Frequency and molecular characterization of invasive isolates of Streptococcus pneumoniae serotypes 6C and 6D in Colombia | Enfermedades Infecciosas y Microbiología Clínica (English Edition)

array:23 ["pii" => "S2529993X17301089" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2017.03.017" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "1494" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Infecc Microbiol Clin. 2017;35:283-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 467 "formatos" => array:3 [ "EPUB" => 4 "HTML" => 333 "PDF" => 130 ] ] "itemSiguiente" => array:19 [ "pii" => "S2529993X17300990" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2017.03.008" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "1491" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Infecc Microbiol Clin. 2017;35:287-92" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 783 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 621 "PDF" => 155 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Community-acquired febrile urinary tract infection caused by extended-spectrum beta-lactamase-producing bacteria in hospitalised infants" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "287" "paginaFinal" => "292" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infección urinaria febril adquirida en la comunidad por bacterias productoras de betalactamasas de espectro extendido en niños hospitalizados" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 986 "Ancho" => 1733 "Tamanyo" => 93616 ] ] "descripcion" => array:1 [ "en" => "Design of the case–control study from 2005 to 2014." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Roberto Hernández Marco, Elena Guillén Olmos, José Rafael Bretón-Martínez, Lourdes Giner Pérez, Benedicta Casado Sánchez, Julia Fujkova, Marina Salamanca Campos, José Miguel Nogueira Coito" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Roberto" "apellidos" => "Hernández Marco" ] 1 => array:2 [ "nombre" => "Elena" "apellidos" => "Guillén Olmos" ] 2 => array:2 [ "nombre" => "José Rafael" "apellidos" => "Bretón-Martínez" ] 3 => array:2 [ "nombre" => "Lourdes" "apellidos" => "Giner Pérez" ] 4 => array:2 [ "nombre" => "Benedicta" "apellidos" => "Casado Sánchez" ] 5 => array:2 [ "nombre" => "Julia" "apellidos" => "Fujkova" ] 6 => array:2 [ "nombre" => "Marina" "apellidos" => "Salamanca Campos" ] 7 => array:2 [ "nombre" => "José Miguel" "apellidos" => "Nogueira Coito" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213005X16000720" "doi" => "10.1016/j.eimc.2016.01.012" "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/S0213005X16000720?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17300990?idApp=UINPBA00004N" "url" => "/2529993X/0000003500000005/v1_201705111055/S2529993X17300990/v1_201705111055/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2529993X17301090" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2017.03.018" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "1499" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Infecc Microbiol Clin. 2017;35:278-82" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 412 "formatos" => array:3 [ "EPUB" => 12 "HTML" => 267 "PDF" => 133 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Antimicrobial susceptibility of 6 antimicrobial agents in Helicobacter pylori clinical isolates by using EUCAST breakpoints compared with previously used breakpoints" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "278" "paginaFinal" => "282" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sensibilidad de aislamientos clínicos de Helicobacter pylori a seis antimicrobianos utilizando los criterios EUCAST y comparando los resultados con criterios utilizados anteriormente" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2701 "Ancho" => 2542 "Tamanyo" => 362932 ] ] "descripcion" => array:1 [ "en" => "Distribution of antibiotic MICs for H. pylori clinical isolates. MICs were determined by E-Test and adjusted to the highest two-fold dilution values. MICs of amoxicillin (A) tetracycline (B), metronidazole (C), clarithromycin (D), rifampicin (E) and levofloxacin (F) are shown. Filled arrows indicate the EUCAST resistance breakpoints and dashed arrows the previously used breakpoints. Exe Y shows the number of H. pylori isolates for each MIC value and Exe X shows each MIC value (mg/L). Arrows indicates the EUCAST (<elsevierMultimedia ident="201705111056197751"></elsevierMultimedia>) or previous (<elsevierMultimedia ident="201705111056197752"></elsevierMultimedia>) resistance breakpoint." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Teresa Alarcón, Pedro Urruzuno, Maria Josefa Martínez, Diego Domingo, Laura Llorca, Ana Correa, Manuel López-Brea" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Teresa" "apellidos" => "Alarcón" ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "Urruzuno" ] 2 => array:2 [ "nombre" => "Maria Josefa" "apellidos" => "Martínez" ] 3 => array:2 [ "nombre" => "Diego" "apellidos" => "Domingo" ] 4 => array:2 [ "nombre" => "Laura" "apellidos" => "Llorca" ] 5 => array:2 [ "nombre" => "Ana" "apellidos" => "Correa" ] 6 => array:2 [ "nombre" => "Manuel" "apellidos" => "López-Brea" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17301090?idApp=UINPBA00004N" "url" => "/2529993X/0000003500000005/v1_201705111055/S2529993X17301090/v1_201705111055/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Frequency and molecular characterization of invasive isolates of Streptococcus pneumoniae serotypes 6C and 6D in Colombia" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "283" "paginaFinal" => "286" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Eliana Liseth Parra, Carolina Duarte, Karina Rodríguez, Olga Sanabria, Jaime Moreno" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Eliana Liseth" "apellidos" => "Parra" ] 1 => array:2 [ "nombre" => "Carolina" "apellidos" => "Duarte" ] 2 => array:2 [ "nombre" => "Karina" "apellidos" => "Rodríguez" ] 3 => array:2 [ "nombre" => "Olga" "apellidos" => "Sanabria" ] 4 => array:4 [ "nombre" => "Jaime" "apellidos" => "Moreno" "email" => array:1 [ 0 => "jmoreno@ins.gov.co" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Grupo de Microbiología, Instituto Nacional de Salud, Colombia" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Frecuencia y caracterización molecular de aislamientos invasivos de Streptococcus pneumoniae serotipos 6C y 6D en Colombia" ] ] "textoCompleto" => "IntroductionThe polysaccharide capsule of Streptococcus pneumoniae is the main virulence factor, and based on its chemical composition more than 96 serotypes have been described.<a class="elsevierStyleCrossRef" href="#bib0175">1</a> Serogroup 6 has been recognized worldwide as an important cause of invasive pneumococcal disease (IPD); initially it was composed of the serotypes 6A and 6B, but in recent years, additional types as the 6C, 6D, 6E, 6F, 6G and 6H have been reported.<a class="elsevierStyleCrossRefs" href="#bib0180">2–6</a>Serotype 6C was described in 2007,<a class="elsevierStyleCrossRef" href="#bib0180">2</a> its capsular loci structure presents a high similitude with the serotype 6A, except the wciNα gene that is substituted in 6C serotype by the wciNβ gene. Therefore, the chemical structures of both serotypes differs; a galactose in the capsular polysaccharide of 6A is replaced for glucose in serotype 6C.<a class="elsevierStyleCrossRef" href="#bib0205">7</a> Since the description of serotype 6C, it has been reported in several surveillance studies as one of the most prevalent serotypes<a class="elsevierStyleCrossRefs" href="#bib0210">8,9</a> and its molecular epidemiology has been associated to 6A serotypes.<a class="elsevierStyleCrossRefs" href="#bib0175">1,10</a> Serotype 6D, was originally considered an artificial strain created at the laboratory by the insertion of wciNβ gene into a 6B strain.<a class="elsevierStyleCrossRef" href="#bib0225">11</a> However, it was posteriorly found in asymptomatic carriers and in IPD isolates.<a class="elsevierStyleCrossRefs" href="#bib0185">3,12</a> Serotype 6D has been mainly reported in Asian countries.<a class="elsevierStyleCrossRefs" href="#bib0230">12–14</a>In Colombia, the National Surveillance Network System Program of Bacterial Agents Causing Pneumonias and Meningitis (SIREVA II–PAHO program) has reported nine serotypes between 1994 and 2014: 14 (23.3%), 1 (13.5%), 6B (7.9%), 23F (7.1%), 3 (6.7%), 19F (6.0%), 6A (5.5%), 5 (5.1%) and 19A (4.0%); these serotypes have been located as the cause of 79.5% IPD cases; among these, the proportion of the serotypes 6A/6B was 13.5%.<a class="elsevierStyleCrossRefs" href="#bib0245">15,16</a> The aim of this study was to describe the frequency, antimicrobial susceptibility and the molecular characterization of serotypes 6C and 6D among the IPD isolates that have been identified as 6A and 6B.Materials and methodsFrom January 1994 through December 2013, a total of 621 isolates of S. pneumoniae serogroup 6 were received at the national surveillance program in Colombia (SIREVA II). All isolate samples were cultured from patients with a diagnosis of invasive disease. The serotyping was performed using the Quellung reaction (Staten Serum Institute Denmark). The susceptibility testing was performed by micro-dilution and using Kirby–Bauer methods according to recommendations by the Clinical and Laboratory Standards Institute (CLSI).<a class="elsevierStyleCrossRef" href="#bib0255">17</a> All isolates were tested with penicillin, erythromycin, ceftriaxone, trimethoprim/sulfamethoxazole, chloramphenicol, tetracycline and vancomycin.Isolates identified as 6A (n=271) were retested by multiplex PCR for the identification of serotype 6C, using primers to detect wciN6C gene in serotype 6C<a class="elsevierStyleCrossRef" href="#bib0260">18</a> and the cpsA (conserved capsular biosynthetic locus).<a class="elsevierStyleCrossRef" href="#bib0265">19</a> The PCR was performed with 100ng of each primer, 2.5mM MgCl2, 0.5mM of each deoxynucleoside triphosphate, 1Unit Taq Polymerase and 5μl of DNA, which was obtained using the boiling method. The cycling PCR conditions were as follows: initial denaturation at 94°C for 5min, followed by 30 cycles of 94°C for 30s, 61°C for 45s and 72°C for 60s, with a final extension at 72°C for 5min. PCR products were resolved on 1.2% agarose gels containing 0.5μg/mL of ethidium bromide. The positive isolates by PCR were confirmed using the Quellung method with the reaction of the factor antiserum 6d (antigenic combination factors 6b−, 6c−, 6d+). In the identification of serotype 6D, 350 isolates recovered in the surveillance and serotyped as 6B were tested by Quellung reaction with the factors antiserum 6c and 6d (antigenic combination factors 6b−, 6c+, 6d+). In the processes, strains serotype 6C and 6D were used as a control, which were donated by the Institute Adolfo Lutz of Brazil and the Centers for Disease Control & Prevention, Atlanta, respectively.Pulsed-field gel electrophoresis (PFGE) was performed in the total of isolates identified as 6C and 6D. Isolates that exhibited a similarity >75% were considered as a cluster by the unweighted-pair group method with arithmetic means (UPGMA), using the Dice similarity coefficient, an optimization value of 1.5% and tolerance position of 1.0%. The genetic relationship was analyzed among isolates 6C/6D, Spain9VST156, Spain23FST81, Spain6BST90, Colombia23FST338, South Africa6BST185 and the 6A and 6B PFGE patterns published previously.<a class="elsevierStyleCrossRef" href="#bib0270">20</a> From each PFGE cluster one isolate was selected to identify the sequence type (ST) by multilocus sequence typing (MLST).<a class="elsevierStyleCrossRef" href="#bib0275">21</a> The STs were determined using the software available on the MLST (<a href="http://pubmlst.org/spneumoniae/">http://pubmlst.org/spneumoniae/</a>).ResultsFrom 1994 to 2013, a total of 4991 isolates of S. pneumoniae as the cause of IPD were collected in Colombia; among all the isolates collection, the serotype 6C had a frequency of 1.2% among all the surveillance isolates (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The identification of 6C serotype by PCR presented a concordance of 100% with the Quellung reaction.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Isolates were recovered from blood (50.8%) (31/61), cerebrospinal fluid (46.0%) (28/61), and other sterile fluids (3.2%) (2/61). Meningitis was the most common diagnosis (46.0%) (28/61), followed by pneumonia (24.5%) (15/61), sepsis (18%) (11/61), and other invasive diseases (11.5%) (7/61).The serotype 6C isolates were mainly recovered from children <5 years old (37.7%) (23/61) and adults >50 years old (26.2%) (16/61). In the other age groups it presented low proportion (5–14 (9.8%) (6/61) and 15–50 (21.3%) (13/61) years old), and 4.9% (3/61) of patients did not report age data. Only one isolate (3.6%) from a patient with meningitis presented a MIC to penicillin ≥0.125μg/mL. Eight isolates (13.1%) were non-susceptible to trimethoprim/sulfamethoxazole (MIC≥8.0μg/mL), seven (11.5%) were non-susceptible to tetracycline (MIC≥8.0μg/mL), and all isolates presented susceptibility to ceftriaxone, erythromycin, chloramphenicol, and vancomycin.Among the 350 isolates identified previously as serotype 6B, 15 (4.3%) were typed as 6D. These isolates were recovered from patients with meningitis (8/15) (53.3%), pneumonia (5/15) (33.3%) and sepsis (2/15) (13.3%). The 6D serotype caused IPD in children <5 years old (20%), 5–14 (26.7%), 14–50 (26.7%) and >50 (20%). One patient (6.7%) did not provide age information. The MIC to penicillin ≥0.125μg/mL was observed in one isolate (6.6%). Two isolates (13.3%) were resistant to trimethoprim/sulfamethoxazole (MIC≥8.0μg/mL).The isolates were grouped in eight clusters by PFGE (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>, figure supplementary). The cluster I grouped a total of 26 (42.6%) isolates that presented a relationship with the ST9007 (aroE: 1, gdh: 10, gki: 9, recP: 43, spi: 10, xpt: 1, ddl: 6). The cluster II was formed by 12 (19.7%) isolates associated with the ST9008 (aroE: 10, gdh: 5, gki: 4, recP: 43, spi: 146, xpt: 20, ddl: 28). Both sequences, ST9007 and ST9008, were found and reported for the first time in this study. These sequences presented a high frequency in the last years of surveillance (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Cluster III grouped 9.8% (6/61) of the isolates, which were related to the ST5464. In Cluster IV, 8.2% (5/61) of the isolates were related to Colombia23FST338 clone. The clusters V and VI associated three and two isolates with ST473 and ST460, respectively. Cluster VII grouped twelve isolates 6D and two 6C that were associated to with ST1135, and identified mainly in 2002–2005 and 2006–2009. In cluster VIII, one isolate 6D was genetically identical to one isolate 6C. Finally, four (6.6%) isolates 6C and two (13.3%) 6D were not genetically related.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionIn this study, serotype 6C isolates were identified in the first year of surveillance (1994), similar to retrospective studies in different countries that showed the presence and circulation, in Denmark, isolates 6C have been reported since 1962<a class="elsevierStyleCrossRef" href="#bib0280">22</a> and in the USA have been found since 1989.<a class="elsevierStyleCrossRef" href="#bib0285">23</a> Among the Colombian isolates serotype 6C presented a low frequency. On the contrary, countries such as the USA<a class="elsevierStyleCrossRef" href="#bib0210">8</a> and Spain<a class="elsevierStyleCrossRef" href="#bib0290">24</a> have reported a high frequency of this serotype in IPD. In Latin America, the SIREVA II program that included the participation of 20 countries, has reported the frequency of 6C isolates from 2009 to 2012 as a cause of IPD in countries such as: Brazil (n=54), Mexico (n=17), Colombia (n=17), Chile (n=14), Argentina (n=11), Costa Rica (n=4), Peru (n=3), Uruguay (n=3), Ecuador (n=2), Dominican Republic (n=2), Bolivia (n=1).<a class="elsevierStyleCrossRef" href="#bib0295">25</a>Even though 6C isolates are generally more susceptible to antimicrobials than 6A,<a class="elsevierStyleCrossRef" href="#bib0300">26</a> resistance and multi-drug resistance in 6C has been reported.<a class="elsevierStyleCrossRef" href="#bib0220">10</a> In contrast, a low frequency of 6C resistant isolates was observed in our results. However, continuous the surveillance is important because the increase of resistance could be due to gene replacement events within the capsular loci from isolates non-susceptible to 6A or others serotypes.<a class="elsevierStyleCrossRef" href="#bib0305">27</a>Two new STs, ST9007 and ST9008, were identified in this study, which clustered over half of the isolates, presented a greater circulation in the last years studied, and suggested the occurrence of clonal groups responsible for IPD caused by serotype 6C in Colombia. The ST 9007 presents with only one variant in the spi allele with the ST 2185, which was reported in isolates 6A in Poland, 6C/D in Germany and isolates 6C in Portugal and South Africa. ST9008 is associated with ST10717 by a single variant in the spi allele, which was reported from an isolate serotype 6C in the USA (<a href="http://pubmlst.org/spneumoniae/">http://pubmlst.org/spneumoniae/</a>).A low proportion of isolates were also associated with ST5464 that has been reported in isolates 6C and 6B from carriers in Peru (<a href="http://spneumoniae.mlst.net/">http://spneumoniae.mlst.net/</a>). Additionally, some 6C isolates were related to Colombia23FST338 clone, which has been associated frequently with isolates serotype 23F, but also with serotypes 19A, 19F, 23A/B.