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Original article
Epidemiological surveillance study of gonococcal infection in Northern Spain
Estudio de vigilancia epidemiológica de la infección gonocócica en el Norte de España
Urko Ibargoyen Garcíaa, Maria Carmen Nieto Tobosob,
Corresponding author
, Elisabet Montoya Azpeitiab, Manuel Imaz Perezb, Leonora Hernandez Ragpab, Jose Angel Álava Menicab, Mari Mar Cámara Pérezc, Josefina López de Munain Lópezc, Josefa Muñoz Sanchezc, Jose Luís Díaz de Tuesta del Arcob, Ramón Cisterna Cancerb
a Departamento de Inmunología, Microbiología y Parasitología (Facultad de Medicina), Universidad del País Vasco, Leioa, Vizcaya, Spain
b Servicio de Microbiología Clínica y Control de Infección, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
c Servicio de Enfermedades Infecciosas, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Gonococcal infection &#40;GI&#41; is the second most prevalent sexually transmitted infection &#40;STI&#41; of bacterial origin&#44; followed by <span class="elsevierStyleItalic">Chlamydia trachomatis</span>&#44; and represents an important public health problem due to its prevalence as well as to the complications it can cause&#46; In 2016&#44; 75&#44;349 cases of GI were reported in 27 countries of the European Union and the European Economic Area &#40;EU&#47;EEA&#41; had an incidence of 18&#46;8 cases per 100&#44;000 inhabitants&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a> Although GIs occasionally are asymptomatic&#44; especially in women&#44; they can cause severe complications such as epididymitis&#44; pelvic inflammatory disease&#44; ectopic pregnancy and an increased transmission risk of the human immunodeficiency virus &#40;HIV&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a> Due to these reasons&#44; an appropriate diagnosis and an effective treatment are necessary&#46; However <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span> &#40;NG&#41; has developed resistance mechanisms to all the antimicrobial introduced for its treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">At present&#44; the &#8220;Centers for Disease Control and Prevention&#8221; &#40;CDC&#41; and the World Health Organisation &#40;WHO&#41; recommend a dual therapy of 250<span class="elsevierStyleHsp" style=""></span>mg of ceftriaxone along with 1<span class="elsevierStyleHsp" style=""></span>g of azithromycin&#44; while the combination of 400<span class="elsevierStyleHsp" style=""></span>mg cefixime and 1<span class="elsevierStyleHsp" style=""></span>g azithromycin constitutes the alternative therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4&#44;5</span></a> On the other hand&#44; some clinical guidelines recommend only treatment with ceftriaxone 1<span class="elsevierStyleHsp" style=""></span>g as a single dose&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a> However&#44; several countries have reported cases of gonococcal strains with resistance or diminished susceptibility to ESCs and treatment failures with cefixime and ceftriaxone&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">7&#8211;9</span></a> Besides&#44; resistance to azithromycin has increased worldwide&#46; Due to these facts&#44; epidemiological surveillance programmes have been developed to detect patterns of antimicrobial resistance at regional&#44; national and international levels&#44; in order to design effective treatments against GI&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Molecular epidemiological surveillance is a useful tool to identify correlations between NG genotypes and antimicrobial resistance profiles&#44; in order to have a better understanding of the emergence and propagation of resistant gonococcal strains&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The objectives of this study are to analyse the antimicrobial susceptibility of the NG strains isolated from patients belonging to the Integrated Health Organisation &#40;OSI&#41; Bilbao-Basurto &#40;Spain&#41;&#44; and to perform their genotyping with the aim of elucidating associations between circulating NG genotypes and antimicrobial resistance&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">All NG strains isolated from 2011 to 2015 in the Clinical Microbiology Service and Infection Control of the Basurto University Hospital of Bilbao &#40;Spain&#41; were included in this study&#46; These NG strains were recovered from patients of the OSI Bilbao-Basurto&#44; which covers a population of 356&#44;000 &#40;2016&#41; inhabitants&#44; and integrates the Basurto University Hospital&#44; 25 Primary Care Centers and two specialized STI consultations&#46; STI consultations are led by specialized staff &#40;infectious disease doctors and clinical microbiologists&#41; where a complete protocol for the diagnosis of STIs is carried out and a patient&#39;s clinical and sexual history are taken&#46; To analyse the results of antimicrobial sensitivity and molecular typing&#44; an isolate by location and patient was included&#46; Regarding the analysis of the incidence of GI&#44; the different episodes were registered&#46; It was considered as a new episode when the same patient returned to the STI consultation with re-infection three months after a GI episode was treated and cured &#40;no signs&#44; nor symptoms nor presence of microorganisms&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Identification of NG strains was performed by means of Gram staining&#44; cytochrome-oxidase test&#44; catalase production and biochemical identification through the NH API system &#40;BioM&#233;rieux&#44; France&#41; and confirmed