Brief report
Comparison of the identification results of Candida species obtained by BD Phoenix™ and Maldi-TOF (Bruker Microflex LT Biotyper 3.1)
Comparación de los resultados de identificación de especies del género Candida obtenidos por BD Phoenix™ y Maldi-TOF (Bruker Microflex LT Biotyper 3.1)
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"apellidos" => "Marucco" "email" => array:1 [ 0 => "apmarucco27@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" => "Patricia" "apellidos" => "Minervini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Gabriela V." "apellidos" => "Snitman" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Adriana" "apellidos" => "Sorge" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Liliana I." "apellidos" => "Guelfand" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Laura López" "apellidos" => "Moral" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 6 => array:2 [ "colaborador" => "Integrantes de la Red de Micología CABA" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn1" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Hospital de Agudos Santojanni, CABA, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Oftalmológico Santa Lucía, CABA, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital de Quemados, CABA, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Instituto de Oncología Roffo, CABA, Argentina" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Hospital Fernández, CABA, Argentina" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Hospital Argerich, CABA, Argentina" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comparación de los resultados de identificación de especies del género <span class="elsevierStyleItalic">Candida</span> obtenidos por BD Phoenix™ y Maldi-TOF (Bruker Microflex LT Biotyper 3.1)" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Candida albicans</span> continues to be the most frequent yeast isolated from clinical specimens. However, <span class="elsevierStyleItalic">Candida</span> species distribution has been changing during the last decades<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">3,5,7</span></a> and it varies based on different factors including region, patient's age group, underlying disease, prophylaxis used<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">2,7</span></a>. <span class="elsevierStyleItalic">Candida glabrata</span> is an important emergent pathogen in Northern Europe, the United States and Canada, whereas <span class="elsevierStyleItalic">Candida parapsilosis</span> prevails in Southern Europe, Asia and South America<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a>. In developed countries <span class="elsevierStyleItalic">C. glabrata</span> ranks second, followed by <span class="elsevierStyleItalic">C. parapsilosis</span> and <span class="elsevierStyleItalic">Candida tropicalis</span><a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a>. In Latin America, <span class="elsevierStyleItalic">C. parapsilosis</span> is found in the second place, followed by <span class="elsevierStyleItalic">C. tropicalis</span> and <span class="elsevierStyleItalic">C. glabrata</span><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a>. In Argentina, <span class="elsevierStyleItalic">C. albicans</span> has been reported to be in the first place, followed by <span class="elsevierStyleItalic">C. parapsilosis</span> and then <span class="elsevierStyleItalic">C. tropicalis</span> and <span class="elsevierStyleItalic">C. glabrata</span>, in studies performed by the National Mycology Network [Instituto Nacional de Microbiología C. Malbrán – Administración Nacional de Laboratorios e Institutos de Salud] and the Buenos Aires City Mycology Network<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">2,6</span></a> thus confirming the data reported for Latin America<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Among other factors, species distribution varies depending on the different stages of the life course, as it can be observed at the extremes of the age spectrum; while <span class="elsevierStyleItalic">C. albicans</span> and <span class="elsevierStyleItalic">C. parapsilosis</span> prevail in newborns, <span class="elsevierStyleItalic">C. glabrata</span> predominates in patients over 60 years old<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">2,7</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The importance of a definitive identification lies on the fact that certain <span class="elsevierStyleItalic">Candida</span> species can show or develop a reduced sensitivity to one or several antifungal drugs, thus leading to crucial clinical consequences<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">4,12</span></a>. A quick turnaround time for this test is critical in current clinical settings, since a rapid diagnosis would enable the prescription of a specific antifungal treatment. On the other hand, identification down to species level allows for a better understanding of the epidemiology of each healthcare facility, which is important when establishing an empirical therapy.