<a class="elsevierStyleCrossRef" href="#bib0270">20</a> The relation of ST338 with isolates serotype 6C was also reported in the USA.<a class="elsevierStyleCrossRef" href="#bib0210">8</a>The isolates also were associated to ST460 and ST473, and both sequences have been related to 6A isolates. In Colombia, the ST473 was previously identified in IPD Colombian serotype 6A isolates.<a class="elsevierStyleCrossRefs" href="#bib0270">20,27</a> ST460 has been more associated with serotype 6A,<a class="elsevierStyleCrossRef" href="#bib0285">23</a> and less with 6C isolates.<a class="elsevierStyleCrossRef" href="#bib0310">28</a> The ST473 associated with 6C isolates has been reported in USA,<a class="elsevierStyleCrossRefs" href="#bib0210">8,18,23</a> Spain<a class="elsevierStyleCrossRef" href="#bib0290">24</a> and Australia.<a class="elsevierStyleCrossRef" href="#bib0315">29</a> Additionally, ST473 was found in isolates serotype 6D in Australia.<a class="elsevierStyleCrossRef" href="#bib0310">28</a>Serotype 6D has been reported as a cause of IPD mainly in Asian countries<a class="elsevierStyleCrossRefs" href="#bib0230">12,14</a> and in a low proportion in Australia,<a class="elsevierStyleCrossRef" href="#bib0315">29</a> Europe<a class="elsevierStyleCrossRef" href="#bib0320">30</a> and Israel.<a class="elsevierStyleCrossRef" href="#bib0325">31</a> In Latin America, he first report of this serotype was done from carriers in Peru.<a class="elsevierStyleCrossRef" href="#bib0330">32</a> Additionally, Cuba reported one isolate 6D from IPD within the SIREVA II–PAHO program.<a class="elsevierStyleCrossRef" href="#bib0295">25</a> We determined that this serotype has been circulating since the beginning of the surveillance in a low frequency, and almost all the isolates were associated with ST1135, which has been reported in association with serotype 6B isolates (<a href="http://www.mlst.net/">www.mlst.net</a>).In Colombia, the PCV7 was included in the Plan of Immunization in 2009 for children of 2 years of age from some regions in the country. Subsequently, PCV7 was switched to PCV10 in 2010, and extended to the whole country.<a class="elsevierStyleCrossRefs" href="#bib0335">33,34</a> During this study, only the serotype 6B had a decrease significant. However, this analysis could be affected by the time after PCVs introduction, and by the collection of isolates, which was done from many regions of the country with a different coverage of the vaccination.In conclusion, this study shows that serotypes 6C and 6D have been circulated in Colombia since the surveillance was started. Even though the number of isolates found was low, a continuous surveillance is necessary to determine the impact of pneumococcal vaccines’ introduction on these serotypes. The detection of pneumococcal 6C serotypes by a PCR had a complete concordance with the Quellung reaction; it offers a substantial cost savings in comparison to the conventional antiserum. Additionally, the serotype 6C genetic structure was associated with switching capsular events among the serotypes of serogroup 6 and Colombian23F ST338 clone, a fact that potentially could lead to the increase of IPD rates caused for this serotype by expansion of capsular variants of international clones.Conflict of interestThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres838135" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methodology" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec833873" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres838134" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Metodología" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec833872" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:2 [ "identificador" => "xack281671" "titulo" => "Acknowledgments" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-10-13" "fechaAceptado" => "2016-01-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec833873" "palabras" => array:4 [ 0 => "Streptococcus pneumoniae" 1 => "Serotypes" 2 => "Surveillance" 3 => "Molecular epidemiology" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec833872" "palabras" => array:4 [ 0 => "Streptococcus pneumoniae" 1 => "Serotipos" 2 => "Vigilancia" 3 => "Epidemiología molecular" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionSerogroup 6 of Streptococcus pneumoniae initially consisted of the 6A and 6B serotypes, but in recent years, the 6C and 6D serotypes were reported. The aim of this study was to determine the frequency and molecular characterization of invasive S. pneumoniae isolates serotypes 6C and 6D in Colombia, from 1994 to 2013. MethodologyAll the isolates recovered during the surveillance from 1994 to 2013, and identified as 6A or 6B, were re-tested to detect the serotypes 6C and 6D. The serotyping was performed using the Quellung reaction and PCR. The susceptibility testing was performed on penicillin, erythromycin, ceftriaxone, trimethoprim/sulfamethoxazole, chloramphenicol, tetracycline and vancomycin. Molecular typing was performed using pulsed-field gel electrophoresis and multilocus sequence typing. ResultsFrom a total of 271 and 350 isolates serotyped previously as serotypes 6A and 6B, 61 (22.5%) and 15 (4.3%) were recognized as 6C and 6D, respectively. Isolates presented with low resistance to antimicrobials. Serotype 6C isolates were mainly associated with ST9007 (42.6%) and ST9008 (19.7%), and serotype 6D isolates with ST1135 (80%). ConclusionThis study showed the circulation of serotype 6C and 6D in Colombia between 1994 and 2013, information that is important to determine the dynamics of these recently described serotypes." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methodology" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Introducciónel serogrupo 6 de Streptococcus pneumoniae estaba conformado inicialmente por los serotipos 6A y 6B, pero en los últimos años los serotipos adicionales 6C y 6D fueron reportados. El objetivo de este estudio fue determinar la frecuencia y la caracterización molecular de aislamientos invasivos de S.pneumoniae serotipos 6C y 6D en Colombia, desde 1994 a 2013. MetodologíaTodos los aislamientos recuperados durante la vigilancia 1994-2013 e identificados como 6A o 6B se analizaron para detectar los serotipos 6C y 6D. La serotipificación se realizó usando la reacción de Quellung y PCR. La prueba de sensibilidad se realizó a la penicilina, eritromicina, ceftriaxona, trimetoprim/sulfametoxazol, cloranfenicol, tetraciclina y vancomicina. La tipificación molecular se realizó mediante electroforesis en gel de campos pulsados y análisis de las secuencias multilocus. ResultadosDe un total de 271 y 350 aislamientos previamente identificados como serotipos 6A y 6B, 61 (22,5%) y 15 (4,3%) fueron reconocidos como 6C y 6D, respectivamente. Los aislamientos presentaron una baja resistencia a los antimicrobianos. Los aislamientos serotipo 6C se asociaron principalmente a los ST9007 (42,6%) y ST9008 (19,7%). El 80% de los aislamientos 6D se asociaron con ST 1135. ConclusiónEste estudio demostró la circulación del serotipo 6C y 6D en Colombia desde 1994. La información es importante para determinar la dinámica de estos serotipos descritos recientemente." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Metodología" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0035" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "P*: Estimated between 2006–2009 and 2010–2013." "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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Serotypes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Surveillance years n (%)</th><th class="td" title="table-head " align="left" valign="top" scope="col">Total \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">P* \t\t\t\t\t\t\n \t\t\t\t</th></tr><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">1994–1997 \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">1998–2001 \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">2002–2005 \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">2006–2009 \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">2010–2013 \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">6A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (4.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (4.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (4.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 (4.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">210 (4.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4801 \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">6B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 (8.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 (6.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 (6.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 (5.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">335 (6.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.042 \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">6C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (1.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (1.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.05 \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">6D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (0.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (0.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.07 \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">614 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">714 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">971 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1157 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1535 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4991 \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></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1414613.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Frequency of invasive serotypes 6A, 6B, 6C, and 6D isolates from 1994 to 2013 among total serogroup 6 pneumococcal isolates from 1994 to 2013." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">ST \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Pattern \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">Serotypes n (%)</th><th class="td" title="table-head " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Temporal distribution of serotypes 6C/6D (n)</th></tr><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="" 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">6C n=61 \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">6D n=15 \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">1994–1997 \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">1998–2001 \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">2002–2005 \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">2006–2009 \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">2010–2013 \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">9007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (42.6) \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">2 \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">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">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">9008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (19.6) \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">1 \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">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \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">5464 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (9.8) \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">2 \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">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \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">338 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (8.2) \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">1 \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">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \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">460 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (4.9) \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">0 \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">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">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">473 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">VI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (3.3) \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">0 \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">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \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">1135 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">VII \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (80) \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">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/2<a class="elsevierStyleCrossRef" href="#tblfn0005">a</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">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">VIII \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (6.67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \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">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \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">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unrelated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (13.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \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">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1414612.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Isolates 6C." ] ] ] "descripcion" => array:1 [ "en" => "Genetic and temporal distribution of S. pneumoniae serotype 6C and 6D isolates." ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 16650 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:34 [ 0 => array:3 [ "identificador" => "bib0175" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical implications of pneumococcal serotypes: invasive disease potential, clinical presentations, and antibiotic resistance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.Y. Song" 1 => "M.H. Nahm" 2 => "M.A. Moseley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Korean Med Sci" "fecha" => "2013" "volumen" => "28" "paginaInicial" => "4" "paginaFinal" => "15" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0180" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Discovery of a new capsular serotype (6C) within serogroup 6 of Streptococcus pneumoniae" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I.H. Park" 1 => "D.G. Pritchard" 2 => "R. Cartee" 3 => "A. Brandao" 4 => "M.C.C. Brandileone" 5 => "M.H. Nahm" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Microbiol" "fecha" => "2007" "volumen" => "45" "paginaInicial" => "1225" "paginaFinal" => "1233" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0185" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "First report of putative Streptococcus pneumoniae serotype 6D among nasopharyngeal isolates from Fijian children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Jin" 1 => "F. Kong" 2 => "M. Xiao" 3 => "S. Oftadeh" 4 => "F. Zhou" 5 => "C. Liu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/606118" "Revista" => array:6 [ "tituloSerie" => "J Infect Dis" "fecha" => "2009" "volumen" => "200" "paginaInicial" => "1375" "paginaFinal" => "1380" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19803727" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0190" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Capsular gene sequences and genotypes of serotype 6E Streptococcus pneumoniae isolates" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.S. Ko" 1 => "J.Y. Baek" 2 => "J. Song" 3 => "A. Pacific" 4 => "K.S. Ko" 5 => "K.S. Ko" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.01645-13" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2013" "volumen" => "51" "paginaInicial" => "3395" "paginaFinal" => "3399" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23824778" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0195" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Discovery of Streptococcus pneumoniae serotype 6 variants with glycosyltransferases synthesizing two differing repeating units" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.B. Oliver" 1 => "M.P.G. Van Der Linden" 2 => "S.A. Küntzel" 3 => "J.S. Saad" 4 => "M.H. Nahm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1074/jbc.M113.480152" "Revista" => array:6 [ "tituloSerie" => "J Biol Chem" "fecha" => "2013" "volumen" => "288" "paginaInicial" => "25976" "paginaFinal" => "25985" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23897812" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0200" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Genetic, biochemical, and serological characterization of a new pneumococcal serotype, 6H, and generation of a Pneumococcal strain producing three different capsular repeat units" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I.H. Park" 1 => "K.A. Geno" 2 => "J. Yu" 3 => "M.B. Oliver" 4 => "K.