Evaluation of a commercial multiplex PCR (Unyvero i60®) designed for the diagnosis of bone and joint infections using prosthetic-joint sonication | Enfermedades Infecciosas y Microbiología Clínica (English Edition)

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"aff0005" ] ] ] 8 => array:3 [ "nombre" => "Antonio" "apellidos" => "Blanco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 9 => array:4 [ "nombre" => "Jaime" "apellidos" => "Esteban" "email" => array:1 [ 0 => "jestebanmoreno@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Orthopaedic Surgery, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Internal Medicine-Emergency, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de una PCR múltiple comercial (Unyvero i60©) diseñada para el diagnóstico de infecciones osteoarticulares utilizando prótesis articulares sonicadas" ] ] "textoCompleto" => "IntroductionDiagnosis of prosthetic-joint infections (PJI) is still a challenge for microbiology laboratories in spite of the advances achieved over the last few years. Although implant sonication has improved the sensitivity of conventional cultures, there are still some infected patients who remain undiagnosed using this technique.<a class="elsevierStyleCrossRefs" href="#bib0120">1,2</a> In an attempt to obtain better results, molecular biology has been used with different samples, most with good results in terms of specificity and sensitivity.<a class="elsevierStyleCrossRefs" href="#bib0125">2–7</a> However, most of these studies are based on locally-developed PCR methods which can have unsatisfactory standardization,<a class="elsevierStyleCrossRef" href="#bib0135">4</a> which is why the development of a commercial system that features higher reproducibility would improve PJI diagnosis in most laboratories. Aiming to achieve this, several studies have used commercial PCR techniques<a class="elsevierStyleCrossRefs" href="#bib0155">8–13</a> with good results, despite the fact that most of them were not designed for the diagnosis of PJI, but rather to identify organisms isolated from blood cultures.<a class="elsevierStyleCrossRefs" href="#bib0155">8–12</a> However, some frequently isolated species from patients with PJI cannot be detected by these kits (notably Propionibacterium acnes<a class="elsevierStyleCrossRef" href="#bib0185">14</a>).Material and methodsDesign of the studyBetween May 2014 and May 2015, a prospective study was carried out to compare two microbiological methods for the diagnosis of PJI basing on parameters of sensitivity, specificity, and predictive values. Traditional diagnosis, which includes culture of sonicated prostheses and culture of synovial fluid and peri-prosthetic tissue, was compared with a new commercial molecular biology technique (Unyvero i60 system (Curetis AG, Holzgerlingen, Germany). This method is specifically designed for the diagnosis of bone and joint infections and it is able to detect not only the main microorganisms responsible for PJI, but also some mechanisms of resistance.Patients and definitionsPatients included were those diagnosed with PJI or aseptic loosening. They were diagnosed as having implant-related infection when at least one of the following commonly accepted criteria<a class="elsevierStyleCrossRef" href="#bib0190">15</a> was met: (1) a draining sinus; (2) presence of acute inflammation identified by histopathological examination; (3) presence of macroscopic purulence around the implant; (4) presence of two or more positive cultures from high-quality samples (synovial fluid, peri-prosthetic tissue, blood cultures); or (5) presence of acute or chronic pain in the absence of a mechanical problem AND at least one altered blood parameter (including erythrocyte sedimentation rate (ESR), CRP, or synovial cell count).Definitions of the different types of PJI (based on the time to infection after the last surgery) were those recommended by Tande et al.<a class="elsevierStyleCrossRef" href="#bib0125">2</a> Infections are classified as early (<3 months), delayed (3–12 or 24 months), or haematogenous one (it is a late-onset PJI, occurring >12–24 months after surgery).From every patient, prostheses were removed (culture and PCR were performed from sonicated fluid) and synovial fluid and peri-prosthetic tissue analyzed by culture.Microbiological proceduresProstheses—in those cases where different parts of the implant were submitted separately, they were processed separately—were sonicated and processed according to a previously described and published protocol.<a class="elsevierStyleCrossRefs" href="#bib0195">16,17</a> A quantitative inoculation was made in different culture media (Tryptic soy agar with 5% sheep blood, chocolate agar, MacConkey agar, Schaedler agar with 5% sheep blood, and Sabouraud-chloramphenicol agar, all from bioMérieux (Marcy L’Etoile, France)) and incubated in different gas mixtures and temperatures during 1 week, with the exception of Sabouraud-chloramphenicol agar, which was maintained at 30°C during 1 month.<a class="elsevierStyleCrossRef" href="#bib0195">16</a>Together with the implants, samples of synovial fluid and 3–6 samples of peri-prosthetic tissue samples were also submitted. Periprosthetic tissue samples were processed by grinding, and the samples were then inoculated in the same media as the sonicated samples. Synovial fluid was inoculated in Bact/Alert® blood culture bottles (bioMérieux, Marcy L’Etoile, France).All organisms isolated from these samples were identified using the MALDI-ToF methodology (Vitek MS, bioMérieux, Marcy L’Etoile, France), and susceptibility testing was performed using the Vitek 2 system (bioMérieux, Marcy L’Etoile, France) or E-test strips (bioMérieux, Marcy L’Etoile, France), depending on the organism isolated.The concentrated sonicate fluids were frozen at −20°C until multiplex PCR was performed.Molecular techniqueIt was carried out, usually 24–48h after the arrival of the sample to the microbiology laboratory, using the Unyvero i60 system® (Curetis AG, Holzgerlingen, Germany) and according to the manufacturer's instructions. This system is designed to detect 27 species or groups of organisms (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a><a class="elsevierStyleCrossRef" href="#bib0205">18</a>). The system allows simultaneous detection of 19 resistance genes (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a><a class="elsevierStyleCrossRef" href="#bib0205">18</a>). Briefly, 180μl of the sonicated fluid were pipetted into the sample tube and placed in the lysis incubator for 30min. Subsequently, the sample was placed in the Unyvero i60 cartridge with the Master mix vial. Then, the loaded cartridge was inserted in the system hardware for amplification and hybridization. After a period of 4.5hours of analysis, the results were displayed on the screen of the system. This technique includes an internal control to determinate whether the result is valid or not.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The results of both studies (culture and molecular biology) were blindly obtained by 2 different authors, each of whom had no knowledge of the results obtained by the other until all results were available.Data analysisMicrobiological and clinical dataAfter molecular and conventional studies were carried out, a retrospective analysis of clinical charts was performed using a predefined protocol. All aspects of the study were approved by the Ethics in Research Committee of the institution (ref. 45/2014_FJD).StatisticsA descriptive analysis of clinical and microbiological data was made. Furthermore, a comparison of the sensitivity (Sn), specificity (Sp), positive (PPV) and negative (NPV) predictive value of both methods was performed. These parameters were calculated using patients without clinical criteria of infection as control group. Furthermore, these data were compared with those of culture of periprosthetic tissue and synovial fluid, since neither molecular biology nor even sonication techniques, are not always available in sanitary centres for the diagnosis of PJI.ResultsDuring the study period, 88 samples from prostheses of 68 patients were analyzed. In some cases, 2 or more samples were taken from the same patient, in particular, 1 patient with 4 samples, 5 with 3, 9 with 2 and 51 with only one sample studied (1.29 samples/patient). In 10 cases, results of PCR technique were not valid since this set in particular was defective. The PCR was repeated with other set and results were then valid.PatientsThere were 39 patients without clinical criteria of infection and 29 with it. Among the last group, the mean age was 72.75 years, 19 of them were women and 10 men. The most frequent type of infection was delayed (n=15), followed by acute, (n=12) and haematogenous (n=2). Only 1 patient received a combination of vancomycin and ceftazidime, undergoing this treatment for the 2 days prior to the operation.SamplesThe type of prostheses studied included knee (n=55), total hip (n=26), partial hip (n=5), and shoulder (n=2).Of the 88 samples, 38 corresponded to patients with clinical criteria of PJI, while 50 did with patients without criteria of PJI.Data among samples related to patients with clinical criteria of PJI (n=38)Twenty samples had both culture of sonicated implant and multiplex PCR positive. Data are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> together with results of culture of periprosthetic tissue and synovial fluid.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Seven samples showed culture of sonication positive but PCR negative (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). These discrepancies are explained as follows: (a) 1 patient with 105CFU/ml of S. agalactiae; (b) 1 patient with 300CFU/ml of S. marcescens (not included among the organisms detected by PCR); (c) 1 patient with 100CFU/ml of S. epidermidis (regarded as a contaminant), with infection due to Mycobacterium tuberculosis which grew 8 weeks later in mycobacterial cultures; (d) 1000CFU/ml of S. simulans; (e) 7000CFU/ml of K. oxytoca; (f) 2000CFU/ml of Finegoldia magna; and (g) 200CFU/ml of Propionibacterium acnes.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Three samples showed positive result by multiplex PCR but negative by culture of sonicated implant (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). PCR were positive for E. faecalis (also isolated in cultures of periprosthetic tissues), S. aureus (not isolated in any other cultures) and P. mirabilis (this patient had a positive culture for P. mirabilis from a debridement surgery 1 month before the retrieval of the implant).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>In 8 cases, both techniques were negative. Only 1 sample from an infected patient was probably culture-negative due to previous antibiotic therapy.Data among samples related to patients without clinical criteria of PJI (n=50)In one case, multiplex PCR gave a positive result while sonication of implant was negative (considered to be a probable false positive). The detected organism was a Coagulase-negative staphylococcus. As all cultures were negative, the patient was diagnosed with probable aseptic loosening. However, the patient received an antibiotic-loaded spacer (vancomycin+gentamicin) and second-stage surgery was performed 1 month after the first stage. Although the result may represent the detection of a true pathogen, because the patient was not treated with antibiotics and the final diagnosis was aseptic loosening, we decided to include it as a false positive of the technique.Two positive cultures (100CFU/ml of S. aureus and 100CFU/ml of S. epidermidis) with PCR negative were considered as contaminants because of several factors: a very low colony count (<500CFU/ml); no other positive cultures from other samples; no clinical diagnosis of infection; and no presentation of complications despite the fact that no treatment was administered in these cases.Mechanisms of resistanceConsidering antimicrobial susceptibility, 9 resistance mechanisms were detected in 5 samples using PCR: 3 mecA, 2 with fluoroquinolone resistance (1 gyrA83 and 1 gyrA87 mutations), 1 ctx-M extended-spectrum beta-lactamase, 1 aminoglycoside resistance (1 aac A4), 1 ermA, and 1 ermC gene. All these findings were confirmed by phenotypic antimicrobial susceptibility assay. Phenotypic susceptibility testing showed 1 isolate of S. simulans to be resistant to erythromycin and clindamycin, going undetected by the system.Data about culture of synovial fluid and periprosthetic tissueAmong patients with clinical criteria of PJI (n=38), culture of periprosthetic tissue was always made, being positive in 16 cases and negative in 38. However, sample of synovial fluid was taken only from 35 patients and 20 had a positive result whereas 15 a negative one.From the 50 patients without clinical criteria of PJI, culture of synovial fluid was negative in 48 cases and of periprosthetic tissue in every sample.Statistical parametersData from which statistical parameters of Sn, Sp, PPV and NPV were calculated, are shown in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> and final results in <a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia>Sensitivity of PCR method was not very high (60.5%) as well as NPV (76.6%). However, the same values for culture of sonicated implant, although slightly higher (Sn=71.1% and NPV=81.36%), were not very great.The main advantage of Unyvero i60 system® is that it improves values of Sp and PPV in relation to sonicated implant culture (Sp=98% and PPV=95.8%, versus Sp=96% and PPV=93.1%, respectively).When PCR technique was compared with culture of periprosthetic tissue, in general it had better values, since, although the last method had Sp and VPP of 100%, Sn and VPN were very low (42.1% and 69.4% respectively).With regard to culture of synovial fluid inoculated in blood bottles, it had similar statistic parameters as PCR, but the last one improves all of them (see <a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>).DiscussionKnowledge of the aetiology of PJI is an essential aspect of patient management, as antibiotic therapy is selected based on the isolated microorganism/s.<a class="elsevierStyleCrossRefs" href="#bib0125">2,19,20</a> The advent of implant sonication in the last decade has improved the conventional methodology, introducing a technique that allows microbiologists to detect bacteria (and fungi) attached to the implant.<a class="elsevierStyleCrossRefs" href="#bib0125">2,21,22</a> However, there are still some patients in whom no microorganisms can be detected despite the use of conventional cultures. For these and other cases, molecular detection seems to be the obvious step to achieve a microbiological diagnosis of PJI.<a class="elsevierStyleCrossRefs" href="#bib0125">2,3,5</a> Many different studies have shown good results using different approaches (e.g., 16S broad-range primers followed by sequencing specific primers, and multiplex PCR), though all these techniques lack reproducibility between centres and require molecular biology laboratories and specialists—resources often not available in microbiology laboratories. Several commercial kits have been tested to overcome these problems. Since there was no kit specifically designed for PJI, kits designed for blood cultures that include most organisms involved in PJI have been used.