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The conventional methodology is laborious and slow, therefore, commercial methods allowing a faster identification have been developed. These methods, such as API 20C AUX<span class="elsevierStyleSup">®</span> and API ID 32C<span class="elsevierStyleSup">®</span> (bioMérieux, France), and RapID™ Yeast Plus<span class="elsevierStyleSup">®</span> (Remel)<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">9,14</span></a>, are based on sugar assimilation and fermentation<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a>.</p><p id="par0025" class="elsevierStylePara elsevierViewall">During the last decades, automated methods appropriate for microbiology laboratories have been developed. Examples of these are Microscan WalkAway RYID<span class="elsevierStyleSup">®</span> (Rapid Yeast Identification), Vitek YBC<span class="elsevierStyleSup">®</span> (Yeast Biochemical Card), Vitek 2 ID-YST<span class="elsevierStyleSup">®</span> and BD Phoenix™ Yeast ID, which can have yeasts identified within 4–48<span class="elsevierStyleHsp" style=""></span>h. The automated microbiology system BD Phoenix™ Yeast ID has been designed for the rapid identification of clinically relevant yeasts<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a>. The assays used in the panels are modifications of standard biochemical methods. They include tests for fermentation, oxidation, degradation and hydrolysis of various substrates, as well as single-carbon-source substrates, both chromogenic and fluorogenic. Use and degradation of specific substrates are detected by different indicator systems. Acid production from carbohydrates is detected by a change in the phenol red indicator. Chromogenic substrates contain p-nitrophenyl or p-nitroanilide compounds that produce a yellow color once its enzymatic hydrolysis has taken place. Enzymatic hydrolysis of fluorogenic substrates results in the release of a product derived from the fluorescent substance coumarin. Organisms using a single-carbon-source reduce a resazurin-based indicator<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">10,14</span></a>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The purpose of this study was to compare the identification results obtained for different species of the genus <span class="elsevierStyleItalic">Candida</span> with either the BD Phoenix™ Yeast ID automated method or the matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) mass spectrometry (MS) method.</p><p id="par0035" class="elsevierStylePara elsevierViewall">A collection of 192 strains of the genus <span class="elsevierStyleItalic">Candida</span>, coming from various clinical specimens processed at member hospitals of the Buenos Aires City Mycology Network, Argentina, between 2009 and 2014, was analyzed. All strains were identified by conventional methods which included: micromorphological study in corn-meal agar (Oxoid, UK) with 1% Tween 80; chromogenic agar for yeasts (CHROMagar™ Candida, Paris, France); API<span class="elsevierStyleSup">®</span> ID 32C or API<span class="elsevierStyleSup">®</span> 20C AUX (bioMérieux, Marcy l’Etoile, France) Biochemical tests were added to differentiate <span class="elsevierStyleItalic">C. albicans</span> from <span class="elsevierStyleItalic">Candida dubliniensis</span>, developmental capacity at different temperatures, production of chlamydoconidia in different substrates and production of halo of opacity in media containing Tween 80 and CaCl<span class="elsevierStyleInf">2</span><a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a>.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Thirty-nine <span class="elsevierStyleItalic">C. tropicalis</span>, 34 <span class="elsevierStyleItalic">Candida guilliermondii</span>, 31 <span class="elsevierStyleItalic">C. albicans</span>, 29 <span class="elsevierStyleItalic">C. parapsilosis</span>, 28 <span class="elsevierStyleItalic">C. glabrata</span>, 23 Candidakrusei, 4 <span class="elsevierStyleItalic">C. dubliniensis</span>, 3 <span class="elsevierStyleItalic">Candida lusitaniae</span> and 1 <span class="elsevierStyleItalic">Candida lipolytica</span> were tested. The strains were inoculated onto chromogenic culture media for yeasts (CHROMagar™ Candida) in order to confirm purity. Each isolate was subcultured in Sabouraud dextrose agar and incubated for 48<span class="elsevierStyleHsp" style=""></span>h, at 35<span class="elsevierStyleHsp" style=""></span>°C, before using the BD Phoenix™ Yeast ID panels as instructed by the manufacturer<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a>. As the Phoenix system does not report confidence values lower than 90%, results with scores >90% were considered to represent acceptable identifications.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Identification results were compared with those obtained by MALDI-TOF MS (Bruker Microflex LT Biotyper 3.1). The MALDI ionization, coupled to a TOF analyzer is a soft ionization technique used in mass spectrometry, which allows the analysis of biomolecules and large organic molecules<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">11,13</span></a>.