Susceptibility to β-lactams in β-hemolytic streptococci

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Lopardo" "autores" => array:9 [ 0 => array:3 [ "nombre" => "Laura" "apellidos" => "Bonofiglio" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "Paula" "apellidos" => "Gagetti" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Gabriela" "apellidos" => "García Gabarrot" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "Sara" "apellidos" => "Kaufman" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 4 => array:3 [ "nombre" => "Marta" "apellidos" => "Mollerach" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Inés" "apellidos" => "Toresani" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "Laura" "apellidos" => "Vigliarolo" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] 7 => array:3 [ "nombre" => "Martha" "apellidos" => "von Specht" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] 2 => array:2 [ "etiqueta" => "i" "identificador" => "aff0045" ] ] ] 8 => array:4 [ "nombre" => "Horacio A." "apellidos" => "Lopardo" "email" => array:1 [ 0 => "hlopar25@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:9 [ 0 => array:3 [ "entidad" => "Grupo STREP de la Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas (SADEBAC), División de la Asociación Argentina de Microbiología, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Microbiología, Inmunología y Biotecnología, Cátedra de Microbiología, Ciudad Autónoma de Buenos Aires, Argentina, CONICET, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Antimicrobianos, Departamento de Bacteriología, Instituto Nacional de Enfermedades Infecciosas (INEI), ANLIS “Dr. Carlos G. Malbrán”, Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Programa de Desarrollo de las Ciencias Básicas (PEDECIBA), Universidad de la República, Montevideo, Uruguay" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Sección Microbiología Clínica, División Laboratorio, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Cátedra de Bacteriología, Facultad de Ciencias Bioquímicas, Universidad Nacional de Rosario, Rosario, Provincia de Santa Fe, Argentina" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Cátedra de Microbiología Clínica, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Provincia de Buenos Aires, Argentina" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Laboratorio de Bacteriología, Hospital Provincial de Pediatría “Dr. F. Barreyro”, Posadas, Misiones, Argentina" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Departamento de Microbiología, Facultad de Ciencias Exactas Químicas y Naturales, Universidad Nacional de Misiones, Posadas, Misiones, Argentina" "etiqueta" => "i" "identificador" => "aff0045" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sensibilidad a los β-lactámicos en estreptococos β-hemolíticos" ] ] "textoCompleto" => "IntroductionGroup A (Streptococcus pyogenes), and large colony group C and G (Streptococcus dysgalactiae subsp. equisimilis) streptococci share the profile of being transient colonizers of human skin and mucous and produce several infections such as pharyngitis, scarlet fever, acute otitis media, impetigo, erysipelas, cellulitis, necrotizing fasciitis, septic arthritis, pneumonia, bacteremia and toxic shock syndrome, among the most frequent ones. Their impact is not only quantitative (more than 600 million infections annually) but it is also qualitative, regarding the severity of necrotizing fasciitis, myositis, puerperal sepsis, and the toxic shock syndrome. Additionally, group A streptococci (GAS) have been investigated for their significant role in the development of post-streptococcal infection sequelae, including acute rheumatic fever, acute glomerulonephritis, and reactive arthritis. Group A streptococcal infections have also been associated with Tourette's syndrome, tics, and movement and attention deficit disorders<a class="elsevierStyleCrossRef" href="#bib0185">5</a>.Streptococcus agalactiae or group B streptococci (GBS) colonize the genital and gastrointestinal tract of women and men and vertical transmission from a colonized mother to her newborn during labor can result in life threatening infections. Because of the latter, GBS is the leading cause of neonatal sepsis and meningitis. In addition, it has been recognized as an important pathogen in non-pregnant individuals, especially elderly people and those suffering from underlying medical disorders<a class="elsevierStyleCrossRef" href="#bib0305">29</a>.Treatment of different streptococcal infections is mainly based on the use of penicillin V administered orally, intramuscular benzathine penicillin, parenteral penicillin G, amoxicillin or cephalosporins (cephalexin, cefotaxime, ceftriaxone). In allergic patients or special clinical presentations, the first options are macrolides (erythromycin, azithromycin, clarithromycin) and/or lincosamides (lincomycin, clindamycin). Clindamycin is the recommended antibiotic to treat severe infections of skin and soft tissues (necrotizing fasciitis, toxic shock syndrome).Depending on the susceptibility tests, the patient may be treated with tetracyclines (tetracycline, minocycline, doxycycline), vancomycin or fluoroquinolones (levofloxacin, moxifloxacin). Aminoglycosides were added to β-lactam antibiotics to treat rare cases of endocarditis due to groups C or G streptococci.The aim of the present review is to describe the mechanisms and the prevalence of β-lactam resistance in β-hemolytic streptococci of groups A, B, C and G.Resistance to β-lactam antibiotics in groups A, C and G streptococciTo date, no group A, C or G streptococci with diminished susceptibility to penicillin or third generation cephalosporins have been detected<a class="elsevierStyleCrossRef" href="#bib0315">31</a>. Values of minimal inhibitory concentration (MIC), MIC90, published in different studies showed a median of 0.016μg/ml and a range of 0.0025–0.032μg/ml. Some authors described ranges of MICs showing some values higher than the CLSI breakpoint for penicillin (0.125μg/ml) for group C and G streptococci; however, these results were not confirmed by reference centers.In Japan, 61.4% of intermediate susceptibility (MIC=0.25μg/ml) and 2.3% of resistance to penicillin (one isolate with a MIC=2μg/ml) was reported in patients with an initial episode of pharyngitis due to S. pyogenes; however, these results were also not confirmed<a class="elsevierStyleCrossRef" href="#bib0275">23</a>.With regard to group A streptococci, one hundred and thirty-three strains were collected in the Rockefeller University (New York, USA) during 80 years and neither of them showed changes in penicillin susceptibility. The MIC90 for the oldest strains (0.032μg/ml) was the same of those collected in the last year of the study<a class="elsevierStyleCrossRef" href="#bib0245">17</a>.The question of why GAS remains susceptible to penicillin, can only be answered with speculations<a class="elsevierStyleCrossRef" href="#bib0200">8</a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">a.β-Lactamase may not be expressed or may be toxic to GAS.</li><li class="elsevierStyleListItem" id="lsti0010">b.Low affinity PBPs are neither expressed nor render organisms nonviable.</li><li class="elsevierStyleListItem" id="lsti0015">c.GAS produce at least four different DNases that could limit the opportunity for acquisition of exogenous DNA via transformation.</li><li class="elsevierStyleListItem" id="lsti0020">d.Circumstances favorable for the development of resistance have not yet occurred.</li></ul>In spite of its universal susceptibility, the success of pharyngitis treatments with penicillin is not 100%; however it is between 62% and 98% in different series, with a median failure of around 12%<a class="elsevierStyleCrossRef" href="#bib0250">18</a>.Failures may be due to different causes:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025">(a)Coexistence of oropharyngeal β-lactamase-producing bacteriaIn the oropharynx there are bacteria that degrade penicillin because they produce extracellular β-lactamases (Staphylococcus aureus, anaerobes), thus protecting GAS from penicillin<a class="elsevierStyleCrossRef" href="#bib0170">2</a>.</li><li class="elsevierStyleListItem" id="lsti0030">(b)Elimination of Streptococcus salivariusS. salivarius interferes with S. pyogenes by means of its bacteriocins. Penicillin eliminates both organisms. As this antibiotic does not preserve S. salivarius in its original niche, it does not provide protection from reinfection with GAS<a class="elsevierStyleCrossRef" href="#bib0170">2</a>.</li><li class="elsevierStyleListItem" id="lsti0035">(c)ToleranceTolerance is the property of some bacteria by which they evade the bactericidal activity of a specific antibiotic. Several authors have published that the rate of tolerance of S. pyogenes and other β-hemolytic streptococci is ≥10%. However, there is insufficient data to support a correlation between tolerance to penicillin and treatment failure, either in clinical cases or in animal studies<a class="elsevierStyleCrossRef" href="#bib0320">32</a>.Moreover, it has not been demonstrated that an antibiotic should have bactericidal effect to eradicate GAS from the throat. Furthermore, in one study it has been reported that none of the 28 cases of therapeutic failure with penicillin the bacteria showed the tolerance phenomenon<a class="elsevierStyleCrossRef" href="#bib0310">30</a>.</li><li class="elsevierStyleListItem" id="lsti0040">(d)InternalizationIt was demonstrated that protein-F1-mediated entry to cells and is involved in the causative process of the carriage state. As penicillin does not gain high intracellular concentrations, cell internalization was proposed as another possible explanation for penicillin treatment failures in children with pharyngitis.By using a human epithelial cell line model, Kaplan et al.<a class="elsevierStyleCrossRef" href="#bib0205">9</a>, showed that penicillin was less effective in killing intracellular streptococci than cephalothin, clindamycin, erythromycin or azithromycin.</li><li class="elsevierStyleListItem" id="lsti0045">(e)Suppression of natural immune responseIt has been proposed that the success of penicillin treatment could be influenced by the delay of at least 2 days the beginning of antibiotic administration. However, there are several studies that do not agree with this theory<a class="elsevierStyleCrossRef" href="#bib0295">27</a>.</li><li class="elsevierStyleListItem" id="lsti0050">(f)Biofilm formationThe role of biofilm formation in evading antibiotic eradication of GAS in patients with pharyngitis was not clearly proved, although, after treatments with high concentrations of antibiotics, S. pyogenes only survived in biofilm<a class="elsevierStyleCrossRef" href="#bib0270">22</a>.</li><li class="elsevierStyleListItem" id="lsti0055">(g)Other explanationsSome defects in the design or performance of studies may erroneously categorize the causes of the outcome of treatments. Data presented in the literature do not often provide sufficient information for distinguishing between true eradication failure and recolonization following successful eradication<a class="elsevierStyleCrossRef" href="#bib0295">27</a>.</li></ul>There are some studies that do not recognize between true failures and GAS carriers that suffer viral infections. Furthermore it was suggested that the majority of reported treatment failures were in fact due to inappropriate dosage of the antibiotic, the duration of therapy and/or poor patient compliance.Is penicillin still the antibiotic of choice for treating GAS pharyngitis?According with current guidelines, penicillin V is still the antibiotic of choice for treating GAS pharyngitis<a class="elsevierStyleCrossRef" href="#bib0300">28</a>.The following are some of the reasons to continue recommending penicillin V for the treatment of GAS pharyngitis:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0060">(1)Its lower cost compared to alternative agents.</li><li class="elsevierStyleListItem" id="lsti0065">(2)GAS isolates with reduced susceptibility to penicillin have not been described yet.</li><li class="elsevierStyleListItem" id="lsti0070">(3)Penicillin is among the best-tolerated antibiotics in non-penicillin-allergic individuals.</li><li class="elsevierStyleListItem" id="lsti0075">(4)It shows a narrow spectrum, causing less selection pressure for multidrug-resistant bacteria.</li><li class="elsevierStyleListItem" id="lsti0080">(5)Penicillin is the only antibiotic with proven efficacy to prevent acute rheumatic fever.</li></ul>Reduced susceptibility to β-lactam antibiotics in S. agalactiaePenicillin remains the first choice to treat GBS infections although since 2008, strains with reduced susceptibility to this antimicrobial agent have been described in Japan, USA, UK and Canada<a class="elsevierStyleCrossRefs" href="#bib0180">4,6,13,16</a>.The prevalence is high in Japan, which was reported to be 2.3% in the period 2005–2006. It increased to 14.7% between 2012 and 2013. The latter GBS with reduced susceptibility to penicillin (PRGBS) were also multidrug-resistant (MDR), being 71.1% and 95.6% resistant to erythromycin and levofloxacin respectively, and 68.9% resistant to both antibiotics<a class="elsevierStyleCrossRef" href="#bib0290">26</a>. Therefore, the spread of PRGBS with a tendency to MDR, has increased in Japan. Most PRGBS were recovered from respiratory samples from elderly patients and some others, reported in Swedish and Japanese studies, were recovered from invasive samples from neonates and adults, but with only 3 PRGBS isolates in total<a class="elsevierStyleCrossRefs" href="#bib0255">19,25</a>.Because the number of PRGBS is scarce, data regarding sequence type (ST) is poor. Kimura et al. found that ST1 and a single locus variant ST458 are predominant in isolates recovered between 1998 and 2003 periods and differ from the results obtained in USA, where ST19 is the only sequence type described so far<a class="elsevierStyleCrossRefs" href="#bib0190">6,12</a>.In Argentina, GBS continue to be susceptible to penicillin<a class="elsevierStyleCrossRefs" href="#bib0165">1,24</a>.Mechanisms of β-lactam resistance in S. agalactiaePenicillin resistance in gram-positive organisms is essentially due to the production of altered, low-affinity target enzymes, penicillin-binding proteins (PBPs) that catalyze the terminal stage of bacterial cell wall peptidoglycan synthesis. In PBPs, three conserved motifs, SXXK, SXN, and KT(S)G, commonly found in transpeptidase domains form the catalytic center; and alterations within or adjacent to these motifs are associated with their reduced affinity for β-lactams<a class="elsevierStyleCrossRef" href="#bib0195">7</a>.Specifically, in GBS with reduced susceptibility to penicillin the substitutions occur mainly in PBP2X in amino acids V405A and/or Q557E<a class="elsevierStyleCrossRefs" href="#bib0190">6,13,20</a>. Moreover, an amino acid substitution in PBP1A confers high-level resistance to cephalosporins<a class="elsevierStyleCrossRef" href="#bib0230">14</a> and multiple amino acid substitutions were found in PBP2X and PBP2B. These mutations are related to their penicillin MIC levels. Recently ceftibuten-resistant but penicillin-susceptible GBS with amino acid substitutions in PBP2X were reported<a class="elsevierStyleCrossRef" href="#bib0265">21</a>.Taking into account all the different cases that have been found in the reports related to changes in PBPs, Kimura et al.