<a class="elsevierStyleCrossRefs" href="#bib0155">8–12</a>The SeptiFast kit (Roche) was initially tested using sonicate samples from 37 patients with PJI,<a class="elsevierStyleCrossRef" href="#bib0155">8</a> revealing a sensitivity of 78% compared to a 65% sensitivity for sonication. Since no non-infected cases were included in the study, no specificity result could be obtained. This kit was also tested by another team, which included aseptic loosening patients as negative controls (62 cases) as well as PJI patients (24 cases). In this study, sensitivity was higher (96%), with a specificity of 100% (no positive results among aseptic loosening cases). Another kit (GenoType BC, Hain Lifescience, Germany) was studied in our laboratory, using the kit to analyze sonicate samples from 79 patients without infection and 47 infected cases.<a class="elsevierStyleCrossRef" href="#bib0165">10</a> In this research, the main problem was the high number of theoretically non-infected cases producing a positive PCR result and negative cultures, which may be due to the low specificity of the kit. Finally, the latest commercial multiplex PCR designed for blood cultures is the FilmArray kit (bioMérieux, Marcy L’Etoile, France),<a class="elsevierStyleCrossRef" href="#bib0175">12</a> which has been shown to have a low sensitivity (53%), especially for coagulase-negative staphylococci. Sensitivity increased to 58% when only potentially detected cases were considered. The main advantage of this methodology was the rapid turnaround time (less than 1hour) and easy management in the laboratory due to the cartridge technology. This circumstance was also used in a previous study with the Xpert MRSA/SA kit for detection of Methicillin-resistant Staphylococcus aureus, yielding good results in spite of the obvious limitation of the kit (only some staphylococci detected).<a class="elsevierStyleCrossRef" href="#bib0160">9</a> For all the above-mentioned studies<a class="elsevierStyleCrossRefs" href="#bib0155">8,10–12</a> except the last one, some important etiological agents of PJI do not appear in the list of each kit, especially Propionibacterium acnes and Corynebacterium sp.Due to this absence, a specific kit for the diagnosis of PJI is desirable. A study performed with a kit with these requisites (Prove-it Bone and Joint StripArray assay, Mobidiag Ltd., Helsinki, Finland) was tested in periprosthetic tissue samples from 60 patients with a diagnosis of suspected PJI. Among these, 38 fulfilled the criteria of PJI, and in 31 the PCR test was positive (82% sensitivity). However, in 6 of the cases without PJI, the results were positive (74% specificity), a problem described in another of the aforementioned studies.<a class="elsevierStyleCrossRef" href="#bib0165">10</a> More recently, a new test was designed specifically for the diagnosis of bone and joint infections, especially PJI. This test was previously tested with tissue samples<a class="elsevierStyleCrossRef" href="#bib0230">23</a> from 54 patients (10 of them infected) and compared against a homemade broad-range 16S rRNA PCR. The commercial test was performed in only 28 patients, showing a high specificity (95.2%) but a low sensitivity (42.9%). In the present study, we used this kit and compared it with the cultures of the sonicated implants in a higher number of patients, all with a diagnosis and follow-up performed in accordance with international recommendations.<a class="elsevierStyleCrossRef" href="#bib0190">15</a> This allowed us to compare the results not only against conventional cultures, but also against clinical and analytical diagnosis. Moreover, we have tried to test the kit in routine conditions, aiming to obtain a more realistic view of its actual usefulness. The results obtained showed a relatively low sensitivity (similar to that obtained in some of the previously mentioned studies<a class="elsevierStyleCrossRefs" href="#bib0155">8,12</a>), but a high specificity, with only 1 false positive. In this case, coagulase-negative Staphylococcus was detected in a patient who underwent a 2-step exchange surgery, with only 4 weeks between surgeries and no antibiotic therapy, but with the use of an antibiotic-loaded spacer. For the false-negative results of the kit, most of them appeared in patients with a low colony count or in patients with a pathogen not included in the kit. There was an infection due to S. agalactiae (105CFU/ml) also isolated in other samples (periprosthetic tissues and synovial fluid), which was persistently negative with this kit. Unfortunately, we do not have an explanation for this result. However, we have detected 2 polymicrobial infections in which some of the organisms were not detected by culture (E. cloacae+E. aerogenes+E. coli infection) or were detected only after reincubation and careful isolation of a few colonies of an E. coli strain (S. aureus+E. coli).We have also detected some resistance genes or mutations. Though most of them correlated well with the conventional antimicrobial susceptibility testing performed, we detected 1 potential discrepancy. Furthermore, some resistance phenotypes, as well as the bacterium S. marcescens, cannot be detected by this PCR because they are not included in this technique, thus marking a limitation of the Unyvero i60® system.To sum up, the main advantages of this molecular biology technique against conventional microbiological diagnosis of PJI are, in first place, the high speed of the result, the possibility to detect mechanisms of resistance in the same step, and the easy management of the sample, which made a promising methodology for this purpose. Furthermore, it has better statistic parameters; in particular, it showed higher specificity and PPV versus culture of sonicated implant. In our opinion, it is of great importance, because a frequent criticism of molecular technology is the amount of false positive results. Secondly, when multiplex PCR was compared with culture of synovial fluid inoculated in blood culture bottles, PCR improved all statistic parameters. And although specificity of culture of peri-prosthetic tissue was higher than that obtained with PCR, the last one had better values in general.With regard to other molecular biology techniques, Unyvero i60® system showed advantages against those designed for blood cultures (that include most organisms involved in PJI) and those specifically designed for the diagnosis of PJI. Among the first group (PCR for blood culture), the main limitations were: the impossibility to obtain specificity result due to the lack of control group (non-infected patients) in one case,<a class="elsevierStyleCrossRef" href="#bib0155">8</a> the low specificity<a class="elsevierStyleCrossRef" href="#bib0165">10</a> and sensitivity<a class="elsevierStyleCrossRef" href="#bib0175">12</a> and the only detection of Methicillin-resistant Staphylococcus.<a class="elsevierStyleCrossRef" href="#bib0160">9</a> Among the group of molecular techniques specifically designed for the diagnosis of PJI, Unyvero i60® system improved specificity of one of them (Prove-it Bone and Joint StripArray assay, Mobidiag Ltd., Helsinki, Finland), and the sensitivity and number of patients included of other one.<a class="elsevierStyleCrossRef" href="#bib0230">23</a>However, this technique had limitations. The main was its relatively low sensitivity, which made a negative result inconclusive for the diagnosis of PJI using sonicated implants. Another one was the number of patients included, which, although higher than in other studies, were not high enough. In addition, there are some microorganisms as well as some resistance mechanisms not detected by this technique because they are not included; and one discrepancy in the mechanisms of resistance was found out. Further studies are necessary to evaluate its role with other samples (especially synovial fluid and periprosthetic tissue) for the diagnosis of PJI in a routine setting. Another important aspect is the price: studies on the economic impact and cost-effectiveness are also necessary, as this technology is costly, and rational use is essential in all cases. To achieve this, a close relationship between clinicians and microbiologists is essential in order to obtain the best possible management of the patient.FundingThis work was funded by a grant from Laboratorios Leti SL and by a grant from the Spanish MINECO (Grant MAT2013-48224-C2-2-R).Conflict of interestJE received travel grants from Laboratorios Leti SL, Pfizer, bioMérieux, and Alere, and research grants from Wyeth and Laboratorios Leti SL. RFR and IG received research grants from Wyeth and Laboratorios Leti SL. No other conflicts of interest are declared.Ethical approval and Informed consentAll aspects of the study were approved by the Ethics in Research Committee of the institution (ref. 45/2014_FJD). No informed consent was required by the Committee." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres827767" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec824083" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres827768" "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" => "xpalclavsec824082" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design of the study" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Patients and definitions" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Microbiological procedures" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Molecular technique" ] 4 => array:3 [ "identificador" => "sec0035" "titulo" => "Data analysis" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Microbiological and clinical data" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Statistics" ] ] ] ] ] 6 => array:3 [ "identificador" => "sec0050" "titulo" => "Results" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Samples" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Data among samples related to patients with clinical criteria of PJI (n = 38)" ] 3 => array:2 [ "identificador" => "sec0070" "titulo" => "Data among samples related to patients without clinical criteria of PJI (n = 50)" ] 4 => array:2 [ "identificador" => "sec0075" "titulo" => "Mechanisms of resistance" ] 5 => array:2 [ "identificador" => "sec0080" "titulo" => "Data about culture of synovial fluid and periprosthetic tissue" ] 6 => array:2 [ "identificador" => "sec0085" "titulo" => "Statistical parameters" ] ] ] 7 => array:2 [ "identificador" => "sec0090" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0095" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0100" "titulo" => "Conflict of interest" ] 10 => array:2 [ "identificador" => "sec0105" "titulo" => "Ethical approval and Informed consent" ] 11 => array:2 [ "identificador" => "xack277734" "titulo" => "Acknowledgments" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-03-20" "fechaAceptado" => "2016-09-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec824083" "palabras" => array:5 [ 0 => "Multiplex PCR" 1 => "Sonication" 2 => "Prosthetic-joint infection" 3 => "Molecular diagnosis" 4 => "Diagnosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec824082" "palabras" => array:5 [ 0 => "Diagnosis PCR múltiple" 1 => "Sonicación" 2 => "Infección de prótesis articular" 3 => "Diagnóstico molecular" 4 => "Diagnóstico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundThe development of sonication protocols over the last few years has improved the sensitivity of conventional cultures for the diagnosis of prosthetic-joint infection (PJI). However, the development of a new, specifically designed kit for the molecular diagnosis of PJI could provide a major improvement in this field. MethodsProstheses retrieved from patients who underwent implant removal from May 2014 to May 2015 were sent for culture, and processed according to a previously defined protocol that included sonication. Furthermore, 180 microlitres of sonication fluid were used to carry out the multiplex PCR test (Unyvero i60 system®). A comparison of the sensitivity, specificity, positive (PPV) and negative (NPV) predictive value, was performed. The study was approved by the Clinical Research Ethics Committee. ResultsThe analysis included 88 prostheses from 68 patients (1.29 prostheses/patient). The type of prostheses studied were knee (n=55), total hip (n=26), partial hip (n=5), and shoulder (n=2). Twenty-nine patients were diagnosed with a PJI (15 delayed, 12 acute, and 2 haematogenous infections). In 24 cases, the result of the PCR was positive, all but 1 corresponding to patients with clinical criteria of PJI. Nine resistance mechanisms were detected from 5 samples. The Unyvero i60 system® showed slightly better results than traditional culture in terms of specificity and PPV. ConclusionsThe Unyvero i60 system® may play a role in rapid diagnosis of PJI, due to its high specificity and PPV. However, despite these results, cultures have to be performed to detect organisms not detected by the system." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl desarrollo de la sonicación durante los pasados años ha incrementado la sensibilidad de los cultivos convencionales para el diagnóstico de Infecciones de Prótesis Articulares (IPA). Sin embargo, el desarrollo de un nuevo kit, diseñado específicamente para el diagnóstico de las IPA podría suponer un avance significativo en este campo. MétodosTodas las prótesis retiradas de pacientes entre mayo 2014 y mayo 2015 fueron enviadas para cultivo mediante un protocolo de procesamiento que incluye la sonicación del implante. Además, se emplearon 180 microlitros del líquido de sonicado en la realización de una PCR múltiple (Unyvero i60®). Se realizó una comparación de la sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN). El estudio fue aprobado por el Comité de Ética en Investigación Clínica. ResultadosSe analizaron 88 prótesis de 68 pacientes (1,29 prótesis/paciente). Las prótesis estudiadas fueron rodillas (n=55), total de cadera (n=26), parcial de cadera (n=5), y hombro (n=2). Veintinueve pacientes fueron diagnosticados de IPA (15 crónicas, 12 agudas y 2 hematógenas). En 24 casos, el resultado de la PCR fue positivo, siendo todas menos 1 de estas de pacientes con criterios de IPA. Se detectaron además 9 mecanismos de resistencia en 5 muestras. El sistema Unyvero i60® mostró resultados ligeramente superiores al cultivo tanto en especificidad como en VPP. ConclusionesEl sistema Unyvero i60® puede tener un papel en el diagnóstico rápido de IPA debido a su elevada especificidad y VPP. Sin embargo, a pesar de estos resultados, debe realizarse cultivo para detectar organismos no detectados por el sistema." "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:6 [ 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:2 [ "leyenda" => "1 Includes Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus lugdunensis, Staphylococcus saprophyticus, Staphylococcus capitis, and Staphylococcus hominis.2 Includes Streptococcus mitis, Streptococcus australis, Streptococcus cristatus, Streptococcus gordonii, Streptococcus infantis, Streptococcus oligofermentans, Streptococcus oralis, Streptococcus parasanguinis, Streptococcus paroris, Streptococcus pseudopneumoniae, Streptococcus sanguinis, and Streptococcus sinensis.3 Includes Streptococcus anginosus, Streptococcus constellatus, and Streptococcus intermedius.4 Includes Streptococcus salivarius, Streptococcus vestibularis, and Streptococcus termophilus.5 Includes Streptococcus pyogenes and Streptococcus dysgalactiae subsp. equisimilis.6 Includes Enterococcus casseliflavus, Enterococcus faecium, Enterococcus hirae, Enterococcus faecalis, Enterococcus sulfurens, Enterococcus saccharolyticus, Enterococcus mundii, Enterococcus gallinarum, Enterococcus flavescens, Enterococcus durans, Enterococcus dispar, Enterococcus columbae, Enterococcus cecorum, and Enterococcus asini.7 Includes Corynebacterium genitalium, Corynebacterium casei, Corynebacterium striatum, Corynebacterium jeikeium, Corynebacterium aurimucosum, Corynebacterium singularis, Corynebacterium simulans, Corynebacterium accolens, Corynebacterium amycolatum, Corynebacterium minutissimum, Corynebacterium macginleyi, and Corynebacterium auriscanis.8 Includes Proteus mirabilis, Proteus vulgaris, and Proteus penneri.9 Includes Klebsiella pneumoniae subsp. Ozenae.10 Includes Bacteroides fragilis, Bacteroides ovatus, and Bacteroides thetaiotaomicron.11 Includes Candida albicans, Candida krusei, Candida dublinensis, Candida tropicalis, and Candida glabrata." "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Detected pathogens \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Staphylococcus epidermidis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coagulase-negative Staphylococcus1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Streptococcus mitis group2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Streptococcus anginosus group3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Streptococcus salivarius group4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Streptococcus agalactiae \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Streptococcus pyogenes5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Enterococcus sp.