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"resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3355 "Ancho" => 3236 "Tamanyo" => 455047 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flow-diagram of the number of studies screened, included and excluded at each stage.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marta Miarons, Laia Rofes" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Marta" "apellidos" => "Miarons" ] 1 => array:2 [ "nombre" => "Laia" "apellidos" => "Rofes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0210570518302887" "doi" => "10.1016/j.gastrohep.2018.09.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570518302887?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382419300707?idApp=UINPBA00004N" "url" => "/24443824/0000004200000004/v1_201905020842/S2444382419300707/v1_201905020842/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Multidrug-resistant bacterial infections in patients with liver cirrhosis in a tertiary referral hospital" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "228" "paginaFinal" => "238" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Sergio Béjar-Serrano, Pablo del Pozo, Margarita Fernández-de la Varga, Salvador Benlloch" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Sergio" "apellidos" => "Béjar-Serrano" "email" => array:1 [ 0 => "sergio.bejar.serrano@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" => "Pablo" "apellidos" => "del Pozo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Margarita" "apellidos" => "Fernández-de la Varga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Salvador" "apellidos" => "Benlloch" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Gastroenterología, Hepatología y Unidad de Trasplante Hepático, Hospital Universitari y Politècnic La Fe, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Grupo Acreditado de Hepatología y Trasplante Hepático, Hospital Universitari i Politècnic La Fe, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centro de Investigación Biomédica en Red del Área de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infecciones por bacterias multirresistentes en pacientes cirróticos en un hospital terciario" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1659 "Ancho" => 2174 "Tamanyo" => 135720 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Types of infection by focus and site of acquisition.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Bacterial infections in patients with cirrhosis are one of the most common causes of acute decompensation and acute-on-chronic liver failure.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">1,2</span></a> Its prevalence upon admission or during a hospital stay is 25–40%, almost five times higher than in the general population.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">3–5</span></a> What is more, complications and mortality are higher than in patients without cirrhosis,<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">6</span></a> with a greater tendency to develop sepsis and septic shock, particularly in intensive care patients.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This can be attributed to the onset of various immune system abnormalities that have recently been grouped together under the umbrella term “<span class="elsevierStyleItalic">cirrhosis-associated immune dysfunction</span>” (CAID),<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a> which affect the innate and adaptive response. This all entails an increased risk of infection, as well as an abnormal immune response that increases predisposition to systemic inflammatory response syndrome (SIRS) above the predisposition of the general population.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The most common infections are spontaneous bacterial peritonitis (SBP) and urinary tract infections (UTIs). Classic aetiological agents include (<span class="elsevierStyleItalic">Escherichia coli</span>, <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>, etc.) and other Gram-negative bacilli, which is why third-generation cephalosporins (TGCs) have traditionally been considered the empirical treatment of choice.</p><p id="par0020" class="elsevierStylePara elsevierViewall">However, increased resistance to cephalosporins,<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">11,12</span></a> the rise of infections by Gram-positive bacteria (<span class="elsevierStyleItalic">Enterococcus</span> spp., <span class="elsevierStyleItalic">Staphylococcus</span>, etc.) and multidrug-resistant bacteria<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">3,5,11,13,14</span></a> have necessitated a paradigm shift in the treatment of infected cirrhotic patients.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The prevalence of multidrug-resistant (MDR) bacteria varies considerably from country to country and even between one hospital and another. There is agreement among the most recent publications<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">5,11,13,15</span></a> that the three pillars that should guide the choice of empirical antibiotic therapy are the local epidemiology, the severity of infection and any possible risk factors for developing MDR bacterial infection.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The primary objective of this study was to evaluate the prevalence of MDR bacterial infections in our tertiary hospital in Spain. The secondary objectives were to analyse the risk factors and complications associated with the onset of MDR bacterial infections, and the correlation between prognosis and the effectiveness of the empirical antibiotic therapy.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study design</span><p id="par0035" class="elsevierStylePara elsevierViewall">This descriptive, retrospective, observational study enrolled patients over the age of 18 years with a confirmed diagnosis of liver cirrhosis and at least one proven microbiological isolate during their hospital stay (either upon admission or during hospitalisation), admitted to Hospital Universitario y Politécnico La Fe in Valencia (Spain) between 1 July 2014 and 31 August 2016. Solid-organ transplant recipients or patients who had received haematopoietic tissue, as well as patients infected with human immunodeficiency virus (HIV) or any other type of immunodeficiency were excluded.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patient data were collected from diagnosis codes on the discharge reports of the electronic medical record and were cross-referenced with the information obtained from the microbiology laboratory.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study variables</span><p id="par0045" class="elsevierStylePara elsevierViewall">The following variables were analysed:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsit0040"><span class="elsevierStyleLabel">–</span><p id="par0365" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Microbiological data</span>: germ, type of bacteria (Gram-positive or negative), multidrug-resistance criteria.</p></li><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">–</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Risk factors</span>: gender, age, cirrhosis aetiology, chronic kidney failure, diabetes mellitus, active cancer, active alcoholism, severity criteria upon admission (creatinine, bilirubin, International Normalised Ratio [INR], Model for End-stage Liver Disease [MELD] score), focus of infection, site of acquisition, hospitalisation in the last 90 days, antibiotics taken in the last 90 days, antibiotic prophylaxis with norfloxacin, treatment with rifaximin, effectiveness of empirical treatment, stay in the Intensive Care Unit (ICU) and isolation of MDR bacteria in the last six months.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">–</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Type of infection</span>: SBP, UTI, pneumonia, spontaneous bacteraemia in patients with cirrhosis, cellulitis, endocarditis, spontaneous bacterial empyema and catheter sepsis.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">–</span><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Measurement of clinical impact</span>: admission to the ICU and tracheal intubation, development of acute kidney failure, sepsis, septic shock and mortality.