by MALDI-TOF&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical data such as patient gender&#44; age&#44; geographic origin&#44; type of sexual relations maintained during the episode &#40;heterosexual or homosexual&#41; and anatomic site of infection&#44; were recorded&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Antimicrobial susceptibility of NG isolates was carried out using the disc diffusion method in GC agar base &#40;difco GC Medium Base&#44; Becton Dickinson&#41; with 1&#37; Vitox &#40;OXOID&#8482;&#41;&#44; according to CLSI recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> Antimicrobials tested were penicillin&#44; ciprofloxacin&#44; tetracycline&#44; azithromycin&#44; gentamicin&#44; spectinomycin&#44; cefixime and ceftriaxone&#46; Antimicrobial susceptibility to cefixime and ceftriaxone was also studied through agar dilution technique&#46; Regarding to azithromycin&#44; determination of MIC &#40;minimum inhibitory concentration&#41; was assessed by Etest&#46; Results were interpreted according to the breakpoints established by EUCAST&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> except for gentamicin for which the breakpoints applied were those proposed by Bala et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a> The results obtained were validated with NG strain ATCC 49226&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> &#946;-Lactamase production was analysed by the Nitrocefin SRO112C &#40;OXOID&#8482;&#41; test&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Molecular typing was performed by NG multi-antigen sequence typing &#40;NG-MAST&#41; technique as described Martin et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a> which differentiates strains according to variations in internal fragments of two genes&#44; the <span class="elsevierStyleItalic">porB</span> gene &#40;producer of the <span class="elsevierStyleItalic">PorB</span> porin&#41; and the <span class="elsevierStyleItalic">tbpB</span> gene &#40;producer of the transferrin binding protein subunit B&#41;&#46; Allele numbers and sequence types &#40;STs&#41; were assigned using the NG-MAST database &#40;<a href="http://www.ng-mast.net/">www&#46;ng-mast&#46;net</a>&#41;&#46; In addition&#44; the alleles of the predominant STs &#40;represented by &#8805;10 isolates&#41; were classified in genogroups as described by Chisholm et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> Genogroups were named using the letter &#8220;G&#8221; followed by the predominant ST of each group&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis of the data</span><p id="par0050" class="elsevierStylePara elsevierViewall">The Kolmogorov&#8211;Smirnov test was used to verify the normality of the distribution when analysing the quantitative variables&#46; To observe whether significant differences existed in the MIC<span class="elsevierStyleInf">50</span> throughout the years&#44; Student&#39;s <span class="elsevierStyleItalic">t</span> test was used&#44; or the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test if the normality of the distribution was not met&#46; When analysing the relationship between categorical variables&#44; Pearson&#39;s Chi-square test &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#41; was used or Fisher&#39;s exact test when any value of the calculation table was equal to zero&#46; To explore associations between STs and Gs with the demographic characteristics of the patients and with the antimicrobial resistance&#44; the &#8220;odds ratio&#8221; &#40;OR&#41; was calculated with a confidence interval &#40;CI&#41; of 95&#37;&#46; To verify if the ORs were significantly different&#44; Pearson&#39;s <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test was used&#44; except when any of the cells of the contingency table had a value equal to zero&#44; in which case the Fisher exact test was conducted&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">A total of 731 NG isolates were recovered from 576 patients&#46; In 22 patients&#44; two episodes of GI were detected and in 3 patients three episodes&#44; resulting 604 episodes&#46; There were 134 episodes in 2011 &#40;38 cases per 100&#44;000 inhabitants&#41;&#44; 91 in 2012 &#40;26&#47;100&#44;000&#41;&#44; 84 in 2013 &#40;24&#47;100&#44;000&#41;&#44; 158 in 2014 &#40;45&#46;6&#47;100&#44;000&#41; and 137 in 2015 &#40;40&#46;6&#47;100&#44;000&#41;&#46; The majority of the patients &#40;85&#46;4&#37;&#41; were attended in the specialized STI consultations&#44; due to appearance of clinical manifestations &#40;68&#37;&#41;&#44; as part of a screening &#40;14&#37;&#41; or due to risky sexual behaviours &#40;18&#37;&#41;&#46; Only a small percentage came from Primary Care Centers &#40;8&#46;4&#37;&#41; or Emergency of Basurto University Hospital &#40;6&#46;2&#37;&#41;&#44; from where they were subsequently referred to STI consultations&#46; 80&#46;3&#37; &#40;463&#41; of patients were male and 19&#46;7&#37; &#40;113&#41; female&#46; The mean age of patients was 33 years &#40;16&#8211;81 years&#41;&#46; Furthermore&#44; 35&#46;4&#37; were in the range of 25&#8211;34 years&#44; followed by the range of 35&#8211;44 years &#40;27&#46;8&#37;&#41;&#44; 16&#8211;24 years &#40;22&#46;4&#37;&#41; and over 44 years &#40;14&#46;4&#37;&#41;&#46; Regarding patient nationality&#44; 72&#46;2&#37; &#40;416&#41; were from Spain&#44; 18&#46;1&#37; &#40;104&#41; from Latin America&#44; 6&#46;7&#37; &#40;39&#41; from Africa&#44; 1&#46;8&#37; &#40;11&#41; Europeans from countries other than Spain and 0&#46;9&#37; &#40;6&#41; from Asia&#46; 43&#46;9&#37; &#40;253&#41; of patients were men who