</p><p id="par0050" class="elsevierStylePara elsevierViewall">MALDI-TOF MS was used as reference method, together with genotyping identification in those strains yielding discrepant identification results. For the molecular technique, DNA extraction was performed, followed by amplification of specific DNA portions with universal primers ITS1 (5′-TCCGTAGGTGAACCTGCGG-3′) and ITS4 (5′-TCCTCCGCTTATTGATATGC-3′) by PCR. Amplification products were sequenced using the Sanger method. The BLAST tool was used for identification and the criteria established were concordance >97% and coverage of at least 99%.</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Candida krusei</span> ATCC 6258, <span class="elsevierStyleItalic">C. parapsilosis</span> ATCC 22019 and <span class="elsevierStyleItalic">C. albicans</span> ATCC 64548 were used as control strains.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Among the different species studied, concordance was variable and rates are detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The general concordance index was 95%. While <span class="elsevierStyleItalic">C. albicans</span> showed a concordance rate of 100%, the remaining species evidenced at least one discrepancy with the reference method. Ten strains (5%) were misidentified with the Yeast ID panels: one <span class="elsevierStyleItalic">C. tropicalis</span>, two <span class="elsevierStyleItalic">C. guilliermondii</span>, one <span class="elsevierStyleItalic">C. parapsilosis</span>, one <span class="elsevierStyleItalic">C. krusei</span>, two <span class="elsevierStyleItalic">C. dubliniensis</span>, one <span class="elsevierStyleItalic">C. lusitaniae</span> and one <span class="elsevierStyleItalic">C. lipolytica</span>. The low concordance rates obtained for the last three species mentioned above can be due to the low number of strains tested. For the remaining species studied the index was ≥96%.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Detection turnaround times for each of the species are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>, with a mean time of 8<span class="elsevierStyleHsp" style=""></span>h 22<span class="elsevierStyleHsp" style=""></span>min (range 4<span class="elsevierStyleHsp" style=""></span>h 23<span class="elsevierStyleHsp" style=""></span>min–15<span class="elsevierStyleHsp" style=""></span>h 68<span class="elsevierStyleHsp" style=""></span>min). MALDI-TOF MS differentiated two of the species of the <span class="elsevierStyleItalic">C. parapsilosis</span> complex as <span class="elsevierStyleItalic">Candida orthopsilosis</span> and one species of the <span class="elsevierStyleItalic">C. glabrata</span> complex as <span class="elsevierStyleItalic">Candida bracarensis</span>. The BD Phoenix™ system did not differentiate the cryptic species from those complexes, because it is a method that identifies microorganisms based on the phenotypic features of yeasts.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">According to the results obtained, we can conclude that the BD Phoenix™ Yeast ID panel system is a reliable, useful and rapid method for routine identification of the yeast species most frequently isolated from clinical specimens. Since mass spectrometry methods such as MALDI-TOF are not available in most clinical microbiology laboratories, the BD Phoenix™ system offers an effective alternative. It is noteworthy that identification was completed in only 8<span class="elsevierStyleHsp" style=""></span>h 22<span class="elsevierStyleHsp" style=""></span>min on average and with a concordance index of 95%.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres1113320" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1051111" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1113319" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1051110" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 5 => array:2 [ "identificador" => "xack378342" "titulo" => "Acknowledgements" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-05-28" "fechaAceptado" => "2017-10-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1051111" "palabras" => array:3 [ 0 => "BD Phoenix™" 1 => "Final yeast identification" 2 => "<span class="elsevierStyleItalic">Candida</span> spp." ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1051110" "palabras" => array:3 [ 0 => "BD Phoenix™" 1 => "Identificación definitiva de levaduras" 2 => "<span class="elsevierStyleItalic">Candida</span> spp." ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In patients with invasive fungal infections, the accurate and rapid identification of the genus <span class="elsevierStyleItalic">Candida</span> is of utmost importance since antimycotic sensitivity is closely related to the species. The aim of the present study was to compare the identification results of species of the genus <span class="elsevierStyleItalic">Candida</span> obtained by BD Phoenix™ (Becton Dickinson [BD]) and Maldi-TOF MS (Bruker Microflex LT Biotyper 3.1). A total of 192 isolates from the strain collection belonging to the Mycology Network of the Autonomous City of Buenos Aires, Argentina, were analyzed. The observed concordance was 95%. Only 10 strains (5%) were not correctly identified by the BD Phoenix™ system. The average identification time with the Yeast ID panels was 8<span class="elsevierStyleHsp" style=""></span>h 22<span class="elsevierStyleHsp" style=""></span>min. The BD Phoenix™ system proved to be a simple, reliable and effective method for identifying the main species of the genus <span class="elsevierStyleItalic">Candida</span>.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En pacientes con infecciones fúngicas invasoras, la identificación certera y rápida de las especies del género <span class="elsevierStyleItalic">Candida</span> es de suma importancia, ya que la sensibilidad a los antifúngicos está íntimamente relacionada con la especie. El objetivo del presente estudio fue comparar los resultados de identificación de especies del género <span class="elsevierStyleItalic">Candida</span> obtenidos con el equipo comercial BD Phoenix<span class="elsevierStyleSup">TM</span> (Becton Dickinson [BD]) y con la técnica de Maldi-TOF MS (Bruker Microflex LT Biotyper 3.1.) Se analizaron 192 aislamientos provenientes del cepario perteneciente a la Red de Micología de la Ciudad Autónoma de Buenos Aires, Argentina. La concordancia observada fue del 95%. Solo 10 cepas (5%) no fueron identificadas correctamente por el sistema BD Phoenix<span class="elsevierStyleSup">TM</span>. El tiempo promedio de identificación con los paneles Yeast ID fue de 8 h 22 min. El sistema BD Phoenix<span class="elsevierStyleSup">TM</span> demostró ser un método simple, confiable y efectivo para la identificación de las principales especies del género <span class="elsevierStyleItalic">Candida</span>.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The members of the group participated in the work are listed in Appendix A.</p>" "identificador" => "fn1" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0090" class="elsevierStylePara elsevierViewall">Ana Maria Romeo (Htal. Penna), Mariela Schijman (Htal. Álvarez), Claudia Garbasz (Htal Pirovano), Graciela Ponce (IREP), Silvana Cataldi (Htal Durand), Laura Dufranc (Htal Zubizarreta), Nora Franco (Htal. Piñero), Mónica López (Htal Ramos Mejía), Ricardo Iachini (I. Pasteur), Rosana Pereda (Htal P. Elizalde), Alicia Arechavala (Hospital Muñiz), Analia Fernandez (F. Favaloro), Silvia Relloso (CEMIC), Ivana Maldonado (Htal Aleman), Agustina Forastiero (Htal Britanico), Norma Fernandez (Htal de Clinicas).</p>" "etiqueta" => "Appendix A" "titulo" => "Integrantes de la Red de Micología-CABA" "identificador" => "sec0015" ] ] ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array: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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Species \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">BRUKER MALDI-TOF (n) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">BD PHOENIX (n) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Concordance index (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Discrepancies \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">C. tropicalis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 <span class="elsevierStyleItalic">C</span>. <span class="elsevierStyleItalic">utilis</span> \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">C. guilliermondii</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 <span class="elsevierStyleItalic">C. melibiosica</span><br>1 <span class="elsevierStyleItalic">C. parapsilosis</span> \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">C. albicans</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \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">C. parapsilosis</span> complex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 <span class="elsevierStyleItalic">C. tropicalis</span> \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">C. glabrata</span> complex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 <span class="elsevierStyleItalic">C. parapsilosis</span> \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">C. krusei</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 <span class="elsevierStyleItalic">C. glabrata</span> \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">C. dubliniensis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 <span class="elsevierStyleItalic">C. albicans</span> \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">C. lusitaniae</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 <span class="elsevierStyleItalic">C</span>. <span class="elsevierStyleItalic">melibiosica</span> \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">C. lipolytica</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 <span class="elsevierStyleItalic">C. rugosa</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">192 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">182 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 \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></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1903332.