<a class="elsevierStyleCrossRef" href="#bib0210">10</a> proposed a classification for PRGBS based on amino acid substitutions and suggested considering whether the isolate has changes in PBP2X and other PBPs and resistance to other β-lactams.How to phenotypically detect isolates with reduced susceptibility to penicillin?It is important to mention that the use of 10IU penicillin disks, as recommended by the CLSI, is not effective to demonstrate the presence of PRGBS. Therefore, dilution methods should be performed for MIC determination. CLSI guides state that if the MIC is ≤0.12μg/ml, the isolate is susceptible to penicillin<a class="elsevierStyleCrossRef" href="#bib0175">3</a>; on the other hand, the EUCAST establishes a cutoff value of >0.25μg/ml for the resistant category (<a id="intr0005" class="elsevierStyleInterRef" href="http://www.eucast.org/clinical_breakpoints/">http://www.eucast.org/clinical_breakpoints/</a>). The study of the resistance mechanism involved in reduced susceptibility has to be done by sequencing PBP coding genes to detect substitutions in PBPs. As we mentioned, other β-lactams could have MIC values in the range of non-susceptibility. In the effort to detect PRGBS isolates without MIC determination, Kimura et al. developed a three disk (3DM) screening method, using ceftibuten (CBT), oxacillin (OXA) and ceftizoxime (ZOX)<a class="elsevierStyleCrossRef" href="#bib0235">15</a>. Cutoff values are: to OXA<17mm, CBT<29mm and ZOX<20mm. In brief, in order to be included in PRGBS according to these criteria, the inhibition zone of 2/3 disks have to be below the cutoff value. Thus, in the isolates tested by Kimura, the growth inhibition zones around the PEN disk were >24mm (CLSI susceptibility criteria) but the MIC values were >0.12μg/ml. With this method they obtained good specificity and sensitivity. The use of 3DM is controversial. When Cooper et al.<a class="elsevierStyleCrossRef" href="#bib0180">4</a> performed this screening they found nearly 50% of false positive rates with too low specificity. The same was found by Arias et al. in Argentina.<a class="elsevierStyleCrossRef" href="#bib0165">1</a>Therefore, there is evidence that the 3DM method is not recommended or, at least, breakpoints would be modified.Another issue is that the Vitek 2 compact system with AST-P456 cards (BioMérieux Clinical Diagnostic, Marcy l’Etoile, France) only detects half of the PRGBS isolates, suggesting that many of these isolates would be misclassified as susceptible to penicillin. The authors also suggested that operators should pay attention if the system gives a result of MIC=0.12μg/ml<a class="elsevierStyleCrossRef" href="#bib0215">11</a>.ConclusionIt is important to highlight that confirmation by reference methods is mandatory when reduced susceptibility to penicillin is suspected in this group of bacteria, and the mechanism involved should be studied.Conflict of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1113369" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1051163" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1113370" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1051162" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Resistance to β-lactam antibiotics in groups A, C and G streptococci" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Is penicillin still the antibiotic of choice for treating GAS pharyngitis?" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Reduced susceptibility to β-lactam antibiotics in S. agalactiae" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Mechanisms of β-lactam resistance in S. agalactiae" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "How to phenotypically detect isolates with reduced susceptibility to penicillin?" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusion" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-05-31" "fechaAceptado" => "2017-11-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1051163" "palabras" => array:6 [ 0 => "Streptococcus agalactiae" 1 => "Streptococcus pyogenes" 2 => "Streptococcus dysgalactiae subsp. equisimilis" 3 => "β-Lactams" 4 => "Penicillin" 5 => "Susceptibility" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1051162" "palabras" => array:6 [ 0 => "Streptococcus agalactiae" 1 => "Streptococcus pyogenes" 2 => "Streptococcus dysgalactiae subsp. equisimilis" 3 => "β-lactámicos" 4 => "Penicilina" 5 => "Sensibilidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Group A (GAS), B (GBS), C (GCS) and G (GGS) β-hemolytic streptococci are important human pathogens. They cause infections of different severity and frequency. Nowadays, after 70 years of use, penicillin is still universally active against GAS, GCS and GGS. However, therapeutic failures have been recorded in 2–28% of pharyngitis cases (median: 12%) attributable to different causes. By contrast, some GBS with reduced susceptibility to penicillin have been described, especially in Japan. In this group of bacteria, it is important to highlight that confirmation by reference methods is mandatory when decreased susceptibility to penicillin is suspected as well as checked for the detection of the mechanisms involved." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Los estreptococos β-hemolíticos de los grupos A (GAS), B (GBS), C (GCS) y G (GGS) son importantes patógenos humanos. Ellos producen infecciones de diversa gravedad y frecuencia. Aún después de más de 70 años de uso, la penicilina sigue siendo activa in vitro frente al 100% de los GAS, GCS y GGS. No obstante se han producido fallas terapéuticas entre el 2-28% de los casos de faringitis (media: 12%), atribuibles a diversas causas. En cambio se han descrito aislados de GBS con sensibilidad reducida a la penicilina, especialmente en Japón. Es importante que toda sospecha de sensibilidad disminuida a la penicilina en este grupo de bacterias sea confirmada por los métodos de referencia y comprobada mediante la detección de los mecanismos involucrados." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0165" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio Nacional Multicéntrico de infecciones invasivas ocasionadas por Streptococcus agalactiae: resistencia a los antibióticos y distribución de serotipos" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "EGB Grupo col. Inf. Invasivas" "etal" => false "autores" => array:9 [ 0 => "B. Arias" 1 => "V. Kovacec" 2 => "M. Suárez" 3 => "L. Vigliarolo" 4 => "C. Tersigni" 5 => "E. Sutich" 6 => "H. Lopardo" 7 => "L. Bonofiglio" 8 => "M. Mollerach" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:3 [ "titulo" => "Resumen MA-0015, XXIII Congreso Latinoamericano de Microbiología y XIV Congreso Argentino de Microbiología" "conferencia" => "Rosario, 26 al 30 de septiembre de 2016" "serieFecha" => "2016" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0170" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of bacterial interference and beta-lactamase production in management of experimental infection with group A beta-hemolytic streptococci" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I. Brook" 1 => "J.D. Gilmore" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "1993" "volumen" => "37" "paginaInicial" => "1452" "paginaFinal" => "1455" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8363375" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S107814391630309X" "estado" => "S300" "issn" => "10781439" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0175" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Performance standards for antimicrobial susceptibility testing: twenty-fourth informational supplement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Clinical and Laboratory Standards Institute" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2016" "editorial" => "Clinical and Laboratory Standards Institute" "editorialLocalizacion" => "Wayne, PA" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0180" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reduced penicillin susceptibility of group B streptococcus: an assessment of emergence in Grampian Scotland" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Cooper" 1 => "F. Abbott" 2 => "I.M. Gould" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/09674845.2016.1144550" "Revista" => array:6 [ "tituloSerie" => "Br J Biomed Sci" "fecha" => "2016" "volumen" => "73" "paginaInicial" => "25" "paginaFinal" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27182673" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0185" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathogenesis of group A streptococcal infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.W. Cunningham" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Rev" "fecha" => "2000" "volumen" => "13" "paginaInicial" => "470" "paginaFinal" => "511" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10885988" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0190" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point mutation in the group B streptococcal pbp2x gene conferring decreased susceptibility to beta-lactam antibiotics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "S. Dahesh" 1 => "M.E. Hensler" 2 => "N.M. Van Sorge" 3 => "R.E. Gertz Jr." 4 => "S. Schrag" 5 => "V. Nizet" 6 => "B.W. Beall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/AAC.00461-08" "Revista" => array:7 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "2008" "volumen" => "52" "paginaInicial" => "2915" "paginaFinal" => "2918" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18541727" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673616324552" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0195" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multimodular penicillin-binding proteins: an enigmatic family of orthologs and paralogs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Goffin" 1 => "J.M. Ghuysen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Microbiol Mol Biol Rev" "fecha" => "1998" "volumen" => "62" "paginaInicial" => "1079" "paginaFinal" => "1093" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9841666" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0200" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Why have group A streptococci remained susceptible to penicillin? Report on a symposium" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:13 [ 0 => "D.L. Horn" 1 => "J.B. Zabriskie" 2 => "R. Austrian" 3 => "P.P. Cleary" 4 => "J.J. Ferretti" 5 => "V.A. Fischetti" 6 => "E. Gotschlich" 7 => "E.L. Kaplan" 8 => "M. McCarty" 9 => "S.M. Opal" 10 => "R.B. Roberts" 11 => "A. Tomasz" 12 => "Y. Wachtfogel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "1998" "volumen" => "26" "paginaInicial" => "1341" "paginaFinal" => "1345" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9636860" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0205" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reduced ability of penicillin to eradicate ingested group A streptococci from epithelial cells: clinical and pathogenetic implications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E.L. Kaplan" 1 => "G.S. Chhatwal" 2 => "M. Rohde" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/508773" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2006" "volumen" => "43" "paginaInicial" => "1398" "paginaFinal" => "1406" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17083011" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0210" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Classification of group B streptococci with reduced beta-lactam susceptibility (GBS-RBS) based on the amino acid substitutions in PBPs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Kimura" 1 => "N. Nagano" 2 => "Y. Arakawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jac/dkv022" "Revista" => array:6 [ "tituloSerie" => "J Antimicrob Chemother" "fecha" => "2015" "volumen" => "70" "paginaInicial" => "1601" "paginaFinal" => "1603" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25667406" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0215" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ability of the VITEK(R) 2 system to detect group B streptococci with reduced penicillin susceptibility (PRGBS)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Kimura" 1 => "N. Nagano" 2 => "Y. Nagano" 3 => "J. Wachino" 4 => "K. Shibayama" 5 => "Y. Arakawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jac/dkt008" "Revista" => array:6 [ "tituloSerie" => "J Antimicrob Chemother" "fecha" => "2013" "volumen" => "68" "paginaInicial" => "1442" "paginaFinal" => "1444" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23378415" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0220" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predominance