Brief report
Clinical and microbiological characteristics of Eggerthella lenta causing bacteremia
Características clínicas y microbiológicas de Eggerthella lenta como causa de bacteriemia
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"idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Clinical and microbiological characteristics of <span class="elsevierStyleItalic">Eggerthella lenta</span> causing bacteremia" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "512" "paginaFinal" => "515" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Domingo Fernández Vecilla, Mikel Joseba Urrutikoetxea Gutiérrez, Mary Paz Roche Matheus, Felicitas Elena Calvo Muro, José Luis Díaz de Tuesta del Arco" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Domingo" "apellidos" => "Fernández Vecilla" "email" => array:1 [ 0 => "domingofvec@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" => "Mikel Joseba" "apellidos" => 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"etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sierrallana Hospital, Microbiology Service, Cantabria, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Basurto University Hospital, Clinical Microbiology Service, Bilbao, Basque Country, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Biocruces Bizkaia Health Research Institute, Barakaldo, Basque Country, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Características clínicas y microbiológicas de <span class="elsevierStyleItalic">Eggerthella lenta</span> como causa de bacteriemia" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Incidence of bacteremia caused by anaerobic microorganisms ranges between 1% and 17%,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> but mortality rate remains very high in spite of being an infrequent event.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> Most of the articles reporting <span class="elsevierStyleItalic">Eggerthella lenta</span> bloodstream infections describe single cases and these are frequently associated with intra-abdominal infections.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3–5</span></a> However, larger case series have been reported too, helping to understand pathogenesis, risk factors and antimicrobial susceptibility of <span class="elsevierStyleItalic">E. lenta</span> bacteremia.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6–10</span></a> This microorganism has been reported causing mild infections such as sinusitis or ulcers.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> However, other author such as Wang et al. and Priputnevich et al. have described severe infections such as liver abscess or endometritis.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,4</span></a> In addition, <span class="elsevierStyleItalic">E. lenta</span> may spread from these locations to the bloodstream causing bacteremia. In this article, we aim to describe clinical and microbiological characteristics of seven <span class="elsevierStyleItalic">E. lenta</span> isolates causing bacteremia.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Material and methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">We conducted a descriptive retrospective study including all <span class="elsevierStyleItalic">E. lenta</span> isolates causing bacteremia, from February 2019 to August 2023 at the Basurto University Hospital. In this study, BD BACTEC™ Plus Aerobic/F and BD BACTEC™ Lytic/10 Anaerobic/F culture flasks were used as blood culture bottles and incubated for five days in the BD® BACTEC FX (Becton Dickinson, New Jersey, USA). Average time of positivity of BD BACTEC™ Lytic/10 Anaerobic/F culture flasks was 61.3<span class="elsevierStyleHsp" style=""></span>h (range from 30.8 to 84.7<span class="elsevierStyleHsp" style=""></span>h). All positive anaerobic blood culture bottles were subcultured on chocolate, MacConkey and BD® Brucella with hemin and vitamin K1 agars. Chocolate agar was incubated under aerobic conditions at 37<span class="elsevierStyleHsp" style=""></span>°C with 5% CO<span class="elsevierStyleInf">2</span> and MacConkey agar under aerobic conditions at 37<span class="elsevierStyleHsp" style=""></span>°C, whereas BD™ Brucella with hemin and vitamin K1 agar was incubated under anaerobic conditions at 37<span class="elsevierStyleHsp" style=""></span>°C. All strains were only isolated and identificated from Brucella agar cultures after at least 48<span class="elsevierStyleHsp" style=""></span>h. Microbial identification of the microorganisms was performed by MALDI-TOF mass spectrometry (Bruker, Massachusetts, USA), using the MALDI-TOF Biotyper® reference library (version 2023). All <span class="elsevierStyleItalic">E. lenta</span> strains were identified with scores greater than 2.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The antibiotic susceptibility of the strains was performed using MIC Test Strip® (Liofilchem, Teramo, Italy) on Brucella agar with hemin and vitamin K1, being incubated at 37<span class="elsevierStyleHsp" style=""></span>°C under anaerobic conditions using the following antibiotics: penicillin, amoxicillin/clavulanic acid, piperacillin/tazobactam, cefoxitin, imipenem, meropenem, clindamycin, metronidazole and moxifloxacin. We used the 2022 breakpoints guidelines from the Clinical & Laboratory Standards Institute (CLSI) because of the absence of specific breakpoints for <span class="elsevierStyleItalic">Eggerthella</span> spp. or Gram-positive bacilli in EUCAST breakpoints guidelines.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0020" class="elsevierStylePara elsevierViewall">The gender distribution was four men and three women with an average age of 72.7 years (age ranges from 54 to 83 years). All patients were admitted to the hospital for intravenous (IV) antibiotic treatment because of suspicious of bloodstream infection associated with abdominal symptoms. Two patients presented diverticulitis (one of them associated with perforated proctosigmoiditis), two patients presented abdominal abscesses and two patients presented nonspecific abdominal symptoms such as diarrhoea, pain, fever or hematochezia. The other remaining patient presented with high fever after a surgical procedure due to previous ureterohydronephrosis. The seven patients received IV beta-lactams including piperacillin/tazobactam (five), ertapenem (one) and meropenem (one), associated with other antibiotics such as linezolid (one), daptomycin (one). The antibiotic regimen was sequenced in two patients to oral amoxicillin/clavulanic acid, while in another patient it was sequenced to oral ciprofloxacin and IV metronidazole. All patients recovered treatment without no complications. A summary of the clinical pictures is presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">All isolates were identified by MALDI-TOF MS with scores greater than 2. The antibiotic susceptibility tests (minimum inhibitory concentration (MIC) values in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) confirmed that all the strains were susceptible to amoxicillin/clavulanic acid, imipenem, meropenem, clindamycin and metronidazole. Concerning the remaining antibiotics:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0030" class="elsevierStylePara elsevierViewall">Three strains were susceptible to moxifloxacin, while the other four strains were resistant.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0035" class="elsevierStylePara elsevierViewall">Four strains were resistant to penicillin, while the other three were susceptible (two intermediate and one susceptible).</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0040" class="elsevierStylePara elsevierViewall">Six strains were susceptible to cefoxitin, whereas the other strain was resistant.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0045" class="elsevierStylePara elsevierViewall">Three strains were susceptible to piperacillin/tazobactam, whereas the other four were intermediate with high MICs.</p></li></ul></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Eggerthella lenta</span> is an obligate anaerobic, non-motile and Gram-positive bacilli, belonging to the human microbiota of gastrointestinal (GI) and female reproductive tracts, oral cavity and prostate gland. Formerly known as <span class="elsevierStyleItalic">Eubacterium lentum</span>, this microorganism was discovered in 1935, being reclassified to the <span class="elsevierStyleItalic">Eggerthella</span> genus as <span class="elsevierStyleItalic">E. lenta</span> in 1999 in the <span class="elsevierStyleItalic">Coriobacteriaceae</span> family.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> Bacteremia cases (both monobacterial or polymicrobial) caused by <span class="elsevierStyleItalic">E. lenta</span> has been associated with different conditions such as appendicitis, intestinal perforation, infected decubitus ulcers or multiple origin abscesses, among others.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3–10</span></a> In this article, 42.9% of the bacteremias presented were polymicrobial and all patients presented intra-abdominal infections (such as diverticultis, perforated proctosigmoiditis, intra-abdominal abscesses or abdominal symptoms), which is remarkable but consistent with previous reports. Therefore, conditions from GI tract seems to be the main source of infection in <span class="elsevierStyleItalic">E. lenta</span> infections. Most frequent symptoms caused by <span class="elsevierStyleItalic">E. lenta</span> bloodstream infections are summarized in the review of Jiang et al. Fever, abdominal pain, vomiting and diarrhoea are often found in <span class="elsevierStyleItalic">E. lenta</span> bacteremia episodes, being fever the most frequent symptom.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> However, fever was not found in 36.7% of the cases, hindering diagnosis for physicians. Risk factors for <span class="elsevierStyleItalic">E. lenta</span> infections include predisposing conditions (surgical procedures or trauma),<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> immunocompromised state (malignancies, HIV, chronic renal failure or diabetes mellitus, among others), GI tract conditions (inflammatory bowel diseases or colonic polyps, among others), cardiovascular diseases.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4–10</span></a> According to the article of Priputnevich et al., mucosa damaged by severe gastrointestinal disorders facilitates spread into the bloodstream.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> In addition, some studies have showed that <span class="elsevierStyleItalic">E. lenta</span> intestinal translocation and bacteremia is often found in patients with colorectal cancer.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> Thus, the possible indication for colonoscopy in these patients may need to be considered in the future.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Gastrointestinal tract is the main source of <span class="elsevierStyleItalic">E. lenta</span> bacteremia since most episodes originate from these sites, however, skin and soft tissue or abscesses have also been found as possible sources of infection.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,6,8</span></a> In this article, seven patients presented comorbidities or predisposing factors such as haematologic or solid organ malignancies, recent admission, surgical procedure or immunomodulator treatments, being also consistent with previous reports.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Incidence of bloodstream infections caused by <span class="elsevierStyleItalic">E. lenta</span> is unknown as case series are scarce, but Wilson et al. reported this microorganism to cause 0.15% of all episodes of bacteremia in one centre.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> On the other hand, <span class="elsevierStyleItalic">E. lenta</span> could be responsible for up to 18% of clinically relevant bacteremia cases caused by Gram-positive bacilli.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> Finally, mortality rate of <span class="elsevierStyleItalic">E. lenta</span> bacteremia ranges between 20% and 36% according to some recent publications.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6,15</span></a> These data contrast with our article, in which no patients died, however, this data could be biased by comparing patients who may have very different characteristics. We consulted data about bacteremia episodes in the same time-period in which the episodes of <span class="elsevierStyleItalic">E. lenta</span> bacteremias occurred. Concerning this topic, 5048 episodes of bacteremia occurred from February 2019 to August 2023 in our institution, with 3.7% of infections caused by anaerobic microorganisms (188 episodes) and <span class="elsevierStyleItalic">E. lenta</span> causing 0.14% of total episodes, being consistent with previous reports. In addition, <span class="elsevierStyleItalic">E. lenta</span> caused 3.7% cases of anaerobic bacteremias in our hospital and none of the patients died. To the best of our knowledge, about 200 cases of <span class="elsevierStyleItalic">E. lenta</span> bacteremia have been described after a brief literature review in PubMed® and according to different publications with other literature reviews.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3–7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Currently, there is no consensus for an adequate antibiotic regimen in <span class="elsevierStyleItalic">E. lenta</span> infections as these are rare and empirical antibiotic treatments plays an important role in the management of <span class="elsevierStyleItalic">E. lenta</span> infections. Treatment of choice include metronidazole, clindamycin, vancomycin, teicoplanin, amoxicillin/clavulanic acid or carbapenems according to previous reports.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4,10</span></a> EUCAST 2023 breakpoints guidelines do not include breakpoints for interpretation of <span class="elsevierStyleItalic">E. lenta</span> MICs results. Then, CLSI guidelines are required in order to interpretate results from antibiotics susceptibility tests. Piperacillin/tazobactam should not be used as empirical treatment due to high MICs, in fact, Ugarte-Torres et al. showed an overall 30-day mortality for bacteremia episodes of 23%, being independently associated with empiric monotherapy of piperacillin/tazobactam.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The introduction of reliable and accurate techniques such as MALDI-TOF MS or 16S rRNA sequencing in the laboratory routine has been a turning point in the identification of growth-demanding microorganisms such as obligate anaerobes. <span class="elsevierStyleItalic">E. lenta</span> may cause both mild and severe infections, mainly in patients with comorbidities, however, its virulence factors are still unknown. In addition, the possible link between colorectal cancer and intestinal translocation of <span class="elsevierStyleItalic">E. lenta</span> may need to be considered in the future.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical approval</span><p id="par0075" class="elsevierStylePara elsevierViewall">This manuscript follows the ethical principles included in the declaration of Helsinki.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Consent to publish</span><p id="par0080" class="elsevierStylePara elsevierViewall">Not applicable due to insufficient data to recognize the patient.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Funding</span><p id="par0085" class="elsevierStylePara elsevierViewall">No funding.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2292649" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1905289" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2292650" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1905290" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Ethical approval" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Consent to publish" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interests" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-02-12" "fechaAceptado" => "2024-05-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1905289" "palabras" => array:4 [ 0 => "Anaerobes" 1 => "<span class="elsevierStyleItalic">Eggerthella lenta</span>" 2 => "Bacteremia" 3 => "MALDI-TOF MS" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1905290" "palabras" => array:4 [ 0 => "Anaerobios" 1 => "<span class="elsevierStyleItalic">Eggerthella lenta</span>" 2 => "Bacteriemia" 3 => "MALDI-TOF MS" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Eggerthella lenta</span> is an obligate anaerobic, Gram-positive bacilli, belonging to the human microbiota of gastrointestinal and female reproductive tracts, oral cavity and prostate gland. In this article, we aim to describe clinical and microbiological characteristics of seven <span class="elsevierStyleItalic">E. lenta</span> strains causing bacteremia. We conducted a descriptive retrospective study including all <span class="elsevierStyleItalic">E. lenta</span> strains causing bacteremia, from February 2019 to August 2023 at the Basurto University Hospital. Seven patients were included in the study with a mean age of 72.7 years. Six patients presented risk factors associated with bacterial infections. All patients were admitted to the hospital because of suspicious of bloodstream infection associated with abdominal symptoms for intravenous antibiotic treatment. Four <span class="elsevierStyleItalic">E. lenta</span> isolates were resistant to penicillin, while all isolates presented high MICs to piperacillin/tazobactam and low MICs to amoxicillin/clavulanic acid. All patients recovered without no complications.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Eggerthella lenta</span> es un bacilo grampositivo, anaerobio obligado, que pertenece a la microbiota humana de los tractos gastrointestinal y reproductor femenino, la cavidad oral y la glándula prostática. En este artículo pretendemos describir las características clínicas y microbiológicas de siete <span class="elsevierStyleItalic">E. lenta</span> causantes de bacteriemia. Se realizó un estudio descriptivo retrospectivo, que incluyó todas las cepas de <span class="elsevierStyleItalic">E. lenta</span> causantes de bacteriemia, desde febrero de 2019 hasta agosto de 2023 en el Hospital Universitario de Basurto. Se incluyeron siete pacientes en el estudio, con una edad media de 72,7 años. Seis pacientes presentaban factores de riesgo asociados a infecciones bacterianas. Todos los pacientes ingresaron en el hospital por sospecha de bacteriemia y con síntomas abdominales para recibir antibiótico intravenoso. Cuatro aislados de <span class="elsevierStyleItalic">E. lenta</span> eran resistentes a la penicilina, mientras que todos los aislados presentaban CMI altas a la piperacilina/tazobactam y CMI bajas a la amoxicilina/ácido clavulánico. Los pacientes se recuperaron sin complicaciones.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">P: penicillin; FOX: cefoxitin; AMC: amoxicillin/clavulanic acid; TAZ: piperacillin/tazobactam; IPM: imipenem; MER: meropenem; CD: clindamycin; MZ: metronidazole; MOX: moxifloxacin.</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">Age and sex \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">Risk factors \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">Clinical characteristics \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">Prescribed antibiotic/evolution \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">Strain 1.M, 78 \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">Bladder cancer, chronic renal disease, right ureterohydronephrosis. Recent admission due to urinary infection by <span class="elsevierStyleItalic">Escherichia coli</span>. \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">Fever >38<span class="elsevierStyleHsp" style=""></span>°C and high levels of neutrophils (9600/μL) a few days after replacement of his double J stent catheter. \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">4<span class="elsevierStyleHsp" style=""></span>g/0.5<span class="elsevierStyleHsp" style=""></span>g/8<span class="elsevierStyleHsp" style=""></span>h of IV piperacillin/tazobactam for 3 days followed by 1000<span class="elsevierStyleHsp" style=""></span>mg/200<span class="elsevierStyleHsp" style=""></span>mg/8<span class="elsevierStyleHsp" style=""></span>h of oral amoxicillin/clavulanic acid for 7 days/good evolution. \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">Strain 2.M, 83 \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">Recent admission due to urosepsis caused by <span class="elsevierStyleItalic">Escherichia coli</span>. \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">Fever >38<span class="elsevierStyleHsp" style=""></span>°C and diverticulitis. High levels of leukocytes (14,000/μL), neutrophils (11,000/μL) and procalcitonin (4.9<span class="elsevierStyleHsp" style=""></span>ng/dL). \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">1<span class="elsevierStyleHsp" style=""></span>g/24<span class="elsevierStyleHsp" style=""></span>h of IV ertapenem for 3 days followed by 1000<span class="elsevierStyleHsp" style=""></span>mg/200<span class="elsevierStyleHsp" style=""></span>mg/8<span class="elsevierStyleHsp" style=""></span>h of oral amoxicillin/clavulanic acid for 7 days/good evolution. \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">Strain 3.W, 77 \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">Myelofibrosis secondary to polycythemia vera, corticosteroids and ruxolitinib as treatment. \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">Subcutaneous abscess in left iliac fossa after subcutaneous injection. Fever >38<span class="elsevierStyleHsp" style=""></span>°C and high levels of procalcitonin (14.4<span class="elsevierStyleHsp" style=""></span>ng/dL) and C-reactive protein (112<span class="elsevierStyleHsp" style=""></span>mg/L). \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">4<span class="elsevierStyleHsp" style=""></span>g/0.5<span class="elsevierStyleHsp" style=""></span>g/8<span class="elsevierStyleHsp" style=""></span>h of IV piperacillin/tazobactam for 5 days followed by 400<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h of oral ciprofloxacin and 500<span class="elsevierStyleHsp" style=""></span>mg/8<span class="elsevierStyleHsp" style=""></span>h of IV metronidazole for 15 days. Abscess drainage/good evolution. \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">Strain 4.W, 73 \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">Multiple myeloma and immunomodulator treatment. \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">Perforated proctosigmoiditis and diverticulitis. Polymicrobial bacteremia caused by <span class="elsevierStyleItalic">E. lenta</span> and <span class="elsevierStyleItalic">Bacteroides caccae</span>. \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">4<span class="elsevierStyleHsp" style=""></span>g/0.5<span class="elsevierStyleHsp" style=""></span>g/8<span class="elsevierStyleHsp" style=""></span>h of IV piperacillin/tazobactam for 10 days. Surgery/good evolution. \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">Strain 5.M, 81 \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">No medical history of interest. \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">Abdominal pain, diarrhoea and hematochezia. Abdominal sepsis with high levels of procalcitonin (8.1<span class="elsevierStyleHsp" style=""></span>ng/dL), C-reactive protein (250<span class="elsevierStyleHsp" style=""></span>mg/L) and leukocytes (17,000/μL). \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">1<span class="elsevierStyleHsp" style=""></span>g/8<span class="elsevierStyleHsp" style=""></span>h of IV meropenem for 7 days. Admission to ICU and good evolution. \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">Strain 6.W, 79 \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">Stage 4 colon cancer. \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">General discomfort with colon cancer diagnosis within the admission. Polymicrobial bacteremia by <span class="elsevierStyleItalic">E. lenta</span>, <span class="elsevierStyleItalic">Parabacteroides diastonis</span> and <span class="elsevierStyleItalic">Enterococcus faecium</span> (likely bacterial translocation). \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">4<span class="elsevierStyleHsp" style=""></span>g/0.5<span class="elsevierStyleHsp" style=""></span>g/8<span class="elsevierStyleHsp" style=""></span>h of IV piperacillin/tazobactam and 700<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h of IV daptomycin for 15 days/good evolution. \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">Strain 7.M, 54 \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">Bladder cancer fistulized to the rectum, moderate alcohol consumption. \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">Pelvic abscess with polymicrobial culture and polymicrobial bacteremia caused by <span class="elsevierStyleItalic">E. lenta</span>, <span class="elsevierStyleItalic">Streptococcus anginosus</span>, <span class="elsevierStyleItalic">Clostridium sporogenes</span> and <span class="elsevierStyleItalic">Bacteroides fragilis</span>. \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">4<span class="elsevierStyleHsp" style=""></span>g/0.5<span class="elsevierStyleHsp" style=""></span>g/8<span class="elsevierStyleHsp" style=""></span>h of IV piperacillin/tazobactam and 600<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h of IV linezolid for 15 days/good evolution. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3715578.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Summary of bacteremia cases.</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:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">P: penicillin; FOX: cefoxitin; AMC: amoxicillin/clavulanic acid; TAZ: piperacillin/tazobactam; IPM: imipenem; MER: meropenem; CD: clindamycin; MZ: metronidazole; MOX: moxifloxacin.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">MIC values are expressed as μg/mL.</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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \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">P \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">FOX \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">AMC \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">TAZ \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">IPM \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">MER \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">CD \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">MZ \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">MOX \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">Strain 1 \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">8 \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">>256 \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">2/2 \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">32/4 \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">0.5 \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">0.25 \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">0.125 \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">0.38 \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">>32 \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">Strain 2 \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">2 \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">16 \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">1/2 \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">64/4 \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">2 \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">0.25 \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">0.047 \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">0.25 \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">>32 \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">Strain 3 \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">2 \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">16 \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">2/2 \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">32/4 \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">0.5 \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">0.38 \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">0.125 \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">0.38 \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">0.38 \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">Strain 4 \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">2 \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">8 \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">1/2 \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">32/4 \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">1 \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">0.38 \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">0.094 \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">0.19 \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">0.125 \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">Strain 5 \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">1 \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">16 \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">1/2 \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">16/4 \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">0.5 \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">0.25 \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">0.5 \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">0.125 \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">0.125 \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">Strain 6 \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">0.5 \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">8 \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">0.5/2 \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">8/4 \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">0.75 \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">0.25 \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">0.125 \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">0.25 \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">>32 \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">Strain 7 \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">1 \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">16 \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">0.19/2 \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">16/4 \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">0.38 \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">0.38 \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">0.125 \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">0.019 \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">>32 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3715579.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Antimicrobial susceptibility test results (MIC values are provided).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relevance of anaerobic bacteremia in adult patients: a never-ending story?" 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