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Granulicatella adjacens \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abiotrophia defective \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Corynebacterium sp.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Escherichia coli \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Enterobacter cloacae complex \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Enterobacter aerogenes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Proteus sp.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Klebsiella pneumoniae9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pseudomonas aeruginosa \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acinetobacter baumannii \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Propionibacterium acnes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Propionibacterium avidum/granulosum \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Finegoldia magna \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bacteroides fragilis group10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Candida sp.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Candida parapsilosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Candida albicans \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1392776.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Antibiotic resistance markers \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">mec A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">mec C (LGA251) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">aac(6′)/aph(2″) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ermA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ermC \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">vanA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">vanB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">rpoB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ctx-M \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">vim \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">imp \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">kpc \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ndm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">aacA4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">gyrA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">oxa-23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">oxa-24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">oxa-48 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">oxa-58 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1392770.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Microorganisms and resistance genes detected by the Unyvero i60 System." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Type of infection: H (haematogenous), D (delayed), and E (early)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Culture of sonicated prosthesis</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of infection \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Count (CFU/ml) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Microorganism \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Result of multiplex PCR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Culture of synovial fluid \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Culture of periprosthetic tissue \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>100,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Klebsiella pneumoniae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Klebsiella pneumoniae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Test not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Klebsiella pneumoniae \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Acinetobacter baumannii \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus coagulase negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">300 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Acinetobacter baumannii \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Acinetobacter baumannii \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">500 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus epidermidis and Staphylococcus haemolyticus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus coagulase negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus epidermidis and Staphylococcus haemolyticus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus simulans \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus coagulase negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus simulans \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus simulans \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus epidermidis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus coagulase negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus epidermidis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus epidermidis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus epidermidis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus coagulase negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus epidermidis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus epidermidis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus simulans \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus coagulase negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus simulans \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus simulans \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>100,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis and Enterococcus spp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>100,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis and Enterococcus spp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>100,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>100,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus spp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>100,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis and Enterococcus spp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1400 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus epidermidis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus coagulase negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>100,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterobacter cloacae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterobacter cloacae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus epidermidis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus coagulase negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Test not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus epidermidis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>100,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Escherichia coli and Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Escherichia coli and Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>100,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterobacter aerogenes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterobacter cloacae complex, Enterobacter aerogenes and Klebsiella pneumoniae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterobacter aerogenes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterobacter aerogenes \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1392774.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of results of all microbiological methods for samples from patients with clinical criteria of PJI. Culture of sonicated implant and PCR positive (n=20)." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Type of infection: H (haematogenous), D (delayed), and E (early)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Culture of sonicated prosthesis</th><th class="td" title="table-head " align="left" valign="top" scope="col">Result of multiplex PCR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Culture of synovial fluid \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Culture of periprosthetic tissue \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of infection \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Count (CFU/ml) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Microorganism \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>100,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Streptococcus agalactiae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="7" align="left" valign="top">Negative</td><td class="td" title="table-entry " align="left" valign="top">Streptococcus agalactiae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Streptococcus agalactiae \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Klebsiella oxytoca \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">300 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Serratia marcescens \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Serratia marcescens \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus simulans \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus simulans \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus simulans \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Finegoldia magna \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Propionibacterium acnes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Propionibacterium acnes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus epidermidis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus epidermidis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1392775.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of results of all microbiological methods for samples from patients with clinical criteria of PJI. Culture of sonicated implant positive but PCR negative (n=7)." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Type of infection: H (haematogenous), and E (early)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Culture of sonicated prosthesis</th><th class="td" title="table-head " align="left" valign="top" scope="col">Result of multiplex PCR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Culture of synovial fluid \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Culture of periprosthetic tissue \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of infection \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Count (CFU/ml) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Microorganism \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">Negative</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enterococcus faecalis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Proteus spp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1392773.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of results of all microbiological methods for samples from patients with clinical criteria of PJI. PCR positive but culture of sonicated implant negative (n=3)." ] ] 4 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "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="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Samples from patients with criteria of PJI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Samples from patients without criteria of PJI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of sonicated implant + \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of sonicated implant − \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PCR + \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PCR − \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of periprosthetic tissue + \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of periprosthetic tissue − \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of synovial fluid + \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of synovial fluid − \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1392771.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Data to calculate statistic parameters of culture of sonicated prostheses multiplex PCR, culture of periprosthetic tissue and culture of synovial fluid for the diagnosis of PJI." ] ] 5 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at6" "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="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sn \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sp \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PPV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NPV \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of sonicated prostheses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PCR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of periprosthetic tissue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of synovial fluid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1392772.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Statistical parameters of all microbiological methods for the diagnosis of PJI (expressed in %)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0120" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Epub 2014 Feb 26" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meta-analysis of sonication fluid samples from prosthetic components for diagnosis of infection after total joint arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. Zhai" 1 => "H. Li" 2 => "A. Qin" 3 => "G. Liu" 4 => "X. Liu" 5 => "C. Wu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.128/JCM.03138-13" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2014" "volumen" => "52" "paginaInicial" => "1730" "paginaFinal" => "1736" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24574298" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0125" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "PubMed PMID: 24696437. Pubmed Central PMCID: 3993098. Epub 2014/04/04. eng" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prosthetic joint infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.J. Tande" 1 => "R. 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"vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000003500000004/v1_201704140226/S2529993X1730093X/v1_201704140226/en/main.assets" "Apartado" => array:4 [ "identificador" => "63564" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000003500000004/v1_201704140226/S2529993X1730093X/v1_201704140226/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X1730093X?idApp=UINPBA00004N"]