</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Definitions</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Antibiotic therapy policy</span><p id="par0065" class="elsevierStylePara elsevierViewall">During the study period, patients with community-acquired SBP or UTI received treatment with TGCs. In SBP with a poor clinical course, treatment was empirically switched to piperacillin–tazobactam or carbapenems. Linezolid was normally used as a third-line treatment in combination with one of the aforementioned drugs. Hospital-acquired SBP or UTI were treated with piperacillin–tazobactam or carbapenems in the first line, adding linezolid in the event of a lack of response.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Community-acquired pneumonia was treated with TGCs in combination with azithromycin or with levofloxacin. Hospital-acquired pneumonia was generally treated with carbapenems and levofloxacin.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Patients with community-acquired cellulitis received treatment with amoxicillin/clavulanic acid, while those with hospital acquired cellulitis received piperacillin–tazobactam. Our hospital did not have a defined antibiotic therapy policy for healthcare-associated infections.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Multidrug-resistance criteria</span><p id="par0080" class="elsevierStylePara elsevierViewall">Bacteria resistant to three or more families of antibiotics were deemed to be multidrug-resistant. Intrinsic resistance to different groups of antimicrobials was not taken into account for this definition.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">16</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The isolated bacteria considered to be multidrug-resistant were: extended-spectrum beta-lactamase (ESBL), AmpC beta-lactamase or carbapenemase producing enterobacteriaceae (<span class="elsevierStyleItalic">Escherichia coli</span>, <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>, <span class="elsevierStyleItalic">Enterobacter cloacae</span>, <span class="elsevierStyleItalic">Proteus mirabilis</span>), <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>, vancomycin-sensitive <span class="elsevierStyleItalic">Enterococcus faecium</span>, <span class="elsevierStyleItalic">Acinetobacter baumannii</span>, <span class="elsevierStyleItalic">methicillin-resistant Staphylococcus aureus</span> (MRSA) and <span class="elsevierStyleItalic">Stenotrophomonas maltophilia</span>.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Focus of infection classification</span><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">SBP</span>: defined as the finding of more than 250 polymorphonuclear leukocytes (PMN) per mm<span class="elsevierStyleSup">3</span> in ascitic fluid, irrespective of the culture results, without a secondary cause. The infection was considered resolved when the PMN count fell below 250 per mm<span class="elsevierStyleSup">3</span>.</p><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">UTI</span>: defined as urinary symptoms accompanied by pathological urinary sediment (more than 10 leukocytes per field) or a positive urine culture. The infection was considered resolved if the UTI clinically improved or following a negative urine culture that was previously positive.</p><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pneumonia</span>: signs and symptoms suggestive of respiratory infection accompanied by compatible findings in imaging tests. Pneumonia that showed clinical improvement together with the disappearance of the radiological findings was considered to be resolved.</p><p id="par0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Others</span>: spontaneous bacteraemia in patients with cirrhosis, cellulitis, endocarditis, spontaneous pleural empyema and catheter sepsis, defined according to traditional criteria.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Classification of infection by site of acquisition<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a></span><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Community-acquired infections</span>: infections present at admission or onset within the first 48 hours of admission.</p><p id="par0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Healthcare-associated infections</span>: infections with onset within the first 48 hours of admission in patients who had recently been admitted to hospital (at least 48 hours in the last 90 days), treated at a haemodialysis centre in the last 30 days or long-term residents of a care home or who require special medical care.</p><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Hospital-acquired infections</span>: infections that manifest at least 48 hours after admission.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">SIRS, sepsis and septic shock<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">18</span></a></span><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">SIRS</span>: if two or more of the following criteria are met:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">–</span><p id="par0130" class="elsevierStylePara elsevierViewall">Body temperature >38<span class="elsevierStyleHsp" style=""></span>°C or <36<span class="elsevierStyleHsp" style=""></span>°C.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">–</span><p id="par0135" class="elsevierStylePara elsevierViewall">Tachycardia >90 beats per minute</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">–</span><p id="par0140" class="elsevierStylePara elsevierViewall">Tachypnoea >20 breaths per minute or hypocapnia <32<span class="elsevierStyleHsp" style=""></span>mmHg.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">–</span><p id="par0145" class="elsevierStylePara elsevierViewall">Leukocytes >12,000/μl or <4000/μl or immature forms >10%.</p></li></ul></p><p id="par0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Sepsis</span>: defined as SIRS caused by an underlying infection.</p><p id="par0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Septic shock</span>: sepsis associated with circulatory failure (systolic blood pressure below 90<span class="elsevierStyleHsp" style=""></span>mmHg or a fall of more than 40<span class="elsevierStyleHsp" style=""></span>mmHg from baseline, or average blood pressure below 60<span class="elsevierStyleHsp" style=""></span>mmHg after appropriate fluid resuscitation) not explainable by other causes.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Acute kidney failure<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">19</span></a></span><p id="par0160" class="elsevierStylePara elsevierViewall">Increased serum creatinine ≥0.3<span class="elsevierStyleHsp" style=""></span>mg/dl in 48 hours or >50% increase in baseline creatinine in the last seven days.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Effectiveness of empirical treatment</span><p id="par0165" class="elsevierStylePara elsevierViewall">An empirical treatment failure is defined as switching the initial antibiotic for another. The following distinctions were made:</p><p id="par0170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Failure due to resistance</span>: if the antibiogram showed resistance to the first antibiotic prescribed. It was also assessed whether resistance was intrinsic (specific to the members of the species) or acquired (variable between different strains).</p><p id="par0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Lack of initial response</span>: if the medication was switched due to a poor clinical course or blood panel despite the subsequent antibiogram showing sensitivity to the initial antibiotic.</p><p id="par0180" class="elsevierStylePara elsevierViewall">The addition of another antibiotic was only considered to be a treatment failure if the antibiogram showed resistance to the initial antibiotic prescribed.