-H. Kim" 5 => "M.H. Nahm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/CVI.00647-14" "Revista" => array:6 [ "tituloSerie" => "Clin Vaccine Immunol" "fecha" => "2015" "volumen" => "22" "paginaInicial" => "313" "paginaFinal" => "318" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25589550" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0205" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Genetic basis for the new pneumococcal serotype, 6C" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I.H. Park" 1 => "S. Park" 2 => "S.K. Hollingshead" 3 => "M.H. Nahm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/IAI.00510-07" "Revista" => array:6 [ "tituloSerie" => "Infect Immun" "fecha" => "2007" "volumen" => "75" "paginaInicial" => "4482" "paginaFinal" => "4489" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17576753" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0210" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increase in prevalence of Streptococcus pneumoniae serotype 6C at eight children's hospitals in the United States from 1993 to 2009" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.C. Green" 1 => "E.O. Mason" 2 => "S.L. Kaplan" 3 => "L.B. Lamberth" 4 => "S.H. Stovall" 5 => "L.B. Givner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.02207-10" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2011" "volumen" => "49" "paginaInicial" => "2097" "paginaFinal" => "2101" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21450963" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0215" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Temporal trends and molecular epidemiology of recently described serotype 6C of Streptococcus pneumoniae" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Nunes" 1 => "C. Valente" 2 => "R. Sá-Leão" 3 => "H. De Lencastre" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.01984-08" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2009" "volumen" => "47" "paginaInicial" => "472" "paginaFinal" => "474" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19073873" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0220" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novel pneumococcal serotypes 6C and 6D: anomaly or harbinger" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.C. McEllistrem" 1 => "M.H. Nahm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/cis691" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2012" "volumen" => "55" "paginaInicial" => "1379" "paginaFinal" => "1386" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22903767" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0225" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Production of a unique pneumococcal capsule serotype belonging to serogroup 6" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.E. Bratcher" 1 => "I.H. Park" 2 => "S.K. Hollingshead" 3 => "M.H. Nahm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1099/mic.0.024521-0" "Revista" => array:6 [ "tituloSerie" => "Microbiology" "fecha" => "2009" "volumen" => "155" "paginaInicial" => "576" "paginaFinal" => "583" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19202106" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0230" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and genetic structures of Streptococcus pneumoniae serotype 6D, South Korea" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.H. Choi" 1 => "H.J. Lee" 2 => "E.Y. Cho" 3 => "C.E. Oh" 4 => "B.W. Eun" 5 => "J. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3201/eid1611.100941" "Revista" => array:6 [ "tituloSerie" => "Emerg Infect Dis" "fecha" => "2010" "volumen" => "16" "paginaInicial" => "1751" "paginaFinal" => "1753" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21029535" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0235" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prevalence and characteristics of Streptococcus pneumoniae isolates expressing serotypes 6C and 6D in Hong Kong prior to the introduction of the 7-valent pneumococcal conjugate vaccine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P.L. Ho" 1 => "I. Ang" 2 => "K.H. Chow" 3 => "E.L. Lai" 4 => "S.S. Chiu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.diagmicrobio.2010.07.020" "Revista" => array:6 [ "tituloSerie" => "Diagn Microbiol Infect Dis" "fecha" => "2010" "volumen" => "68" "paginaInicial" => "439" "paginaFinal" => "444" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20926218" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0240" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Type distribution of serogroup 6 Streptococcus pneumoniae and molecular epidemiology of newly identified serotypes 6C and 6D in China" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.-H. Yao" 1 => "Z.-J. Liu" 2 => "J.-G. Yu" 3 => "S.-J. Yu" 4 => "L. Yuan" 5 => "M.H. Nahm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.diagmicrobio.2011.03.015" "Revista" => array:6 [ "tituloSerie" => "Diagn Microbiol Infect Dis" "fecha" => "2011" "volumen" => "70" "paginaInicial" => "291" "paginaFinal" => "298" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21546198" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0245" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Grupo de Microbiología Informe Nacional de SIREVA II Colombia 1994–2005 Streptococcus pneumoniae. Distribución de los aislamientos invasores por año de vigilancia departamento, grupos de edad, serotipos y sensibilidad antimicrobiana; <a href="http://www.ins.gov.co/tramites-y-servicios/examenes-de-inter%C3%A9s-en-salud-publica/Microbiologa/Informe%20Nacional%20de%20SIREVA%20II%20Colombia%201994-2005.%20Streptococcus%20pneumoniae.pdf">http://www.ins.gov.co/tramites-y-servicios/examenes-de-inter%C3%A9s-en-salud-publica/Microbiologa/Informe%20Nacional%20de%20SIREVA%20II%20Colombia%201994-2005.%20Streptococcus%20pneumoniae.pdf</a> [cited 13 January 2016]." ] ] ] 15 => array:3 [ "identificador" => "bib0250" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Grupo de Microbiología Informe Nacional de SIREVA II Colombia 2006–2014. Streptococcus pneumoniae Distribución de los aislamientos invasores por año de vigilancia departamento, grupos de edad, serotipos y sensibilidad antimicrobiana; Available from: <a href="http://www.ins.gov.co/tramites-y-servicios/examenes-de-inter%C3%A9s-en-salud-publica/Microbiologa/Informe%20Nacional%20de%20SIREVA%20II%20Colombia%202006-2014.%20Streptococcus%20pneumoniae.pdf">http://www.ins.gov.co/tramites-y-servicios/examenes-de-inter%C3%A9s-en-salud-publica/Microbiologa/Informe%20Nacional%20de%20SIREVA%20II%20Colombia%202006-2014.%20Streptococcus%20pneumoniae.pdf</a> [cited 13 January 2016]." ] ] ] 16 => array:3 [ "identificador" => "bib0255" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Performance standards for antimicrobial susceptibility testing; twenty-first informational supplement. CLSI document M100-S25" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "CLSI" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2015" "editorial" => "Clinical Laboratory Standards Institute" "editorialLocalizacion" => "Wayne, PA" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0260" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PCR-based quantitation and clonal diversity of the current prevalent invasive serogroup 6 pneumococcal serotype, 6C, in the United States in 1999 and 2006 to 2007" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.D.G. Carvalho" 1 => "F.C. Pimenta" 2 => "R.E. Gertz" 3 => "H.H. Joshi" 4 => "A.A. Trujillo" 5 => "L.E. Keys" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.01919-08" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2009" "volumen" => "47" "paginaInicial" => "554" "paginaFinal" => "559" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19116353" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0265" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sequential multiplex PCR approach for determining capsular serotypes of Streptococcus pneumoniae isolates" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Pai" 1 => "R.E. Gertz" 2 => "B. Beall" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "fecha" => "2006" "volumen" => "44" "paginaInicial" => "124" "paginaFinal" => "131" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0270" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serotype and genotype distribution among invasive Streptococcus pneumoniae isolates in Colombia, 2005–2010" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.L. Parra" 1 => "V. Ramos" 2 => "O. Sanabria" 3 => "J. Moreno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0084993" "Revista" => array:5 [ "tituloSerie" => "PLOS ONE" "fecha" => "2014" "volumen" => "9" "paginaInicial" => "e84993" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24416330" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0275" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: http://www.ncbi.nlm.nih.gov/pubmed/9846740" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A multilocus sequence typing scheme for Streptococcus pneumoniae: identification of clones associated with serious invasive disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.C. Enright" 1 => "B.G. Spratt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1099/00221287-144-11-3049" "Revista" => array:7 [ "tituloSerie" => "Microbiology" "fecha" => "1998" "volumen" => "144" "numero" => "Pt 1" "paginaInicial" => "3049" "paginaFinal" => "3060" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9846740" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0280" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Test of a novel Streptococcus pneumoniae serotype 6C type specific polyclonal antiserum (factor antiserum 6d) and characterisation of serotype 6C isolates in Denmark" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Lambertsen" 1 => "M.B. Kerrn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "BMC Infect" "fecha" => "2010" "volumen" => "10" "paginaInicial" => "282" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0285" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occurrence, distribution, and origins of Streptococcus pneumoniae Serotype 6C, a recently recognized serotype" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.R. Jacobs" 1 => "S. Bajaksouzian" 2 => "R.A. Bonomo" 3 => "C.E. Good" 4 => "A.R. Windau" 5 => "A.M. Hujer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.01524-08" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2009" "volumen" => "47" "paginaInicial" => "64" "paginaFinal" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18971356" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0290" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characterization of invasive pneumococci of serogroup 6 from adults in Barcelona, Spain, in 1994 to 2008" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Rolo" 1 => "C. Ardanuy" 2 => "L. Calatayud" 3 => "R. Pallares" 4 => "I. Grau" 5 => "E. García" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.02545-10" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2011" "volumen" => "49" "paginaInicial" => "2328" "paginaFinal" => "2330" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21450964" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0295" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "PAHO SIREVA II. Regional Report 2012 to 2013 Data by country and by age group on the characteristics of isolates of Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis in invasive processes. Washington, DC Document available in: <a href="http://new.paho.org/hq/index.php?option=com_content%26view=category%26layout=blog%26id=3609%26Itemid=3953">http://new.paho.org/hq/index.php?option=com_content&view=category&layout=blog&id=3609&Itemid=3953</a>" ] ] ] 25 => array:3 [ "identificador" => "bib0300" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased penicillin nonsusceptibility of nonvaccine-serotype invasive pneumococci other than serotypes 19A and 6A in post-7-valent conjugate vaccine era" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.E. Gertz" 1 => "Z. Li" 2 => "F.C. Pimenta" 3 => "D. Jackson" 4 => "B.A. Juni" 5 => "R. Lynfield" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Infect Dis" "fecha" => "2010" "volumen" => "201" "paginaInicial" => "770" "paginaFinal" => "775" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20178139" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0305" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elementos genéticos móviles asociados con resistencia a eritromicina en aislamientos de Streptococcus pneumoniae en Colombia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V. Ramos" 1 => "C. Duarte" 2 => "A. Díaz" 3 => "J. Moreno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/S0120-41572014000500023" "Revista" => array:7 [ "tituloSerie" => "Biomedica" "fecha" => "2014" "volumen" => "34" "numero" => "Suppl. 1" "paginaInicial" => "209" "paginaFinal" => "216" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24968052" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0310" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular epidemiology of Streptococcus pneumoniae serogroup 6 isolates from Fijian children, including newly identified serotypes 6C and 6D" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Satzke" 1 => "B.D. Ortika" 2 => "S. Oftadeh" 3 => "F.M. Russell" 4 => "R.M. Robins-Browne" 5 => "E.K. Mulholland" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.00861-10" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2010" "volumen" => "48" "paginaInicial" => "4298" "paginaFinal" => "4300" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20810769" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0315" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and genetic diversity of pneumococcal serogroup 6 in Australia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Zhuo" 1 => "M. Xiao" 2 => "F. Kong" 3 => "S. Oftadeh" 4 => "F. Zhou" 5 => "J. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1469-0691.2010.03404.x" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "1246" "paginaFinal" => "1253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20950338" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0320" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A report of Streptococcus pneumoniae serotype 6D in Europe" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.H. Nahm" 1 => "M.B. Oliver" 2 => "L. Siira" 3 => "T. Kaijalainen" 4 => "L.M. Lambertsen" 5 => "A. Virolainen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1099/jmm.0.023853-0" "Revista" => array:6 [ "tituloSerie" => "J Med Microbiol" "fecha" => "2011" "volumen" => "60" "paginaInicial" => "46" "paginaFinal" => "48" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20829399" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0325" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Baseline epidemiology and genetic structure of Streptococcus pneumoniae serotype 6D in southern Israel prior to introduction of pneumococcal conjugate vaccines" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Porat" 1 => "R. Benisty" 2 => "R. Trefler" 3 => "D. Ozalvo" 4 => "N. Givon-Lavi" 5 => "R. Dagan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.03320-12" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2013" "volumen" => "51" "paginaInicial" => "1580" "paginaFinal" => "1582" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23447629" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0330" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "First report of Streptococcus pneumoniae serotype 6D in South America" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Mercado" 1 => "V. Srinivasan" 2 => "P. Hawkins" 3 => "S. Chochua" 4 => "T. Ochoa" 5 => "B. Beall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.00153-11" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2011" "volumen" => "49" "paginaInicial" => "2080" "paginaFinal" => "2081" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21430101" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0335" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de la Protección Social. Acuerdo Número 406 de 2009. Available: <a href="https://www.minsalud.gov.co/Normatividad_Nuevo/ACUERDO%20406%20DE%202009.pdf#search=%252Cneumococo">https://www.minsalud.gov.co/Normatividad_Nuevo/ACUERDO%20406%20DE%202009.pdf#search=%252Cneumococo</a> [accessed 14 January 2016]." ] ] ] 33 => array:3 [ "identificador" => "bib0340" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de Salud y Protección Social. Dirección de Promoción y Prevención Subdirección de enfermedades transmisibles Programa Ampliado de Inmunizaciones Jornada de Vacunación en Las Americas 2012. Available: <a href="https://www.minsalud.gov.co/Lineamientos/Documento_Marco_Jornada_de_Vacunacion_de_las_Am%C3%A9ricas_abril2012.pdf#search=%252Cneumococo">https://www.minsalud.gov.co/Lineamientos/Documento_Marco_Jornada_de_Vacunacion_de_las_Am%C3%A9ricas_abril2012.pdf#search=%252Cneumococo</a> [accessed 14 January 2016]." ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack281671" "titulo" => "Acknowledgments" "texto" => "We acknowledge Elizabeth Castañeda (PhD and Emeritus Researcher, Instituto Nacional de Salud, Bogotá, Colombia) for her critical review to the manuscript. We also thank Dr. María Cristina Brandileone at the Institute Adolfo Lutz of Brazil by the Portugal6AST327 clone and serotype 6C strains, which were used in the PFGE and PCR controls. We also are grateful Dr. Carvahalo at the Centers for Disease Control & Prevention, Atlanta, by the isolate 6D, was used as a control in the quellung reaction. Also, we want to express our gratitude to Diana Diaz and Viviana Ramos by their technical support in the molecular methodology." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000003500000005/v1_201705111055/S2529993X17301089/v1_201705111055/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/0000003500000005/v1_201705111055/S2529993X17301089/v1_201705111055/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17301089?idApp=UINPBA00004N"]

