Scientific letter
Multiple organ failure by serotype K1 Klebsiella pneumoniae
Afectación multiorgánica por Klebsiella pneumoniae serotipo K1
Gema Barbeito-Castiñeirasa,
, María Jesús Ladra Gonzálezb, María Jesús Domínguez Santallac, Carmen Rivero Velascod
Corresponding author
a Servicio de Microbiología y Parasitología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
b Servicio de Cirugía General y Digestiva, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
c Servicio de Medicina Interna, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
d Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
Read
2257
Timeswas read the article
624
Total PDF
1633
Total HTML
Share statistics
array:24 [ "pii" => "S2529993X17301016" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2017.03.010" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "1573" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Enferm Infecc Microbiol Clin. 2017;35:321-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 535 "formatos" => array:3 [ "EPUB" => 5 "HTML" => 359 "PDF" => 171 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0213005X16301987" "issn" => "0213005X" "doi" => "10.1016/j.eimc.2016.07.002" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "1573" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Enferm Infecc Microbiol Clin. 2017;35:321-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2411 "formatos" => array:3 [ "EPUB" => 9 "HTML" => 1597 "PDF" => 805 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Afectación multiorgánica por <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> serotipo K1" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "321" "paginaFinal" => "322" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Multiple organ failure by serotype K1 <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gema Barbeito-Castiñeiras, María Jesús Ladra González, María Jesús Domínguez Santalla, Carmen Rivero Velasco" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Gema" "apellidos" => "Barbeito-Castiñeiras" ] 1 => array:2 [ "nombre" => "María Jesús" "apellidos" => "Ladra González" ] 2 => array:2 [ "nombre" => "María Jesús" "apellidos" => "Domínguez Santalla" ] 3 => array:2 [ "nombre" => "Carmen" "apellidos" => "Rivero Velasco" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2529993X17301016" "doi" => "10.1016/j.eimce.2017.03.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17301016?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X16301987?idApp=UINPBA00004N" "url" => "/0213005X/0000003500000005/v2_201804050444/S0213005X16301987/v2_201804050444/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2529993X17301028" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2017.03.011" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "1588" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Enferm Infecc Microbiol Clin. 2017;35:322-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1212 "formatos" => array:3 [ "EPUB" => 3 "HTML" => 960 "PDF" => 249 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "First case of ceftazidime/avibactam administration in home care. ESBL producing <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> bacteremia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "322" "paginaFinal" => "323" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Primer caso de administración de ceftazidima/avibactam en hospitalización a domicilio. Bacteriemia por <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> BLEE multirresistente" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elisa Torres-del-Pliego, Elena Delgado-Mejía, Leire Gil-Alonso, Leonor del Mar-Periáñez-Párraga" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Elisa" "apellidos" => "Torres-del-Pliego" ] 1 => array:2 [ "nombre" => "Elena" "apellidos" => "Delgado-Mejía" ] 2 => array:2 [ "nombre" => "Leire" "apellidos" => "Gil-Alonso" ] 3 => array:2 [ "nombre" => "Leonor" "apellidos" => "del Mar-Periáñez-Párraga" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213005X16302567" "doi" => "10.1016/j.eimc.2016.08.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X16302567?