</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Data analysis</span><p id="par0185" class="elsevierStylePara elsevierViewall">A descriptive analysis of the baseline characteristics of the population and the other study variables was performed. The risk factors associated with the onset of MDR bacterial infections and their clinical impact were also evaluated. A bivariate analysis using Student's <span class="elsevierStyleItalic">t</span> test, the Mann–Whitney <span class="elsevierStyleItalic">U</span> test and ANOVA for quantitative variables, and the Pearson's chi-squared test for qualitative variables, was performed to establish the relationship between each individual variable and outcome. Results with a <span class="elsevierStyleItalic">p</span>-value less than 0.05 were considered statistically significant. The software SPSS Statistics 23.0<span class="elsevierStyleSup">®</span> was used for data collection and analysis, performed by the Biomedical Research Network Centre in the field of Liver and Gastrointestinal Diseases (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Ethical considerations</span><p id="par0190" class="elsevierStylePara elsevierViewall">The study protocol adhered to the ethical principles of the 1975 Declaration of Helsinki. The study design did not require written informed consent. The identity of the patients was protected and anonymised at all times, encoded by alphanumeric code during the data collection phase. All files were digitised and password-protected, thereby prohibiting access to non-study personnel and complying with the confidentiality regulations. The study was approved by the Independent Ethics Committee of the Hospital Universitario y Politécnico La Fe's Instituto de Investigación Sanitaria [Health Research Institute] (register number: 2017/0210).</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Results</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Study population</span><p id="par0195" class="elsevierStylePara elsevierViewall">During the study period (1 July 2014 to 31 August 2016), 217 patients were initially included, 78 of whom were excluded due to exhibiting some form of immunosuppression and 67 due to a lack of a positive culture. Ultimately, 72 patients were analysed, isolating 102 bacteria in 86 infections (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Every infection identified during hospitalisation was considered to be a separate episode.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Baseline characteristics</span><p id="par0200" class="elsevierStylePara elsevierViewall">Data were obtained from 86 cases of infection (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), 70.9% of which were from men (61 in total). The median age was 62 years, with a range of 63 years (26–89 years). The most common cause of cirrhosis was alcoholism, followed by hepatitis C virus (HCV), which individually or collectively affected 74 patients (86.1%).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0205" class="elsevierStylePara elsevierViewall">41.5% of patients had been admitted within the last 90 days and 45.1% (37 patients) had taken an antibiotic (including norfloxacin for SBP prophylaxis in 18 cases) during the previous 90 days.</p><p id="par0210" class="elsevierStylePara elsevierViewall">Upon admission, the mean creatinine level was 1.44 (SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.91) and the mean INR was 1.64 (SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.51), median bilirubin was 1.90 (P25<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.3 and P75<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4.05) and the MELD score was 17 (P25<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13 and P75<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>23).</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Analysis by focus of infection (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>)</span><p id="par0215" class="elsevierStylePara elsevierViewall">Overall, urinary tract infection was the most common focus of infection (26 cases; 30.2% of the total sample). This was followed by SBP (19 cases; 22.1%), cellulitis (11 cases; 12.8%), pneumonia (10 cases; 11.6%) and spontaneous bacteraemia (seven cases; 8.1%). There were 13 less common infections (endocarditis, catheter sepsis, <span class="elsevierStyleItalic">Clostridium difficile</span> colitis, meningitis, cholangitis and pleural empyema) accounting for 15.2% of the total.</p><p id="par0220" class="elsevierStylePara elsevierViewall">A more detailed analysis of the microbiological isolates by focus of infection is provided in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Infections by site of acquisition</span><p id="par0225" class="elsevierStylePara elsevierViewall">Half of the infections were community-acquired (43 cases in total). 36% were considered to be healthcare-associated infections (31 cases) and 12 hospital-acquired (14%). UTI was the most common focus (32.6%), followed by SBP (20.9%). This trend was also seen in healthcare-associated infections.</p><p id="par0230" class="elsevierStylePara elsevierViewall">With regards to the hospital setting, SBP was the predominant infection (33.3% of all hospital-acquired infections), with only one case of hospital-acquired UTI with a valid microbiological isolate identified (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Microbiological isolates</span><p id="par0235" class="elsevierStylePara elsevierViewall">Isolates were obtained from 26 blood cultures (30.2%), 24 urine cultures (27.9%), 16 ascitic fluid cultures (18.6%), nine exudates (10.5%), six bronchoalveolar lavage or sputum samples (7%), two faecal serological tests (2.4%), one serological blood test (1.2%), one antigenuria (1.2%) and one pleural fluid sample (1.2%).</p><p id="par0240" class="elsevierStylePara elsevierViewall">Of the 102 isolated bacteria (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>), 48 were community-acquired (47%), 39 were healthcare-associated (38.2%) and 15 were hospital-acquired (14.7%).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0245" class="elsevierStylePara elsevierViewall">Fifty-seven (55.8%) were Gram-negative bacteria and 45 (44.2%) were Gram-positive. The <span class="elsevierStyleItalic">Enterobacteriaceae</span> family accounted for the most common cause of infection (49 microorganisms). <span class="elsevierStyleItalic">E. coli</span> (30 cases; 29.4%), <span class="elsevierStyleItalic">K. pneumoniae</span> (10 cases; 9.8%), <span class="elsevierStyleItalic">S. aureus</span> (10 cases; 9.8%), <span class="elsevierStyleItalic">E. faecalis</span> (9 cases; 8.8%), <span class="elsevierStyleItalic">E. faecium</span> (6 cases; 5.8%) and <span class="elsevierStyleItalic">S. pneumoniae</span> (6 cases; 5.8%) were the most commonly isolated bacteria overall.</p><p id="par0250" class="elsevierStylePara elsevierViewall">In total, 29 bacteria (28.4%) met the multidrug-resistance criteria, giving rise to the onset of 26 different infections. The most prevalent were extended-spectrum beta-lactamase-producing enterobacteriaceae and <span class="elsevierStyleItalic">Enterococcus faecium</span>, which were detected on 19 (18.6%) and six (5.9%) occasions, respectively. Two carbapenemase-producing bacteria were also isolated (<span class="elsevierStyleItalic">Enterobacter cloacae</span> and <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>). Other MDR bacteria, such as <span class="elsevierStyleItalic">Acinetobacter baumannii</span> and <span class="elsevierStyleItalic">Stenotrophomonas maltophilia</span>, were isolated on one occasion. No cases of methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> or vancomycin-resistant <span class="elsevierStyleItalic">Enterococcus</span> (VRE) were isolated.</p><p id="par0255" class="elsevierStylePara elsevierViewall">Most MDR bacteria were isolated in hospital-acquired and healthcare-associated infections (10 and 13 cases, respectively; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). Overall, MDR bacteria were isolated in 66.6% of hospital-acquired infections, 33.3% of healthcare-associated infections and 12.5% of community-acquired infections.</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Empirical antibiotic therapy (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>)</span><p id="par0260" class="elsevierStylePara elsevierViewall">TGCs were administered as the treatment of choice in 46.5% of patients, followed by carbapenems and other beta-lactam antibiotics (18.6% of patients). Carbapenems were particularly used in hospital-acquired infections (25%) and healthcare-associated infections (29%).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Effectiveness of empirical treatment</span><p id="par0265" class="elsevierStylePara elsevierViewall">Overall, the chosen empirical antibiotic therapy was effective in 50% of cases (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>), particularly in community acquired infections (58.1%) and healthcare-acquired infections (54.8%), but was markedly less effective in hospital-acquired infections (8.3%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.008).