Statistics

Original article

Frequency and molecular characterization of invasive isolates of Streptococcus pneumoniae serotypes 6C and 6D in Colombia

Frecuencia y caracterización molecular de aislamientos invasivos de Streptococcus pneumoniae serotipos 6C y 6D en Colombia

Eliana Liseth Parra, Carolina Duarte, Karina Rodríguez, Olga Sanabria, Jaime Moreno

Corresponding author

jmoreno@ins.gov.co

Corresponding author.

Grupo de Microbiología, Instituto Nacional de Salud, Colombia

Read

1361

Times
was read the article

427

Total PDF

934

Total HTML

Share statistics

 array:23 [
  "pii" => "S2529993X17301089"
  "issn" => "2529993X"
  "doi" => "10.1016/j.eimce.2017.03.017"
  "estado" => "S300"
  "fechaPublicacion" => "2017-05-01"
  "aid" => "1494"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Enfermedades Infecciosas y Microbiolog&#237;a Cl&#237;nica"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Enferm Infecc Microbiol Clin. 2017;35:283-6"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 467
    "formatos" => array:3 [
      "EPUB" => 4
      "HTML" => 333
      "PDF" => 130
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2529993X17300990"
    "issn" => "2529993X"
    "doi" => "10.1016/j.eimce.2017.03.008"
    "estado" => "S300"
    "fechaPublicacion" => "2017-05-01"
    "aid" => "1491"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Enfermedades Infecciosas y Microbiolog&#237;a Cl&#237;nica"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Enferm Infecc Microbiol Clin. 2017;35:287-92"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 783
      "formatos" => array:3 [
        "EPUB" => 7
        "HTML" => 621
        "PDF" => 155
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Community-acquired febrile urinary tract infection caused by extended-spectrum beta-lactamase-producing bacteria in hospitalised infants"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "287"
          "paginaFinal" => "292"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Infecci&#243;n urinaria febril adquirida en la comunidad por bacterias productoras de betalactamasas de espectro extendido en ni&#241;os hospitalizados"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 986
              "Ancho" => 1733
              "Tamanyo" => 93616
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Design of the case&#8211;control study from 2005 to 2014&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Roberto Hern&#225;ndez Marco, Elena Guill&#233;n Olmos, Jos&#233; Rafael Bret&#243;n-Mart&#237;nez, Lourdes Giner P&#233;rez, Benedicta Casado S&#225;nchez, Julia Fujkova, Marina Salamanca Campos, Jos&#233; Miguel Nogueira Coito"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "Roberto"
              "apellidos" => "Hern&#225;ndez Marco"
            ]
            1 => array:2 [
              "nombre" => "Elena"
              "apellidos" => "Guill&#233;n Olmos"
            ]
            2 => array:2 [
              "nombre" => "Jos&#233; Rafael"
              "apellidos" => "Bret&#243;n-Mart&#237;nez"
            ]
            3 => array:2 [
              "nombre" => "Lourdes"
              "apellidos" => "Giner P&#233;rez"
            ]
            4 => array:2 [
              "nombre" => "Benedicta"
              "apellidos" => "Casado S&#225;nchez"
            ]
            5 => array:2 [
              "nombre" => "Julia"
              "apellidos" => "Fujkova"
            ]
            6 => array:2 [
              "nombre" => "Marina"
              "apellidos" => "Salamanca Campos"
            ]
            7 => array:2 [
              "nombre" => "Jos&#233; Miguel"
              "apellidos" => "Nogueira Coito"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0213005X16000720"
        "doi" => "10.1016/j.eimc.2016.01.012"
        "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/S0213005X16000720?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17300990?idApp=UINPBA00004N"
    "url" => "/2529993X/0000003500000005/v1_201705111055/S2529993X17300990/v1_201705111055/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S2529993X17301090"
    "issn" => "2529993X"
    "doi" => "10.1016/j.eimce.2017.03.018"
    "estado" => "S300"
    "fechaPublicacion" => "2017-05-01"
    "aid" => "1499"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Enfermedades Infecciosas y Microbiolog&#237;a Cl&#237;nica"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Enferm Infecc Microbiol Clin. 2017;35:278-82"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 412
      "formatos" => array:3 [
        "EPUB" => 12
        "HTML" => 267
        "PDF" => 133
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Antimicrobial susceptibility of 6 antimicrobial agents in <span class="elsevierStyleItalic">Helicobacter pylori</span> clinical isolates by using EUCAST breakpoints compared with previously used breakpoints"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "278"
          "paginaFinal" => "282"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Sensibilidad de aislamientos cl&#237;nicos de <span class="elsevierStyleItalic">Helicobacter pylori</span> a seis antimicrobianos utilizando los criterios EUCAST y comparando los resultados con criterios utilizados anteriormente"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 2701
              "Ancho" => 2542
              "Tamanyo" => 362932
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of antibiotic MICs for <span class="elsevierStyleItalic">H&#46; pylori</span> clinical isolates&#46; MICs were determined by E-Test and adjusted to the highest two-fold dilution values&#46; MICs of amoxicillin &#40;A&#41; tetracycline &#40;B&#41;&#44; metronidazole &#40;C&#41;&#44; clarithromycin &#40;D&#41;&#44; rifampicin &#40;E&#41; and levofloxacin &#40;F&#41; are shown&#46; Filled arrows indicate the EUCAST resistance breakpoints and dashed arrows the previously used breakpoints&#46; Exe Y shows the number of <span class="elsevierStyleItalic">H&#46; pylori</span> isolates for each MIC value and Exe X shows each MIC value &#40;mg&#47;L&#41;&#46; Arrows indicates the EUCAST &#40;<elsevierMultimedia ident="201705111056197751"></elsevierMultimedia>&#41; or previous &#40;<elsevierMultimedia ident="201705111056197752"></elsevierMultimedia>&#41; resistance breakpoint&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Teresa Alarc&#243;n, Pedro Urruzuno, Maria Josefa Mart&#237;nez, Diego Domingo, Laura Llorca, Ana Correa, Manuel L&#243;pez-Brea"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "Alarc&#243;n"
            ]
            1 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Urruzuno"
            ]
            2 => array:2 [
              "nombre" => "Maria Josefa"
              "apellidos" => "Mart&#237;nez"
            ]
            3 => array:2 [
              "nombre" => "Diego"
              "apellidos" => "Domingo"
            ]
            4 => array:2 [
              "nombre" => "Laura"
              "apellidos" => "Llorca"
            ]
            5 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Correa"
            ]
            6 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "L&#243;pez-Brea"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17301090?idApp=UINPBA00004N"
    "url" => "/2529993X/0000003500000005/v1_201705111055/S2529993X17301090/v1_201705111055/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Frequency and molecular characterization of invasive isolates of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> serotypes 6C and 6D in Colombia"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "283"
        "paginaFinal" => "286"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Eliana Liseth Parra, Carolina Duarte, Karina Rodr&#237;guez, Olga Sanabria, Jaime Moreno"
        "autores" => array:5 [
          0 => array:2 [
            "nombre" => "Eliana Liseth"
            "apellidos" => "Parra"
          ]
          1 => array:2 [
            "nombre" => "Carolina"
            "apellidos" => "Duarte"
          ]
          2 => array:2 [
            "nombre" => "Karina"
            "apellidos" => "Rodr&#237;guez"
          ]
          3 => array:2 [
            "nombre" => "Olga"
            "apellidos" => "Sanabria"
          ]
          4 => array:4 [
            "nombre" => "Jaime"
            "apellidos" => "Moreno"
            "email" => array:1 [
              0 => "jmoreno&#64;ins&#46;gov&#46;co"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Grupo de Microbiolog&#237;a&#44; Instituto Nacional de Salud&#44; Colombia"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Frecuencia y caracterizaci&#243;n molecular de aislamientos invasivos de <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> serotipos 6C y 6D en Colombia"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The polysaccharide capsule of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> is the main virulence factor&#44; and based on its chemical composition more than 96 serotypes have been described&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">1</span></a> Serogroup 6 has been recognized worldwide as an important cause of invasive pneumococcal disease &#40;IPD&#41;&#59; initially it was composed of the serotypes 6A and 6B&#44; but in recent years&#44; additional types as the 6C&#44; 6D&#44; 6E&#44; 6F&#44; 6G and 6H have been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">2&#8211;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Serotype 6C was described in 2007&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a> its capsular loci structure presents a high similitude with the serotype 6A&#44; except the <span class="elsevierStyleItalic">wciN&#945;</span> gene that is substituted in 6C serotype by the <span class="elsevierStyleItalic">wciN&#946;</span> gene&#46; Therefore&#44; the chemical structures of both serotypes differs&#59; a galactose in the capsular polysaccharide of 6A is replaced for glucose in serotype 6C&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">7</span></a> Since the description of serotype 6C&#44; it has been reported in several surveillance studies as one of the most prevalent serotypes<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">8&#44;9</span></a> and its molecular epidemiology has been associated to 6A serotypes&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">1&#44;10</span></a> Serotype 6D&#44; was originally considered an artificial strain created at the laboratory by the insertion of <span class="elsevierStyleItalic">wciN&#946;</span> gene into a 6B strain&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">11</span></a> However&#44; it was posteriorly found in asymptomatic carriers and in IPD isolates&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">3&#44;12</span></a> Serotype 6D has been mainly reported in Asian countries&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">12&#8211;14</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In Colombia&#44; the National Surveillance Network System Program of Bacterial Agents Causing Pneumonias and Meningitis &#40;SIREVA II&#8211;PAHO program&#41; has reported nine serotypes between 1994 and 2014&#58; 14 &#40;23&#46;3&#37;&#41;&#44; 1 &#40;13&#46;5&#37;&#41;&#44; 6B &#40;7&#46;9&#37;&#41;&#44; 23F &#40;7&#46;1&#37;&#41;&#44; 3 &#40;6&#46;7&#37;&#41;&#44; 19F &#40;6&#46;0&#37;&#41;&#44; 6A &#40;5&#46;5&#37;&#41;&#44; 5 &#40;5&#46;1&#37;&#41; and 19A &#40;4&#46;0&#37;&#41;&#59; these serotypes have been located as the cause of 79&#46;5&#37; IPD cases&#59; among these&#44; the proportion of the serotypes 6A&#47;6B was 13&#46;5&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">15&#44;16</span></a> The aim of this study was to describe the frequency&#44; antimicrobial susceptibility and the molecular characterization of serotypes 6C and 6D among the IPD isolates that have been identified as 6A and 6B&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">From January 1994 through December 2013&#44; a total of 621 isolates of <span class="elsevierStyleItalic">S&#46; pneumoniae</span> serogroup 6 were received at the national surveillance program in Colombia &#40;SIREVA II&#41;&#46; All isolate samples were cultured from patients with a diagnosis of invasive disease&#46; The serotyping was performed using the Quellung reaction &#40;Staten Serum Institute Denmark&#41;&#46; The susceptibility testing was performed by micro-dilution and using Kirby&#8211;Bauer methods according to recommendations by the Clinical and Laboratory Standards Institute &#40;CLSI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a> All isolates were tested with penicillin&#44; erythromycin&#44; ceftriaxone&#44; trimethoprim&#47;sulfamethoxazole&#44; chloramphenicol&#44; tetracycline and vancomycin&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Isolates identified as 6A &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>271&#41; were retested by multiplex PCR for the identification of serotype 6C&#44; using primers to detect <span class="elsevierStyleItalic">wciN6C</span> gene in serotype 6C<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">18</span></a> and the <span class="elsevierStyleItalic">cpsA</span> &#40;conserved capsular biosynthetic locus&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">19</span></a> The PCR was performed with 100<span class="elsevierStyleHsp" style=""></span>ng of each primer&#44; 2&#46;5<span class="elsevierStyleHsp" style=""></span>mM MgCl<span class="elsevierStyleInf">2</span>&#44; 0&#46;5<span class="elsevierStyleHsp" style=""></span>mM of each deoxynucleoside triphosphate&#44; 1<span class="elsevierStyleHsp" style=""></span>Unit Taq Polymerase and 5<span class="elsevierStyleHsp" style=""></span>&#956;l of DNA&#44; which was obtained using the boiling method&#46; The cycling PCR conditions were as follows&#58; initial denaturation at 94<span class="elsevierStyleHsp" style=""></span>&#176;C for 5<span class="elsevierStyleHsp" style=""></span>min&#44; followed by 30 cycles of 94<span class="elsevierStyleHsp" style=""></span>&#176;C for 30<span class="elsevierStyleHsp" style=""></span>s&#44; 61<span class="elsevierStyleHsp" style=""></span>&#176;C for 45<span class="elsevierStyleHsp" style=""></span>s and 72<span class="elsevierStyleHsp" style=""></span>&#176;C for 60<span class="elsevierStyleHsp" style=""></span>s&#44; with a final extension at 72<span class="elsevierStyleHsp" style=""></span>&#176;C for 5<span class="elsevierStyleHsp" style=""></span>min&#46; PCR products were resolved on 1&#46;2&#37; agarose gels containing 0&#46;5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL of ethidium bromide&#46; The positive isolates by PCR were confirmed using the Quellung method with the reaction of the factor antiserum 6d &#40;antigenic combination factors 6b&#8722;&#44; 6c&#8722;&#44; 6d&#43;&#41;&#46; In the identification of serotype 6D&#44; 350 isolates recovered in the surveillance and serotyped as 6B were tested by Quellung reaction with the factors antiserum 6c and 6d &#40;antigenic combination factors 6b&#8722;&#44; 6c&#43;&#44; 6d&#43;&#41;&#46; In the processes&#44; strains serotype 6C and 6D were used as a control&#44; which were donated by the Institute Adolfo Lutz of Brazil and the Centers for Disease Control &#38; Prevention&#44; Atlanta&#44; respectively&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Pulsed-field gel electrophoresis &#40;PFGE&#41; was performed in the total of isolates identified as 6C and 6D&#46; Isolates that exhibited a similarity &#62;75&#37; were considered as a cluster by the unweighted-pair group method with arithmetic means &#40;UPGMA&#41;&#44; using the Dice similarity coefficient&#44; an optimization value of 1&#46;5&#37; and tolerance position of 1&#46;0&#37;&#46; The genetic relationship was analyzed among isolates 6C&#47;6D&#44; Spain<span class="elsevierStyleSup">9V</span>ST156&#44; Spain<span class="elsevierStyleSup">23F</span>ST81&#44; Spain<span class="elsevierStyleSup">6B</span>ST90&#44; Colombia<span class="elsevierStyleSup">23F</span>ST338&#44; South Africa<span class="elsevierStyleSup">6B</span>ST185 and the 6A and 6B PFGE patterns published previously&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">20</span></a> From each PFGE cluster one isolate was selected to identify the sequence type &#40;ST&#41; by multilocus sequence typing &#40;MLST&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">21</span></a> The STs were determined using the software available on the MLST &#40;<a href="http://pubmlst.org/spneumoniae/">http&#58;&#47;&#47;pubmlst&#46;org&#47;spneumoniae&#47;</a>&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">From 1994 to 2013&#44; a total of 4991 isolates of <span class="elsevierStyleItalic">S&#46; pneumoniae</span> as the cause of IPD were collected in Colombia&#59; among all the isolates collection&#44; the serotype 6C had a frequency of 1&#46;2&#37; among all the surveillance isolates &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The identification of 6C serotype by PCR presented a concordance of 100&#37; with the Quellung reaction&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Isolates were recovered from blood &#40;50&#46;8&#37;&#41; &#40;31&#47;61&#41;&#44; cerebrospinal fluid &#40;46&#46;0&#37;&#41; &#40;28&#47;61&#41;&#44; and other sterile fluids &#40;3&#46;2&#37;&#41; &#40;2&#47;61&#41;&#46; Meningitis was the most common diagnosis &#40;46&#46;0&#37;&#41; &#40;28&#47;61&#41;&#44; followed by pneumonia &#40;24&#46;5&#37;&#41; &#40;15&#47;61&#41;&#44; sepsis &#40;18&#37;&#41; &#40;11&#47;61&#41;&#44; and other invasive diseases &#40;11&#46;5&#37;&#41; &#40;7&#47;61&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The serotype 6C isolates were mainly recovered from children &#60;5 years old &#40;37&#46;7&#37;&#41; &#40;23&#47;61&#41; and adults &#62;50 years old &#40;26&#46;2&#37;&#41; &#40;16&#47;61&#41;&#46; In the other age groups it presented low proportion &#40;5&#8211;14 &#40;9&#46;8&#37;&#41; &#40;6&#47;61&#41; and 15&#8211;50 &#40;21&#46;3&#37;&#41; &#40;13&#47;61&#41; years old&#41;&#44; and 4&#46;9&#37; &#40;3&#47;61&#41; of patients did not report age data&#46; Only one isolate &#40;3&#46;6&#37;&#41; from a patient with meningitis presented a MIC to penicillin &#8805;0&#46;125<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL&#46; Eight isolates &#40;13&#46;1&#37;&#41; were non-susceptible to trimethoprim&#47;sulfamethoxazole &#40;MIC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>8&#46;0<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL&#41;&#44; seven &#40;11&#46;5&#37;&#41; were non-susceptible to tetracycline &#40;MIC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>8&#46;0<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL&#41;&#44; and all isolates presented susceptibility to ceftriaxone&#44; erythromycin&#44; chloramphenicol&#44; and vancomycin&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Among the 350 isolates identified previously as serotype 6B&#44; 15 &#40;4&#46;3&#37;&#41; were typed as 6D&#46; These isolates were recovered from patients with meningitis &#40;8&#47;15&#41; &#40;53&#46;3&#37;&#41;&#44; pneumonia &#40;5&#47;15&#41; &#40;33&#46;3&#37;&#41; and sepsis &#40;2&#47;15&#41; &#40;13&#46;3&#37;&#41;&#46; The 6D serotype caused IPD in children &#60;5 years old &#40;20&#37;&#41;&#44; 5&#8211;14 &#40;26&#46;7&#37;&#41;&#44; 14&#8211;50 &#40;26&#46;7&#37;&#41; and &#62;50 &#40;20&#37;&#41;&#46; One patient &#40;6&#46;7&#37;&#41; did not provide age information&#46; The MIC to penicillin &#8805;0&#46;125<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL was observed in one isolate &#40;6&#46;6&#37;&#41;&#46; Two isolates &#40;13&#46;3&#37;&#41; were resistant to trimethoprim&#47;sulfamethoxazole &#40;MIC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>8&#46;0<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The isolates were grouped in eight clusters by PFGE &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; figure supplementary&#41;&#46; The cluster I grouped a total of 26 &#40;42&#46;6&#37;&#41; isolates that presented a relationship with the ST9007 &#40;<span class="elsevierStyleItalic">aroE</span>&#58; 1&#44; <span class="elsevierStyleItalic">gdh</span>&#58; 10&#44; <span class="elsevierStyleItalic">gki</span>&#58; 9&#44; <span class="elsevierStyleItalic">recP</span>&#58; 43&#44; <span class="elsevierStyleItalic">spi</span>&#58; 10&#44; <span class="elsevierStyleItalic">xpt</span>&#58; 1&#44; <span class="elsevierStyleItalic">ddl</span>&#58; 6&#41;&#46; The cluster II was formed by 12 &#40;19&#46;7&#37;&#41; isolates associated with the ST9008 &#40;<span class="elsevierStyleItalic">aroE</span>&#58; 10&#44; <span class="elsevierStyleItalic">gdh</span>&#58; 5&#44; <span class="elsevierStyleItalic">gki</span>&#58; 4&#44; <span class="elsevierStyleItalic">recP</span>&#58; 43&#44; <span class="elsevierStyleItalic">spi</span>&#58; 146&#44; <span class="elsevierStyleItalic">xpt</span>&#58; 20&#44; <span class="elsevierStyleItalic">ddl</span>&#58; 28&#41;&#46; Both sequences&#44; ST9007 and ST9008&#44; were found and reported for the first time in this study&#46; These sequences presented a high frequency in the last years of surveillance &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Cluster III grouped 9&#46;8&#37; &#40;6&#47;61&#41; of the isolates&#44; which were related to the ST5464&#46; In Cluster IV&#44; 8&#46;2&#37; &#40;5&#47;61&#41; of the isolates were related to Colombia<span class="elsevierStyleSup">23F</span>ST338 clone&#46; The clusters V and VI associated three and two isolates with ST473 and ST460&#44; respectively&#46; Cluster VII grouped twelve isolates 6D and two 6C that were associated to with ST1135&#44; and identified mainly in 2002&#8211;2005 and 2006&#8211;2009&#46; In cluster VIII&#44; one isolate 6D was genetically identical to one isolate 6C&#46; Finally&#44; four &#40;6&#46;6&#37;&#41; isolates 6C and two &#40;13&#46;3&#37;&#41; 6D were not genetically related&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">In this study&#44; serotype 6C isolates were identified in the first year of surveillance &#40;1994&#41;&#44; similar to retrospective studies in different countries that showed the presence and circulation&#44; in Denmark&#44; isolates 6C have been reported since 1962<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">22</span></a> and in the USA have been found since 1989&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">23</span></a> Among the Colombian isolates serotype 6C presented a low frequency&#46; On the contrary&#44; countries such as the USA<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a> and Spain<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">24</span></a> have reported a high frequency of this serotype in IPD&#46; In Latin America&#44; the SIREVA II program that included the participation of 20 countries&#44; has reported the frequency of 6C isolates from 2009 to 2012 as a cause of IPD in countries such as&#58; Brazil &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>54&#41;&#44; Mexico &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;&#44; Colombia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;&#44; Chile &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41;&#44; Argentina &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&#44; Costa Rica &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; Peru &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; Uruguay &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; Ecuador &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; Dominican Republic &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; Bolivia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">25</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Even though 6C isolates are generally more susceptible to antimicrobials than 6A&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">26</span></a> resistance and multi-drug resistance in 6C has been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">10</span></a> In contrast&#44; a low frequency of 6C resistant isolates was observed in our results&#46; However&#44; continuous the surveillance is important because the increase of resistance could be due to gene replacement events within the capsular loci from isolates non-susceptible to 6A or others serotypes&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">27</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Two new STs&#44; ST9007 and ST9008&#44; were identified in this study&#44; which clustered over half of the isolates&#44; presented a greater circulation in the last years studied&#44; and suggested the occurrence of clonal groups responsible for IPD caused by serotype 6C in Colombia&#46; The ST 9007 presents with only one variant in the <span class="elsevierStyleItalic">spi</span> allele with the ST 2185&#44; which was reported in isolates 6A in Poland&#44; 6C&#47;D in Germany and isolates 6C in Portugal and South Africa&#46; ST9008 is associated with ST10717 by a single variant in the <span class="elsevierStyleItalic">spi</span> allele&#44; which was reported from an isolate serotype 6C in the USA &#40;<a href="http://pubmlst.org/spneumoniae/">http&#58;&#47;&#47;pubmlst&#46;org&#47;spneumoniae&#47;</a>&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">A low proportion of isolates were also associated with ST5464 that has been reported in isolates 6C and 6B from carriers in Peru &#40;<a href="http://spneumoniae.mlst.net/">http&#58;&#47;&#47;spneumoniae&#46;mlst&#46;net&#47;</a>&#41;&#46; Additionally&#44; some 6C isolates were related to Colombia<span class="elsevierStyleSup">23F</span>ST338 clone&#44; which has been associated frequently with isolates serotype 23F&#44; but also with serotypes 19A&#44; 19F&#44; 23A&#47;B&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">20</span></a> The relation of ST338 with isolates serotype 6C was also reported in the USA&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The isolates also were associated to ST460 and ST473&#44; and both sequences have been related to 6A isolates&#46; In Colombia&#44; the ST473 was previously identified in IPD Colombian serotype 6A isolates&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">20&#44;27</span></a> ST460 has been more associated with serotype 6A&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">23</span></a> and less with 6C isolates&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">28</span></a> The ST473 associated with 6C isolates has been reported in USA&#44;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">8&#44;18&#44;23</span></a> Spain<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">24</span></a> and Australia&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">29</span></a> Additionally&#44; ST473 was found in isolates serotype 6D in Australia&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">28</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Serotype 6D has been reported as a cause of IPD mainly in Asian countries<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">12&#44;14</span></a> and in a low proportion in Australia&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">29</span></a> Europe<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">30</span></a> and Israel&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">31</span></a> In Latin America&#44; he first report of this serotype was done from carriers in Peru&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">32</span></a> Additionally&#44; Cuba reported one isolate 6D from IPD within the SIREVA II&#8211;PAHO program&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">25</span></a> We determined that this serotype has been circulating since the beginning of the surveillance in a low frequency&#44; and almost all the isolates were associated with ST1135&#44; which has been reported in association with serotype 6B isolates &#40;<a href="http://www.mlst.net/">www&#46;mlst&#46;net</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In Colombia&#44; the PCV7 was included in the Plan of Immunization in 2009 for children of 2 years of age from some regions in the country&#46; Subsequently&#44; PCV7 was switched to PCV10 in 2010&#44; and extended to the whole country&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">33&#44;34</span></a> During this study&#44; only the serotype 6B had a decrease significant&#46; However&#44; this analysis could be affected by the time after PCVs introduction&#44; and by the collection of isolates&#44; which was done from many regions of the country with a different coverage of the vaccination&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In conclusion&#44; this study shows that serotypes 6C and 6D have been circulated in Colombia since the surveillance was started&#46; Even though the number of isolates found was low&#44; a continuous surveillance is necessary to determine the impact of pneumococcal vaccines&#8217; introduction on these serotypes&#46; The detection of pneumococcal 6C serotypes by a PCR had a complete concordance with the Quellung reaction&#59; it offers a substantial cost savings in comparison to the conventional antiserum&#46; Additionally&#44; the serotype 6C genetic structure was associated with switching capsular events among the serotypes of serogroup 6 and Colombian<span class="elsevierStyleSup">23F</span> ST338 clone&#44; a fact that potentially could lead to the increase of IPD rates caused for this serotype by expansion of capsular variants of international clones&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres838135"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methodology"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec833873"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres838134"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Metodolog&#237;a"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusi&#243;n"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec833872"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflict of interest"
        ]
        9 => array:2 [
          "identificador" => "xack281671"
          "titulo" => "Acknowledgments"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-10-13"
    "fechaAceptado" => "2016-01-28"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec833873"
          "palabras" => array:4 [
            0 => "<span class="elsevierStyleItalic">Streptococcus pneumoniae</span>"
            1 => "Serotypes"
            2 => "Surveillance"
            3 => "Molecular epidemiology"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec833872"
          "palabras" => array:4 [
            0 => "<span class="elsevierStyleItalic">Streptococcus pneumoniae</span>"
            1 => "Serotipos"
            2 => "Vigilancia"
            3 => "Epidemiolog&#237;a molecular"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Serogroup 6 of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> initially consisted of the 6A and 6B serotypes&#44; but in recent years&#44; the 6C and 6D serotypes were reported&#46; The aim of this study was to determine the frequency and molecular characterization of invasive <span class="elsevierStyleItalic">S&#46; pneumoniae</span> isolates serotypes 6C and 6D in Colombia&#44; from 1994 to 2013&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methodology</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">All the isolates recovered during the surveillance from 1994 to 2013&#44; and identified as 6A or 6B&#44; were re-tested to detect the serotypes 6C and 6D&#46; The serotyping was performed using the Quellung reaction and PCR&#46; The susceptibility testing was performed on penicillin&#44; erythromycin&#44; ceftriaxone&#44; trimethoprim&#47;sulfamethoxazole&#44; chloramphenicol&#44; tetracycline and vancomycin&#46; Molecular typing was performed using pulsed-field gel electrophoresis and multilocus sequence typing&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">From a total of 271 and 350 isolates serotyped previously as serotypes 6A and 6B&#44; 61 &#40;22&#46;5&#37;&#41; and 15 &#40;4&#46;3&#37;&#41; were recognized as 6C and 6D&#44; respectively&#46; Isolates presented with low resistance to antimicrobials&#46; Serotype 6C isolates were mainly associated with ST9007 &#40;42&#46;6&#37;&#41; and ST9008 &#40;19&#46;7&#37;&#41;&#44; and serotype 6D isolates with ST1135 &#40;80&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This study showed the circulation of serotype 6C and 6D in Colombia between 1994 and 2013&#44; information that is important to determine the dynamics of these recently described serotypes&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methodology"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">el serogrupo 6 de <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> estaba conformado inicialmente por los serotipos 6A y 6B&#44; pero en los &#250;ltimos a&#241;os los serotipos adicionales 6C y 6D fueron reportados&#46; El objetivo de este estudio fue determinar la frecuencia y la caracterizaci&#243;n molecular de aislamientos invasivos de <span class="elsevierStyleItalic">S&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">pneumoniae</span> serotipos 6C y 6D en Colombia&#44; desde 1994 a 2013&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Metodolog&#237;a</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Todos los aislamientos recuperados durante la vigilancia 1994-2013 e identificados como 6A o 6B se analizaron para detectar los serotipos 6C y 6D&#46; La serotipificaci&#243;n se realiz&#243; usando la reacci&#243;n de Quellung y PCR&#46; La prueba de sensibilidad se realiz&#243; a la penicilina&#44; eritromicina&#44; ceftriaxona&#44; trimetoprim&#47;sulfametoxazol&#44; cloranfenicol&#44; tetraciclina y vancomicina&#46; La tipificaci&#243;n molecular se realiz&#243; mediante electroforesis en gel de campos pulsados y an&#225;lisis de las secuencias multilocus&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De un total de 271 y 350 aislamientos previamente identificados como serotipos 6A y 6B&#44; 61 &#40;22&#44;5&#37;&#41; y 15 &#40;4&#44;3&#37;&#41; fueron reconocidos como 6C y 6D&#44; respectivamente&#46; Los aislamientos presentaron una baja resistencia a los antimicrobianos&#46; Los aislamientos serotipo 6C se asociaron principalmente a los ST9007 &#40;42&#44;6&#37;&#41; y ST9008 &#40;19&#44;7&#37;&#41;&#46; El 80&#37; de los aislamientos 6D se asociaron con ST 1135&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este estudio demostr&#243; la circulaci&#243;n del serotipo 6C y 6D en Colombia desde 1994&#46; La informaci&#243;n es importante para determinar la din&#225;mica de estos serotipos descritos recientemente&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Metodolog&#237;a"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0115" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0035"