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Evaluation of a commercial multiplex PCR (Unyvero i60®) designed for the diagnosis of bone and joint infections using prosthetic-joint sonication

Evaluación de una PCR múltiple comercial (Unyvero i60©) diseñada para el diagnóstico de infecciones osteoarticulares utilizando prótesis articulares sonicadas

Laura Prieto-Borjaa, Graciela Rodriguez-Sevillaa, Alvaro Auñonb, Concepción Pérez-Jorgea, Enrique Sandovalb, Joaquín Garcia-Cañetec, Ignacio Gadeaa, Ricardo Fernandez-Roblasa, Antonio Blancoc, Jaime Estebana,

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jestebanmoreno@gmail.com

Corresponding author.

a Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain

b Department of Orthopaedic Surgery, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain

c Department of Internal Medicine-Emergency, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain

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sheep blood&#44; chocolate agar&#44; MacConkey agar&#44; Schaedler agar with 5&#37; sheep blood&#44; and Sabouraud-chloramphenicol agar&#44; all from bioM&#233;rieux &#40;Marcy L&#8217;Etoile&#44; France&#41;&#41; and incubated in different gas mixtures and temperatures during 1 week&#44; with the exception of Sabouraud-chloramphenicol agar&#44; which was maintained at 30<span class="elsevierStyleHsp" style=""></span>&#176;C during 1 month&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Together with the implants&#44; samples of synovial fluid and 3&#8211;6 samples of peri-prosthetic tissue samples were also submitted&#46; Periprosthetic tissue samples were processed by grinding&#44; and the samples were then inoculated in the same media as the sonicated samples&#46; Synovial fluid was inoculated in Bact&#47;Alert<span class="elsevierStyleSup">&#174;</span> blood culture bottles &#40;bioM&#233;rieux&#44; Marcy L&#8217;Etoile&#44; France&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">All organisms isolated from these samples were identified using the MALDI-ToF methodology &#40;Vitek MS&#44; bioM&#233;rieux&#44; Marcy L&#8217;Etoile&#44; France&#41;&#44; and susceptibility testing was performed using the Vitek 2 system &#40;bioM&#233;rieux&#44; Marcy L&#8217;Etoile&#44; France&#41; or E-test strips &#40;bioM&#233;rieux&#44; Marcy L&#8217;Etoile&#44; France&#41;&#44; depending on the organism isolated&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The concentrated sonicate fluids were frozen at &#8722;20<span class="elsevierStyleHsp" style=""></span>&#176;C until multiplex PCR was performed&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Molecular technique</span><p id="par0050" class="elsevierStylePara elsevierViewall">It was carried out&#44; usually 24&#8211;48<span class="elsevierStyleHsp" style=""></span>h after the arrival of the sample to the microbiology laboratory&#44; using the Unyvero i60 system<span class="elsevierStyleSup">&#174;</span> &#40;Curetis AG&#44; Holzgerlingen&#44; Germany&#41; and according to the manufacturer&#39;s instructions&#46; This system is designed to detect 27 species or groups of organisms &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a><span class="elsevierStyleHsp" style=""></span><a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a>&#41;&#46; The system allows simultaneous detection of 19 resistance genes &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a><span class="elsevierStyleHsp" style=""></span><a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a>&#41;&#46; Briefly&#44; 180<span class="elsevierStyleHsp" style=""></span>&#956;l of the sonicated fluid were pipetted into the sample tube and placed in the lysis incubator for 30<span class="elsevierStyleHsp" style=""></span>min&#46; Subsequently&#44; the sample was placed in the Unyvero i60 cartridge with the Master mix vial&#46; Then&#44; the loaded cartridge was inserted in the system hardware for amplification and hybridization&#46; After a period of 4&#46;5<span class="elsevierStyleHsp" style=""></span>hours of analysis&#44; the results were displayed on the screen of the system&#46; This technique includes an internal control to determinate whether the result is valid or not&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The results of both studies &#40;culture and molecular biology&#41; were blindly obtained by 2 different authors&#44; each of whom had no knowledge of the results obtained by the other until all results were available&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data analysis</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Microbiological and clinical data</span><p id="par0060" class="elsevierStylePara elsevierViewall">After molecular and conventional studies were carried out&#44; a retrospective analysis of clinical charts was performed using a predefined protocol&#46; All aspects of the study were approved by the Ethics in Research Committee of the institution &#40;ref&#46; 45&#47;2014&#95;FJD&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistics</span><p id="par0065" class="elsevierStylePara elsevierViewall">A descriptive analysis of clinical and microbiological data was made&#46; Furthermore&#44; a comparison of the sensitivity &#40;Sn&#41;&#44; specificity &#40;Sp&#41;&#44; positive &#40;PPV&#41; and negative &#40;NPV&#41; predictive value of both methods was performed&#46; These parameters were calculated using patients without clinical criteria of infection as control group&#46; Furthermore&#44; these data were compared with those of culture of periprosthetic tissue and synovial fluid&#44; since neither molecular biology nor even sonication techniques&#44; are not always available in sanitary centres for the diagnosis of PJI&#46;</p></span></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">During the study period&#44; 88 samples from prostheses of 68 patients were analyzed&#46; In some cases&#44; 2 or more samples were taken from the same patient&#44; in particular&#44; 1 patient with 4 samples&#44; 5 with 3&#44; 9 with 2 and 51 with only one sample studied &#40;1&#46;29 samples&#47;patient&#41;&#46; In 10 cases&#44; results of PCR technique were not valid since this set in particular was defective&#46; The PCR was repeated with other set and results were then valid&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Patients</span><p id="par0075" class="elsevierStylePara elsevierViewall">There were 39 patients without clinical criteria of infection and 29 with it&#46; Among the last group&#44; the mean age was 72&#46;75 years&#44; 19 of them were women and 10 men&#46; The most frequent type of infection was delayed &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&#44; followed by acute&#44; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41; and haematogenous &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#46; Only 1 patient received a combination of vancomycin and ceftazidime&#44; undergoing this treatment for the 2 days prior to the operation&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Samples</span><p id="par0080" class="elsevierStylePara elsevierViewall">The type of prostheses studied included knee &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#41;&#44; total hip &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&#44; partial hip &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; and shoulder &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Of the 88 samples&#44; 38 corresponded to patients with clinical criteria of PJI&#44; while 50 did with patients without criteria of PJI&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Data among samples related to patients with clinical criteria of PJI &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#41;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Twenty samples had both culture of sonicated implant and multiplex PCR positive&#46; Data are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> together with results of culture of periprosthetic tissue and synovial fluid&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Seven samples showed culture of sonication positive but PCR negative &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; These discrepancies are explained as follows&#58; &#40;a&#41; 1 patient with 10<span class="elsevierStyleSup">5</span><span class="elsevierStyleHsp" style=""></span>CFU&#47;ml of <span class="elsevierStyleItalic">S&#46; agalactiae</span>&#59; &#40;b&#41; 1 patient with 300<span class="elsevierStyleHsp" style=""></span>CFU&#47;ml of <span class="elsevierStyleItalic">S&#46; marcescens</span> &#40;not included among the organisms detected by PCR&#41;&#59; &#40;c&#41; 1 patient with 100<span class="elsevierStyleHsp" style=""></span>CFU&#47;ml of <span class="elsevierStyleItalic">S&#46; epidermidis</span> &#40;regarded as a contaminant&#41;&#44; with infection due to <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> which grew 8 weeks later in mycobacterial cultures&#59; &#40;d&#41; 1000<span class="elsevierStyleHsp" style=""></span>CFU&#47;ml of <span class="elsevierStyleItalic">S&#46; simulans</span>&#59; &#40;e&#41; 7000<span class="elsevierStyleHsp" style=""></span>CFU&#47;ml of <span class="elsevierStyleItalic">K&#46; oxytoca</span>&#59; &#40;f&#41; 2000<span class="elsevierStyleHsp" style=""></span>CFU&#47;ml of <span class="elsevierStyleItalic">Finegoldia magna</span>&#59; and &#40;g&#41; 200<span class="elsevierStyleHsp" style=""></span>CFU&#47;ml of <span class="elsevierStyleItalic">Propionibacterium acnes&#46;</span></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Three samples showed positive result by multiplex PCR but negative by culture of sonicated implant &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; PCR were positive for <span class="elsevierStyleItalic">E&#46; faecalis</span> &#40;also isolated in cultures of periprosthetic tissues&#41;&#44; <span class="elsevierStyleItalic">S&#46; aureus</span> &#40;not isolated in any other cultures&#41; and <span class="elsevierStyleItalic">P&#46; mirabilis</span> &#40;this patient had a positive culture for <span class="elsevierStyleItalic">P&#46; mirabilis</span> from a debridement surgery 1 month before the retrieval of the implant&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">In 8 cases&#44; both techniques were negative&#46; Only 1 sample from an infected patient was probably culture-negative due to previous antibiotic therapy&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Data among samples related to patients without clinical criteria of PJI &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41;</span><p id="par0110" class="elsevierStylePara elsevierViewall">In one case&#44; multiplex PCR gave a positive result while sonication of implant was negative &#40;considered to be a probable false positive&#41;&#46; The detected organism was a Coagulase-negative <span class="elsevierStyleItalic">staphylococcus</span>&#46; As all cultures were negative&#44; the patient was diagnosed with probable aseptic loosening&#46; However&#44; the patient received an antibiotic-loaded spacer &#40;vancomycin<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>gentamicin&#41; and second-stage surgery was performed 1 month after the first stage&#46; Although the result may represent the detection of a true pathogen&#44; because the patient was not treated with antibiotics and the final diagnosis was aseptic loosening&#44; we decided to include it as a false positive of the technique&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Two positive cultures &#40;100<span class="elsevierStyleHsp" style=""></span>CFU&#47;ml of <span class="elsevierStyleItalic">S&#46; aureus</span> and 100<span class="elsevierStyleHsp" style=""></span>CFU&#47;ml of <span class="elsevierStyleItalic">S&#46; epidermidis</span>&#41; with PCR negative were considered as contaminants because of several factors&#58; a very low colony count &#40;&#60;500<span class="elsevierStyleHsp" style=""></span>CFU&#47;ml&#41;&#59; no other positive cultures from other samples&#59; no clinical diagnosis of infection&#59; and no presentation of complications despite the fact that no treatment was administered in these cases&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Mechanisms of resistance</span><p id="par0120" class="elsevierStylePara elsevierViewall">Considering antimicrobial susceptibility&#44; 9 resistance mechanisms were detected in 5 samples using PCR&#58; 3 mecA&#44; 2 with fluoroquinolone resistance &#40;1 gyrA83 and 1 gyrA87 mutations&#41;&#44; 1 ctx-M extended-spectrum beta-lactamase&#44; 1 aminoglycoside resistance &#40;1 aac A4&#41;&#44; 1 ermA&#44; and 1 ermC gene&#46; All these findings were confirmed by phenotypic antimicrobial susceptibility assay&#46; Phenotypic susceptibility testing showed 1 isolate of <span class="elsevierStyleItalic">S&#46; simulans</span> to be resistant to erythromycin and clindamycin&#44; going undetected by the system&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Data about culture of synovial fluid and periprosthetic