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17301028?idApp=UINPBA00004N" "url" => "/2529993X/0000003500000005/v1_201705111055/S2529993X17301028/v1_201705111055/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2529993X17301120" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2017.03.021" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "1630" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "article" "crossmark" => 1 "subdocumento" => "pgl" "cita" => "Enferm Infecc Microbiol Clin. 2017;35:314-20" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 744 "formatos" => array:3 [ "EPUB" => 13 "HTML" => 419 "PDF" => 312 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Consensus statement</span>" "titulo" => "Executive summary of the diagnosis and treatment of urinary tract infection: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "314" "paginaFinal" => "320" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resumen ejecutivo del diagnóstico y tratamiento de las infecciones del tracto urinario. Guía de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC)" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marina de Cueto, Luis Aliaga, Juan-Ignacio Alós, Andres Canut, Ibai Los-Arcos, Jose Antonio Martínez, Jose Mensa, Vicente Pintado, Dolors Rodriguez-Pardo, Jose Ramon Yuste, Carles Pigrau" "autores" => array:11 [ 0 => array:2 [ "nombre" => "Marina" "apellidos" => "de Cueto" ] 1 => array:2 [ "nombre" => "Luis" "apellidos" => "Aliaga" ] 2 => array:2 [ "nombre" => "Juan-Ignacio" "apellidos" => "Alós" ] 3 => array:2 [ "nombre" => "Andres" "apellidos" => "Canut" ] 4 => array:2 [ "nombre" => "Ibai" "apellidos" => "Los-Arcos" ] 5 => array:2 [ "nombre" => "Jose Antonio" "apellidos" => "Martínez" ] 6 => array:2 [ "nombre" => "Jose" "apellidos" => "Mensa" ] 7 => array:2 [ "nombre" => "Vicente" "apellidos" => "Pintado" ] 8 => array:2 [ "nombre" => "Dolors" "apellidos" => "Rodriguez-Pardo" ] 9 => array:2 [ "nombre" => "Jose Ramon" "apellidos" => "Yuste" ] 10 => array:2 [ "nombre" => "Carles" "apellidos" => "Pigrau" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17301120?idApp=UINPBA00004N" "url" => "/2529993X/0000003500000005/v1_201705111055/S2529993X17301120/v1_201705111055/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Multiple organ failure by serotype K1 <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "321" "paginaFinal" => "322" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Gema Barbeito-Castiñeiras, María Jesús Ladra González, María Jesús Domínguez Santalla, Carmen Rivero Velasco" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Gema" "apellidos" => "Barbeito-Castiñeiras" "email" => array:1 [ 0 => "Gema.Barbeito.Castineiras@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María Jesús" "apellidos" => "Ladra González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "María Jesús" "apellidos" => "Domínguez Santalla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Carmen" "apellidos" => "Rivero Velasco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Microbiología y Parasitología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía General y Digestiva, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Afectación multiorgánica por <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> serotipo K1" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Liver abscess syndrome caused by <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> (<span class="elsevierStyleItalic">K. pneumoniae</span>) is a community-acquired infection characterised by primary liver abscess, bacteraemia and metastatic complications (lung, brain and psoas abscesses; osteomyelitis; meningitis; and endophthalmitis) with high mortality (10–40%). It occurs in immunocompetent patients, and the main risk factor is diabetes.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 67-year-old diabetic patient had a history of ischaemic cardiomyopathy and hypertension. In 2006, he had bilateral pneumonia, calculous cholecystitis and septic shock caused by <span class="elsevierStyleItalic">K. pneumoniae</span>. In 2007, he contracted community-acquired pneumonia (<span class="elsevierStyleItalic">K. pneumoniae</span> in sputum), and in 2008, he underwent laparoscopic cholecystectomy.</p><p id="par0015" class="elsevierStylePara elsevierViewall">He attended the emergency department due to signs and symptoms for 48<span class="elsevierStyleHsp" style=""></span>h of a sudden decrease in visual acuity, fever (39<span class="elsevierStyleHsp" style=""></span>°C) and headache. He was diagnosed with posterior uveitis of the right eye, and treatment with corticosteroids was started. One day later, he was in very poor general condition, with severe holocranial headache, phonophobia, photophobia, fever (38<span class="elsevierStyleHsp" style=""></span>°C) and abdominal pain on palpation.