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0270" class="elsevierStylePara elsevierViewall">The most common cause of treatment failure in community-acquired infections was a lack of initial response (10 out of 18 cases), despite a subsequent antibiogram showing sensitivity to the prescribed antibiotic. Four bacteria (22.2%) were resistant (two ESBL-producing enterobacteriaceae, one <span class="elsevierStyleItalic">Listeria monocytogenes</span> and one coagulase-negative <span class="elsevierStyleItalic">Staphylococcus</span>) and a further four were intrinsically resistant (three <span class="elsevierStyleItalic">Enterococcus faecalis</span> and one <span class="elsevierStyleItalic">Listeria monocytogenes</span>) to the empirical treatment.</p><p id="par0275" class="elsevierStylePara elsevierViewall">With regards to healthcare-associated infections, resistance was detected in six of the 14 cases (42.9%), lack of initial treatment response in a further six (42.9%) and intrinsic resistance in two cases (14.3%). Resistance to the prescribed treatment was the cause of treatment failure in eight of the 11 cases (72.7%) of hospital-acquired infection. Seven of those eight cases (87.5%) were caused by MDR bacteria.</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Clinical impact</span><p id="par0280" class="elsevierStylePara elsevierViewall">The onset of sepsis was significantly higher in MDR bacterial infections (OR 3.13; 95% CI: 1.18–8.32; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.025). Although the mortality rate and prevalence of septic shock was higher in this group, it did not reach statistical significance (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.55 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.28, respectively).</p><p id="par0285" class="elsevierStylePara elsevierViewall">Failure of the empirical antibiotic therapy was associated with higher mortality (OR 7.05; 95% CI: 1.86–26.75; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.000); acute kidney failure at any time during the hospital stay (OR 2.72; 95% CI: 1.45–5.13; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.000); admission to the ICU (OR 3.53; 95% CI: 1.23–10.11; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.003); sepsis (OR 2.024; 95% CI: 1.13–3.63; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.012) and septic shock (OR 4.69; 95% CI: 1.26–17.39; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.002).</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Risk factors</span><p id="par0290" class="elsevierStylePara elsevierViewall">The bivariate analysis revealed significant differences in the following variables: hospital-acquired infection (versus community-acquired: OR 18.5; 95% CI: 3.87–88.54; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.000, and versus healthcare-associated infections: OR 5.46; 95% CI: 1.22–24.43; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.039); healthcare-associated infection (versus community-acquired: OR 3.39; 95% CI: 1.09–10.54; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.048); antibiotic use in the last 90 days, both with prophylaxis with norfloxacin (OR 4.37; 95% CI: 1.59–11.99; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.005), and without (OR 3.62; 95% CI: 1.35–9.67; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01); hospital stay in excess of 48 hours in the last 90 days (OR 3.18; 95% CI: 1.19–8.47; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.018); active cancer (OR 2.93; 95% CI: 1.08–7.99; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.038) and use of norfloxacin as SBP prophylaxis (OR 3; 95% CI: 1.02–8.79; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.012). In contrast, use of rifaximin was not associated with an increased risk of MDR bacterial infection (OR 2.42; 95% CI: 0.32–18.16; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.58).</p><p id="par0295" class="elsevierStylePara elsevierViewall">Although not reaching statistical significance, the proportion of MDR bacterial infections was much higher in patients who had recently been admitted to the ICU (OR 3.45; 95% CI: 0.71–16.7; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.19) and in those patients in whom any MDR bacteria had been isolated in the last six months (OR 2.14; 95% CI: 0.59–7.78; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.29). No significant differences were found in the following variables: gender (39.1% versus 25.4%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.21); active alcoholism (8.7% versus 25.4%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.09); diabetes (34.8% versus 33.3%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.90) or chronic kidney failure (17.4% versus 22.4% <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.62).</p></span></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">Discussion</span><p id="par0300" class="elsevierStylePara elsevierViewall">The prevalence of multidrug-resistant bacterial infections is increasing, particularly in patients with liver cirrhosis. Knowledge of the local epidemiology is essential in order to prescribe the appropriate empirical treatment.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">5,11,13,15</span></a></p><p id="par0305" class="elsevierStylePara elsevierViewall">The multidrug resistance rate in our study (28.4% of all infections) is comparable with the rate published in a recent European multicentre study,<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">20</span></a> which found an overall MDR rate of 31%, with 14% of infections caused by ESBL-producing bacteria and 7% by <span class="elsevierStyleItalic">Enterococcus faecium</span>. However, a detailed analysis reveals very important differences For example: in Italy, multidrug resistance rates of up to 50% have been published,<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">21</span></a> while other tertiary hospitals in Spain have reported similar rates to ours (32.6% at Hospital Universitario Gregorio Marañón and 28% at Hospital Clínic de Barcelona<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">4,22</span></a>), but with very different proportions of ESBL-producing bacteria (7–5–8.7% at Hospital Clínic (depending on the series), 8–9% at Hospital Universitario de Bellvitge<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">12</span></a> and 25.2% at Hospital Gregorio Marañón<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">22</span></a>).</p><p id="par0310" class="elsevierStylePara elsevierViewall">These data add further weight to the importance of knowing the local epidemiology in order to adapt the empirical antibiotic therapy regimens to suit the prevalence of the different MDR bacteria.</p><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0200">Risk factors</span><p id="par0315" class="elsevierStylePara elsevierViewall">In our study, the presence of MDR bacterial infections was associated with the hospital setting, the use of antibiotics or hospital admission in the last 90 days, the existence of active cancer and the use of norfloxacin as SBP prophylaxis, which is consistent with the results published in the scientific literature.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">3,11,22</span></a> The association between active cancer and risk of MDR bacterial infection in cirrhotic patients had never been studied to date, although given the limitations of this study, the findings cannot yet be extrapolated to daily clinical practice. No association between recent ICU admission and prior MDR bacteria isolation was found.</p></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0205">Clinical impact</span><p id="par0320" class="elsevierStylePara elsevierViewall">The results of the study point to a need to amend the empirical antibiotic therapy regimens used at our hospital, especially those prescribed for hospital-acquired and healthcare-associated infections. Given the high prevalence of ESBL-producing bacteria, use of carbapenems as the first-line treatment of hospital-acquired infections should be standardised. Furthermore, and in line with the results of a recent study,<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">23</span></a> coverage against Gram-positive bacteria in hospital-acquired SBP should also be standardised, as the proportion of cases caused by <span class="elsevierStyleItalic">Enterococcus</span> spp. is very high. The implementation of these changes should result in the improved prognosis of cirrhotic patients admitted to our hospital, although a comparative study would be needed to confirm this hypothesis.