of sequence type 1 group with serotype VI among group B streptococci with reduced penicillin susceptibility identified in Japan" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "K. Kimura" 1 => "N. Nagano" 2 => "Y. Nagano" 3 => "J. Wachino" 4 => "S. Suzuki" 5 => "K. Shibayama" 6 => "Y. Arakawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jac/dkr352" "Revista" => array:6 [ "tituloSerie" => "J Antimicrob Chemother" "fecha" => "2011" "volumen" => "66" "paginaInicial" => "2460" "paginaFinal" => "2464" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21873288" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0225" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "First molecular characterization of group B streptococci with reduced penicillin susceptibility" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:10 [ 0 => "K. Kimura" 1 => "S. Suzuki" 2 => "J. Wachino" 3 => "H. Kurokawa" 4 => "K. Yamane" 5 => "N. Shibata" 6 => "N. Nagano" 7 => "H. Kato" 8 => "K. Shibayama" 9 => "Y. Arakawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/AAC.00185-08" "Revista" => array:6 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "2008" "volumen" => "52" "paginaInicial" => "2890" "paginaFinal" => "2897" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18490507" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0230" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High cephalosporin resistance due to amino acid substitutions in PBP1A and PBP2X in a clinical isolate of group B streptococcus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:9 [ 0 => "K. Kimura" 1 => "J. Wachino" 2 => "H. Kurokawa" 3 => "M. Matsui" 4 => "S. Suzuki" 5 => "K. Yamane" 6 => "N. Nagano" 7 => "K. Shibayama" 8 => "Y. Arakawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jac/dkt060" "Revista" => array:7 [ "tituloSerie" => "J Antimicrob Chemother" "fecha" => "2013" "volumen" => "68" "paginaInicial" => "1533" "paginaFinal" => "1536" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23449828" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1470204517302279" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0235" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Practical disk diffusion test for detecting group B streptococcus with reduced penicillin susceptibility" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "K. Kimura" 1 => "J. Wachino" 2 => "H. Kurokawa" 3 => "S. Suzuki" 4 => "K. Yamane" 5 => "N. Shibata" 6 => "Y. Arakawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.02063-08" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2009" "volumen" => "47" "paginaInicial" => "4154" "paginaFinal" => "4157" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19812274" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0240" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novel mutations in a patient isolate of Streptococcus agalactiae with reduced penicillin susceptibility emerging after long-term oral suppressive therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "J. Longtin" 1 => "C. Vermeiren" 2 => "D. Shahinas" 3 => "G.S. Tamber" 4 => "A. McGeer" 5 => "D.E. Low" 6 => "K. Katz" 7 => "D.R. Pillai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/AAC.01243-10" "Revista" => array:6 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "2011" "volumen" => "55" "paginaInicial" => "2983" "paginaFinal" => "2985" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21383092" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0245" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Studies of the continuing susceptibility of group A streptococcal strains to penicillin during eight decades" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "M.H. Macris" 1 => "N. Hartman" 2 => "B. Murray" 3 => "R.F. Klein" 4 => "R.B. Roberts" 5 => "E.L. Kaplan" 6 => "D. Horn" 7 => "J.B. Zabriskie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Infect Dis J" "fecha" => "1998" "volumen" => "17" "paginaInicial" => "377" "paginaFinal" => "381" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9613649" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0250" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of streptococcal pharyngotonsillitis: reports of penicillin's demise are premature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Markowitz" 1 => "M.A. Gerber" 2 => "E.L. Kaplan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr" "fecha" => "1993" "volumen" => "123" "paginaInicial" => "679" "paginaFinal" => "685" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8229474" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0255" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Capsular type and antibiotic resistance in Streptococcus agalactiae isolates from patients, ranging from newborns to the elderly, with invasive infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "S.Y. Murayama" 1 => "C. Seki" 2 => "H. Sakata" 3 => "K. Sunaoshi" 4 => "E. Nakayama" 5 => "S. Iwata" 6 => "K. Sunakawa" 7 => "K. Ubukata" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/AAC.01716-08" "Revista" => array:6 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "2009" "volumen" => "53" "paginaInicial" => "2650" "paginaFinal" => "2653" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19332682" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0260" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Genetic heterogeneity in pbp genes among clinically isolated group B streptococci with reduced penicillin susceptibility" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Nagano" 1 => "Y. Nagano" 2 => "K. Kimura" 3 => "K. Tamai" 4 => "H. Yanagisawa" 5 => "Y. Arakawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/AAC.00596-08" "Revista" => array:7 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "2008" "volumen" => "52" "paginaInicial" => "4258" "paginaFinal" => "4267" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18809936" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673616005614" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0265" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Penicillin-susceptible group B streptococcal clinical isolates with reduced cephalosporin susceptibility" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Nagano" 1 => "Y. Nagano" 2 => "M. Toyama" 3 => "K. Kimura" 4 => "K. Shibayama" 5 => "Y. Arakawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.01291-14" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2014" "volumen" => "52" "paginaInicial" => "3406" "paginaFinal" => "3410" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24920773" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0270" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biofilm formation or internalization into epithelial cells enable Streptococcus pyogenes to evade antibiotic eradication in patients with pharyngitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "T. Ogawa" 1 => "Y. Terao" 2 => "H. Okuni" 3 => "K. Ninomiya" 4 => "H. Sakata" 5 => "K. Ikebe" 6 => "Y. Maeda" 7 => "S. Kawabata" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.micpath.2011.03.009" "Revista" => array:7 [ "tituloSerie" => "Microb Pathog" "fecha" => "2011" "volumen" => "51" "paginaInicial" => "58" "paginaFinal" => "68" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21443942" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1078143917302533" "estado" => "S300" "issn" => "10781439" ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0275" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiological characterization of Streptococcus pyogenes isolated from patients with multiple onsets of pharyngitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "T. Ogawa" 1 => "Y. Terao" 2 => "H. Sakata" 3 => "H. Okuni" 4 => "K. Ninomiya" 5 => "K. Ikebe" 6 => "Y. Maeda" 7 => "S. Kawabata" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1574-6968.2011.02252.x" "Revista" => array:6 [ "tituloSerie" => "FEMS Microbiol Lett" "fecha" => "2011" "volumen" => "318" "paginaInicial" => "143" "paginaFinal" => "151" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21362024" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0280" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Distribución de tipo capsular y sensibilidad antimicrobiana de Streptococcus agalactiae productores de infecciones en Argentina" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:22 [ 0 => "J. Pérez" 1 => "A. Limansky" 2 => "I. Toresani" 3 => "G. Ebner" 4 => "S. Di Bartolomeo" 5 => "I. de Inocenti" 6 => "G. Pretto" 7 => "N. Salazar" 8 => "M. Laferrara" 9 => "M. Bottiglieri" 10 => "D. Ballester" 11 => "M. Morales" 12 => "L. Rivera" 13 => "M.L. Cacace" 14 => "H. Castro" 15 => "L. Roldán" 16 => "R. Notario" 17 => "N. Borda" 18 => "G. Cera" 19 => "M.J. Spoletti" 20 => "E. Gregorini" 21 => "E.G. Sutich" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Argent Microbiol" "fecha" => "2004" "volumen" => "36" "paginaInicial" => "63" "paginaFinal" => "67" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15473046" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0285" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antimicrobial susceptibility of invasive group B streptococcal isolates from South-West Sweden 1988-2001" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Persson" 1 => "S. Berg" 2 => "H. Bergseng" 3 => "K. Bergh" 4 => "R. Valso-Lyng" 5 => "B. Trollfors" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/00365540701678702" "Revista" => array:7 [ "tituloSerie" => "Scand J Infect Dis" "fecha" => "2008" "volumen" => "40" "paginaInicial" => "308" "paginaFinal" => "313" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17918014" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S147020451630242X" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0290" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High isolation rate of MDR group B streptococci with reduced penicillin susceptibility in Japan" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:9 [ 0 => "T. Seki" 1 => "K. Kimura" 2 => "M.E. Reid" 3 => "A. Miyazaki" 4 => "H. Banno" 5 => "W. Jin" 6 => "J. Wachino" 7 => "K. Yamada" 8 => "Y. Arakawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jac/dkv203" "Revista" => array:7 [ "tituloSerie" => "J Antimicrob Chemother" "fecha" => "2015" "volumen" => "70" "paginaInicial" => "2725" "paginaFinal" => "2728" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26169560" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1470204517302395" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0295" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Why do we fail with penicillin in the treatment of group A streptococcus infections?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Sela" 1 => "A. Barzilai" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Ann Med" "fecha" => "1999" "volumen" => "31" "paginaInicial" => "303" "paginaFinal" => "307" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10574501" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1470204517302401" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0300" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "S.T. Shulman" 1 => "A.L. Bisno" 2 => "H.W. Clegg" 3 => "M.A. Gerber" 4 => "E.L. Kaplan" 5 => "G. Lee" 6 => "J.M. Martin" 7 => "C. Van Beneden" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/cis629" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2012" "volumen" => "55" "paginaInicial" => "e86" "paginaFinal" => "e102" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22965026" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0305" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increasing burden of invasive group B streptococcal disease in nonpregnant adults, 1990-2007" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:16 [ 0 => "T.H. Skoff" 1 => "M.M. Farley" 2 => "S. Petit" 3 => "A.S. Craig" 4 => "W. Schaffner" 5 => "K. Gershman" 6 => "L.H. Harrison" 7 => "R. Lynfield" 8 => "J. Mohle-Boetani" 9 => "S. Zansky" 10 => "B.A. Albanese" 11 => "K. Stefonek" 12 => "E.R. Zell" 13 => "D. Jackson" 14 => "T. Thompson" 15 => "S.J. Schrag" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/599369" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2009" "volumen" => "49" "paginaInicial" => "85" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19480572" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0310" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical significance of inhibition kinetics for Streptococcus pyogenes in response to penicillin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Steininger" 1 => "F. Allerberger" 2 => "E. Gnaiger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Antimicrob Chemother" "fecha" => "2002" "volumen" => "50" "paginaInicial" => "517" "paginaFinal" => "523" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12356796" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0315" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular characterization of invasive Streptococcus dysgalactiae subsp. equisimilis. Multicenter study: Argentina 2011-2012" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "National Collaborative Group for the Study of Streptococci and Related Bacteria" "etal" => false "autores" => array:6 [ 0 => "F. Traverso" 1 => "A. Blanco" 2 => "P. Villalón" 3 => "N. Beratz" 4 => "J.A. Sáez Nieto" 5 => "H. Lopardo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ram.2016.07.001" "Revista" => array:6 [ "tituloSerie" => "Rev Argent Microbiol" "fecha" => "2016" "volumen" => "48" "paginaInicial" => "279" "paginaFinal" => "289" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28341023" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0320" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A proposed standard for MIC-MBC laboratory techniques to detect penicillin tolerance in group A streptococci" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.J. van Asselt" 1 => "R.P. 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Sensibilidad a los β-lactámicos en estreptococos β-hemolíticos