have sex with men &#40;MSM&#41; and among the females no homosexual relation was declared&#46; Most of isolates were obtained from urethral samples &#40;54&#46;0&#37;&#41;&#44; followed by rectal &#40;19&#46;0&#37;&#41;&#44; pharyngeal &#40;12&#46;3&#37;&#41;&#44; endocervical &#40;9&#46;5&#37;&#41; and vaginal &#40;5&#46;2&#37;&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Ten isolates &#40;1&#46;3&#37;&#41; were susceptible to penicillin &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; and 9&#46;2&#37; were resistant due to plasmid-mediated beta-lactamase production&#46; All the strains were susceptible to cefixime and ceftriaxone&#46; However&#44; three strains presented MICs of 0&#46;125<span class="elsevierStyleHsp" style=""></span>mg&#47;L to ceftriaxone&#44; a dilution close to EUCAST breakpoint &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;125<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#41;&#46; Both cefixime and ceftriaxone presented a MIC<span class="elsevierStyleInf">50</span> of 0&#46;004<span class="elsevierStyleHsp" style=""></span>mg&#47;L and the MIC<span class="elsevierStyleInf">90</span> was 0&#46;030<span class="elsevierStyleHsp" style=""></span>mg&#47;L in cefixime and 0&#46;015<span class="elsevierStyleHsp" style=""></span>mg&#47;L in ceftriaxone&#46; Throughout the study a decrease of the MIC<span class="elsevierStyleInf">90</span> of ceftriaxone from 0&#46;060<span class="elsevierStyleHsp" style=""></span>mg&#47;L to 0&#46;015<span class="elsevierStyleHsp" style=""></span>mg&#47;L was observed &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The percentage of resistant strains to azithromycin was 1&#46;3&#37; and 3&#46;4&#37; in 2011 and 2012 respectively&#44; and increased to 5&#46;1&#37; in 2013&#46; However&#44; it decreased significantly&#44; being 0&#46;5&#37; in 2014 and 0&#46;6&#37; in 2015&#46; Throughout the study&#44; the percentage of resistant to azithromycin has been 1&#46;8&#37; and&#44; in the year 2013&#44; one strain showed a MIC of 96<span class="elsevierStyleHsp" style=""></span>mg&#47;L by Etest&#46; Regarding ciprofloxacin 50&#46;6&#37; of the strains showed resistance or intermediate susceptibility&#46; 41&#46;2&#37; of strains were susceptible to tetracycline&#44; and 730 isolates &#40;99&#46;9&#37;&#41; were susceptible to spectinomycin&#46; Regarding gentamicin&#44; considering susceptible those strains with zone diameter &#8805;16<span class="elsevierStyleHsp" style=""></span>mm&#44; with intermediate susceptibility between 13&#8211;15<span class="elsevierStyleHsp" style=""></span>mm and resistant &#8804;12<span class="elsevierStyleHsp" style=""></span>mm&#44; all strains were susceptible&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Molecular characterization was performed on 573 strains corresponding to the 2012&#8211;2015 period&#46; In 42 strains had no database match &#40;<a href="http://www.ng-mast.net/">www&#46;ng-mast&#46;net</a>&#41;&#44; while the remainder matched to 110 different STs&#44; with 83 <span class="elsevierStyleItalic">porB</span> alleles and 42 <span class="elsevierStyleItalic">tbpB</span> alleles&#46; Fifty-three STs were represented by &#8805;2 isolates and 37 STs by &#8805;3 isolates&#46; The most prevalent STs&#44; represented by <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10 isolates&#44; are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; The STs 2992&#44; 292&#44; 1407 and 2487 were observed throughout the entire period studied &#40;2012&#8211;2015&#41;&#46; Conversely&#44; ST5533 was just detected from January to April of 2012&#44; affecting both heterosexual men&#44; women and MSM and the ST4186&#44; which was the most prevalent ST&#44; was only observed in 2014 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41; and in 2015 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Six genogroups were defined encompassing 242 &#40;42&#46;23&#37;&#41; of all isolates &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; G2992 was the largest and G1407 grouped the higher number of different STs&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Based on gender category&#44; G1861 &#40;OR&#58; 4&#46;763&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; G1407 &#40;OR&#58; 2&#46;377&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#41;&#44; G2018 &#40;OR&#58; 4&#46;667&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41; and ST387 &#40;OR&#58; 7&#46;038&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; were more prevalent in females&#44; while ST5624 was only present in males &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;016&#41;&#46; With regard to age category&#44; G1861 was found more frequently in patients aged under 24 &#40;OR&#58; 4&#46;281&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#44; whereas G2018 &#40;OR&#58; 4&#46;860&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41; and G2992 &#40;OR&#58; 2&#46;671&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#44; were more associated with patients aged over 44&#46; Regarding sexual orientation&#44; G1407 was more common among heterosexual patients &#40;OR&#58; 4&#46;574&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41; and all isolates of G2018 were detected in heterosexual patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46; On the other hand&#44; G2992 &#40;OR&#58; 4&#46;734&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41; and G2400 &#40;OR&#58; 16&#46;488&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; were more frequently observed in MSM&#46; An association was not found between patient geographic location and the genogroups or STs described&#46; It was also observed that the strains belonging to G1407 presented high MICs &#40;MIC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;030<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#41; to cefixime &#40;OR&#58; 16&#46;393&#41; and ceftriaxone &#40;OR&#58; 26&#46;881&#41;&#46; G2018 was associated with strains with high MICs to ceftriaxone &#40;OR&#58; 19&#46;164&#41; and azithromycin resistance &#40;OR&#58; 3&#46;017&#41; was associated with G2992&#46; G2400 showed a high ratio of isolates with resistance to ciprofloxacin &#40;OR&#58; 41&#46;090&#41; and a moderate ratio with a high MICs to cefixime &#40;OR&#58; 3&#46;654&#41;&#46; All the isolates of G1861&#44; G2018&#44; G1407 and ST5624 showed resistance or intermediate susceptibility to ciprofloxacin &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#44; based on a significant association detected by means of Fisher&#39;s exact test &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">This study is one of the few published in Spain&#44; along with the ones published in Barcelona<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">15&#44;16</span></a> and Almer&#237;a&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> that analyses associations between STs of NG and antimicrobial resistance profile&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The incidence of GI observed&#44; with a minimum of 24 cases per 100&#44;000 inhabitants &#40;2013&#41; and a maximum of 45&#46;6 cases per 100&#44;000 inhabitants &#40;2014&#41;&#44; is much higher than that observed in Spain during the same period of time by the National Epidemiological Monitoring Network &#40;RENAVE&#41;&#44; who recorded a minimum of 5&#46;7 cases per 100&#44;000 inhabitants &#40;2011&#41; and a maximum of 11&#46;4 cases per 100&#44;000 &#40;2015&#41;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a> or by ECDC who detected a rate of 18&#46;8 cases per 100&#44;000 inhabitants of the EU&#47;EEA &#40;2016&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a> These data indicate that GI could be underestimated due to a suboptimal diagnosis&#44; a lack of screening in asymptomatic patients and&#47;or incomplete diagnostics in cases of STD&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the present study&#44; male patients are predominantly involved&#44; accounting for 80&#46;3&#37; of the episodes&#46; A similar percentage was observed in the RENAVE network in 2015 &#40;88&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a> and by the EU&#47;EEA in 2016 &#40;70&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a> Most of the cases were produced in patients aged 25&#8211;44 while patients under 25 years comprised 22&#46;4&#37; of cases&#44; lower than the 36&#37; observed by the ECDC&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a> The MSM group accounted for 43&#46;9&#37; of the patients with GI&#44; which is in close agreement with the rate observed by the ECDC in 2016 &#40;46&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The high rates of resistance to penicillin&#44; ciprofloxacin and tetracycline are similar to those observed in other studies carried out in Spain<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">15&#44;17</span></a> and the ECDC&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> This fact reinforces the instructions of the ECDC and WHO to not use these antimicrobials for the empirical treatment of the GIs&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4&#44;19</span></a> NG strains resistant to cefixime and ceftriaxone have been reported from several countries&#44; including Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a> However&#44; in the present study there was no observation of any strain resistant to these antibiotics&#44; for which reason the dual therapy based on ESC plus azithromycin recommended by ECDC and WHO continues to be the best therapeutic option to treat GI in our health area&#46; Since antimicrobial resistance is the principal challenge associated with this microorganism&#44; institutions should determine a unique breakpoint to define resistance&#46; As a matter of fact&#44; three isolates showed MIC to ceftriaxone of 0&#46;125<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#44; a dilution below the resistance threshold according to the breakpoints published by EUCAST &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;125<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#41;&#44; but far from being considered resistant according to CLSI &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;25<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#41;&#46; Azithromycin constitutes a front-line option in dual therapy along with ceftriaxone with the objective of eradicating the possible coexisting infection by <span class="elsevierStyleItalic">C&#46; trachomatis</span> and due to its involvement in the treatment of pharyngeal gonorrhoea&#46; However&#44; probably due to the generalised use that has been made of this antibiotic to treat this type of infections as well as for respiratory infections&#44; resistance to azithromycin has been developed&#44; as it was shown in ECDC published percentages &#40;7&#46;5&#37; in 2017<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a>&#41;&#46; In our study&#44; in contrast&#44; a clear decline of strains with intermediate susceptibility or resistance to azithromycin from 8&#46;3&#37; in 2013 to 0&#46;7&#37; in 2015 was detected&#46; From all isolates tested only one was resistant to spectinomycin and no resistance was observed to gentamicin according to the criteria used&#46; These results could suggest the use of these antibiotics as an alternative treatment of GI&#46; However&#44; the national therapeutic guidelines do not recommend them because spectinomycin is not available in Spain and its effectiveness is lower in pharyngeal and rectal infections&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a> and the WHO does not consider the use of gentamicin due to lack of data supporting its <span class="elsevierStyleItalic">in vivo</span> efficacy in GI&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">ST1407 and ST2992 stand out for being prevalent in Spain<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">15&#8211;17</span></a> and in the Euro-GASP study &#40;2010&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> in which they observed that ST1407 was the predominant ST in 13 countries of the EU&#47;EEA&#46; ST387&#44; one of the most frequent in our study was also detected by the Euro-GASP<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> and in the study conducted in Almer&#237;a&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> Regarding the ST4186&#44; the most prevalent in our study&#44; in the study of Chisholm et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> it is not among the most prevalent ST in Europe and has not been published in Spain&#44; which indicates that it could be an ST endemic to our area&#46; In addition&#44; ST4186 does not belong to any genogroup&#44; which reveals that it is a new clone that does not descend from the most prevalent&#46; Given that ST5533 was isolated in a determined period of time &#40;January to April of 2012&#41; and was not reported in other studies as a frequent ST&#44; it could be an outbreak of GI in our area&#46; In this study 42 strains were not detected in NG-MAST database suggesting that they could be newly emerging or previously not characterized STs&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Regarding the genogroups&#44; G2992 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#41; and G1407 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#41; were the largest&#46; These were also the largest in the Euro-GASP study in 2010<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> and they were detected in other European studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">16&#44;21&#8211;24</span></a> G2400 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#41; was detected in Italy&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a> France<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a> and other areas of our country&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a> The association between genogroups G2992 and G2400 and the MSM collective also were observed by Euro-GASP group&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> In addition&#44; G2992 was widely detected throughout the study period&#44; which could indicate the presence of an outbreak of GI within MSM&#46; Another important fact that the analysis of the genogroups and the antimicrobial resistance provides us is the significant relationship found between G2992&#44; and the presence of resistance to azithromycin&#44; an association already published by a Dutch study &#40;2008&#8211;2015&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> which indicates that the presence of G2992 could become a public health problem in our area&#46; The relationship between infection by G1407 and the presence of high MICs &#40;MIC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;030<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#41; to cefixime and ceftriaxone has already been described in several European studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">14&#44;16&#44;23&#8211;26</span></a> These results show how valuable molecular typing is in predicting the NG antimicrobial resistance&#44; since the use of cefixime as the empirical treatment of the GI produced by G1407 seems inappropriate&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> The relationship between G2400 and high MICs for cefixime has not been published to date in any European study&#46; Nonetheless&#44; in USA in 2014 a study demonstrated a significant relationship between this genogroup and the presence of strains with intermediate MICs &#40;0&#46;032&#8211;0&#46;0394<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#41; to cefixime and ceftriaxone<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> and in Canada G2400 was correlated with reduced susceptibility to cefixime and ceftriaxone&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a> We found a significant relationship between G2400 and resistance to ciprofloxacin&#44; a fact already published in studies conducted in Greenland<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a> and in Canada&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a> In this work we describe for the first time the presence of G1861 and G2018 as well as their relationship with resistance to ciprofloxacin and association of G2018 with the presence of high MICs to ceftriaxone&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In conclusion&#44; by analysing the associations between the different STs and Gs detected and antimicrobial resistance&#44; we obtained very valuable information&#46; G1407&#44; G2400 and G2018&#44; which encompassed 14&#46;5&#37; of the strains isolated&#44; are significantly related to high MICs of cefixime and&#47;or ceftriaxone&#46; Furthermore&#44; the resistance to azithromycin shown by the strains belonging to G2992&#44; indicates that a high number of resistant strains or with high MICs to the antimicrobials recommended are circulating in our environment&#44; which could cause treatment failures with cefixime and ceftriaxone in the future and azithromycin at present&#46; In this context&#44; it seems necessary to develop novel antimicrobials or to design new antimicrobial therapies based on drugs that show their efficacy against GI&#44; such as gentamicin&#46; We must highlight the importance of STI surveillance especially in the homosexual population&#44; since two of the most prevalent genotypes in our area&#44; G2992 and G2400&#44; are significantly associated with MSM&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding source</span><p id="par0115" class="elsevierStylePara elsevierViewall">The present investigation has received a scholarship from OSI Bilbao- Basurto&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0120" class="elsevierStylePara elsevierViewall">None of the authors show a conflict of interest&#46;</p></span></span>"
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              "titulo" => "Introducci&#243;n"
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          "titulo" => "Palabras clave"
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    "fechaRecibido" => "2019-01-06"
    "fechaAceptado" => "2019-05-01"
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec1199214"
          "palabras" => array:5 [
            0 => "<span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>"
            1 => "Gonorrhoea"
            2 => "Epidemiological surveillance"
            3 => "Antimicrobial susceptibility"
            4 => "Molecular typing"
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        0 => array:4 [
          "clase" => "keyword"
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          "identificador" => "xpalclavsec1199213"
          "palabras" => array:5 [
            0 => "<span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>"
            1 => "Gonorrea"
            2 => "Vigilancia epidemiol&#243;gica"
            3 => "Sensibilidad antimicrobiana"
            4 => "Tipado molecular"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Treatment of gonorrhoea is threatened by antimicrobial resistance&#44; and decreased susceptibility to recommended therapies is emerging&#46; Thus&#44; gonococcal infection &#40;GI&#41; is becoming a public health problem&#46; The objectives of the present study were to monitor the antimicrobial sensitivity in <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span> &#40;NG&#41; during 2011&#8211;2015 and to study their genogroups&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Antimicrobial susceptibility was studied by disc diffusion&#44; in addition to the agar dilution method for cefixime and ceftriaxone and the Etest&#174; for azithromycin&#46; Genotyping was performed by the NG multi-antigen sequence typing &#40;NG-MAST&#41; method&#46; Genogroups of closely related sequence types &#40;STs&#41; were defined&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">All the strains were susceptible to cefixime&#44; ceftriaxone and gentamicin and 1&#46;8&#37; of the strains were resistant to azithromycin&#46; A total of 531 STs and 6 genotypes &#40;Gs&#41; were identified during 2012&#8211;2015 period&#46; G2992 was the largest and was associated with resistance to azithromycin&#44; and with men who have sex with men &#40;MSM&#41;&#44; alongside G2400&#46; G1407 and G2400 strains were related to high minimum inhibitory concentration &#40;MICs&#41; to cefixime and G1407 also to ceftriaxone&#46; For the first time&#44; G1861 and G2018 were described and associated with ciprofloxacin resistance and G2018 also with high MICs to ceftriaxone&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Molecular typing is a useful tool to predict antimicrobial resistance&#46; These results show the need to develop novel antimicrobials or to design new antimicrobial therapies based on drugs that show their efficacy against GI&#46; This also highlights the importance of developing sexually transmitted infection &#40;STI&#41; surveillance in homosexual populations&#46;</p></span>"
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            "identificador" => "abst0005"
            "titulo" => "Background"
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            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "titulo" => "Conclusion"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">el tratamiento de la gonorrea est&#225; amenazado por la resistencia antimicrobiana&#44; y la disminuci&#243;n de la sensibilidad a las terapias recomendadas est&#225; emergiendo&#46; Por ello la infecci&#243;n gonoc&#243;cica &#40;IG&#41; se est&#225; convirtiendo en un problema de salud p&#250;blica&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">la sensibilidad antimicrobiana se estudi&#243; por el m&#233;todo de difusi&#243;n en disco&#44; cefixima y ceftriaxona fueron testados por el m&#233;todo de diluci&#243;n en agar y azitromicina por Etest&#46; El genotipado se realiz&#243; por el m&#233;todo NG multi-antigen sequence typing &#40;NG-MAST&#41;&#46; Se definieron genogrupos con secuenciotipos &#40;STs&#41; relacionados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">todas las cepas fueron sensibles a cefixima&#44; ceftriaxona y gentamicina y el 1&#44;8&#37; resistentes a azitromicina&#46; Se identificaron 531 STs y 6 genotipos &#40;Gs&#41; durante el per&#237;odo 2012-2015&#46; El G2992 fue el m&#225;s grande y se relacion&#243; con resistencia a azitromicina&#44; y con hombres que tienen sexo con hombres &#40;HSH&#41; junto con el G2400&#46; Las cepas pertenecientes a los G1407 y G2400 se relacionaron con altas concentraciones m&#237;nimas inhibitorias &#40;CMIs&#41; a cefixima y el G1407 tambi&#233;n a ceftriaxona&#46; Se describe por primera vez la presencia del G1861 y G2018 y su relaci&#243;n con la resistencia a ciprofloxacino y la relaci&#243;n del G2018 con alta CMI a ceftriaxona&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El tipado molecular es una herramienta &#250;til para predecir la resistencia antimicrobiana&#46; Estos resultados muestran la necesidad de desarrollar nuevos antimicrobianos o nuevas terapias basadas en f&#225;rmacos que demuestren su eficacia contra la IG&#46; Tambi&#233;n muestra la importancia del desarrollo de la vigilancia de las infecciones de transmisi&#243;n sexual &#40;ITS&#41; en la poblaci&#243;n homosexual&#46;</p></span>"
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            "titulo" => "M&#233;todos"
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            "titulo" => "Conclusi&#243;n"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">S&#58; susceptible&#59; I&#58; intermediate susceptibility&#59; R&#58; resistant&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">I &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">R &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Penicillin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">597 &#40;81&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">124 &#40;17&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cefixime&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">731 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ceftriaxone&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">731 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ciprofloxacin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">361 &#40;49&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;4&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">341 &#40;46&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Azithromycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">706 &#40;96&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">12 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tetracycline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">301 &#40;41&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">315 &#40;43&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">115 &#40;15&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spectinomycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">730 &#40;99&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gentamicin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">731 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2225445.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Antimicrobial susceptibility of <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span> strains studied&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antimicrobial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MIC<span class="elsevierStyleInf">50</span> and MIC<span class="elsevierStyleInf">90</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cefixime</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MIC<span class="elsevierStyleInf">50</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MIC<span class="elsevierStyleInf">90</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ceftriaxone</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MIC<span class="elsevierStyleInf">50</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MIC<span class="elsevierStyleInf">90</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;060&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;060&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2225443.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Evolution of the MIC<span class="elsevierStyleInf">50</span> and MIC<span class="elsevierStyleInf">90</span> to cefixime and ceftriaxone throughout the period studied &#40;2011&#8211;2015&#41;&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">ST&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Isolates &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Allele</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">porB</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">tbpB</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">387&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">266&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">118&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2013&#8211;2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5533&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3345&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2012&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1808&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2012&#8211;2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4186&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2569&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">241&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2014&#8211;2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total &#40;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">339&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2012&#8211;2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2225444.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Distribution of most prevalent STs &#40;represented by <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10 isolates&#41;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
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          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
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        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">ST&#58; sequence type&#59; G&#58; genogroup&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Genogroup &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Predominant ST &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">STs with same <span class="elsevierStyleItalic">porB</span> and &#8805;99&#37; <span class="elsevierStyleItalic">tbpB</span> &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">STs with same <span class="elsevierStyleItalic">tbpB</span> and &#8805;99&#37; <span class="elsevierStyleItalic">porB</span> &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G2992 &#40;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2992 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5119 &#40;25&#41;&#44; 7758 &#40;1&#41;&#44; 4751 &#40;1&#41;&#44; 5049 &#40;6&#41;&#44; 5515 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G1407 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1407 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3149 &#40;4&#41;&#44; 4269 &#40;3&#41;&#44; 8993 &#40;2&#41;&#44; 3378 &#40;1&#41;&#44; 3431 &#40;1&#41;&#44; 5335 &#40;1&#41;&#44; 2212 &#40;1&#41;&#44; 4120 &#40;2&#41;&#44; 5533 &#40;12&#41;&#44; 6146 &#40;1&#41;&#44; 7245 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G210 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">210 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">292 &#40;26&#41;&#44; 3146 &#40;1&#41;&#44; 9559 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G2400 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2400 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6360 &#40;3&#41;&#44; 8030 &#40;1&#41;&#44; 9184 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G1861 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1861 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2264 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G2018 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2018 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">897 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2225442.png"
              ]
            ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Genogroups obtained by grouping the STs based on the similarity of the <span class="elsevierStyleItalic">porB</span> and <span class="elsevierStyleItalic">tbpB</span> alleles and the STs that form them&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">R&#58; resistant&#59; I&#58; intermediate susceptibility&#59; OR&#58; odds ratio&#59; CI 95&#37;&#58; confidence interval of 95&#37;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Genogroup&#47;ST&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antimicrobial agent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">R and I &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CI 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G1861&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ciprofloxacin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
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                  \t\t\t\t">G1407</td><td class="td" title="\n
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                  \t\t\t\t">Ciprofloxacin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tetracycline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">38 &#40;63&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Cefixime&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;30&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#44;396&#8211;36&#44;332&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ceftriaxone&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41 &#40;68&#46;3&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">G2018</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ciprofloxacin&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ceftriaxone&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;53&#46;3&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;645&#8211;21&#44;430&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">G2992</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Azithromycin&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tetracycline&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">43 &#40;68&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;348&#8211;4&#44;138&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">G2400</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ciprofloxacin&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30 &#40;96&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41&#44;090&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;560&#8211;303&#44;693&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Cefixime&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;16&#46;1&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;009&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ST 5624</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ciprofloxacin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#946;-Lactamase&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;46&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;571&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#44;775&#8211;31&#44;904&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Penicillin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;73&#46;1&#41;Solo R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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