tissue</span><p id="par0125" class="elsevierStylePara elsevierViewall">Among patients with clinical criteria of PJI &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#41;&#44; culture of periprosthetic tissue was always made&#44; being positive in 16 cases and negative in 38&#46; However&#44; sample of synovial fluid was taken only from 35 patients and 20 had a positive result whereas 15 a negative one&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">From the 50 patients without clinical criteria of PJI&#44; culture of synovial fluid was negative in 48 cases and of periprosthetic tissue in every sample&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Statistical parameters</span><p id="par0135" class="elsevierStylePara elsevierViewall">Data from which statistical parameters of Sn&#44; Sp&#44; PPV and NPV were calculated&#44; are shown in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> and final results in <a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Sensitivity of PCR method was not very high &#40;60&#46;5&#37;&#41; as well as NPV &#40;76&#46;6&#37;&#41;&#46; However&#44; the same values for culture of sonicated implant&#44; although slightly higher &#40;Sn<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>71&#46;1&#37; and NPV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>81&#46;36&#37;&#41;&#44; were not very great&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The main advantage of Unyvero i60 system<span class="elsevierStyleSup">&#174;</span> is that it improves values of Sp and PPV in relation to sonicated implant culture &#40;Sp<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>98&#37; and PPV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>95&#46;8&#37;&#44; versus Sp<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>96&#37; and PPV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>93&#46;1&#37;&#44; respectively&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">When PCR technique was compared with culture of periprosthetic tissue&#44; in general it had better values&#44; since&#44; although the last method had Sp and VPP of 100&#37;&#44; Sn and VPN were very low &#40;42&#46;1&#37; and 69&#46;4&#37; respectively&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">With regard to culture of synovial fluid inoculated in blood bottles&#44; it had similar statistic parameters as PCR&#44; but the last one improves all of them &#40;see <a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Discussion</span><p id="par0160" class="elsevierStylePara elsevierViewall">Knowledge of the aetiology of PJI is an essential aspect of patient management&#44; as antibiotic therapy is selected based on the isolated microorganism&#47;s&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2&#44;19&#44;20</span></a> The advent of implant sonication in the last decade has improved the conventional methodology&#44; introducing a technique that allows microbiologists to detect bacteria &#40;and fungi&#41; attached to the implant&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2&#44;21&#44;22</span></a> However&#44; there are still some patients in whom no microorganisms can be detected despite the use of conventional cultures&#46; For these and other cases&#44; molecular detection seems to be the obvious step to achieve a microbiological diagnosis of PJI&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2&#44;3&#44;5</span></a> Many different studies have shown good results using different approaches &#40;e&#46;g&#46;&#44; 16S broad-range primers followed by sequencing specific primers&#44; and multiplex PCR&#41;&#44; though all these techniques lack reproducibility between centres and require molecular biology laboratories and specialists&#8212;resources often not available in microbiology laboratories&#46; Several commercial kits have been tested to overcome these problems&#46; Since there was no kit specifically designed for PJI&#44; kits designed for blood cultures that include most organisms involved in PJI have been used&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">8&#8211;12</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">The SeptiFast kit &#40;Roche&#41; was initially tested using sonicate samples from 37 patients with PJI&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a> revealing a sensitivity of 78&#37; compared to a 65&#37; sensitivity for sonication&#46; Since no non-infected cases were included in the study&#44; no specificity result could be obtained&#46; This kit was also tested by another team&#44; which included aseptic loosening patients as negative controls &#40;62 cases&#41; as well as PJI patients &#40;24 cases&#41;&#46; In this study&#44; sensitivity was higher &#40;96&#37;&#41;&#44; with a specificity of 100&#37; &#40;no positive results among aseptic loosening cases&#41;&#46; Another kit &#40;GenoType BC&#44; Hain Lifescience&#44; Germany&#41; was studied in our laboratory&#44; using the kit to analyze sonicate samples from 79 patients without infection and 47 infected cases&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> In this research&#44; the main problem was the high number of theoretically non-infected cases producing a positive PCR result and negative cultures&#44; which may be due to the low specificity of the kit&#46; Finally&#44; the latest commercial multiplex PCR designed for blood cultures is the FilmArray kit &#40;bioM&#233;rieux&#44; Marcy L&#8217;Etoile&#44; France&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a> which has been shown to have a low sensitivity &#40;53&#37;&#41;&#44; especially for coagulase-negative staphylococci&#46; Sensitivity increased to 58&#37; when only potentially detected cases were considered&#46; The main advantage of this methodology was the rapid turnaround time &#40;less than 1<span class="elsevierStyleHsp" style=""></span>hour&#41; and easy management in the laboratory due to the cartridge technology&#46; This circumstance was also used in a previous study with the Xpert MRSA&#47;SA kit for detection of Methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#44; yielding good results in spite of the obvious limitation of the kit &#40;only some staphylococci detected&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> For all the above-mentioned studies<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">8&#44;10&#8211;12</span></a> except the last one&#44; some important etiological agents of PJI do not appear in the list of each kit&#44; especially <span class="elsevierStyleItalic">Propionibacterium acnes</span> and <span class="elsevierStyleItalic">Corynebacterium sp&#46;</span></p><p id="par0170" class="elsevierStylePara elsevierViewall">Due to this absence&#44; a specific kit for the diagnosis of PJI is desirable&#46; A study performed with a kit with these requisites &#40;Prove-it Bone and Joint StripArray assay&#44; Mobidiag Ltd&#46;&#44; Helsinki&#44; Finland&#41; was tested in periprosthetic tissue samples from 60 patients with a diagnosis of suspected PJI&#46; Among these&#44; 38 fulfilled the criteria of PJI&#44; and in 31 the PCR test was positive &#40;82&#37; sensitivity&#41;&#46; However&#44; in 6 of the cases without PJI&#44; the results were positive &#40;74&#37; specificity&#41;&#44; a problem described in another of the aforementioned studies&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> More recently&#44; a new test was designed specifically for the diagnosis of bone and joint infections&#44; especially PJI&#46; This test was previously tested with tissue samples<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a> from 54 patients &#40;10 of them infected&#41; and compared against a homemade broad-range 16S rRNA PCR&#46; The commercial test was performed in only 28 patients&#44; showing a high specificity &#40;95&#46;2&#37;&#41; but a low sensitivity &#40;42&#46;9&#37;&#41;&#46; In the present study&#44; we used this kit and compared it with the cultures of the sonicated implants in a higher number of patients&#44; all with a diagnosis and follow-up performed in accordance with international recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a> This allowed us to compare the results not only against conventional cultures&#44; but also against clinical and analytical diagnosis&#46; Moreover&#44; we have tried to test the kit in routine conditions&#44; aiming to obtain a more realistic view of its actual usefulness&#46; The results obtained showed a relatively low sensitivity &#40;similar to that obtained in some of the previously mentioned studies<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">8&#44;12</span></a>&#41;&#44; but a high specificity&#44; with only 1 false positive&#46; In this case&#44; coagulase-negative <span class="elsevierStyleItalic">Staphylococcus</span> was detected in a patient who underwent a 2-step exchange surgery&#44; with only 4 weeks between surgeries and no antibiotic therapy&#44; but with the use of an antibiotic-loaded spacer&#46; For the false-negative results of the kit&#44; most of them appeared in patients with a low colony count or in patients with a pathogen not included in the kit&#46; There was an infection due to <span class="elsevierStyleItalic">S&#46; agalactiae</span> &#40;10<span class="elsevierStyleSup">5</span><span class="elsevierStyleHsp" style=""></span>CFU&#47;ml&#41; also isolated in other samples &#40;periprosthetic tissues and synovial fluid&#41;&#44; which was persistently negative with this kit&#46; Unfortunately&#44; we do not have an explanation for this result&#46; However&#44; we have detected 2 polymicrobial infections in which some of the organisms were not detected by culture &#40;<span class="elsevierStyleItalic">E&#46; cloacae<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>E&#46; aerogenes<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>E&#46; coli</span> infection&#41; or were detected only after reincubation and careful isolation of a few colonies of an <span class="elsevierStyleItalic">E&#46; coli</span> strain &#40;<span class="elsevierStyleItalic">S&#46; aureus<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>E&#46; coli</span>&#41;&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">We have also detected some resistance genes or mutations&#46; Though most of them correlated well with the conventional antimicrobial susceptibility testing performed&#44; we detected 1 potential discrepancy&#46; Furthermore&#44; some resistance phenotypes&#44; as well as the bacterium <span class="elsevierStyleItalic">S&#46; marcescens</span>&#44; cannot be detected by this PCR because they are not included in this technique&#44; thus marking a limitation of the Unyvero i60<span class="elsevierStyleSup">&#174;</span> system&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">To sum up&#44; the main advantages of this molecular biology technique against conventional microbiological diagnosis of PJI are&#44; in first place&#44; the high speed of the result&#44; the possibility to detect mechanisms of resistance in the same step&#44; and the easy management of the sample&#44; which made a promising methodology for this purpose&#46; Furthermore&#44; it has better statistic parameters&#59; in particular&#44; it showed higher specificity and PPV versus culture of sonicated implant&#46; In our opinion&#44; it is of great importance&#44; because a frequent criticism of molecular technology is the amount of false positive results&#46; Secondly&#44; when multiplex PCR was compared with culture of synovial fluid inoculated in blood culture bottles&#44; PCR improved all statistic parameters&#46; And although specificity of culture of peri-prosthetic tissue was higher than that obtained with PCR&#44; the last one had better values in general&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">With regard to other molecular biology techniques&#44; Unyvero i60<span class="elsevierStyleSup">&#174;</span> system showed advantages against those designed for blood cultures &#40;that include most organisms involved in PJI&#41; and those specifically designed for the diagnosis of PJI&#46; Among the first group &#40;PCR for blood culture&#41;&#44; the main limitations were&#58; the impossibility to obtain specificity result due to the lack of control group &#40;non-infected patients&#41; in one case&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a> the low specificity<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> and sensitivity<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a> and the only detection of Methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> Among the group of molecular techniques specifically designed for the diagnosis of PJI&#44; Unyvero i60<span class="elsevierStyleSup">&#174;</span> system improved specificity of one of them &#40;Prove-it Bone and Joint StripArray assay&#44; Mobidiag Ltd&#46;&#44; Helsinki&#44; Finland&#41;&#44; and the sensitivity and number of patients included of other one&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">However&#44; this technique had limitations&#46; The main was