Laura Bonofiglioa,b, Paula Gagettia,c, Gabriela García Gabarrota,d, Sara Kaufmana,e, Marta Molleracha,b, Inés Toresania,f, Laura Vigliaroloa,g, Martha von Spechta,h,i, Horacio A. Lopardoa,g,

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hlopar25@gmail.com

Corresponding author.

a Grupo STREP de la Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas (SADEBAC), División de la Asociación Argentina de Microbiología, Argentina

b Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Microbiología, Inmunología y Biotecnología, Cátedra de Microbiología, Ciudad Autónoma de Buenos Aires, Argentina, CONICET, Argentina

c Servicio de Antimicrobianos, Departamento de Bacteriología, Instituto Nacional de Enfermedades Infecciosas (INEI), ANLIS “Dr. Carlos G. Malbrán”, Ciudad Autónoma de Buenos Aires, Argentina

d Programa de Desarrollo de las Ciencias Básicas (PEDECIBA), Universidad de la República, Montevideo, Uruguay

e Sección Microbiología Clínica, División Laboratorio, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina

f Cátedra de Bacteriología, Facultad de Ciencias Bioquímicas, Universidad Nacional de Rosario, Rosario, Provincia de Santa Fe, Argentina

g Cátedra de Microbiología Clínica, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Provincia de Buenos Aires, Argentina

h Laboratorio de Bacteriología, Hospital Provincial de Pediatría “Dr. F. Barreyro”, Posadas, Misiones, Argentina

i Departamento de Microbiología, Facultad de Ciencias Exactas Químicas y Naturales, Universidad Nacional de Misiones, Posadas, Misiones, Argentina