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Complementary studies revealed significant hyperglycaemia, mild hypertransaminaemia, mild impairment of renal function, clear lumbar puncture fluid, pleocytosis and abnormal cerebrospinal fluid protein level. An electrocardiogram, chest X-ray, head CT scan and echocardiogram were normal. An abdominal ultrasound showed a 12-mm abscess on the left lobe of the liver.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Empirical therapy with intravenous ceftriaxone and vancomycin, as well as intravitreal ceftazidime and vancomycin was started. <span class="elsevierStyleItalic">K. pneumoniae</span> susceptible to all antibiotics except ampicillin was isolated in CSF, urine and blood cultures. The isolate was sent to a reference laboratory to confirm the suspected K1 serotype.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Six days after admission, due to the patient's poor clinical course, it was decided to enucleate the right eye. <span class="elsevierStyleItalic">K. pneumoniae</span> was again isolated in the vitreous humour.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient had a lower level of consciousness and left-sided hemiparesis. A whole-body CT scan was performed which showed multiple cerebral haemorrhages, pulmonary nodules, 2 abscessified collections in liver segment <span class="elsevierStyleSmallCaps">IV</span> and left-sided perirenal free fluid. Treatment was changed to meropenem, amikacin and linezolid. A planned colonoscopy was performed which showed no abnormalities.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In subsequent ultrasound scans, hepatic fluid collection had reached 40<span class="elsevierStyleHsp" style=""></span>mm. Radiologically guided percutaneous drainage was unsuccessfully attempted. Treatment with meropenem, ceftriaxone and azithromycin was continued up to 8 weeks. Neurological recovery and resolution of brain, lung and liver lesions were achieved.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">K. pneumoniae</span> is a Gram-negative enterobacterium that colonises the nasopharynx and gastrointestinal tract. Hypermucoviscosity is a characteristic possessed by only some <span class="elsevierStyleItalic">K. pneumoniae</span> strains that is associated with greater pathogenic power. Serotype K1 strains are positive for the magA gene, associated with hypermucoviscosity, which is part of the capsular operon of serotype K1 and essential for synthesising exopolysaccharides. The mucoid phenotype A (rpmA) regulator plasmid is the transcriptional activator which forms part of the molecular mechanism which in turn amplifies polysaccharide synthesis. Its virulence has also been associated with the aerobactin gene, a siderophore which maintains a constant flow of iron to the bacterium, thereby increasing its lethality.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">These strains cause liver abscesses with metastatic impairment (endogenous endophthalmitis and CNS infections).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> This syndrome is an emerging infectious disease, initially reported in Asia but also documented in non-Asian patients and patients whose only risk factor is diabetes (which alters phagocytosis in Kupffer cells). Other authors think that the serotype K1 is the only risk factor for developing septic complications, including in immunocompetent patients.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Few cases have been reported in Spain.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a> This is the first with multi-organ impairment documented at our hospital. The patient was a representative of an airline with journeys to eastern countries and had lived in the United Arab Emirates for 4 years. Therefore, we thought that he may have acquired <span class="elsevierStyleItalic">K. pneumoniae</span> outside of Spain and that it may have found its way into his biliary tract despite the correct antibiotic treatment.