las caracter&#237;sticas cl&#237;nicas y microbiol&#243;gicas de 9 casos de infecciones en localizaciones profundas causadas por EC&#44; diagnosticadas en localizaciones diferentes de la cabeza y el cuello&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Las infecciones profundas por EC aparecen con frecuencia en pacientes con comorbilidades y antecedentes de procedimientos invasivos&#46; Dada la evoluci&#243;n t&#243;rpida caracter&#237;stica de los abscesos causados por EC&#44; emplear t&#233;cnicas de imagen para valorar la necesidad de desbridamiento y evitar la retirada prematura de los antimicrobianos&#46;</p></span>"
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            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Site of infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Underlying disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Possible route of entry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Polymicrobial infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antibiotic treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intraabdominal abscess&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pancreatic adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Piperacillin-tazobactam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intraabdominal abscess&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perforated colonic adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Piperacillin-tazobactam&#44; gentamicin&#44; metronidazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peritonitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chronic kidney disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peritoneal dyalisis catheter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Levofloxacin&#44; vancomycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Liver abscess&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acute cholecystitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laparoscopic colecistechtomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Piperacillin-tazobactam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Empyema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S&#46; intermedius</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Piperacillin-tazobactam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Liver and psoas abscess&#44; empyema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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">Unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Prevotella</span> spp&#44; <span class="elsevierStyleItalic">Fusobacterium</span> spp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Meropenem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Empyema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alcohol abuse&#44; periodontal disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aspiration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Streptococcus</span> spp&#44; <span class="elsevierStyleItalic">Corynebacterium</span> spp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ertapenem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Empyema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Morbid obesity&#44; post-surgery pneumonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Piperacillin-tazobactam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Empyema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oesophageal cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Meropenem&#44; linezolid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2221812.png"
              ]
            ]
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Article information

ISSN: 0213005X
Original language: English

DOI:10.1016/j.eimc.2019.04.004

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Year/Month	Html	Pdf	Total

2024 November	38	2	40
2024 October	46	17	63
2024 September	74	33	107
2024 August	64	22	86
2024 July	46	29	75
2024 June	52	14	66
2024 May	34	12	46
2024 April	35	27	62
2024 March	50	33	83
2024 February	34	35	69
2024 January	43	32	75
2023 December	26	35	61
2023 November	24	33	57
2023 October	39	46	85
2023 September	14	24	38
2023 August	15	9	24
2023 July	16	17	33
2023 June	42	26	68
2023 May	53	25	78
2023 April	55	30	85
2023 March	66	13	79
2023 February	37	4	41
2023 January	34	14	48
2022 December	31	22	53
2022 November	35	16	51
2022 October	40	25	65
2022 September	46	24	70
2022 August	55	15	70
2022 July	35	10	45
2022 June	33	11	44
2022 May	46	22	68
2022 April	44	7	51
2022 March	74	15	89
2022 February	88	10	98
2022 January	60	19	79
2021 December	70	15	85
2021 November	52	13	65
2021 October	60	21	81
2021 September	36	16	52
2021 August	28	15	43
2021 July	33	13	46
2021 June	26	10	36
2021 May	29	14	43
2021 April	62	25	87
2021 March	48	9	57
2021 February	26	5	31
2021 January	22	11	33
2020 December	17	5	22
2020 November	15	4	19
2020 October	17	4	21
2020 September	35	11	46
2020 August	21	8	29
2020 July	1	0	1
2020 June	1	0	1
2020 May	4	0	4
2020 April	2	2	4
2020 March	44	20	64
2020 February	17	12	29
2019 August	0	2	2
2019 June	0	2	2

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