          ]
        ]
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">P</span>&#42;&#58; Estimated between 2006&#8211;2009 and 2010&#8211;2013&#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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Serotypes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Surveillance years<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Total&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"><span class="elsevierStyleItalic">P</span>&#42;&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="" 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">1994&#8211;1997&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">1998&#8211;2001&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">2002&#8211;2005&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">2006&#8211;2009&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">2010&#8211;2013&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">6A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;4&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;4&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;4&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63 &#40;4&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">210 &#40;4&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4801&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">6B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65 &#40;6&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77 &#40;6&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">335 &#40;6&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;042&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">6C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;05&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">6D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;07&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">614&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">714&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">971&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1535&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4991&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></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1414613.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Frequency of invasive serotypes 6A&#44; 6B&#44; 6C&#44; and 6D isolates from 1994 to 2013 among total serogroup 6 pneumococcal isolates from 1994 to 2013&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">ST&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">Pattern&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">Serotypes<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;</th><th class="td" title="table-head  " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Temporal distribution of serotypes 6C&#47;6D &#40;<span class="elsevierStyleItalic">n</span>&#41;</th></tr><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="" 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">6C<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&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">6D<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&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">1994&#8211;1997&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">1998&#8211;2001&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">2002&#8211;2005&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">2006&#8211;2009&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">2010&#8211;2013&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">9007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;42&#46;6&#41;&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">2&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">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&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">9008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;19&#46;6&#41;&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">1&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">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&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">5464&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;9&#46;8&#41;&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">2&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&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">338&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;8&#46;2&#41;&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">1&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">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&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">460&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;4&#46;9&#41;&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">0&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&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">473&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">VI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;3&#46;3&#41;&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">0&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&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">1135&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">VII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;80&#41;&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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;2<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">VIII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#46;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&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">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unrelated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1414612.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Isolates 6C&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Genetic and temporal distribution of <span class="elsevierStyleItalic">S&#46; pneumoniae</span> serotype 6C and 6D isolates&#46;</p>"
        ]
      ]
      2 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc1.pdf"
          "ficheroTamanyo" => 16650
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:34 [
            0 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical implications of pneumococcal serotypes&#58; invasive disease potential&#44; clinical presentations&#44; and antibiotic resistance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;Y&#46; Song"
                            1 => "M&#46;H&#46; Nahm"
                            2 => "M&#46;A&#46; Moseley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Korean Med Sci"
                        "fecha" => "2013"
                        "volumen" => "28"
                        "paginaInicial" => "4"
                        "paginaFinal" => "15"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Discovery of a new capsular serotype &#40;6C&#41; within serogroup 6 of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46;H&#46; Park"
                            1 => "D&#46;G&#46; Pritchard"
                            2 => "R&#46; Cartee"
                            3 => "A&#46; Brandao"
                            4 => "M&#46;C&#46;C&#46; Brandileone"
                            5 => "M&#46;H&#46; Nahm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Microbiol"
                        "fecha" => "2007"
                        "volumen" => "45"
                        "paginaInicial" => "1225"
                        "paginaFinal" => "1233"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "First report of putative <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> serotype 6D among nasopharyngeal isolates from Fijian children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Jin"
                            1 => "F&#46; Kong"
                            2 => "M&#46; Xiao"
                            3 => "S&#46; Oftadeh"
                            4 => "F&#46; Zhou"
                            5 => "C&#46; Liu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/606118"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "2009"
                        "volumen" => "200"
                        "paginaInicial" => "1375"
                        "paginaFinal" => "1380"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19803727"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Capsular gene sequences and genotypes of serotype 6E <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> isolates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;S&#46; Ko"
                            1 => "J&#46;Y&#46; Baek"
                            2 => "J&#46; Song"
                            3 => "A&#46; Pacific"
                            4 => "K&#46;S&#46; Ko"
                            5 => "K&#46;S&#46; Ko"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/JCM.01645-13"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "2013"
                        "volumen" => "51"
                        "paginaInicial" => "3395"
                        "paginaFinal" => "3399"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23824778"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Discovery of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> serotype 6 variants with glycosyltransferases synthesizing two differing repeating units"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;B&#46; Oliver"
                            1 => "M&#46;P&#46;G&#46; Van Der Linden"
                            2 => "S&#46;A&#46; K&#252;ntzel"
                            3 => "J&#46;S&#46; Saad"
                            4 => "M&#46;H&#46; Nahm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1074/jbc.M113.480152"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Biol Chem"
                        "fecha" => "2013"
                        "volumen" => "288"
                        "paginaInicial" => "25976"
                        "paginaFinal" => "25985"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23897812"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Genetic&#44; biochemical&#44; and serological characterization of a new pneumococcal serotype&#44; 6H&#44; and generation of a Pneumococcal strain producing three different capsular repeat units"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46;H&#46; Park"
                            1 => "K&#46;A&#46; Geno"
                            2 => "J&#46; Yu"
                            3 => "M&#46;B&#46; Oliver"
                            4 => "K&#46;-H&#46; Kim"
                            5 => "M&#46;H&#46; Nahm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/CVI.00647-14"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Vaccine Immunol"
                        "fecha" => "2015"
                        "volumen" => "22"
                        "paginaInicial" => "313"
                        "paginaFinal" => "318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25589550"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Genetic basis for the new pneumococcal serotype&#44; 6C"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "I&#46;H&#46; Park"
                            1 => "S&#46; Park"
                            2 => "S&#46;K&#46; Hollingshead"
                            3 => "M&#46;H&#46; Nahm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/IAI.00510-07"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infect Immun"
                        "fecha" => "2007"
                        "volumen" => "75"
                        "paginaInicial" => "4482"
                        "paginaFinal" => "4489"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17576753"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increase in prevalence of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> serotype 6C at eight children&#39;s hospitals in the United States from 1993 to 2009"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;C&#46; Green"
                            1 => "E&#46;O&#46; Mason"
                            2 => "S&#46;L&#46; Kaplan"
                            3 => "L&#46;B&#46; Lamberth"
                            4 => "S&#46;H&#46; Stovall"
                            5 => "L&#46;B&#46; Givner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/JCM.02207-10"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "2011"
                        "volumen" => "49"
                        "paginaInicial" => "2097"
                        "paginaFinal" => "2101"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21450963"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Temporal trends and molecular epidemiology of recently described serotype 6C of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Nunes"
                            1 => "C&#46; Valente"
                            2 => "R&#46; S&#225;-Le&#227;o"
                            3 => "H&#46; De Lencastre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/JCM.01984-08"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "2009"
                        "volumen" => "47"
                        "paginaInicial" => "472"
                        "paginaFinal" => "474"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19073873"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Novel pneumococcal serotypes 6C and 6D&#58; anomaly or harbinger"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;C&#46; McEllistrem"
                            1 => "M&#46;H&#46; Nahm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cid/cis691"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2012"
                        "volumen" => "55"
                        "paginaInicial" => "1379"
                        "paginaFinal" => "1386"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22903767"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Production of a unique pneumococcal capsule serotype belonging to serogroup 6"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46;E&#46; Bratcher"
                            1 => "I&#46;H&#46; Park"
                            2 => "S&#46;K&#46; Hollingshead"
                            3 => "M&#46;H&#46; Nahm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1099/mic.0.024521-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Microbiology"
                        "fecha" => "2009"
                        "volumen" => "155"
                        "paginaInicial" => "576"
                        "paginaFinal" => "583"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19202106"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and genetic structures of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> serotype 6D&#44; South Korea"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;H&#46; Choi"
                            1 => "H&#46;J&#46; Lee"
                            2 => "E&#46;Y&#46; Cho"
                            3 => "C&#46;E&#46; Oh"
                            4 => "B&#46;W&#46; Eun"
                            5 => "J&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3201/eid1611.100941"
                      "Revista" => array:6 [
                        "tituloSerie" => "Emerg Infect Dis"
                        "fecha" => "2010"
                        "volumen" => "16"
                        "paginaInicial" => "1751"
                        "paginaFinal" => "1753"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21029535"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prevalence and characteristics of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> isolates expressing serotypes 6C and 6D in Hong Kong prior to the introduction of the 7-valent pneumococcal conjugate vaccine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46;L&#46; Ho"
                            1 => "I&#46; Ang"
                            2 => "K&#46;H&#46; Chow"
                            3 => "E&#46;L&#46; Lai"
                            4 => "S&#46;S&#46; Chiu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.diagmicrobio.2010.07.020"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diagn Microbiol Infect Dis"
                        "fecha" => "2010"
                        "volumen" => "68"
                        "paginaInicial" => "439"
                        "paginaFinal" => "444"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20926218"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Type distribution of serogroup 6 <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> and molecular epidemiology of newly identified serotypes 6C and 6D in China"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;-H&#46; Yao"