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Group A &#40;<span class="elsevierStyleItalic">Streptococcus pyogenes</span>&#41;&#44; and large colony group C and G &#40;<span class="elsevierStyleItalic">Streptococcus dysgalactiae</span> subsp&#46; <span class="elsevierStyleItalic">equisimilis</span>&#41; streptococci share the profile of being transient colonizers of human skin and mucous and produce several infections such as pharyngitis&#44; scarlet fever&#44; acute otitis media&#44; impetigo&#44; erysipelas&#44; cellulitis&#44; necrotizing fasciitis&#44; septic arthritis&#44; pneumonia&#44; bacteremia and toxic shock syndrome&#44; among the most frequent ones&#46; Their impact is not only quantitative &#40;more than 600 million infections annually&#41; but it is also qualitative&#44; regarding the severity of necrotizing fasciitis&#44; myositis&#44; puerperal sepsis&#44; and the toxic shock syndrome&#46; Additionally&#44; group A streptococci &#40;GAS&#41; have been investigated for their significant role in the development of post-streptococcal infection sequelae&#44; including acute rheumatic fever&#44; acute glomerulonephritis&#44; and reactive arthritis&#46; Group A streptococcal infections have also been associated with Tourette&#39;s syndrome&#44; tics&#44; and movement and attention deficit disorders<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Streptococcus agalactiae</span> or group B streptococci &#40;GBS&#41; colonize the genital and gastrointestinal tract of women and men and vertical transmission from a colonized mother to her newborn during labor can result in life threatening infections&#46; Because of the latter&#44; GBS is the leading cause of neonatal sepsis and meningitis&#46; In addition&#44; it has been recognized as an important pathogen in non-pregnant individuals&#44; especially elderly people and those suffering from underlying medical disorders<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Treatment of different streptococcal infections is mainly based on the use of penicillin V administered orally&#44; intramuscular benzathine penicillin&#44; parenteral penicillin G&#44; amoxicillin or cephalosporins &#40;cephalexin&#44; cefotaxime&#44; ceftriaxone&#41;&#46; In allergic patients or special clinical presentations&#44; the first options are macrolides &#40;erythromycin&#44; azithromycin&#44; clarithromycin&#41; and&#47;or lincosamides &#40;lincomycin&#44; clindamycin&#41;&#46; Clindamycin is the recommended antibiotic to treat severe infections of skin and soft tissues &#40;necrotizing fasciitis&#44; toxic shock syndrome&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Depending on the susceptibility tests&#44; the patient may be treated with tetracyclines &#40;tetracycline&#44; minocycline&#44; doxycycline&#41;&#44; vancomycin or fluoroquinolones &#40;levofloxacin&#44; moxifloxacin&#41;&#46; Aminoglycosides were added to &#946;-lactam antibiotics to treat rare cases of endocarditis due to groups C or G streptococci&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of the present review is to describe the mechanisms and the prevalence of &#946;-lactam resistance in &#946;-hemolytic streptococci of groups A&#44; B&#44; C and G&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Resistance to &#946;-lactam antibiotics in groups A&#44; C and G streptococci</span><p id="par0030" class="elsevierStylePara elsevierViewall">To date&#44; no group A&#44; C or G streptococci with diminished susceptibility to penicillin or third generation cephalosporins have been detected<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">31</span></a>&#46; Values of minimal inhibitory concentration &#40;MIC&#41;&#44; MIC<span class="elsevierStyleInf">90</span>&#44; published in different studies showed a median of 0&#46;016<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml and a range of 0&#46;0025&#8211;0&#46;032<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&#46; Some authors described ranges of MICs showing some values higher than the CLSI breakpoint for penicillin &#40;0&#46;125<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&#41; for group C and G streptococci&#59; however&#44; these results were not confirmed by reference centers&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In Japan&#44; 61&#46;4&#37; of intermediate susceptibility &#40;MIC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;25<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&#41; and 2&#46;3&#37; of resistance to penicillin &#40;one isolate with a MIC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&#41; was reported in patients with an initial episode of pharyngitis due to <span class="elsevierStyleItalic">S&#46; pyogenes</span>&#59; however&#44; these results were also not confirmed<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">With regard to group A streptococci&#44; one hundred and thirty-three strains were collected in the Rockefeller University &#40;New York&#44; USA&#41; during 80 years and neither of them showed changes in penicillin susceptibility&#46; The MIC<span class="elsevierStyleInf">90</span> for the oldest strains &#40;0&#46;032<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&#41; was the same of those collected in the last year of the study<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The question of why GAS remains susceptible to penicillin&#44; can only be answered with speculations<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a&#46;</span><p id="par0050" class="elsevierStylePara elsevierViewall">&#946;-Lactamase may not be expressed or may be toxic to GAS&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b&#46;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Low affinity PBPs are neither expressed nor render organisms nonviable&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c&#46;</span><p id="par0060" class="elsevierStylePara elsevierViewall">GAS produce at least four different DNases that could limit the opportunity for acquisition of exogenous DNA via transformation&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d&#46;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Circumstances favorable for the development of resistance have not yet occurred&#46;</p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">In spite of its universal susceptibility&#44; the success of pharyngitis treatments with penicillin is not 100&#37;&#59; however it is between 62&#37; and 98&#37; in different series&#44; with a median failure of around 12&#37;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Failures may be due to different causes&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#40;a&#41;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Coexistence of oropharyngeal &#946;-lactamase-producing bacteria</p><p id="par0085" class="elsevierStylePara elsevierViewall">In the oropharynx there are bacteria that degrade penicillin because they produce extracellular &#946;-lactamases &#40;<span class="elsevierStyleItalic">Staphylococcus aureus</span>&#44; anaerobes&#41;&#44; thus protecting GAS from penicillin<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#40;b&#41;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Elimination of <span class="elsevierStyleItalic">Streptococcus salivarius</span></p><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">S&#46; salivarius</span> interferes with <span class="elsevierStyleItalic">S&#46; pyogenes</span> by means of its bacteriocins&#46; Penicillin eliminates both organisms&#46; As this antibiotic does not preserve <span class="elsevierStyleItalic">S&#46; salivarius</span> in its original niche&#44; it does not provide protection from reinfection with GAS<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#40;c&#41;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Tolerance</p><p id="par0105" class="elsevierStylePara elsevierViewall">Tolerance is the property of some bacteria by which they evade the bactericidal activity of a specific antibiotic&#46; Several authors have published that the rate of tolerance of <span class="elsevierStyleItalic">S&#46; pyogenes</span> and other &#946;-hemolytic streptococci is &#8805;10&#37;&#46; However&#44; there is insufficient data to support a correlation between tolerance to penicillin and treatment failure&#44; either in clinical cases or in animal studies<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Moreover&#44; it has not been demonstrated that an antibiotic should have bactericidal effect to eradicate GAS from the throat&#46; Furthermore&#44; in one study it has been reported that none of the 28 cases of therapeutic failure with penicillin the bacteria showed the tolerance phenomenon<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#40;d&#41;</span><p id="par0115" class="elsevierStylePara elsevierViewall">Internalization</p><p id="par0120" class="elsevierStylePara elsevierViewall">It was demonstrated that protein-F1-mediated entry to cells and is involved in the causative process of the carriage state&#46; As penicillin does not gain high intracellular concentrations&#44; cell internalization was proposed as another possible explanation for penicillin treatment failures in children with pharyngitis&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">By using a human epithelial cell line model&#44; Kaplan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">9</span></a>&#44; showed that penicillin was less effective in killing intracellular streptococci than cephalothin&#44; clindamycin&#44; erythromycin or azithromycin&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#40;e&#41;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Suppression of natural immune response</p><p id="par0135" class="elsevierStylePara elsevierViewall">It has been proposed that the success of penicillin treatment could be influenced by the delay of at least 2 days the beginning of antibiotic administration&#46; However&#44; there are several studies that do not agree with this theory<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">27</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#40;f&#41;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Biofilm formation</p><p id="par0145" class="elsevierStylePara elsevierViewall">The role of biofilm formation in evading antibiotic eradication of GAS in patients with pharyngitis was not clearly proved&#44; although&#44; after treatments with high concentrations of antibiotics&#44; <span class="elsevierStyleItalic">S&#46; pyogenes</span> only survived in biofilm<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">22</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#40;g&#41;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Other explanations</p><p id="par0155" class="elsevierStylePara elsevierViewall">Some defects in the design or performance of studies may erroneously categorize the causes of the outcome of treatments&#46; Data presented in the literature do not often provide sufficient information for distinguishing between true eradication failure and recolonization following successful eradication<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">27</span></a>&#46;</p></li></ul></p><p id="par0160" class="elsevierStylePara elsevierViewall">There are some studies that do not recognize between true failures and GAS carriers that suffer viral infections&#46; Furthermore it was suggested that the majority of reported treatment failures were in fact due to inappropriate dosage of the antibiotic&#44; the duration of therapy and&#47;or poor patient compliance&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Is penicillin still the antibiotic of choice for treating GAS pharyngitis&#63;</span><p id="par0165" class="elsevierStylePara elsevierViewall">According with current guidelines&#44; penicillin V is still the antibiotic of choice for treating GAS pharyngitis<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">28</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The following are some of the reasons to continue recommending penicillin <span class="elsevierStyleSmallCaps">V</span> for the treatment of GAS pharyngitis&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#40;1&#41;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Its lower cost compared to alternative agents&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#40;2&#41;</span><p id="par0180" class="elsevierStylePara elsevierViewall">GAS isolates with reduced susceptibility to penicillin have not been described yet&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#40;3&#41;</span><p id="par0185" class="elsevierStylePara elsevierViewall">Penicillin is among the best-tolerated antibiotics in non-penicillin-allergic individuals&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">&#40;4&#41;</span><p id="par0190" class="elsevierStylePara elsevierViewall">It shows a narrow spectrum&#44; causing less selection pressure for multidrug-resistant bacteria&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#40;5&#41;</span><p id="par0260" class="elsevierStylePara elsevierViewall">Penicillin is the only antibiotic with proven efficacy to prevent acute rheumatic fever&#46;</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Reduced susceptibility to &#946;-lactam antibiotics in <span class="elsevierStyleItalic">S&#46; agalactiae</span></span><p id="par0195" class="elsevierStylePara elsevierViewall">Penicillin remains the first choice to treat GBS infections although since 2008&#44; strains with reduced susceptibility to this antimicrobial agent have been described in Japan&#44; USA&#44; UK and Canada<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">4&#44;6&#44;13&#44;16</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">The prevalence is high in Japan&#44; which was reported to be 2&#46;3&#37; in the period 2005&#8211;2006&#46; It increased to 14&#46;7&#37; between 2012 and 2013&#46; The latter GBS with reduced susceptibility to penicillin &#40;PRGBS&#41; were also multidrug-resistant &#40;MDR&#41;&#44; being 71&#46;1&#37; and 95&#46;6&#37; resistant to erythromycin and levofloxacin respectively&#44; and 68&#46;9&#37; resistant to both antibiotics<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">26</span></a>&#46; Therefore&#44; the spread of PRGBS with a tendency to MDR&#44; has increased in Japan&#46; Most PRGBS were recovered from respiratory samples from elderly patients and some others&#44; reported in Swedish and Japanese studies&#44; were recovered from invasive samples from neonates and adults&#44; but with only 3 PRGBS isolates in total<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">19&#44;25</span></a>&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Because the number of PRGBS is scarce&#44; data regarding sequence type &#40;ST&#41; is poor&#46; Kimura et al&#46; found that ST1 and a single <span class="elsevierStyleItalic">locus</span> variant ST458 are predominant in isolates recovered between 1998 and 2003 periods and differ from the results obtained in USA&#44; where ST19 is the only sequence type described so far<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">6&#44;12</span></a>&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">In Argentina&#44; GBS continue to be susceptible to penicillin<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">1&#44;24</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Mechanisms of &#946;-lactam resistance in <span class="elsevierStyleItalic">S&#46; agalactiae</span></span><p id="par0220" class="elsevierStylePara elsevierViewall">Penicillin resistance in gram-positive organisms is essentially due to the production of altered&#44; low-affinity target enzymes&#44; penicillin-binding proteins &#40;PBPs&#41; that catalyze the terminal stage of bacterial cell wall peptidoglycan synthesis&#46; In PBPs&#44; three conserved motifs&#44; SXXK&#44; SXN&#44; and KT&#40;S&#41;G&#44; commonly found in transpeptidase domains form the catalytic center&#59; and alterations within or adjacent to these motifs are associated with their reduced affinity for &#946;-lactams<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Specifically&#44; in GBS with reduced susceptibility to penicillin the substitutions occur mainly in PBP2X in amino acids V405A and&#47;or Q557E<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">6&#44;13&#44;20</span></a>&#46; Moreover&#44; an amino acid substitution in PBP1A confers high-level resistance to cephalosporins<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a> and multiple amino acid substitutions were found in PBP2X and PBP2B&#46; These mutations are related to their penicillin MIC levels&#46; Recently ceftibuten-resistant but penicillin-susceptible GBS with amino acid substitutions in PBP2X were reported<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Taking into account all the different cases that have been found in the reports related to changes in PBPs&#44; Kimura et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">10</span></a> proposed a classification for PRGBS based on amino acid substitutions and suggested considering whether the isolate has changes in PBP2X and other PBPs and resistance to other &#946;-lactams&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">How to phenotypically detect isolates with reduced susceptibility to penicillin&#63;</span><p id="par0235" class="elsevierStylePara elsevierViewall">It is important to mention that the use of 10<span class="elsevierStyleHsp" style=""></span>IU penicillin disks&#44; as recommended by the CLSI&#44; is not effective to demonstrate the presence of PRGBS&#46; Therefore&#44; dilution methods should be performed for MIC determination&#46; CLSI guides state that if the MIC is &#8804;0&#46;12<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&#44; the isolate is susceptible to penicillin<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">3</span></a>&#59; on the other hand&#44; the EUCAST establishes a cutoff value of &#62;0&#46;25<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml for the resistant category &#40;<a id="intr0005" class="elsevierStyleInterRef" href="http://www.eucast.org/clinical_breakpoints/">http&#58;&#47;&#47;www&#46;eucast&#46;org&#47;clinical&#95;breakpoints&#47;</a>&#41;&#46; The study of the resistance mechanism involved in reduced susceptibility has to be done by sequencing PBP coding genes to detect substitutions in PBPs&#46; As we mentioned&#44; other &#946;-lactams could have MIC values in the range of non-susceptibility&#46; In the effort to detect PRGBS isolates without MIC determination&#44; Kimura et al&#46; developed a three disk &#40;3<span class="elsevierStyleHsp" style=""></span>DM&#41; screening method&#44; using ceftibuten &#40;CBT&#41;&#44; oxacillin &#40;OXA&#41; and ceftizoxime &#40;ZOX&#41;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a>&#46; Cutoff values are&#58; to OXA<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>17<span class="elsevierStyleHsp" style=""></span>mm&#44; CBT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>29<span class="elsevierStyleHsp" style=""></span>mm and ZOX<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mm&#46; In brief&#44; in order to be included in PRGBS according to these criteria&#44; the inhibition zone of 2&#47;3 disks have to be below the cutoff value&#46; Thus&#44; in the isolates tested by Kimura&#44; the growth inhibition zones around the PEN disk were &#62;24<span class="elsevierStyleHsp" style=""></span>mm &#40;CLSI susceptibility criteria&#41; but the MIC values were &#62;0&#46;12<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&#46; With this method they obtained good specificity and sensitivity&#46; The use of 3<span class="elsevierStyleHsp" style=""></span>DM is controversial&#46; When Cooper et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">4</span></a> performed this screening they found nearly 50&#37; of false positive rates with too low specificity&#46; The same was found by Arias et al&#46; in Argentina&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">1</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Therefore&#44; there is evidence that the 3<span class="elsevierStyleHsp" style=""></span>DM method is not recommended or&#44; at least&#44; breakpoints would be modified&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Another issue is that the Vitek 2 compact system with AST-P456 cards &#40;BioM&#233;rieux Clinical Diagnostic&#44; Marcy l&#8217;Etoile&#44; France&#41; only detects half of the PRGBS isolates&#44; suggesting that many of these isolates would be misclassified as susceptible to penicillin&#46; The authors also suggested that operators should pay attention if the system gives a result of MIC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;12<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0250" class="elsevierStylePara elsevierViewall">It is important to highlight that confirmation by reference methods is mandatory when reduced susceptibility to penicillin is suspected in this group of bacteria&#44; and the mechanism involved should be studied&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0255" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "How to phenotypically detect isolates with reduced susceptibility to penicillin&#63;"
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            1 => "<span class="elsevierStyleItalic">Streptococcus pyogenes</span>"
            2 => "<span class="elsevierStyleItalic">Streptococcus dysgalactiae</span> subsp&#46; <span class="elsevierStyleItalic">equisimilis</span>"
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            2 => "<span class="elsevierStyleItalic">Streptococcus dysgalactiae</span> subsp&#46; <span class="elsevierStyleItalic">equisimilis</span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Group A &#40;GAS&#41;&#44; B &#40;GBS&#41;&#44; <span class="elsevierStyleSmallCaps">C</span> &#40;GCS&#41; and G &#40;GGS&#41; &#946;-hemolytic streptococci are important human pathogens&#46; They cause infections of different severity and frequency&#46; Nowadays&#44; after 70 years of use&#44; penicillin is still universally active against GAS&#44; GCS and GGS&#46; However&#44; therapeutic failures have been recorded in 2&#8211;28&#37; of pharyngitis cases &#40;median&#58; 12&#37;&#41; attributable to different causes&#46; By contrast&#44; some GBS with reduced susceptibility to penicillin have been described&#44; especially in Japan&#46; In this group of bacteria&#44; it is important to highlight that confirmation by reference methods is mandatory when decreased susceptibility to penicillin is suspected as well as checked for the detection of the mechanisms involved&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los estreptococos &#946;-hemol&#237;ticos de los grupos A &#40;GAS&#41;&#44; B &#40;GBS&#41;&#44; C &#40;GCS&#41; y G &#40;GGS&#41; son importantes pat&#243;genos humanos&#46; Ellos producen infecciones de diversa gravedad y frecuencia&#46; A&#250;n despu&#233;s de m&#225;s de 70 a&#241;os de uso&#44; la penicilina sigue siendo activa <span class="elsevierStyleItalic">in vitro</span> frente al 100&#37; de los GAS&#44; GCS y GGS&#46; No obstante se han producido fallas terap&#233;uticas entre el 2-28&#37; de los casos de faringitis &#40;media&#58; 12&#37;&#41;&#44; atribuibles a diversas causas&#46; En cambio se han descrito aislados de GBS con sensibilidad reducida a la penicilina&#44; especialmente en Jap&#243;n&#46; Es importante que toda sospecha de sensibilidad disminuida a la penicilina en este grupo de bacterias sea confirmada por los m&#233;todos de referencia y comprobada mediante la detecci&#243;n de los mecanismos involucrados&#46;</p></span>"
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                0 => array:2 [
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                      "titulo" => "Estudio Nacional Multic&#233;ntrico de infecciones invasivas ocasionadas por <span class="elsevierStyleItalic">Streptococcus agalactiae</span>&#58; resistencia a los antibi&#243;ticos y distribuci&#243;n de serotipos"
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                        0 => array:3 [
                          "colaboracion" => "EGB Grupo col&#46; Inf&#46; Invasivas"
                          "etal" => false
                          "autores" => array:9 [
                            0 => "B&#46; Arias"
                            1 => "V&#46; Kovacec"
                            2 => "M&#46; Su&#225;rez"
                            3 => "L&#46; Vigliarolo"
                            4 => "C&#46; Tersigni"
                            5 => "E&#46; Sutich"
                            6 => "H&#46; Lopardo"
                            7 => "L&#46; Bonofiglio"
                            8 => "M&#46; Mollerach"
                          ]
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                  ]
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                      "LibroEditado" => array:3 [
                        "titulo" => "Resumen MA-0015&#44; XXIII Congreso Latinoamericano de Microbiolog&#237;a y XIV Congreso Argentino de Microbiolog&#237;a"
                        "conferencia" => "Rosario&#44; 26 al 30 de septiembre de 2016"
                        "serieFecha" => "2016"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0170"
              "etiqueta" => "2"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Evaluation of bacterial interference and beta-lactamase production in management of experimental infection with group A beta-hemolytic streptococci"
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                        0 => array:2 [
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                          "autores" => array:2 [
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                            1 => "J&#46;D&#46; Gilmore"
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                    0 => array:1 [
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                        "tituloSerie" => "Antimicrob Agents Chemother"
                        "fecha" => "1993"
                        "volumen" => "37"
                        "paginaInicial" => "1452"
                        "paginaFinal" => "1455"
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                          "pii" => "S107814391630309X"
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                          "issn" => "10781439"
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              ]
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                0 => array:2 [
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                      "titulo" => "Performance standards for antimicrobial susceptibility testing&#58; twenty-fourth informational supplement"
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                        0 => array:2 [
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                          "autores" => array:1 [
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                          ]
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                        "editorialLocalizacion" => "Wayne&#44; PA"
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              ]
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                0 => array:2 [
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                      "titulo" => "Reduced penicillin susceptibility of group B streptococcus&#58; an assessment of emergence in Grampian Scotland"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:3 [
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                            1 => "F&#46; Abbott"
                            2 => "I&#46;M&#46; Gould"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1080/09674845.2016.1144550"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Biomed Sci"
                        "fecha" => "2016"
                        "volumen" => "73"
                        "paginaInicial" => "25"
                        "paginaFinal" => "27"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27182673"
                            "web" => "Medline"
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                      ]
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                  ]
                ]
              ]
            ]
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              "identificador" => "bib0185"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathogenesis of group A streptococcal infections"
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                          "autores" => array:1 [
                            0 => "M&#46;W&#46; Cunningham"
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                        "tituloSerie" => "Clin Microbiol Rev"
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                        "volumen" => "13"
                        "paginaInicial" => "470"
                        "paginaFinal" => "511"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10885988"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Point mutation in the group B streptococcal <span class="elsevierStyleItalic">pbp2x</span> gene conferring decreased susceptibility to beta-lactam antibiotics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "S&#46; Dahesh"
                            1 => "M&#46;E&#46; Hensler"
                            2 => "N&#46;M&#46; Van Sorge"
                            3 => "R&#46;E&#46; Gertz Jr&#46;"
                            4 => "S&#46; Schrag"
                            5 => "V&#46; Nizet"
                            6 => "B&#46;W&#46; Beall"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/AAC.00461-08"
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                        "tituloSerie" => "Antimicrob Agents Chemother"
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                        "volumen" => "52"
                        "paginaInicial" => "2915"
                        "paginaFinal" => "2918"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18541727"
                            "web" => "Medline"
                          ]
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                          "issn" => "01406736"
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              "identificador" => "bib0195"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Multimodular penicillin-binding proteins&#58; an enigmatic family of orthologs and paralogs"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Goffin"
                            1 => "J&#46;M&#46; Ghuysen"
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                  ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Microbiol Mol Biol Rev"
                        "fecha" => "1998"
                        "volumen" => "62"
                        "paginaInicial" => "1079"
                        "paginaFinal" => "1093"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9841666"
                            "web" => "Medline"
                          ]
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                ]
              ]
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              "identificador" => "bib0200"
              "etiqueta" => "8"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Why have group A streptococci remained susceptible to penicillin&#63; Report on a symposium"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:13 [
                            0 => "D&#46;L&#46; Horn"
                            1 => "J&#46;B&#46; Zabriskie"
                            2 => "R&#46; Austrian"
                            3 => "P&#46;P&#46; Cleary"
                            4 => "J&#46;J&#46; Ferretti"
                            5 => "V&#46;A&#46; Fischetti"
                            6 => "E&#46; Gotschlich"
                            7 => "E&#46;L&#46; Kaplan"
                            8 => "M&#46; McCarty"
                            9 => "S&#46;M&#46; Opal"
                            10 => "R&#46;B&#46; Roberts"
                            11 => "A&#46; Tomasz"
                            12 => "Y&#46; Wachtfogel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "1998"
                        "volumen" => "26"
                        "paginaInicial" => "1341"
                        "paginaFinal" => "1345"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9636860"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "9"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reduced ability of penicillin to eradicate ingested group A streptococci from epithelial cells&#58; clinical and pathogenetic implications"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;L&#46; Kaplan"
                            1 => "G&#46;S&#46; Chhatwal"
                            2 => "M&#46; Rohde"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1086/508773"
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                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2006"
                        "volumen" => "43"
                        "paginaInicial" => "1398"
                        "paginaFinal" => "1406"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17083011"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0210"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Classification of group B streptococci with reduced beta-lactam susceptibility &#40;GBS-RBS&#41; based on the amino acid substitutions in PBPs"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; Kimura"
                            1 => "N&#46; Nagano"
                            2 => "Y&#46; Arakawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jac/dkv022"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Antimicrob Chemother"
                        "fecha" => "2015"
                        "volumen" => "70"
                        "paginaInicial" => "1601"
                        "paginaFinal" => "1603"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25667406"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0215"
              "etiqueta" => "11"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ability of the VITEK&#40;R&#41; 2 system to detect group B streptococci with reduced penicillin susceptibility &#40;PRGBS&#41;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46; Kimura"
                            1 => "N&#46; Nagano"
                            2 => "Y&#46; Nagano"
                            3 => "J&#46; Wachino"
                            4 => "K&#46; Shibayama"
                            5 => "Y&#46; Arakawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jac/dkt008"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Antimicrob Chemother"
                        "fecha" => "2013"
                        "volumen" => "68"
                        "paginaInicial" => "1442"
                        "paginaFinal" => "1444"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23378415"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0220"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predominance of sequence type 1 group with serotype VI among group B streptococci with reduced penicillin susceptibility identified in Japan"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
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                            2 => "Y&#46; Nagano"
                            3 => "J&#46; Wachino"
                            4 => "S&#46; Suzuki"
                            5 => "K&#46; Shibayama"
                            6 => "Y&#46; Arakawa"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jac/dkr352"
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                        "tituloSerie" => "J Antimicrob Chemother"
                        "fecha" => "2011"
                        "volumen" => "66"
                        "paginaInicial" => "2460"
                        "paginaFinal" => "2464"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21873288"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0225"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "First molecular characterization of group B streptococci with reduced penicillin susceptibility"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:10 [
                            0 => "K&#46; Kimura"
                            1 => "S&#46; Suzuki"
                            2 => "J&#46; Wachino"
                            3 => "H&#46; Kurokawa"
                            4 => "K&#46; Yamane"
                            5 => "N&#46; Shibata"
                            6 => "N&#46; Nagano"
                            7 => "H&#46; Kato"
                            8 => "K&#46; Shibayama"
                            9 => "Y&#46; Arakawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/AAC.00185-08"
                      "Revista" => array:6 [
                        "tituloSerie" => "Antimicrob Agents Chemother"
                        "fecha" => "2008"
                        "volumen" => "52"
                        "paginaInicial" => "2890"
                        "paginaFinal" => "2897"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18490507"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0230"
              "etiqueta" => "14"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High cephalosporin resistance due to amino acid substitutions in PBP1A and PBP2X in a clinical isolate of group B streptococcus"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:9 [
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                            1 => "J&#46; Wachino"
                            2 => "H&#46; Kurokawa"
                            3 => "M&#46; Matsui"
                            4 => "S&#46; Suzuki"
                            5 => "K&#46; Yamane"
                            6 => "N&#46; Nagano"
                            7 => "K&#46; Shibayama"
                            8 => "Y&#46; Arakawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jac/dkt060"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Antimicrob Chemother"
                        "fecha" => "2013"
                        "volumen" => "68"
                        "paginaInicial" => "1533"
                        "paginaFinal" => "1536"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23449828"
                            "web" => "Medline"
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                          "pii" => "S1470204517302279"
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                          "issn" => "14702045"
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              "identificador" => "bib0235"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Practical disk diffusion test for detecting group B streptococcus with reduced penicillin susceptibility"
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                          "etal" => false
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                            0 => "K&#46; Kimura"
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                            2 => "H&#46; Kurokawa"
                            3 => "S&#46; Suzuki"
                            4 => "K&#46; Yamane"
                            5 => "N&#46; Shibata"
                            6 => "Y&#46; Arakawa"
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                    0 => array:2 [
                      "doi" => "10.1128/JCM.02063-08"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "2009"
                        "volumen" => "47"
                        "paginaInicial" => "4154"
                        "paginaFinal" => "4157"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19812274"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0240"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Novel mutations in a patient isolate of <span class="elsevierStyleItalic">Streptococcus agalactiae</span> with reduced penicillin susceptibility emerging after long-term oral suppressive therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
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                            1 => "C&#46; Vermeiren"
                            2 => "D&#46; Shahinas"
                            3 => "G&#46;S&#46; Tamber"
                            4 => "A&#46; McGeer"
                            5 => "D&#46;E&#46; Low"
                            6 => "K&#46; Katz"
                            7 => "D&#46;R&#46; Pillai"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/AAC.01243-10"
                      "Revista" => array:6 [
                        "tituloSerie" => "Antimicrob Agents Chemother"
                        "fecha" => "2011"
                        "volumen" => "55"
                        "paginaInicial" => "2983"
                        "paginaFinal" => "2985"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21383092"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
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            16 => array:3 [
              "identificador" => "bib0245"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Studies of the continuing susceptibility of group A streptococcal strains to penicillin during eight decades"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "M&#46;H&#46; Macris"
                            1 => "N&#46; Hartman"
                            2 => "B&#46; Murray"
                            3 => "R&#46;F&#46; Klein"
                            4 => "R&#46;B&#46; Roberts"
                            5 => "E&#46;L&#46; Kaplan"
                            6 => "D&#46; Horn"
                            7 => "J&#46;B&#46; Zabriskie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "1998"
                        "volumen" => "17"
                        "paginaInicial" => "377"
                        "paginaFinal" => "381"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9613649"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0250"
              "etiqueta" => "18"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Treatment of streptococcal pharyngotonsillitis&#58; reports of penicillin&#39;s demise are premature"
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                        0 => array:2 [
                          "etal" => false
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                            2 => "E&#46;L&#46; Kaplan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1993"
                        "volumen" => "123"
                        "paginaInicial" => "679"
                        "paginaFinal" => "685"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8229474"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0255"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Capsular type and antibiotic resistance in <span class="elsevierStyleItalic">Streptococcus agalactiae</span> isolates from patients&#44; ranging from newborns to the elderly&#44; with invasive infections"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
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                            1 => "C&#46; Seki"
                            2 => "H&#46; Sakata"
                            3 => "K&#46; Sunaoshi"
                            4 => "E&#46; Nakayama"
                            5 => "S&#46; Iwata"
                            6 => "K&#46; Sunakawa"
                            7 => "K&#46; Ubukata"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/AAC.01716-08"
                      "Revista" => array:6 [
                        "tituloSerie" => "Antimicrob Agents Chemother"
                        "fecha" => "2009"
                        "volumen" => "53"
                        "paginaInicial" => "2650"
                        "paginaFinal" => "2653"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19332682"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0260"
              "etiqueta" => "20"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Genetic heterogeneity in <span class="elsevierStyleItalic">pbp</span> genes among clinically isolated group B streptococci with reduced penicillin susceptibility"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            1 => "Y&#46; Nagano"
                            2 => "K&#46; Kimura"
                            3 => "K&#46; Tamai"
                            4 => "H&#46; Yanagisawa"
                            5 => "Y&#46; Arakawa"
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                        "tituloSerie" => "Antimicrob Agents Chemother"
                        "fecha" => "2008"
                        "volumen" => "52"
                        "paginaInicial" => "4258"
                        "paginaFinal" => "4267"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18809936"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Penicillin-susceptible group B streptococcal clinical isolates with reduced cephalosporin susceptibility"
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                          "etal" => false
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                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "2014"
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                        "paginaFinal" => "3410"
                        "link" => array:1 [
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                    0 => array:2 [
                      "titulo" => "Biofilm formation or internalization into epithelial cells enable <span class="elsevierStyleItalic">Streptococcus pyogenes</span> to evade antibiotic eradication in patients with pharyngitis"
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                        0 => array:2 [
                          "etal" => false
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                            2 => "H&#46; Okuni"
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                            4 => "H&#46; Sakata"
                            5 => "K&#46; Ikebe"
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                      "titulo" => "Epidemiological characterization of <span class="elsevierStyleItalic">Streptococcus pyogenes</span> isolated from patients with multiple onsets of pharyngitis"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "T&#46; Ogawa"
                            1 => "Y&#46; Terao"
                            2 => "H&#46; Sakata"
                            3 => "H&#46; Okuni"
                            4 => "K&#46; Ninomiya"
                            5 => "K&#46; Ikebe"
                            6 => "Y&#46; Maeda"
                            7 => "S&#46; Kawabata"
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                      ]
                    ]
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                        "tituloSerie" => "FEMS Microbiol Lett"
                        "fecha" => "2011"
                        "volumen" => "318"
                        "paginaInicial" => "143"
                        "paginaFinal" => "151"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21362024"
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                      "titulo" => "Distribuci&#243;n de tipo capsular y sensibilidad antimicrobiana de <span class="elsevierStyleItalic">Streptococcus agalactiae</span> productores de infecciones en Argentina"
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                          "etal" => false
                          "autores" => array:22 [
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                            1 => "A&#46; Limansky"
                            2 => "I&#46; Toresani"
                            3 => "G&#46; Ebner"
                            4 => "S&#46; Di Bartolomeo"
                            5 => "I&#46; de Inocenti"
                            6 => "G&#46; Pretto"
                            7 => "N&#46; Salazar"
                            8 => "M&#46; Laferrara"
                            9 => "M&#46; Bottiglieri"
                            10 => "D&#46; Ballester"
                            11 => "M&#46; Morales"
                            12 => "L&#46; Rivera"
                            13 => "M&#46;L&#46; Cacace"
                            14 => "H&#46; Castro"
                            15 => "L&#46; Rold&#225;n"
                            16 => "R&#46; Notario"
                            17 => "N&#46; Borda"
                            18 => "G&#46; Cera"
                            19 => "M&#46;J&#46; Spoletti"
                            20 => "E&#46; Gregorini"
                            21 => "E&#46;G&#46; Sutich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Argent Microbiol"
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                        "volumen" => "36"
                        "paginaInicial" => "63"
                        "paginaFinal" => "67"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15473046"
                            "web" => "Medline"
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                ]
              ]
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                      "titulo" => "Antimicrobial susceptibility of invasive group B streptococcal isolates from South-West Sweden 1988-2001"
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                          "etal" => false
                          "autores" => array:6 [
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                            3 => "K&#46; Bergh"
                            4 => "R&#46; Valso-Lyng"
                            5 => "B&#46; Trollfors"
                          ]
                        ]
                      ]
                    ]
                  ]
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                        "tituloSerie" => "Scand J Infect Dis"
                        "fecha" => "2008"
                        "volumen" => "40"
                        "paginaInicial" => "308"
                        "paginaFinal" => "313"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17918014"
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              ]
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              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High isolation rate of MDR group B streptococci with reduced penicillin susceptibility in Japan"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:9 [
                            0 => "T&#46; Seki"
                            1 => "K&#46; Kimura"
                            2 => "M&#46;E&#46; Reid"
                            3 => "A&#46; Miyazaki"
                            4 => "H&#46; Banno"
                            5 => "W&#46; Jin"
                            6 => "J&#46; Wachino"
                            7 => "K&#46; Yamada"
                            8 => "Y&#46; Arakawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jac/dkv203"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Antimicrob Chemother"
                        "fecha" => "2015"
                        "volumen" => "70"
                        "paginaInicial" => "2725"
                        "paginaFinal" => "2728"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26169560"
                            "web" => "Medline"
                          ]
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                          "pii" => "S1470204517302395"
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                          "issn" => "14702045"
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                  ]
                ]
              ]
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                      "titulo" => "Why do we fail with penicillin in the treatment of group A streptococcus infections&#63;"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Sela"
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                        "paginaFinal" => "307"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10574501"
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                      "titulo" => "Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis&#58; 2012 update by the Infectious Diseases Society of America"
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                          "etal" => false
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                            2 => "H&#46;W&#46; Clegg"
                            3 => "M&#46;A&#46; Gerber"
                            4 => "E&#46;L&#46; Kaplan"
                            5 => "G&#46; Lee"
                            6 => "J&#46;M&#46; Martin"
                            7 => "C&#46; Van Beneden"
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                    ]
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                      "doi" => "10.1093/cid/cis629"
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                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2012"
                        "volumen" => "55"
                        "paginaInicial" => "e86"
                        "paginaFinal" => "e102"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22965026"
                            "web" => "Medline"
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                      ]
                    ]
                  ]
                ]
              ]
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                      "titulo" => "Increasing burden of invasive group B streptococcal disease in nonpregnant adults&#44; 1990-2007"
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                          "etal" => false
                          "autores" => array:16 [
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                            4 => "W&#46; Schaffner"
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                            6 => "L&#46;H&#46; Harrison"
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                            8 => "J&#46; Mohle-Boetani"
                            9 => "S&#46; Zansky"
                            10 => "B&#46;A&#46; Albanese"
                            11 => "K&#46; Stefonek"
                            12 => "E&#46;R&#46; Zell"
                            13 => "D&#46; Jackson"
                            14 => "T&#46; Thompson"
                            15 => "S&#46;J&#46; Schrag"
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                      "doi" => "10.1086/599369"
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                        "tituloSerie" => "Clin Infect Dis"
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                        "volumen" => "49"
                        "paginaInicial" => "85"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19480572"
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                        "paginaFinal" => "523"
                        "link" => array:1 [
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                      "titulo" => "A proposed standard for MIC-MBC laboratory techniques to detect penicillin tolerance in group A streptococci"
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Article information