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Although <span class="elsevierStyleItalic">K. pneumoniae</span> liver abscess syndrome in our area may be very uncommon, we believe that it should be taken into account, especially in diabetic patients. Diabetes is a risk factor and is associated with a worse visual prognosis in patients with endophthalmitis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Strict glycaemic control may prevent metastatic complications in patients infected with serotype K1 <span class="elsevierStyleItalic">K. pneumoniae</span>. Even with suitable treatment (third-generation cephalosporins which penetrate the vitreous and CNS well), an early diagnosis would allow prompt percutaneous drainage, which could prevent the development of metastatic foci.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Barbeito-Castiñeiras G, Ladra González MJ, Domínguez Santalla MJ, Rivero Velasco C. Afectación multiorgánica por <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> serotipo K1. Enferm Infecc Microbiol Clin. 2017;35:321–322.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Klebsiella pneumoniae</span> genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.T. Fang" 1 => "S.Y. Lai" 2 => "W.C. Yi" 3 => "P.R. Hsueh" 4 => "K.L. Liu" 5 => "S.C. Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/519262" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2007" "volumen" => "45" "paginaInicial" => "284" "paginaFinal" => "293" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17599305" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Klebsiella pneumoniae</span> liver abscess: a new invasive syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Kristopher Siu" 1 => "Y. Kuo-Ming" 2 => "L. Jung-Chung" 3 => "F. Chang-Phone" 4 => "C. Feng-Yee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(12)70205-0" "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2012" "volumen" => "12" "paginaInicial" => "881" "paginaFinal" => "887" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23099082" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Síndrome de absceso hepático secundario a <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> hipermucoviscosa con involucro pulmonar" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.C. Esper" 1 => "J. Luis" 2 => "S. Hernández" 3 => "C. Alberto" 4 => "P. Pérez" 5 => "L. Daniel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gac Med Mex" "fecha" => "2013" "volumen" => "149" "paginaInicial" => "102" "paginaFinal" => "107" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23435082" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Klebsiella</span> spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Podschun" 1 => "U. Ullmann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Rev" "fecha" => "1998" "volumen" => "11" "paginaInicial" => "589" "paginaFinal" => "603" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9767057" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Klebsiella pneumoniae</span> liver abscess: a new invasive syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.K. Siu" 1 => "K.M. Yeh" 2 => "J.C. Lin" 3 => "C.P. Fung" 4 => "F.Y. Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(12)70205-0" "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2012" "volumen" => "12" "paginaInicial" => "881" "paginaFinal" => "887" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23099082" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factor analysis of invasive liver abscess caused by the K1 serotipe <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Korean Study group for Liver abscess" "etal" => false "autores" => array:5 [ 0 => "J.K. Kim" 1 => "D.R. Chung" 2 => "S.H. Wie" 3 => "J.H. Yoo" 4 => "S.W. Park" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10096-008-0595-2" "Revista" => array:6 [ "tituloSerie" => "Eur J Clin Microbiol Infect Dis" "fecha" => "2009" "volumen" => "28" "paginaInicial" => "109" "paginaFinal" => "111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18663497" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics of pyogenic liver abscess patients with and without diabetes mellitus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N.P. Foo" 1 => "K.T. Chen" 2 => "H.J. Lin" 3 => "H.R. Guo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ajg.2009.586" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2010" "volumen" => "105" "paginaInicial" => "328" "paginaFinal" => "335" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19826410" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Absceso hepático por <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> en un paciente diabético" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F.A. Rodríguez-Lagos" 1 => "J.C. Ferrer-García" 2 => "M. Ramón-Capilla" 3 => "C. Sánchez-Juan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.endonu.2012.01.022" "Revista" => array:6 [ "tituloSerie" => "Endocrinol Nutr" "fecha" => "2013" "volumen" => "60" "paginaInicial" => "106" "paginaFinal" => "109" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22516616" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Absceso hepático piógeno por <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>. Revisión de Abscesos Hepáticos (1998–2003). Revista Canarias" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Martín Sánchez" 1 => "F. Acosta de Bilbao" 2 => "P. Peña Quintana" 3 => "J.C. Pérez Marín" 4 => "M. Suárez Cabrera" 5 => "L.M. Calvo Hernández" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Méd Quir" "fecha" => "2004" "paginaInicial" => "1" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pyogenic liver abscesses caused by <span class="elsevierStyleItalic">Klebsiella pneumoniae:</span> US appearance and aspiration findings" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Hui" 1 => "M. Yang" 2 => "D. Cho" 3 => "A. Li" 4 => "T. Loke" 5 => "J. Chan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.2423051344" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2007" "volumen" => "242" "paginaInicial" => "769" "paginaFinal" => "796" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17325065" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000003500000005/v1_201705111055/S2529993X17301016/v1_201705111055/en/main.assets" "Apartado" => array:4 [ "identificador" => "63562" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000003500000005/v1_201705111055/S2529993X17301016/v1_201705111055/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17301016?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 15 | 4 | 19 |
| 2024 September | 20 | 6 | 26 |
| 2024 August | 20 | 4 | 24 |
| 2024 July | 15 | 4 | 19 |
| 2024 June | 24 | 2 | 26 |
| 2024 May | 21 | 4 | 25 |
| 2024 April | 17 | 4 | 21 |
| 2024 March | 16 | 7 | 23 |
| 2024 February | 14 | 3 | 17 |
| 2024 January | 22 | 10 | 32 |
| 2023 December | 24 | 8 | 32 |
| 2023 November | 19 | 17 | 36 |
| 2023 October | 35 | 6 | 41 |
| 2023 September | 18 | 3 | 21 |
| 2023 August | 23 | 3 | 26 |
| 2023 July | 10 | 8 | 18 |
| 2023 June | 21 | 5 | 26 |
| 2023 May | 41 | 4 | 45 |
| 2023 April | 30 | 5 | 35 |
| 2023 March | 15 | 7 | 22 |
| 2023 February | 13 | 4 | 17 |
| 2023 January | 58 | 7 | 65 |
| 2022 December | 13 | 8 | 21 |
| 2022 November | 13 | 7 | 20 |
| 2022 October | 16 | 7 | 23 |
| 2022 September | 11 | 8 | 19 |
| 2022 August | 26 | 10 | 36 |
| 2022 July | 20 | 10 | 30 |
| 2022 June | 10 | 8 | 18 |
| 2022 May | 23 | 7 | 30 |
| 2022 April | 20 | 12 | 32 |
| 2022 March | 24 | 10 | 34 |
| 2022 February | 26 | 4 | 30 |
| 2022 January | 54 | 6 | 60 |
| 2021 December | 33 | 11 | 44 |
| 2021 November | 24 | 7 | 31 |
| 2021 October | 31 | 14 | 45 |
| 2021 September | 27 | 9 | 36 |
| 2021 August | 29 | 9 | 38 |
| 2021 July | 17 | 10 | 27 |
| 2021 June | 21 | 6 | 27 |
| 2021 May | 33 | 16 | 49 |
| 2021 April | 81 | 11 | 92 |
| 2021 March | 39 | 10 | 49 |
| 2021 February | 32 | 20 | 52 |
| 2021 January | 20 | 7 | 27 |
| 2020 December | 19 | 14 | 33 |
| 2020 November | 18 | 10 | 28 |
| 2020 October | 9 | 11 | 20 |
| 2020 September | 18 | 14 | 32 |
| 2020 August | 10 | 8 | 18 |
| 2020 July | 5 | 8 | 13 |
| 2020 June | 13 | 10 | 23 |
| 2020 May | 9 | 7 | 16 |
| 2020 April | 13 | 5 | 18 |
| 2020 March | 17 | 7 | 24 |
| 2020 February | 14 | 8 | 22 |
| 2020 January | 14 | 4 | 18 |
| 2019 December | 19 | 7 | 26 |
| 2019 November | 14 | 8 | 22 |
| 2019 October | 14 | 5 | 19 |
| 2019 September | 10 | 19 | 29 |
| 2019 August | 11 | 0 | 11 |
| 2019 July | 16 | 17 | 33 |
| 2019 June | 34 | 17 | 51 |
| 2019 May | 84 | 32 | 116 |
| 2019 April | 27 | 12 | 39 |
| 2019 March | 7 | 4 | 11 |
| 2019 February | 5 | 7 | 12 |
| 2019 January | 5 | 6 | 11 |
| 2018 December | 2 | 5 | 7 |
| 2018 November | 7 | 1 | 8 |
| 2018 October | 6 | 4 | 10 |
| 2018 September | 4 | 0 | 4 |
| 2018 August | 9 | 0 | 9 |
| 2018 July | 8 | 1 | 9 |
| 2018 June | 9 | 11 | 20 |
| 2018 May | 5 | 1 | 6 |
| 2018 April | 1 | 1 | 2 |
| 2018 March | 10 | 0 | 10 |
| 2018 February | 4 | 2 | 6 |
| 2018 January | 10 | 1 | 11 |
| 2017 December | 5 | 1 | 6 |
| 2017 November | 7 | 2 | 9 |
| 2017 October | 3 | 2 | 5 |
| 2017 May | 2 | 0 | 2 |
Show all