its relatively low sensitivity&#44; which made a negative result inconclusive for the diagnosis of PJI using sonicated implants&#46; Another one was the number of patients included&#44; which&#44; although higher than in other studies&#44; were not high enough&#46; In addition&#44; there are some microorganisms as well as some resistance mechanisms not detected by this technique because they are not included&#59; and one discrepancy in the mechanisms of resistance was found out&#46; Further studies are necessary to evaluate its role with other samples &#40;especially synovial fluid and periprosthetic tissue&#41; for the diagnosis of PJI in a routine setting&#46; Another important aspect is the price&#58; studies on the economic impact and cost-effectiveness are also necessary&#44; as this technology is costly&#44; and rational use is essential in all cases&#46; To achieve this&#44; a close relationship between clinicians and microbiologists is essential in order to obtain the best possible management of the patient&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Funding</span><p id="par0195" class="elsevierStylePara elsevierViewall">This work was funded by a grant from Laboratorios Leti SL and by a grant from the Spanish <span class="elsevierStyleGrantSponsor" id="gs1">MINECO</span> &#40;Grant <span class="elsevierStyleGrantNumber" refid="gs1">MAT2013-48224-C2-2-R</span>&#41;&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Conflict of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">JE received travel grants from Laboratorios Leti SL&#44; Pfizer&#44; bioM&#233;rieux&#44; and Alere&#44; and research grants from Wyeth and Laboratorios Leti SL&#46; RFR and IG received research grants from Wyeth and Laboratorios Leti SL&#46; No other conflicts of interest are declared&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Ethical approval and Informed consent</span><p id="par0205" class="elsevierStylePara elsevierViewall">All aspects of the study were approved by the Ethics in Research Committee of the institution &#40;ref&#46; 45&#47;2014&#95;FJD&#41;&#46; No informed consent was required by the Committee&#46;</p></span></span>"
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              "titulo" => "Data among samples related to patients with clinical criteria of PJI &#40;n &#61; 38&#41;"
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              "titulo" => "Data among samples related to patients without clinical criteria of PJI &#40;n &#61; 50&#41;"
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    "fechaRecibido" => "2016-03-20"
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            0 => "Multiplex PCR"
            1 => "Sonication"
            2 => "Prosthetic-joint infection"
            3 => "Molecular diagnosis"
            4 => "Diagnosis"
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            0 => "Diagnosis PCR m&#250;ltiple"
            1 => "Sonicaci&#243;n"
            2 => "Infecci&#243;n de pr&#243;tesis articular"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The development of sonication protocols over the last few years has improved the sensitivity of conventional cultures for the diagnosis of prosthetic-joint infection &#40;PJI&#41;&#46; However&#44; the development of a new&#44; specifically designed kit for the molecular diagnosis of PJI could provide a major improvement in this field&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Prostheses retrieved from patients who underwent implant removal from May 2014 to May 2015 were sent for culture&#44; and processed according to a previously defined protocol that included sonication&#46; Furthermore&#44; 180 microlitres of sonication fluid were used to carry out the multiplex PCR test &#40;Unyvero i60 system<span class="elsevierStyleSup">&#174;</span>&#41;&#46; A comparison of the sensitivity&#44; specificity&#44; positive &#40;PPV&#41; and negative &#40;NPV&#41; predictive value&#44; was performed&#46; The study was approved by the Clinical Research Ethics Committee&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The analysis included 88 prostheses from 68 patients &#40;1&#46;29 prostheses&#47;patient&#41;&#46; The type of prostheses studied were knee &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#41;&#44; total hip &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&#44; partial hip &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; and shoulder &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#46; Twenty-nine patients were diagnosed with a PJI &#40;15 delayed&#44; 12 acute&#44; and 2 haematogenous infections&#41;&#46; In 24 cases&#44; the result of the PCR was positive&#44; all but 1 corresponding to patients with clinical criteria of PJI&#46; Nine resistance mechanisms were detected from 5 samples&#46; The Unyvero i60 system<span class="elsevierStyleSup">&#174;</span> showed slightly better results than traditional culture in terms of specificity and PPV&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The Unyvero i60 system<span class="elsevierStyleSup">&#174;</span> may play a role in rapid diagnosis of PJI&#44; due to its high specificity and PPV&#46; However&#44; despite these results&#44; cultures have to be performed to detect organisms not detected by the system&#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="spar0025" class="elsevierStyleSimplePara elsevierViewall">El desarrollo de la sonicaci&#243;n durante los pasados a&#241;os ha incrementado la sensibilidad de los cultivos convencionales para el diagn&#243;stico de Infecciones de Pr&#243;tesis Articulares &#40;IPA&#41;&#46; Sin embargo&#44; el desarrollo de un nuevo kit&#44; dise&#241;ado espec&#237;ficamente para el diagn&#243;stico de las IPA podr&#237;a suponer un avance significativo en este campo&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Todas las pr&#243;tesis retiradas de pacientes entre mayo 2014 y mayo 2015 fueron enviadas para cultivo mediante un protocolo de procesamiento que incluye la sonicaci&#243;n del implante&#46; Adem&#225;s&#44; se emplearon 180 microlitros del l&#237;quido de sonicado en la realizaci&#243;n de una PCR m&#250;ltiple &#40;Unyvero i60<span class="elsevierStyleSup">&#174;</span>&#41;&#46; Se realiz&#243; una comparaci&#243;n de la sensibilidad&#44; especificidad&#44; valor predictivo positivo &#40;VPP&#41; y negativo &#40;VPN&#41;&#46; El estudio fue aprobado por el Comit&#233; de &#201;tica en Investigaci&#243;n Cl&#237;nica&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 88 pr&#243;tesis de 68 pacientes &#40;1&#44;29 pr&#243;tesis&#47;paciente&#41;&#46; Las pr&#243;tesis estudiadas fueron rodillas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#41;&#44; total de cadera &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&#44; parcial de cadera &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; y hombro &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#46; Veintinueve pacientes fueron diagnosticados de IPA &#40;15 cr&#243;nicas&#44; 12 agudas y 2 hemat&#243;genas&#41;&#46; En 24 casos&#44; el resultado de la PCR fue positivo&#44; siendo todas menos 1 de estas de pacientes con criterios de IPA&#46; Se detectaron adem&#225;s 9 mecanismos de resistencia en 5 muestras&#46; El sistema Unyvero i60<span class="elsevierStyleSup">&#174;</span> mostr&#243; resultados ligeramente superiores al cultivo tanto en especificidad como en VPP&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El sistema Unyvero i60<span class="elsevierStyleSup">&#174;</span> puede tener un papel en el diagn&#243;stico r&#225;pido de IPA debido a su elevada especificidad y VPP&#46; Sin embargo&#44; a pesar de estos resultados&#44; debe realizarse cultivo para detectar organismos no detectados por el sistema&#46;</p></span>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">1</span> Includes <span class="elsevierStyleItalic">Staphylococcus epidermidis&#44; Staphylococcus haemolyticus&#44; Staphylococcus lugdunensis&#44; Staphylococcus saprophyticus&#44; Staphylococcus capitis</span>&#44; and <span class="elsevierStyleItalic">Staphylococcus hominis&#46;</span></p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">2</span> Includes <span class="elsevierStyleItalic">Streptococcus mitis&#44; Streptococcus australis&#44; Streptococcus cristatus&#44; Streptococcus gordonii&#44; Streptococcus infantis&#44; Streptococcus oligofermentans&#44; Streptococcus oralis&#44; Streptococcus parasanguinis&#44; Streptococcus paroris&#44; Streptococcus pseudopneumoniae&#44; Streptococcus sanguinis</span>&#44; and <span class="elsevierStyleItalic">Streptococcus sinensis</span>&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">3</span> Includes <span class="elsevierStyleItalic">Streptococcus anginosus&#44; Streptococcus constellatus</span>&#44; and <span class="elsevierStyleItalic">Streptococcus intermedius</span>&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">4</span> Includes <span class="elsevierStyleItalic">Streptococcus salivarius&#44; Streptococcus vestibularis</span>&#44; and <span class="elsevierStyleItalic">Streptococcus termophilus</span>&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">5</span> Includes <span class="elsevierStyleItalic">Streptococcus pyogenes</span> and <span class="elsevierStyleItalic">Streptococcus dysgalactiae</span> subsp&#46; <span class="elsevierStyleItalic">equisimilis</span>&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">6</span> Includes <span class="elsevierStyleItalic">Enterococcus casseliflavus&#44; Enterococcus faecium&#44; Enterococcus hirae&#44; Enterococcus faecalis&#44; Enterococcus sulfurens&#44; Enterococcus saccharolyticus&#44; Enterococcus mundii&#44; Enterococcus gallinarum&#44; Enterococcus flavescens&#44; Enterococcus durans&#44; Enterococcus dispar&#44; Enterococcus columbae&#44; Enterococcus cecorum</span>&#44; and <span class="elsevierStyleItalic">Enterococcus asini</span>&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">7</span> Includes <span class="elsevierStyleItalic">Corynebacterium genitalium&#44; Corynebacterium casei&#44; Corynebacterium striatum&#44; Corynebacterium jeikeium&#44; Corynebacterium aurimucosum&#44; Corynebacterium singularis&#44; Corynebacterium simulans&#44; Corynebacterium accolens&#44; Corynebacterium amycolatum&#44; Corynebacterium minutissimum&#44; Corynebacterium macginleyi</span>&#44; and <span class="elsevierStyleItalic">Corynebacterium auriscanis</span>&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">8</span> Includes <span class="elsevierStyleItalic">Proteus mirabilis&#44; Proteus vulgaris</span>&#44; and <span class="elsevierStyleItalic">Proteus penneri</span>&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">9</span> Includes <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> subsp&#46; <span class="elsevierStyleItalic">Ozenae</span>&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">10</span> Includes <span class="elsevierStyleItalic">Bacteroides fragilis&#44; Bacteroides ovatus</span>&#44; and <span class="elsevierStyleItalic">Bacteroides thetaiotaomicron</span>&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">11</span> Includes <span class="elsevierStyleItalic">Candida albicans&#44; Candida krusei&#44; Candida dublinensis&#44; Candida tropicalis</span>&#44; and <span class="elsevierStyleItalic">Candida glabrata</span>&#46;</p>"
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Streptococcus salivarius group</span><span class="elsevierStyleSup">4</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Streptococcus agalactiae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Streptococcus pyogenes</span><span class="elsevierStyleSup">5</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus</span> sp&#46;<span class="elsevierStyleSup">6</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Granulicatella adjacens</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Abiotrophia defective</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Corynebacterium</span> sp&#46;<span class="elsevierStyleSup">7</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Escherichia coli</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Enterobacter cloacae complex</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Enterobacter aerogenes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Proteus</span> sp&#46;<span class="elsevierStyleSup">8</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Klebsiella pneumoniae</span><span class="elsevierStyleSup">9</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Acinetobacter baumannii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Propionibacterium acnes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Propionibacterium avidum&#47;granulosum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Finegoldia magna</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Bacteroides fragilis group</span><span class="elsevierStyleSup">10</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Candida</span> sp&#46;<span class="elsevierStyleSup">11</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Candida parapsilosis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Candida albicans</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Antibiotic resistance markers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">mec A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">mec C</span> &#40;LGA251&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">aac&#40;6&#8242;&#41;&#47;aph&#40;2&#8243;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">ermA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">ermC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">vanA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">vanB</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">rpoB</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">ctx-M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">vim</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">imp</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">kpc</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">ndm</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">aacA4</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">gyrA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">oxa-23</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">oxa-24</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">oxa-48</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">oxa-58</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Microorganisms and resistance genes detected by the Unyvero i60 System&#46;</p>"