ISSN: 03257541
Original language: English

DOI:10.1016/j.ram.2017.11.002

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Year/Month	Html	Pdf	Total

2024 October	38	11	49
2024 September	74	17	91
2024 August	56	14	70
2024 July	62	6	68
2024 June	71	1	72
2024 May	84	5	89
2024 April	92	13	105
2024 March	62	2	64
2024 February	78	6	84
2024 January	91	6	97
2023 December	82	14	96
2023 November	95	10	105
2023 October	120	16	136
2023 September	59	3	62
2023 August	66	11	77
2023 July	60	6	66
2023 June	68	6	74
2023 May	83	17	100
2023 April	74	4	78
2023 March	76	3	79
2023 February	76	6	82
2023 January	58	3	61
2022 December	66	12	78
2022 November	89	19	108
2022 October	51	8	59
2022 September	60	10	70
2022 August	62	15	77
2022 July	77	18	95
2022 June	74	7	81
2022 May	128	6	134
2022 April	147	9	156
2022 March	249	14	263
2022 February	239	5	244
2022 January	175	8	183
2021 December	108	13	121
2021 November	135	8	143
2021 October	44	11	55
2021 September	46	10	56
2021 August	48	11	59
2021 July	34	11	45
2021 June	29	13	42
2021 May	43	8	51
2021 April	95	23	118
2021 March	49	12	61
2021 February	53	11	64
2021 January	60	17	77
2020 December	51	6	57
2020 November	42	11	53
2020 October	40	6	46
2020 September	34	9	43
2020 August	49	13	62
2020 July	39	18	57
2020 June	40	16	56
2020 May	43	7	50
2020 April	34	7	41
2020 March	59	17	76
2020 February	44	10	54
2020 January	45	13	58
2019 December	48	8	56
2019 November	42	7	49
2019 October	51	13	64
2019 September	44	10	54
2019 August	29	2	31
2019 July	45	13	58
2019 June	49	28	77
2019 May	122	73	195
2019 April	71	41	112
2019 March	22	11	33
2019 February	19	9	28
2019 January	34	15	49
2018 December	18	8	26
2018 November	12	21	33
2018 October	21	34	55
2018 September	28	10	38
2018 August	1	12	13
2018 July	1	20	21
2018 June	0	19	19
2018 May	8	20	28
2018 April	1	28	29
2018 March	1	25	26

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