                            1 => "Z&#46;-J&#46; Liu"
                            2 => "J&#46;-G&#46; Yu"
                            3 => "S&#46;-J&#46; Yu"
                            4 => "L&#46; Yuan"
                            5 => "M&#46;H&#46; Nahm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.diagmicrobio.2011.03.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diagn Microbiol Infect Dis"
                        "fecha" => "2011"
                        "volumen" => "70"
                        "paginaInicial" => "291"
                        "paginaFinal" => "298"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21546198"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Grupo de Microbiolog&#237;a Informe Nacional de SIREVA II Colombia 1994&#8211;2005 <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>&#46; Distribuci&#243;n de los aislamientos invasores por a&#241;o de vigilancia departamento&#44; grupos de edad&#44; serotipos y sensibilidad antimicrobiana&#59; <a href="http://www.ins.gov.co/tramites-y-servicios/examenes-de-inter%C3%A9s-en-salud-publica/Microbiologa/Informe%20Nacional%20de%20SIREVA%20II%20Colombia%201994-2005.%20Streptococcus%20pneumoniae.pdf">http&#58;&#47;&#47;www&#46;ins&#46;gov&#46;co&#47;tramites-y-servicios&#47;examenes-de-inter&#37;C3&#37;A9s-en-salud-publica&#47;Microbiologa&#47;Informe&#37;20Nacional&#37;20de&#37;20SIREVA&#37;20II&#37;20Colombia&#37;201994-2005&#46;&#37;20Streptococcus&#37;20pneumoniae&#46;pdf</a> &#91;cited 13 January 2016&#93;&#46;"
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Grupo de Microbiolog&#237;a Informe Nacional de SIREVA II Colombia 2006&#8211;2014&#46; <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> Distribuci&#243;n de los aislamientos invasores por a&#241;o de vigilancia departamento&#44; grupos de edad&#44; serotipos y sensibilidad antimicrobiana&#59; Available from&#58; <a href="http://www.ins.gov.co/tramites-y-servicios/examenes-de-inter%C3%A9s-en-salud-publica/Microbiologa/Informe%20Nacional%20de%20SIREVA%20II%20Colombia%202006-2014.%20Streptococcus%20pneumoniae.pdf">http&#58;&#47;&#47;www&#46;ins&#46;gov&#46;co&#47;tramites-y-servicios&#47;examenes-de-inter&#37;C3&#37;A9s-en-salud-publica&#47;Microbiologa&#47;Informe&#37;20Nacional&#37;20de&#37;20SIREVA&#37;20II&#37;20Colombia&#37;202006-2014&#46;&#37;20Streptococcus&#37;20pneumoniae&#46;pdf</a> &#91;cited 13 January 2016&#93;&#46;"
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Performance standards for antimicrobial susceptibility testing&#59; twenty-first informational supplement&#46; CLSI document M100-S25"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "CLSI"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2015"
                        "editorial" => "Clinical Laboratory Standards Institute"
                        "editorialLocalizacion" => "Wayne&#44; PA"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "PCR-based quantitation and clonal diversity of the current prevalent invasive serogroup 6 pneumococcal serotype&#44; 6C&#44; in the United States in 1999 and 2006 to 2007"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;D&#46;G&#46; Carvalho"
                            1 => "F&#46;C&#46; Pimenta"
                            2 => "R&#46;E&#46; Gertz"
                            3 => "H&#46;H&#46; Joshi"
                            4 => "A&#46;A&#46; Trujillo"
                            5 => "L&#46;E&#46; Keys"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/JCM.01919-08"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "2009"
                        "volumen" => "47"
                        "paginaInicial" => "554"
                        "paginaFinal" => "559"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19116353"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sequential multiplex PCR approach for determining capsular serotypes of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> isolates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Pai"
                            1 => "R&#46;E&#46; Gertz"
                            2 => "B&#46; Beall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "fecha" => "2006"
                        "volumen" => "44"
                        "paginaInicial" => "124"
                        "paginaFinal" => "131"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Serotype and genotype distribution among invasive <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> isolates in Colombia&#44; 2005&#8211;2010"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46;L&#46; Parra"
                            1 => "V&#46; Ramos"
                            2 => "O&#46; Sanabria"
                            3 => "J&#46; Moreno"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0084993"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLOS ONE"
                        "fecha" => "2014"
                        "volumen" => "9"
                        "paginaInicial" => "e84993"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24416330"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available from&#58; <span class="elsevierStyleInterRef" id="intr0040" href="http://www.ncbi.nlm.nih.gov/pubmed/9846740">http&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;pubmed&#47;9846740</span>"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A multilocus sequence typing scheme for <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>&#58; identification of clones associated with serious invasive disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;C&#46; Enright"
                            1 => "B&#46;G&#46; Spratt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1099/00221287-144-11-3049"
                      "Revista" => array:7 [
                        "tituloSerie" => "Microbiology"
                        "fecha" => "1998"
                        "volumen" => "144"
                        "numero" => "Pt 1"
                        "paginaInicial" => "3049"
                        "paginaFinal" => "3060"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9846740"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Test of a novel <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> serotype 6C type specific polyclonal antiserum &#40;factor antiserum 6d&#41; and characterisation of serotype 6C isolates in Denmark"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Lambertsen"
                            1 => "M&#46;B&#46; Kerrn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "BMC Infect"
                        "fecha" => "2010"
                        "volumen" => "10"
                        "paginaInicial" => "282"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Occurrence&#44; distribution&#44; and origins of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> Serotype 6C&#44; a recently recognized serotype"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;R&#46; Jacobs"
                            1 => "S&#46; Bajaksouzian"
                            2 => "R&#46;A&#46; Bonomo"
                            3 => "C&#46;E&#46; Good"
                            4 => "A&#46;R&#46; Windau"
                            5 => "A&#46;M&#46; Hujer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/JCM.01524-08"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "2009"
                        "volumen" => "47"
                        "paginaInicial" => "64"
                        "paginaFinal" => "72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18971356"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characterization of invasive pneumococci of serogroup 6 from adults in Barcelona&#44; Spain&#44; in 1994 to 2008"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Rolo"
                            1 => "C&#46; Ardanuy"
                            2 => "L&#46; Calatayud"
                            3 => "R&#46; Pallares"
                            4 => "I&#46; Grau"
                            5 => "E&#46; Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/JCM.02545-10"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "2011"
                        "volumen" => "49"
                        "paginaInicial" => "2328"
                        "paginaFinal" => "2330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21450964"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "PAHO SIREVA II&#46; Regional Report 2012 to 2013 Data by country and by age group on the characteristics of isolates of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>&#44; <span class="elsevierStyleItalic">Haemophilus influenzae</span> and <span class="elsevierStyleItalic">Neisseria meningitidis</span> in invasive processes&#46; Washington&#44; DC Document available in&#58; <a href="http://new.paho.org/hq/index.php?option=com_content%26view=category%26layout=blog%26id=3609%26Itemid=3953">http&#58;&#47;&#47;new&#46;paho&#46;org&#47;hq&#47;index&#46;php&#63;option&#61;com&#95;content&#38;view&#61;category&#38;layout&#61;blog&#38;id&#61;3609&#38;Itemid&#61;3953</a>"
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increased penicillin nonsusceptibility of nonvaccine-serotype invasive pneumococci other than serotypes 19A and 6A in post-7-valent conjugate vaccine era"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;E&#46; Gertz"
                            1 => "Z&#46; Li"
                            2 => "F&#46;C&#46; Pimenta"
                            3 => "D&#46; Jackson"
                            4 => "B&#46;A&#46; Juni"
                            5 => "R&#46; Lynfield"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "2010"
                        "volumen" => "201"
                        "paginaInicial" => "770"
                        "paginaFinal" => "775"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20178139"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Elementos gen&#233;ticos m&#243;viles asociados con resistencia a eritromicina en aislamientos de <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> en Colombia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46; Ramos"
                            1 => "C&#46; Duarte"
                            2 => "A&#46; D&#237;az"
                            3 => "J&#46; Moreno"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/S0120-41572014000500023"
                      "Revista" => array:7 [
                        "tituloSerie" => "Biomedica"
                        "fecha" => "2014"
                        "volumen" => "34"
                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "209"
                        "paginaFinal" => "216"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24968052"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Molecular epidemiology of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> serogroup 6 isolates from Fijian children&#44; including newly identified serotypes 6C and 6D"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Satzke"
                            1 => "B&#46;D&#46; Ortika"
                            2 => "S&#46; Oftadeh"
                            3 => "F&#46;M&#46; Russell"
                            4 => "R&#46;M&#46; Robins-Browne"
                            5 => "E&#46;K&#46; Mulholland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/JCM.00861-10"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "2010"
                        "volumen" => "48"
                        "paginaInicial" => "4298"
                        "paginaFinal" => "4300"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20810769"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and genetic diversity of pneumococcal serogroup 6 in Australia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Zhuo"
                            1 => "M&#46; Xiao"
                            2 => "F&#46; Kong"
                            3 => "S&#46; Oftadeh"
                            4 => "F&#46; Zhou"
                            5 => "J&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1469-0691.2010.03404.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Infect"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "1246"
                        "paginaFinal" => "1253"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20950338"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A report of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> serotype 6D in Europe"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;H&#46; Nahm"
                            1 => "M&#46;B&#46; Oliver"
                            2 => "L&#46; Siira"
                            3 => "T&#46; Kaijalainen"
                            4 => "L&#46;M&#46; Lambertsen"
                            5 => "A&#46; Virolainen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1099/jmm.0.023853-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Med Microbiol"
                        "fecha" => "2011"
                        "volumen" => "60"
                        "paginaInicial" => "46"
                        "paginaFinal" => "48"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20829399"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Baseline epidemiology and genetic structure of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> serotype 6D in southern Israel prior to introduction of pneumococcal conjugate vaccines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46; Porat"
                            1 => "R&#46; Benisty"
                            2 => "R&#46; Trefler"
                            3 => "D&#46; Ozalvo"
                            4 => "N&#46; Givon-Lavi"
                            5 => "R&#46; Dagan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/JCM.03320-12"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "2013"
                        "volumen" => "51"
                        "paginaInicial" => "1580"
                        "paginaFinal" => "1582"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23447629"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "First report of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> serotype 6D in South America"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Mercado"
                            1 => "V&#46; Srinivasan"
                            2 => "P&#46; Hawkins"
                            3 => "S&#46; Chochua"
                            4 => "T&#46; Ochoa"
                            5 => "B&#46; Beall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/JCM.00153-11"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "2011"
                        "volumen" => "49"
                        "paginaInicial" => "2080"
                        "paginaFinal" => "2081"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21430101"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ministerio de la Protecci&#243;n Social&#46; Acuerdo N&#250;mero 406 de 2009&#46; Available&#58; <a href="https://www.minsalud.gov.co/Normatividad_Nuevo/ACUERDO%20406%20DE%202009.pdf#search=%252Cneumococo">https&#58;&#47;&#47;www&#46;minsalud&#46;gov&#46;co&#47;Normatividad&#95;Nuevo&#47;ACUERDO&#37;20406&#37;20DE&#37;202009&#46;pdf&#35;search&#61;&#37;252Cneumococo</a> &#91;accessed 14 January 2016&#93;&#46;"
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ministerio de Salud y Protecci&#243;n Social&#46; Direcci&#243;n de Promoci&#243;n y Prevenci&#243;n Subdirecci&#243;n de enfermedades transmisibles Programa Ampliado de Inmunizaciones Jornada de Vacunaci&#243;n en Las Americas 2012&#46; Available&#58; <a href="https://www.minsalud.gov.co/Lineamientos/Documento_Marco_Jornada_de_Vacunacion_de_las_Am%C3%A9ricas_abril2012.pdf#search=%252Cneumococo">https&#58;&#47;&#47;www&#46;minsalud&#46;gov&#46;co&#47;Lineamientos&#47;Documento&#95;Marco&#95;Jornada&#95;de&#95;Vacunacion&#95;de&#95;las&#95;Am&#37;C3&#37;A9ricas&#95;abril2012&#46;pdf&#35;search&#61;&#37;252Cneumococo</a> &#91;accessed 14 January 2016&#93;&#46;"
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack281671"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0105" class="elsevierStylePara elsevierViewall">We acknowledge Elizabeth Casta&#241;eda &#40;PhD and Emeritus Researcher&#44; Instituto Nacional de Salud&#44; Bogot&#225;&#44; Colombia&#41; for her critical review to the manuscript&#46; We also thank Dr&#46; Mar&#237;a Cristina Brandileone at the Institute Adolfo Lutz of Brazil by the Portugal<span class="elsevierStyleSup">6A</span>ST327 clone and serotype 6C strains&#44; which were used in the PFGE and PCR controls&#46; We also are grateful Dr&#46; Carvahalo at the Centers for Disease Control &#38; Prevention&#44; Atlanta&#44; by the isolate 6D&#44; was used as a control in the quellung reaction&#46; Also&#44; we want to express our gratitude to Diana Diaz and Viviana Ramos by their technical support in the molecular methodology&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/2529993X/0000003500000005/v1_201705111055/S2529993X17301089/v1_201705111055/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/0000003500000005/v1_201705111055/S2529993X17301089/v1_201705111055/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17301089?idApp=UINPBA00004N"
]