        ]
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        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
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          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Type of infection&#58; H &#40;haematogenous&#41;&#44; D &#40;delayed&#41;&#44; and E &#40;early&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Culture of sonicated prosthesis</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Count &#40;CFU&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Microorganism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Result of multiplex PCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Culture of synovial fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Culture of periprosthetic tissue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;100&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Klebsiella pneumoniae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Klebsiella pneumoniae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Test not performed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Klebsiella pneumoniae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Acinetobacter baumannii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus coagulase negative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Acinetobacter baumannii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Acinetobacter baumannii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus epidermidis and Staphylococcus haemolyticus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus coagulase negative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus epidermidis and Staphylococcus haemolyticus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus simulans</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus coagulase negative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus simulans</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus simulans</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus epidermidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus coagulase negative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus epidermidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus epidermidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus epidermidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus coagulase negative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus epidermidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus epidermidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus simulans</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus coagulase negative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus simulans</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus simulans</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;100&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis and Enterococcus</span> spp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;100&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis and Enterococcus</span> spp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;100&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;100&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus</span> spp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;100&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis and Enterococcus</span> spp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus epidermidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus coagulase negative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;100&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterobacter cloacae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterobacter cloacae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus epidermidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus coagulase negative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Test not performed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus epidermidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;100&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Escherichia coli and Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Escherichia coli and Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;100&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterobacter aerogenes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterobacter cloacae complex&#44; Enterobacter aerogenes and Klebsiella pneumoniae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterobacter aerogenes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterobacter aerogenes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1392774.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Comparison of results of all microbiological methods for samples from patients with clinical criteria of PJI&#46; Culture of sonicated implant and PCR positive &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46;</p>"
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        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at3"
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          "leyenda" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Type of infection&#58; H &#40;haematogenous&#41;&#44; D &#40;delayed&#41;&#44; and E &#40;early&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Culture of sonicated prosthesis</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Result of multiplex PCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Culture of synovial fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Culture of periprosthetic tissue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Count &#40;CFU&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Microorganism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;100&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Streptococcus agalactiae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="7" align="left" valign="top">Negative</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Streptococcus agalactiae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Streptococcus agalactiae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Klebsiella oxytoca</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Serratia marcescens</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Serratia marcescens</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus simulans</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus simulans</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus simulans</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Finegoldia magna</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Propionibacterium acnes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Propionibacterium acnes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus epidermidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus epidermidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1392775.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Comparison of results of all microbiological methods for samples from patients with clinical criteria of PJI&#46; Culture of sonicated implant positive but PCR negative &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Type of infection&#58; H &#40;haematogenous&#41;&#44; and E &#40;early&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Culture of sonicated prosthesis</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Result of multiplex PCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Culture of synovial fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Culture of periprosthetic tissue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Count &#40;CFU&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Microorganism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Negative</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Proteus</span> spp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1392773.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Comparison of results of all microbiological methods for samples from patients with clinical criteria of PJI&#46; PCR positive but culture of sonicated implant negative &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Samples from patients with criteria of PJI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Samples from patients without criteria of PJI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of sonicated implant &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of sonicated implant &#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PCR &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PCR &#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of periprosthetic tissue &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of periprosthetic tissue &#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of synovial fluid &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of synovial fluid &#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1392771.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Data to calculate statistic parameters of culture of sonicated prostheses multiplex PCR&#44; culture of periprosthetic tissue and culture of synovial fluid for the diagnosis of PJI&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0030"
        "etiqueta" => "Table 6"
        "tipo" => "MULTIMEDIATABLA"
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        "mostrarDisplay" => false
        "detalles" => array:1 [
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            "identificador" => "at6"
            "detalle" => "Table "
            "rol" => "short"
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        "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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sn&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PPV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NPV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of sonicated prostheses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of periprosthetic tissue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Culture of synovial fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1392772.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">Statistical parameters of all microbiological methods for the diagnosis of PJI &#40;expressed in &#37;&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:23 [
            0 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Epub 2014 Feb 26"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Meta-analysis of sonication fluid samples from prosthetic components for diagnosis of infection after total joint arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Z&#46; Zhai"
                            1 => "H&#46; Li"
                            2 => "A&#46; Qin"
                            3 => "G&#46; Liu"
                            4 => "X&#46; Liu"
                            5 => "C&#46; Wu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.128/JCM.03138-13"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "2014"
                        "volumen" => "52"
                        "paginaInicial" => "1730"
                        "paginaFinal" => "1736"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24574298"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "PubMed PMID&#58; 24696437&#46; Pubmed Central PMCID&#58; 3993098&#46; Epub 2014&#47;04&#47;04&#46; eng"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prosthetic joint infection"
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Article information

ISSN: 2529993X
Original language: English

DOI:10.1016/j.eimce.2016.09.001

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Year/Month	Html	Pdf	Total

2024 November	4	2	6
2024 October	14	8	22
2024 September	20	12	32
2024 August	23	5	28
2024 July	25	4	29
2024 June	49	10	59
2024 May	30	6	36
2024 April	21	4	25
2024 March	28	7	35
2024 February	11	6	17
2024 January	15	2	17
2023 December	27	7	34
2023 November	22	7	29
2023 October	26	10	36
2023 September	27	3	30
2023 August	26	4	30
2023 July	20	3	23
2023 June	27	5	32
2023 May	46	5	51
2023 April	51	0	51
2023 March	58	7	65
2023 February	20	1	21
2023 January	18	47	65
2022 December	9	11	20
2022 November	16	12	28
2022 October	26	11	37
2022 September	16	10	26
2022 August	24	11	35
2022 July	23	14	37
2022 June	26	11	37
2022 May	31	9	40
2022 April	56	9	65
2022 March	86	16	102
2022 February	77	7	84
2022 January	43	4	47
2021 December	29	12	41
2021 November	44	8	52
2021 October	16	8	24
2021 September	18	7	25
2021 August	46	6	52
2021 July	23	4	27
2021 June	15	12	27
2021 May	24	12	36
2021 April	40	21	61
2021 March	17	10	27
2021 February	10	7	17
2021 January	17	13	30
2020 December	14	6	20
2020 November	18	14	32
2020 October	13	7	20
2020 September	19	12	31
2020 August	17	3	20
2020 July	5	1	6
2020 June	8	6	14
2020 May	17	7	24
2020 April	7	0	7
2020 March	7	8	15
2020 February	8	5	13
2020 January	7	10	17
2019 December	16	6	22
2019 November	2	8	10
2019 October	10	5	15
2019 September	9	3	12
2019 August	10	2	12
2019 July	16	12	28
2019 June	26	13	39
2019 May	97	21	118
2019 April	37	25	62
2019 March	9	10	19
2019 February	10	8	18
2019 January	10	1	11
2018 December	9	3	12
2018 November	16	4	20
2018 October	7	6	13
2018 September	33	9	42
2018 August	30	4	34
2018 July	5	0	5
2018 June	11	1	12
2018 May	14	0	14
2018 April	19	2	21
2018 March	3	0	3
2018 February	8	1	9
2018 January	9	0	9
2017 December	9	1	10
2017 November	5	1	6
2017 October	12	0	12
2017 September	4	0	4
2017 July	1	0	1
2017 May	6	0	6
2017 April	2	0	2

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