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Concordance index and discrepancies obtained when comparing the BD Phoenix™ system with the MALDI-TOF</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">h, hours.</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">Species BD Phoenix \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Confidence interval (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Detection time (range) (h) \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">C. tropicalis</span> (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95–99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.34 (4.23–8.43) \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">C. guilliermondii</span> (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95–99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.44 (4.43–15.67) \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">C. albicans</span> (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95–99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.42 (4.23–8.45) \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">C. parapsilosis complex</span> (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.21 (4.25–15.66) \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">C. glabrata complex</span> (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96–99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.32 (8.12–15.68) \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">C. krusei</span> (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97–99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.34 (8.42–15.67) \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">C. dubliniensis</span> (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.48 \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">C. lusitaniae</span> (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.43 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1903333.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Detection time of each <span class="elsevierStyleItalic">Candida</span> species</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "L.S.I. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 0 | 3 |
| 2024 October | 42 | 2 | 44 |
| 2024 September | 35 | 4 | 39 |
| 2024 August | 36 | 5 | 41 |
| 2024 July | 29 | 2 | 31 |
| 2024 June | 36 | 6 | 42 |
| 2024 May | 35 | 3 | 38 |
| 2024 April | 32 | 13 | 45 |
| 2024 March | 41 | 4 | 45 |
| 2024 February | 51 | 15 | 66 |
| 2024 January | 73 | 9 | 82 |
| 2023 December | 48 | 14 | 62 |
| 2023 November | 41 | 12 | 53 |
| 2023 October | 54 | 8 | 62 |
| 2023 September | 33 | 7 | 40 |
| 2023 August | 39 | 7 | 46 |
| 2023 July | 36 | 7 | 43 |
| 2023 June | 31 | 4 | 35 |
| 2023 May | 38 | 7 | 45 |
| 2023 April | 23 | 7 | 30 |
| 2023 March | 19 | 9 | 28 |
| 2023 February | 13 | 21 | 34 |
| 2023 January | 19 | 17 | 36 |
| 2022 December | 28 | 18 | 46 |
| 2022 November | 41 | 13 | 54 |
| 2022 October | 38 | 16 | 54 |
| 2022 September | 31 | 14 | 45 |
| 2022 August | 32 | 15 | 47 |
| 2022 July | 26 | 5 | 31 |
| 2022 June | 27 | 10 | 37 |
| 2022 May | 27 | 11 | 38 |
| 2022 April | 58 | 15 | 73 |
| 2022 March | 95 | 10 | 105 |
| 2022 February | 92 | 4 | 96 |
| 2022 January | 60 | 10 | 70 |
| 2021 December | 51 | 15 | 66 |
| 2021 November | 65 | 11 | 76 |
| 2021 October | 25 | 9 | 34 |
| 2021 September | 17 | 13 | 30 |
| 2021 August | 22 | 8 | 30 |
| 2021 July | 21 | 10 | 31 |
| 2021 June | 21 | 6 | 27 |
| 2021 May | 26 | 9 | 35 |
| 2021 April | 36 | 28 | 64 |
| 2021 March | 23 | 11 | 34 |
| 2021 February | 30 | 12 | 42 |
| 2021 January | 24 | 25 | 49 |
| 2020 December | 18 | 17 | 35 |
| 2020 November | 21 | 18 | 39 |
| 2020 October | 20 | 25 | 45 |
| 2020 September | 17 | 22 | 39 |
| 2020 August | 27 | 27 | 54 |
| 2020 July | 18 | 13 | 31 |
| 2020 June | 21 | 19 | 40 |
| 2020 May | 26 | 16 | 42 |
| 2020 April | 22 | 28 | 50 |
| 2020 March | 27 | 14 | 41 |
| 2020 February | 29 | 18 | 47 |
| 2020 January | 20 | 9 | 29 |
| 2019 December | 17 | 5 | 22 |
| 2019 November | 18 | 9 | 27 |
| 2019 October | 31 | 4 | 35 |
| 2019 September | 36 | 16 | 52 |
| 2019 August | 17 | 11 | 28 |
| 2019 July | 29 | 22 | 51 |
| 2019 June | 62 | 24 | 86 |
| 2019 May | 104 | 50 | 154 |
| 2019 April | 73 | 19 | 92 |
| 2019 March | 29 | 19 | 48 |
| 2019 February | 36 | 14 | 50 |
| 2019 January | 33 | 13 | 46 |
| 2018 December | 25 | 12 | 37 |
| 2018 November | 17 | 8 | 25 |
| 2018 October | 24 | 23 | 47 |
| 2018 September | 21 | 13 | 34 |
| 2018 August | 1 | 6 | 7 |
| 2018 July | 0 | 13 | 13 |
| 2018 June | 0 | 8 | 8 |
| 2018 May | 0 | 8 | 8 |
| 2018 April | 5 | 6 | 11 |
| 2018 March | 2 | 15 | 17 |
| 2018 February | 3 | 19 | 22 |
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