</p><p id="par0325" class="elsevierStylePara elsevierViewall">Despite the fact that the multidrug resistance rate in healthcare-associated infections is very similar to that of other studies, the response to empirical treatment is very similar to that for community-acquired infections (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). This casts some doubt over whether it is necessary to implement the recommendations of current clinical practice guidelines, which endorse the use of carbapenems as first-line treatment in this group of patients. It must also be considered that use of these antibiotics may give rise to increased resistance, in addition to the high economic cost it would entail. The only study conducted to date that evaluates the economic impact of this strategy<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">24</span></a> found that broad-spectrum antibiotics represent a cost saving in patients with healthcare-associated infections as it reduces morbidity and mortality and length of hospital stay.</p><p id="par0330" class="elsevierStylePara elsevierViewall">In light of the results obtained, it would therefore seem reasonable to reserve carbapenems for patients with added multidrug-resistance risk factors as well as for patients who exhibit serious signs and symptoms, as early administration of an appropriate empirical treatment is associated with a better prognosis.</p></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0210">The immediate future</span><p id="par0335" class="elsevierStylePara elsevierViewall">The restricted use of antibiotics in the general population has proven to be an effective measure for reducing rates of antimicrobial resistance. An example of such success comes from a recent single-centre study conducted in the Netherlands,<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">25</span></a> a country with a very restrictive antibiotics policy. The results showed that the MDR rate and the cephalosporin resistance rate in a population of cirrhotic patients with SBP were similar in two cohorts compared 10 years apart. Campaigns raising awareness of responsible antibiotic prescription practices represent one aspect that needs to be improved in order to control the rate of multidrug-resistant bacterial infections.</p><p id="par0340" class="elsevierStylePara elsevierViewall">The widespread use of broad-spectrum antibiotics is giving rise to, and will continue to give rise to the emergence of new resistances, which will further hinder the management of these infections.<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">11,26</span></a> Early antibiotic de-escalation (or step-down therapy) is essential in order to minimise the repercussions of their use. It is vital that cultures that provide early microbiological results are taken correctly in order to implement antibiotic de-escalation safely and prevent the generation of resistance.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">5,11</span></a> Epidemiological surveillance by taking periodic cultures, which is widely used in the ICU, is being implemented more and more on hospital wards as it effectively establishes early isolation measures if multidrug-resistant bacteria are detected and enables the antibiotic therapy to be adjusted in the event of infection.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">27</span></a></p><p id="par0345" class="elsevierStylePara elsevierViewall">SBP prophylaxis is another important aspect. The effectiveness of primary prophylaxis with norfloxacin in patients with early-stage cirrhosis is much disputed.<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">28,29</span></a> It is associated with multidrug-resistance<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">3</span></a> and its efficacy in secondary prophylaxis after an initial episode of Gram-positive or MDR SBP is unknown. That is why it is important to conduct further studies that seek to limit norfloxacin's indications, as well as to look for treatment alternatives.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">29</span></a> One such alternative could be rifaximin, a non-absorbable antibiotic with a negligible resistance rate.<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">30,31</span></a> Although the results are disputable,<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">32,33</span></a> consensus for its protective role in SBP seems to be growing.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">34</span></a> Large-scale clinical trials are required to assess its actual relevance.</p><p id="par0350" class="elsevierStylePara elsevierViewall">Our study has a series of methodological limitations. Its retrospective design prevented certain clinical data of interest from being obtained, particularly concerning prior use of antibiotics. The lack of diagnosis codes in the discharge reports may have reduced the sample size of the population studied, therefore also limiting the results obtained. In addition, it was a single-centre study, which means that the results obtained cannot be extrapolated to other hospitals without knowing the local bacterial epidemiology of each centre.</p></span></span><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0215">Conclusions</span><p id="par0355" class="elsevierStylePara elsevierViewall">The multidrug-resistant bacterial infection rate at our hospital is comparable with that of other similar European hospitals. The results obtained support the adoption of the antibiotic therapy regimens recommended by current clinical practice guidelines, limiting the use of carbapenems to hospital-acquired infections and to healthcare-associated infections with other multidrug-resistance risk factors or with serious signs or symptoms. The early administration of an appropriate empirical treatment is associated with improved prognosis.</p></span><span id="sec0150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0220">Conflicts of interest</span><p id="par0360" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1185407" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Patients and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1105299" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1185406" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Pacientes y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1105300" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study variables" ] 2 => array:3 [ "identificador" => "sec0025" "titulo" => "Definitions" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Antibiotic therapy policy" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Multidrug-resistance criteria" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Focus of infection classification" ] 3 => array:2 [ "identificador" => "sec0045" "titulo" => "Classification of infection by site of acquisition" ] 4 => array:2 [ "identificador" => "sec0050" "titulo" => "SIRS, sepsis and septic shock" ] 5 => array:2 [ "identificador" => "sec0055" "titulo" => "Acute kidney failure" ] 6 => array:2 [ "identificador" => "sec0060" "titulo" => "Effectiveness of empirical treatment" ] ] ] 3 => array:2 [ "identificador" => "sec0065" "titulo" => "Data analysis" ] 4 => array:2 [ "identificador" => "sec0070" "titulo" => "Ethical considerations" ] ] ] 6 => array:3 [ "identificador" => "sec0075" "titulo" => "Results" "secciones" => array:9 [ 0 => array:2 [ "identificador" => "sec0080" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0085" "titulo" => "Baseline characteristics" ] 2 => array:2 [ "identificador" => "sec0090" "titulo" => "Analysis by focus of infection (Fig. 2)" ] 3 => array:2 [ "identificador" => "sec0095" "titulo" => "Infections by site of acquisition" ] 4 => array:2 [ "identificador" => "sec0100" "titulo" => "Microbiological isolates" ] 5 => array:2 [ "identificador" => "sec0105" "titulo" => "Empirical antibiotic therapy (Fig. 3)" ] 6 => array:2 [ "identificador" => "sec0110" "titulo" => "Effectiveness of empirical treatment" ] 7 => array:2 [ "identificador" => "sec0115" "titulo" => "Clinical impact" ] 8 => array:2 [ "identificador" => "sec0120" "titulo" => "Risk factors" ] ] ] 7 => array:3 [ "identificador" => "sec0125" "titulo" => "Discussion" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0130" "titulo" => "Risk factors" ] 1 => array:2 [ "identificador" => "sec0135" "titulo" => "Clinical impact" ] 2 => array:2 [ "identificador" => "sec0140" "titulo" => "The immediate future" ] ] ] 8 => array:2 [ "identificador" => "sec0145" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0150" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-03-08" "fechaAceptado" => "2018-07-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1105299" "palabras" => array:4 [ 0 => "Multidrug-resistant bacterial" 1 => "Liver cirrhosis" 2 => "Bacterial infections/epidemiology" 3 => "Risk factors" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1105300" "palabras" => array:4 [ 0 => "Farmacorresistencia bacteriana múltiple" 1 => "Cirrosis hepática" 2 => "Infecciones bacterianas/epidemiología" 3 => "Factores de riesgo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Infections in cirrhotic patients caused by multidrug-resistant bacteria are currently increasing and are associated with greater morbidity and mortality.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To assess the epidemiology, risk factors and prognoses of infections caused by multidrug-resistant bacterial infections in cirrhotic patients.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Patients and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Retrospective study on patients with liver cirrhosis who developed an infection during hospitalisations between July 2014 and August 2016 at our centre (Hospital Universitari i Politècnic La Fe, Valencia, Spain).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Urinary tract infection (30.2%) and spontaneous bacterial peritonitis (22.1%) were the most common infections. A total of 102 microbiological isolates were analysed: 50% in community-acquired infections, 36% in isolates associated with healthcare infections and 14% in nosocomial infections. <span class="elsevierStyleItalic">Escherichia coli</span> was the main aetiology (29.4%). The overall multiresistance rate was 28.4%. The univariate analysis showed that infection caused by multidrug-resistant bacteria (28.4%) was associated with nosocomial infection compared to those associated with healthcare (OR 5.46; 95% CI: 1.22–24.43; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.039) and healthcare-associated infections (compared to community-acquired infections, OR 3.39; 95% CI: 1.09–10.54; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.048), use of antibiotics (OR 4.37; 95% CI: 1.59–11.99; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.005), hospital admission in the previous 90 days (OR 3.18; 95% CI: 1.19–8.47; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.018), active cancer (OR 2.93; 95% CI: 1.08–7.99; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.038), and use of prophylactic norfloxacin (OR 3; 95% CI: 1.02–8.79; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.012). Moreover, it was associated with a higher rate of sepsis (OR 3.13; 95% CI: 1.18–8.32; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.025). The failure of initial treatment was related to greater development of acute renal failure (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001), sepsis (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.012), septic shock (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.002), ICU admission (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001) and mortality (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001).</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The rate of multidrug-resistant bacteria infections in our centre is comparable to that of other European centres with similar characteristics. The results obtained make it recommendable to implement the antibiotic treatment guidelines in current clinical practice guidelines, limiting the use of carbapenems to nosocomial infections and healthcare-associated infections with other risk factors of multidrug resistance or signs of severe sepsis. Early and adequate empirical treatment correlates with a better prognosis.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Patients and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las infecciones por bacterias multirresistentes en pacientes cirróticos se encuentran en aumento y se asocian a una mayor morbimortalidad.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudiar la epidemiología y los factores de riesgo y pronósticos de las infecciones por gérmenes multirresistentes en pacientes cirróticos.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Pacientes y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo en el que se analizaron a pacientes con cirrosis hepática que presentaron una infección al ingreso o durante la hospitalización entre julio del 2014 y agosto del 2016 en el Hospital Universitario y Politécnico La Fe (Valencia, España).</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La infección urinaria (30,2%) y la peritonitis bacteriana espontánea (22,1%) fueron las infecciones más frecuentes. Se analizaron 102 aislamientos microbiológicos: el 50% en infecciones comunitarias, el 36% en asociadas a los cuidados de la salud y el 14% en nosocomiales. <span class="elsevierStyleItalic">Escherichia coli</span> fue el germen más frecuentemente aislado (29,4%). La tasa de multirresistencia fue del 28,4%. El análisis univariante mostró que la infección por gérmenes multirresistentes (28,4%) se asoció a infección nosocomial respecto a las asociadas a los cuidados de la salud (OR 5,46; IC del 95%: 1,22–24,43; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,039) y asociada a los cuidados de la salud (respecto a las comunitarias OR 3,39; IC del 95%: 1,09-10,54; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,048), uso de antibióticos (OR 4,37; IC del 95%: 1,59-11,99; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,005) e ingreso hospitalario en los últimos 90 días (OR 3,18; IC del 95%: 1,19-8,47; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,018), neoplasia activa (OR 2,93; IC del 95%: 1,08-7,99; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,038) y toma de norfloxacino profiláctico (OR 3; IC del 95%: 1,02-8,79; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,012). Además, se asoció a mayor frecuencia de sepsis (OR 3,13; IC del 95% 1,18-8,32; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,025). El fracaso del tratamiento inicial se relacionó con mayor desarrollo de insuficiencia renal aguda (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), sepsis (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,012), shock séptico (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,002), ingreso en UCI (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001) y mortalidad (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001).</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusión</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La tasa de infecciones por gérmenes multirresistentes en nuestro centro es comparable con la de otros centros europeos de características similares. Los resultados obtenidos hacen recomendable la adopción de las pautas de tratamiento antibiótico contempladas en las guías de práctica clínica actuales, limitando el uso de carbapenemes a las infecciones nosocomiales y a las asociadas a los cuidados de salud con otros factores de riesgo de multirresistencia o con signos de gravedad. Un tratamiento empírico adecuado de forma precoz se correlaciona con un mejor pronóstico.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Pacientes y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as: Béjar-Serrano S, del Pozo P, Fernández-de la Varga M, Benlloch S. Infecciones por bacterias multirresistentes en pacientes cirróticos en un hospital terciario. Gastroenterol Hepatol. 2019;42:228–238.</p>" ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2352 "Ancho" => 1590 "Tamanyo" => 108903 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Flowchart of patients included in the study.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1659 "Ancho" => 2174 "Tamanyo" => 135720 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Types of infection by focus and site of acquisition.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1720 "Ancho" => 2506 "Tamanyo" => 164239 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Empirical antibiotic therapy administered by focus and site of acquisition.</p>" ] ] 3 => 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="spar0075" class="elsevierStyleSimplePara elsevierViewall">HCV: hepatitis C virus; INR: International Normalised Ratio; MELD: Model End-stage Liver Disease; NASH: nonalcoholic steatohepatitis.