Article information

ISSN: 2529993X
Original language: English

DOI:10.1016/j.eimce.2017.03.017

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	2	0	2
2024 October	9	4	13
2024 September	5	3	8
2024 August	11	8	19
2024 July	12	5	17
2024 June	4	3	7
2024 May	7	1	8
2024 April	10	7	17
2024 March	7	5	12
2024 February	7	2	9
2024 January	10	1	11
2023 December	8	5	13
2023 November	9	8	17
2023 October	11	1	12
2023 September	8	0	8
2023 August	4	0	4
2023 July	4	3	7
2023 June	5	2	7
2023 May	6	1	7
2023 April	5	1	6
2023 March	8	2	10
2023 February	8	2	10
2023 January	6	1	7
2022 December	8	13	21
2022 November	10	4	14
2022 October	11	9	20
2022 September	10	7	17
2022 August	21	7	28
2022 July	7	5	12
2022 June	4	3	7
2022 May	11	5	16
2022 April	18	6	24
2022 March	35	7	42
2022 February	21	6	27
2022 January	21	7	28
2021 December	24	4	28
2021 November	6	5	11
2021 October	11	9	20
2021 September	20	13	33
2021 August	11	5	16
2021 July	9	4	13
2021 June	13	10	23
2021 May	16	7	23
2021 April	19	14	33
2021 March	11	6	17
2021 February	10	4	14
2021 January	10	8	18
2020 December	11	12	23
2020 November	10	6	16
2020 October	9	5	14
2020 September	11	7	18
2020 August	11	7	18
2020 July	7	8	15
2020 June	8	7	15
2020 May	13	7	20
2020 April	7	2	9
2020 March	10	2	12
2020 February	6	4	10
2020 January	9	4	13
2019 December	16	13	29
2019 November	8	6	14
2019 October	12	3	15
2019 September	9	2	11
2019 August	8	6	14
2019 July	15	9	24
2019 June	30	15	45
2019 May	106	11	117
2019 April	34	11	45
2019 March	6	5	11
2019 February	3	4	7
2019 January	2	5	7
2018 December	0	3	3
2018 November	3	3	6
2018 October	7	7	14
2018 September	5	2	7
2018 August	7	3	10
2018 July	5	1	6
2018 June	2	2	4
2018 May	3	4	7
2018 April	2	1	3
2018 March	8	1	9
2018 February	2	4	6
2018 January	11	0	11
2017 December	1	1	2
2017 November	4	1	5
2017 October	10	0	10

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter