Scientific letter
Intermittent bladder irrigation with liposomal amphotericin B for the treatment of fluconazole-resistant Meyerozyma guilliermondii cystitis in an immunosuppressed adolescent
Instilaciones vesicales intermitentes con anfotericina B liposomal para el tratamiento de una cistitis por Meyerozyma guilliermondii resistente a fluconazol en un adolescente inmunodeprimido
Ana Capilla-Mirandaa,
, Diego Plaza-Lópezb, Paloma Garcia-Clementec, Fernando Baquero-Artigaod,e
Corresponding author
a Servicio de Inmunología, Reumatología e Infectología Pediátrica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
b Servicio de Hemato-Oncología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
c Servicio de Microbiología, Hospital Universitario La Paz, Madrid, Spain
d Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital Universitario La Paz, Madrid, Spain
e CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
Read
1202
Timeswas read the article
338
Total PDF
864
Total HTML
Share statistics
array:24 [ "pii" => "S2529993X2300076X" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2023.02.001" "estado" => "S300" "fechaPublicacion" => "2023-04-01" "aid" => "2609" "copyright" => "Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "copyrightAnyo" => "2022" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Enferm Infecc Microbiol Clin. 2023;41:253-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0213005X22001379" "issn" => "0213005X" "doi" => "10.1016/j.eimc.2022.05.013" "estado" => "S300" "fechaPublicacion" => "2023-04-01" "aid" => "2609" "copyright" => "Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Enferm Infecc Microbiol Clin. 2023;41:253-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Instilaciones vesicales intermitentes con anfotericina B liposomal para el tratamiento de una cistitis por <span class="elsevierStyleItalic">Meyerozyma guilliermondii</span> resistente a fluconazol en un adolescente inmunodeprimido" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "253" "paginaFinal" => "254" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Intermittent bladder irrigation with liposomal amphotericin B for the treatment of fluconazole-resistant <span class="elsevierStyleItalic">Meyerozyma guilliermondii</span> cystitis in an immunosuppressed adolescent" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Capilla-Miranda, Diego Plaza-López, Paloma Garcia-Clemente, Fernando Baquero-Artigao" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ana" "apellidos" => "Capilla-Miranda" ] 1 => array:2 [ "nombre" => "Diego" "apellidos" => "Plaza-López" ] 2 => array:2 [ "nombre" => "Paloma" "apellidos" => "Garcia-Clemente" ] 3 => array:2 [ "nombre" => "Fernando" "apellidos" => "Baquero-Artigao" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2529993X2300076X" "doi" => "10.1016/j.eimce.2023.02.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X2300076X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X22001379?idApp=UINPBA00004N" "url" => "/0213005X/0000004100000004/v3_202304141050/S0213005X22001379/v3_202304141050/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2529993X23000229" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2022.06.018" "estado" => "S300" "fechaPublicacion" => "2023-04-01" "aid" => "2628" "copyright" => "Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Enferm Infecc Microbiol Clin. 2023;41:254-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Unusual microscopic finding in a hepatic abscess content" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "254" "paginaFinal" => "255" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hallazgo microscópico inusual en muestra de absceso hepático" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1021 "Ancho" => 1254 "Tamanyo" => 136659 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cyst of <span class="elsevierStyleItalic">Entamoeba histolytica</span>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marta Rolo, Alhena Reyes, Juan Martín Torres, Ana Pérez-Ayala" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Marta" "apellidos" => "Rolo" ] 1 => array:2 [ "nombre" => "Alhena" "apellidos" => "Reyes" ] 2 => array:2 [ "nombre" => "Juan Martín" "apellidos" => "Torres" ] 3 => array:2 [ "nombre" => "Ana" "apellidos" => "Pérez-Ayala" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X23000229?idApp=UINPBA00004N" "url" => "/2529993X/0000004100000004/v2_202304072117/S2529993X23000229/v2_202304072117/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2529993X23000771" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2023.02.002" "estado" => "S300" "fechaPublicacion" => "2023-04-01" "aid" => "2616" "copyright" => "Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Enferm Infecc Microbiol Clin. 2023;41:251-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "High rates of colonization by <span class="elsevierStyleItalic">Staphylococcus aureus</span> in medical students before their clinical practices" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "251" "paginaFinal" => "253" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Elevadas tasas de colonización por <span class="elsevierStyleItalic">Staphylococcus aureus</span> en los estudiantes de medicina antes de realizar sus prácticas clínicas" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1362 "Ancho" => 3183 "Tamanyo" => 214924 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distribution of the rates of <span class="elsevierStyleItalic">Staphylococcus aureus</span> carriers according to the academic year and location (nasal, pharyngeal and both).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">*Total percentage of students colonized at least in the nose.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Esther Ríos, Iciar Rodríguez-Avial, Esther Culebras, Carmen Rodríguez-Avial" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Esther" "apellidos" => "Ríos" ] 1 => array:2 [ "nombre" => "Iciar" "apellidos" => "Rodríguez-Avial" ] 2 => array:2 [ "nombre" => "Esther" "apellidos" => "Culebras" ] 3 => array:2 [ "nombre" => "Carmen" "apellidos" => "Rodríguez-Avial" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213005X22001458" "doi" => "10.1016/j.eimc.2022.06.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X22001458?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X23000771?idApp=UINPBA00004N" "url" => "/2529993X/0000004100000004/v2_202304072117/S2529993X23000771/v2_202304072117/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Intermittent bladder irrigation with liposomal amphotericin B for the treatment of fluconazole-resistant <span class="elsevierStyleItalic">Meyerozyma guilliermondii</span> cystitis in an immunosuppressed adolescent" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "253" "paginaFinal" => "254" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ana Capilla-Miranda, Diego Plaza-López, Paloma Garcia-Clemente, Fernando Baquero-Artigao" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Ana" "apellidos" => "Capilla-Miranda" "email" => array:1 [ 0 => "anacapillam@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Diego" "apellidos" => "Plaza-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Paloma" "apellidos" => "Garcia-Clemente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Fernando" "apellidos" => "Baquero-Artigao" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Inmunología, Reumatología e Infectología Pediátrica, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Hemato-Oncología Pediátrica, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Instilaciones vesicales intermitentes con anfotericina B liposomal para el tratamiento de una cistitis por <span class="elsevierStyleItalic">Meyerozyma guilliermondii</span> resistente a fluconazol en un adolescente inmunodeprimido" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Urinary tract infection (UTI) is the third leading cause of nosocomial infection in paediatrics.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although most infections are of bacterial origin, fungal aetiology is increasing due to <span class="elsevierStyleItalic">Candida</span> species with less sensitivity to azoles.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The treatment of these infections is complex due to a lack of therapeutic options.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 16-year-old patient with a left pelvic metastatic osteosarcoma undergoing chemotherapy who required permanent bladder catheterisation because of tumour compression. He had a history of urinary infections in the previous two months caused by <span class="elsevierStyleItalic">Candida parapsilosis</span> and <span class="elsevierStyleItalic">Meyerozyma guilliermondii</span> (<span class="elsevierStyleItalic">Candida guilliermondii</span>), which had been resolved by replacing the catheter and treatment with fluconazole. After receiving a cycle of chemotherapy and being in a state of neutropenia, the patient developed sepsis of abdominal origin, requiring broad-spectrum antibiotic therapy with meropenem, amikacin and vancomycin. In this context, <span class="elsevierStyleItalic">M. guilliermondii</span> was isolated in his urine, persisting in successive urine cultures despite the catheter being replaced once again and treatment with intravenous fluconazole for two weeks. Blood cultures were negative and renal ultrasound showed no significant findings apart from bilateral pyelocalyceal dilation secondary to obstruction caused by the tumour mass. The antifungal susceptibility tests showed resistance to fluconazole (MIC 16 μg/mL), with sensitivity to the other antifungals tested. With these findings, it was decided to start combined treatment with intravenous micafungin, which was continued for 14 days, and daily bladder irrigation with liposomal amphotericin B (30 mg/100 ml); 100 ml was introduced through the catheter, clamped for 10 min only. The treatment was well tolerated, with no adverse effects detected, and it was continued for five days, achieving microbiological eradication.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Treating asymptomatic candiduria is not indicated in paediatrics unless the patient develops symptoms or belongs to a group at risk of spread (neutropenia, need for urological manipulation, newborn or a kidney transplant). The treatment of choice is oral fluconazole,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> with amphotericin B deoxycholate, flucytosine, or bladder irrigation with amphotericin B deoxycholate recommended for resistant species.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In our case, amphotericin B deoxycholate is not available for use in Spain, and flucytosine was ruled out because it is associated with myelotoxicity in up to 22% of patients.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Liposomal amphotericin B, triazole derivatives and echinocandins have limited excretion in the urine. We opted for intermittent bladder irrigation with liposomal amphotericin B, in combination with micafungin as systemic treatment in view of the patient's neutropenia. The concentration of echinocandins in urine is very low (0.7% of the plasma concentration in the case of mucafungin). Still, there are reported cases of successful use in the treatment of candiduria due to <span class="elsevierStyleItalic">Candida</span> species resistant to fluconazole,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> although there have also been therapeutic failures.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> We cannot, therefore, rule out that micafungin may have contributed to our patient being cured.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Most of the literature consulted for bladder irrigation with amphotericin B refers to using the deoxycholate form. We only found one case of intravesical administration of the liposomal form. This was a 65-year-old female patient who developed septic shock of abdominal origin, with isolation of <span class="elsevierStyleItalic">C. parapsilosis</span> in blood culture, urine culture and surgical wound. As part of the treatment of candiduria, bladder irrigation with liposomal amphotericin B was used continuously for three days at a concentration of 50 mg/l with a good outcome.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Our case is the first to be described in a paediatric patient.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Intravesical administration of amphotericin B deoxycholate is more effective using continuous rather than intermittent irrigation. The most commonly used concentration is 50 mg/l, although a higher concentration is used in intermittent administrations.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In our case, intermittent instillations of liposomal amphotericin B were administered as the urinary catheter had only one lumen, and catheter replacement was difficult. The concentration we used was effective in intermittent irrigation with amphotericin B deoxycholate<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and was used for five consecutive days with good results.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We would conclude that intravesical instillation of liposomal amphotericin B may be a safe alternative in treating azole-resistant <span class="elsevierStyleItalic">Candida</span> species cystitis. However, more extensive studies are needed to support this assertion.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infecciones nosocomiales (II). Otras infecciones" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Botrán" 1 => "M. José Solana" 2 => "A. Bustinza" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "An Pediatría Contin [Internet]" "fecha" => "2010" "volumen" => "8" "numero" => "4" "paginaInicial" => "174" "paginaFinal" => "182" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.elsevier.es/es-revista-anales-pediatria-continuada-51-articulo-infecciones-nosocomiales-ii-otras-infecciones-S1696281810700329" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Candida urinary tract infections—epidemiology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.D. Sobel" 1 => "J.F. Fisher" 2 => "C.A. Kauffman" 3 => "C.A. Newman" ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1093/cid/cir109" "Revista" => array:7 [ "tituloSerie" => "Clin Infect Dis [Internet]" "fecha" => "2011" "volumen" => "52" "numero" => "suppl_6" "paginaInicial" => "S433" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21498836" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1093/cid/cir109" "WWW" => array:1 [ "link" => "https://academic.oup.com/cid/article/52/suppl_6/S433/284564" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases society of America" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.G. Pappas" 1 => "C.A. Kauffman" 2 => "D.R. Andes" 3 => "C.J. Clancy" 4 => "K.A. Marr" 5 => "L. Ostrosky-Zeichner" ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1093/cid/civ933" "Revista" => array:7 [ "tituloSerie" => "Clin Infect Dis [Internet]" "fecha" => "2016" "volumen" => "62" "numero" => "4" "paginaInicial" => "e1" "paginaFinal" => "50" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26679628" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1093/cid/civ933" "WWW" => array:1 [ "link" => "https://pubmed.ncbi.nlm.nih.gov/26679628/" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recomendaciones de la Sociedad Española de Infectología Pediátrica sobre diagnóstico y tratamiento de la candidiasis invasiva" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Figueras" 1 => "C. Díaz de Heredia" 2 => "J.J. García" 3 => "M. Navarro" 4 => "J. Ruiz-Contreras" 5 => "R. Rossich" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr [Internet]" "fecha" => "2011" "volumen" => "74" "numero" => "5" "paginaInicial" => "337" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.analesdepediatria.org/es-recomendaciones-sociedad-espanola-infectologia-pediatrica-articulo-S1695403311000397" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía de terapéutica antimicrobiana" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Mensa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2021" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Micafungin treatment and eradication of candiduria among hospitalized patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Gabardi" 1 => "S. Martin" 2 => "M. Sura" 3 => "A. Mohammed" 4 => "Y. Golan" ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1007/s11255-016-1410-0" "Revista" => array:7 [ "tituloSerie" => "Int Urol Nephrol [Internet]" "fecha" => "2016" "volumen" => "48" "numero" => "11" "paginaInicial" => "1881" "paginaFinal" => "1885" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27587066" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1007/s11255-016-1410-0" "WWW" => array:1 [ "link" => "https://pubmed.ncbi.nlm.nih.gov/27587066/" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Caspofungin in the treatment of symptomatic candiduria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.D. Sobel" 1 => "S.K. Bradshaw" 2 => "C.J. Lipka" 3 => "N.A. Kartsonis" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Clin Infect Dis [Internet]" "fecha" => "2007" "volumen" => "44" "numero" => "5" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://pubmed.ncbi.nlm.nih.gov/17278048/" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Failure of caspofungin for treatment of candida glabrata candiduria: case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.N. Malani" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Infect Dis Clin Pract [Internet]" "fecha" => "2010" "volumen" => "18" "numero" => "4" "paginaInicial" => "271" "paginaFinal" => "272" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://journals.lww.com/infectdis/Fulltext/2010/07000/Failure_of_Caspofungin_for_Treatment_of_Candida.15.aspx" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sellado rotatorio del catéter vascular e instilaciones vesicales con anfotericina B liposomal para erradicar <span class="elsevierStyleItalic">Candida parapsilosis</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Val-Jordán" 1 => "L.M. Claraco-Vega" 2 => "R. Huarte-Lacunzar" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Quimioter [Internet]" "fecha" => "2016" "volumen" => "5" "paginaInicial" => "278" "paginaFinal" => "279" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://medes.com/publication/114832" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bladder irrigation with amphotericin B and fungal urinary tract infection-systematic review with meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F.F. Tuon" 1 => "V.S. Amato" 2 => "S.R.P. Filho" ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1016/j.ijid.2008.10.012" "Revista" => array:7 [ "tituloSerie" => "Int J Infect Dis [Internet]" "fecha" => "2009" "volumen" => "13" "numero" => "6" "paginaInicial" => "701" "paginaFinal" => "706" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19155184" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1016/j.ijid.2008.10.012" "WWW" => array:1 [ "link" => "https://pubmed.ncbi.nlm.nih.gov/19155184/" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000004100000004/v2_202304072117/S2529993X2300076X/v2_202304072117/en/main.assets" "Apartado" => array:4 [ "identificador" => "63562" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000004100000004/v2_202304072117/S2529993X2300076X/v2_202304072117/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X2300076X?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 20 | 34 |
| 2024 October | 110 | 71 | 181 |
| 2024 September | 78 | 58 | 136 |
| 2024 August | 89 | 51 | 140 |
| 2024 July | 93 | 44 | 137 |
| 2024 June | 94 | 27 | 121 |
| 2024 May | 52 | 14 | 66 |
| 2024 April | 78 | 16 | 94 |
| 2024 March | 74 | 15 | 89 |
| 2024 February | 26 | 1 | 27 |
| 2024 January | 72 | 4 | 76 |
| 2023 December | 34 | 4 | 38 |
| 2023 November | 32 | 9 | 41 |
| 2023 October | 16 | 4 | 20 |
| 2023 April | 2 | 0 | 2 |
Show all