</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="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total number of patients, <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>86<br>Mean (SD)<br>Median (P25 and P75) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61 (70.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (29.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62.60 (13.6)<br>62 (52; 73) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Reason for admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60 (69.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Encephalopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (12.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ascites \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (8.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gastrointestinal bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (3.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (5.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Cirrhosis aetiology</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Alcohol (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 (40.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HCV (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 (34.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HCV<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>alcohol (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (10.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>NASH (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (2.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (11.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Recent cancer (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 (26.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chronic kidney failure (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 (20.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Active alcoholism (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 (20.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 (33.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Admission in the last 90 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 (41.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Antibiotic in the last 90 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 (45.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Prophylaxis with norfloxacin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 (20.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Treatment with rifaximin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (4.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Prior MDR bacteria isolation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (12.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Upon admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Creatinine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.44 (0.91)<br>1.13 (0.77; 1.92) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Total bilirubin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.26 (4.08)<br>1.90 (0.3; 4.05) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>INR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.64 (0.51)<br>1.51 (1.29; 1.93) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MELD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17.86 (6.46)<br>17 (13; 23) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2021428.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of the population.</p>" ] ] 4 => 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:3 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">In the right-hand column, the detection percentage of each bacterium compared to the total number of isolates at each focus is expressed in brackets.</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">GNB: Gram-negative bacilli; GPC: Gram-positive cocci.</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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Focus of infection (number of isolates) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Microorganisms isolated \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">UTI (30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">GNB<br><span class="elsevierStyleItalic">Escherichia coli</span><br><span class="elsevierStyleItalic">Klebsiella pneumoniae</span><br><span class="elsevierStyleItalic">Enterobacter cloacae</span><br><span class="elsevierStyleItalic">GPC</span>/<span class="elsevierStyleItalic">Enterococcus</span> spp.<br><span class="elsevierStyleItalic">Other</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (83.3)<br>20 (66.7)<br>4 (13.3)<br>1 (3.3)<br>5/3 (16.6/10)<br>1 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP (22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">GNB<br><span class="elsevierStyleItalic">Escherichia coli</span><br><span class="elsevierStyleItalic">Klebsiella pneumoniae</span><br><span class="elsevierStyleItalic">Enterobacter cloacae</span><br><span class="elsevierStyleItalic">GPC</span>/<span class="elsevierStyleItalic">Enterococcus</span> spp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (50)<br>7 (31.8)<br>2 (9.1)<br>2 (9.1)<br>11/6 (50/27.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cellulitis (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">GNB<br><span class="elsevierStyleItalic">Enterobacter cloacae</span><br><span class="elsevierStyleItalic">Proteus mirabilis</span><br><span class="elsevierStyleItalic">Acinetobacter baumannii</span><br><span class="elsevierStyleItalic">Escherichia coli</span><br><span class="elsevierStyleItalic">Serratia marcescens</span><br><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span><br><span class="elsevierStyleItalic">GPC</span>/<span class="elsevierStyleItalic">Enterococcus</span> spp.<br>Other<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (44.4)<br>2 (11.1)<br>2 (11.1)<br>1 (5.5)<br>1 (5.5)<br>1 (5.5)<br>1 (5.5)<br>8/3 (44.4/16.7)<br>2 (11.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pneumonia (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">GNB<br><span class="elsevierStyleItalic">Klebsiella pneumoniae</span><br><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span><br><span class="elsevierStyleItalic">Stenotrophomonas maltophilia</span><br><span class="elsevierStyleItalic">GPC</span>/<span class="elsevierStyleItalic">Enterococcus</span> spp.<br>Other<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (45.5)<br>3 (27.2)<br>1 (9.1)<br>1 (9.1)<br>4/0 (36.4/0)<br>2 (18.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Spontaneous bacteraemia (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">GNB<br><span class="elsevierStyleItalic">Escherichia coli</span><br><span class="elsevierStyleItalic">Enterobacter cloacae</span><br><span class="elsevierStyleItalic">GPC</span>/<span class="elsevierStyleItalic">Enterococcus</span> spp.<br>Other<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (28.6)<br>1 (14.3)<br>1 (14.3)<br>3/2 (42.8/28.6)<br>2 (28.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">GNB<br><span class="elsevierStyleItalic">Klebsiella pneumoniae</span><br><span class="elsevierStyleItalic">Escherichia coli</span><br><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span><br><span class="elsevierStyleItalic">GPC</span><br>Other<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (21.4)<br>1 (7.14)<br>1 (7.14)<br>1 (7.14)<br>9/1 (64.3/7.14)<br>2 (14.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2021427.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">One case due to <span class="elsevierStyleItalic">Fusobacterium nucleatum</span> and another due to <span class="elsevierStyleItalic">Actinomyces turicensis</span>.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">One case due to <span class="elsevierStyleItalic">Chlamydophila pneumoniae</span> and another due to <span class="elsevierStyleItalic">Moraxella catarrhalis</span>.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Two cases due to <span class="elsevierStyleItalic">Listeria monocytogenes</span>.</p>" ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Two <span class="elsevierStyleItalic">Clostridium difficile</span> infections.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Microbiological isolates by focus on infection.</p>" ] ] 5 => 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:2 [ "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">The figures in brackets indicate the proportion of MDR bacteria compared to the total number of microbiological isolates by focus of infection and site of acquisition.</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="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Community-acquired, <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>48 (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Healthcare-associated, <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>39 (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hospital-acquired, <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15 (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total, <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>102 (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Total MDR bacteria (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (12.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (66.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 (28.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ESBL-producing enterobacteriaceae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (8.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (25.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (18.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">E. faecium</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (5.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (5.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">A. baumannii</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Stenotrophomonas maltophilia</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (6.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Carbapenemase-producing <span class="elsevierStyleItalic">P. aeruginosa</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Carbapenemase-producing <span class="elsevierStyleItalic">E. cloacae</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (6.66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">UTI</span> (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ESBL-producing enterobacteriaceae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (38.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total MDR bacteria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (38.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">SBP</span> (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ESBL-producing enterobacteriaceae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (8.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (16.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">E. faecium</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (8.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (16.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total MDR bacteria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (16.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (33.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cellulitis</span> (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.51 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ESBL-producing enterobacteriaceae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (18.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (11.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">A. baumannii</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (5.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total MDR bacteria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (27.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (16.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Pneumonia</span> (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.027 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ESBL-producing enterobacteriaceae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (66.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (27.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">S. maltophilia</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total MDR bacteria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (66.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (66.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (36.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Spontaneous bacteraemia</span> (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><br>0.048 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Carbapenemase-producing <span class="elsevierStyleItalic">E. cloacae</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (14.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">E. faecium</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (14.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total MDR bacteria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (28.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Other infections</span> (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.47 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ESBL-producing enterobacteriaceae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (16.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Carbapenemase-producing <span class="elsevierStyleItalic">P. aeruginosa</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (16.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total MDR bacteria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (16.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (16.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (14.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2021429.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Prevalence of multidrug-resistant bacteria by type of infection and site of acquisition.</p>" ] ] 6 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "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="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Community-acquired \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Healthcare-associated \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hospital-acquired \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Total infections</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Response rate (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (58.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (54.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (8.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">UTI</span> (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Response rate (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (57.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (81.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (65) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">SBP</span> (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Response rate (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (44.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (36.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cellulitis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Response rate (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (54.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Pneumonia</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Response rate (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (66.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Spontaneous bacteraemia</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Response rate (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (28.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Other</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Response rate (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (16.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (38.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.42 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 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Original article
Multidrug-resistant bacterial infections in patients with liver cirrhosis in a tertiary referral hospital
Infecciones por bacterias multirresistentes en pacientes cirróticos en un hospital terciario
Sergio Béjar-Serranoa,
, Pablo del Pozoa, Margarita Fernández-de la Vargaa, Salvador Benllocha,b,c
Corresponding author
a Departamento de Gastroenterología, Hepatología y Unidad de Trasplante Hepático, Hospital Universitari y Politècnic La Fe, Valencia, Spain
b Grupo Acreditado de Hepatología y Trasplante Hepático, Hospital Universitari i Politècnic La Fe, Valencia, Spain
c Centro de Investigación Biomédica en Red del Área de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain