Brief report
Bacillus cereus bacteremia in a patient with an abdominal stab wound
Bacteriemia por Bacillus cereus en paciente con herida de arma blanca abdominal
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"apellidos" => "Krivokapich" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754119300847?idApp=UINPBA00004N" "url" => "/03257541/0000005200000002/v1_202006200800/S0325754119300847/v1_202006200800/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0325754119300835" "issn" => "03257541" "doi" => "10.1016/j.ram.2019.06.004" "estado" => "S300" "fechaPublicacion" => "2020-04-01" "aid" => "356" "copyright" => "Asociación Argentina de Microbiología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Argent Microbiol. 2020;52:107-14" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 122 "formatos" => array:3 [ "EPUB" => 24 "HTML" => 30 "PDF" => 68 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Comparación de ELISAs comerciales para la detección de anticuerpos en la investigación diagnóstica del aborto asociado a <span class="elsevierStyleItalic">Neospora caninum</span> en rodeos lecheros de Uruguay" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "107" "paginaFinal" => "114" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "A comparative study of commercial ELISAs for antibody detection in the diagnostic investigation of <span class="elsevierStyleItalic">Neospora caninum</span>-associated abortion in dairy cattle herds in Uruguay" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Caroline da Silva Silveira, Joaquín Ignacio Armendano, Dadín Prando Moore, Germán José Cantón, Melissa Macías-Rioseco, Franklin Riet-Correa, Federico Giannitti" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Caroline" "apellidos" => "da Silva Silveira" ] 1 => array:2 [ "nombre" => "Joaquín Ignacio" "apellidos" => "Armendano" ] 2 => array:2 [ "nombre" => "Dadín Prando" "apellidos" => "Moore" ] 3 => array:2 [ "nombre" => "Germán José" "apellidos" => "Cantón" ] 4 => array:2 [ "nombre" => "Melissa" "apellidos" => "Macías-Rioseco" ] 5 => array:2 [ "nombre" => "Franklin" "apellidos" => "Riet-Correa" ] 6 => array:2 [ "nombre" => "Federico" "apellidos" => "Giannitti" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754119300835?idApp=UINPBA00004N" "url" => "/03257541/0000005200000002/v1_202006200800/S0325754119300835/v1_202006200800/es/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "<span class="elsevierStyleItalic">Bacillus cereus</span> bacteremia in a patient with an abdominal stab wound" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "115" "paginaFinal" => "117" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Noelia B. Acosta Pedemonte, Nicolás S. Rocchetti, Juan Villalba, Damián Lerman Tenenbaum, Claudio J. Settecase, Daniel H. Bagilet, Laura G. Colombo, Eduardo R. Gregorini" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Noelia B." "apellidos" => "Acosta Pedemonte" "email" => array:1 [ 0 => "noelia_acosta_fcm@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Nicolás S." "apellidos" => "Rocchetti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Juan" "apellidos" => "Villalba" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Damián" "apellidos" => "Lerman Tenenbaum" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Claudio J." "apellidos" => "Settecase" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Daniel H." "apellidos" => "Bagilet" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Laura G." "apellidos" => "Colombo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 7 => array:3 [ "nombre" => "Eduardo R." "apellidos" => "Gregorini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos, Hospital Eva Perón, Granadero Baigorria, Santa Fe, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Infectología, Hospital Eva Perón, Granadero Baigorria, Santa Fe, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital Eva Perón, Granadero Baigorria, Santa Fe, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bacteriemia por <span class="elsevierStyleItalic">Bacillus cereus</span> en paciente con herida de arma blanca abdominal" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Bacillus cereus</span> is a gram positive, facultatively anaerobic, spore-forming rod widely distributed environmentally, with no substantial pathogenic potential despite its great capacity of surviving adverse conditions<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>. This microorganism is frequently associated with gastrointestinal infections, mostly related to rice ingestion, and is characterized by vomiting and diarrhea in the immunocompetent host<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3</span></a>. It belongs to the genus <span class="elsevierStyleItalic">Bacillus</span> that comprises seven closely related species: <span class="elsevierStyleItalic">Bacillus cereus sensu lato,</span><span class="elsevierStyleItalic">Bacillus anthracis,</span><span class="elsevierStyleItalic">Bacillus thuringiensis, Bacillus mycoides, Bacillus pseudomycoides</span>, <span class="elsevierStyleItalic">Bacillus weihenstephanensis</span> and <span class="elsevierStyleItalic">Bacillus cytotoxicus</span>. These strains share a highly conserved genome, and their 16S rRNA gene sequences show high levels of similarity<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a>. Extraintestinal infections due to <span class="elsevierStyleItalic">B. cereus</span> are rare; however, when present they could manifest as bacteremia, endocarditis, meningitis, endophthalmitis, pneumonia, and soft tissue infections<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>. Therefore, the isolation of this microorganism from blood culture samples is often regarded as contamination, which delays diagnosis and the choice of appropriate treatment<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">There have been many reports of hospitals outbreaks of <span class="elsevierStyleItalic">B. cereus</span> bacteremia, mainly among immunocompromised patients attributable to contaminated medical equipment, alcohol-based hand wash solutions, linens, reused towels, intravenous catheters and other implantable devices<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,8,5</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We present here a case of <span class="elsevierStyleItalic">B. cereus</span> bacteremia due to an abdominal stab wound. This work was approved by the Research and Teaching Committee of the “Eva Perón” Hospital.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">An otherwise healthy 32 year-old- female was admitted to the intensive care unit (ICU) after exploratory laparotomy for a penetrating abdominal stab wound and hepatic lesion. Remarkable laboratory findings included, white cell blood count 16<span class="elsevierStyleHsp" style=""></span>900 (91% neutrophils), pH 7.19 (PCo<span class="elsevierStyleInf">2</span> 42 Hco<span class="elsevierStyleInf">3</span> 19) and ASAT 378<span class="elsevierStyleHsp" style=""></span>mUI/ml ALAT 388<span class="elsevierStyleHsp" style=""></span>mUI/ml. As the patient reached a temperature of 38.6<span class="elsevierStyleHsp" style=""></span>°C in the next 48<span class="elsevierStyleHsp" style=""></span>h, blood, urine and BAL cultures were taken.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A computerized tomography (CT) was performed revealing bilateral pulmonary consolidation, in addition to a segment IV hepatic fluid collection. CT-guided percutaneous drainage was performed and treatment with ampicillin/sulbactam was initiated. Blood samples were processed with the BacT/ALERT 3D automated microbial detection system for five days. These samples became positive after 8<span class="elsevierStyleHsp" style=""></span>h of incubation showing gram positive bacilli. A small volume of this material was inoculated onto blood, chocolate, Cysteine Lactose Electrolyte Deficient (CLED) agar, and thioglycolate broth. Blood agar with hemin and vitamin K1 was the non-selective medium used for anaerobic bacteria and Wilking-Chagren agar was chosen as selective medium. A gram positive bacillus surrounded by wide beta hemolysis was isolated from blood on the fourth day, and from the hepatic samples after 24<span class="elsevierStyleHsp" style=""></span>h of incubation. After micro and macro observation of the morphological characters, the microbe was assumed to belong to the <span class="elsevierStyleItalic">Bacillus</span> spp. and finally the isolate was finally confirmed as <span class="elsevierStyleItalic">B. cereus</span> using MALDI-TOF mass spectrometry (Bruker, Daltonics) with a score value >2.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This <span class="elsevierStyleItalic">Bacillus</span> spp. was susceptible to vancomycin assessed by the Etest according to the Clinical and Laboratory Standards Institute (CLSI) guidelines (M45, 3rd Edition) obtaining a MIC value of 2<span class="elsevierStyleHsp" style=""></span>μg/ml.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Samples from the liver abscess were obtained during CT-guided drainage and were again inoculated onto blood, chocolate, Cysteine Lactose Electrolyte Deficient (CLED) AGAR, a selective medium for anaerobic bacteria and thioglycolate broth. Again, abundant gram positive bacilli developed.</p><p id="par0040" class="elsevierStylePara elsevierViewall">MiniBAL cultures and the urine sample turned negative by using quantitative methods.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Vancomycin was added to the antibiotic treatment, and since the patient's condition failed to improve, surgical removal of the remaining liver collection was performed.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The patient had a favorable clinical evolution after fourteen days of regular dose of intravenous ampicillin/sulbactam plus vancomycin treatment, and required vasopressors for three days and twelve days of mechanical ventilation. She was discharged from hospital after 24 days.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Bacillus</span> spp. bacteremia in the immunocompetent host is mostly transient and resolves spontaneously, which is perhaps the reason why most <span class="elsevierStyleItalic">Bacillus</span> species (except <span class="elsevierStyleItalic">B. anthracis</span>) isolated from blood cultures are often considered contaminants<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>.</p><p id="par0060" class="elsevierStylePara elsevierViewall">There are many case reports of severe infections caused by <span class="elsevierStyleItalic">B. cereus</span> in the literature<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,4,9</span></a>, the majority of which take place in immunocompromised patients, intravenous drug addicts, or are associated with neoplastic processes or hospital outbreaks<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8–10</span></a>. There are only a few reports of severe infection by this microorganism linked to trauma despite of the environmental ubiquity of this bacteria<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Our search only found one case report of <span class="elsevierStyleItalic">Bacillus</span> spp. bacteremia developed after trauma, and it occurred in patients who had suffered gunshot wounds<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>. We could not find infections associated with stab wounds, which gives relevance to our report, since it implies a young immunocompetent patient, without previous gastrointestinal symptoms, in whom the bacteremia could be secondary to the abdominal stab wound. Nevertheless, it is still possible that the infection had occurred during the surgical act, although this option was dismissed given the absence of similar cases at the time of the microorganism isolation.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The study published by Ikeda et al.<span class="elsevierStyleSup">6</span> attempted to characterize the antibiotic susceptibility and the impact of the correct treatment choice and showed that all the isolates of <span class="elsevierStyleItalic">B. cereus</span> were sensitive to gentamicin, carbapenems and vancomycin, according to Walkaway system and the standard criteria of CLSI guidelines. Between 48.3% and 100% of isolates were resistant to cephalosporins, 65.5% were resistant to clindamycin, and 10.3% were resistant to levofloxacin<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>. In the mentioned study the appropriateness of the empirical antibiotic therapy was not related to survival. However, it was still beneficial because early defervescence was significantly linked to the correct choice of empirical antibiotic treatment<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In the case we present in this study, the antibiotic treatment was adjusted 72<span class="elsevierStyleHsp" style=""></span>h after the patient developed a fever, in accordance with the microbiological findings, with a favorable outcome.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the article written by Veysseyre et al. presenting 57 cases of <span class="elsevierStyleItalic">B. Cereus</span> infection, the presence of bacteremia was identified as a factor related to poor prognosis, contrary to our results, although it was a single patient<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>.</p><p id="par0085" class="elsevierStylePara elsevierViewall">We finally insist on highlighting the importance of considering <span class="elsevierStyleItalic">B. cereus</span> as a pathogen capable of causing severe infections in all types of patients, due to its extensive environmental presence, multiple and complex virulence factors and resistance mechanisms. It is worth insisting on the fact that this microorganism should not be considered a simple contaminant, a situation that continues to occur despite the ongoing documentation of cases of extraintestinal infection<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,10,6</span></a>.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1351606" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1242994" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1351605" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1242995" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-11-03" "fechaAceptado" => "2019-07-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1242994" "palabras" => array:4 [ 0 => "<span class="elsevierStyleItalic">Bacillus cereus</span>" 1 => "Bacteremia" 2 => "Intensive care unit" 3 => "Stab wound" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1242995" "palabras" => array:4 [ 0 => "<span class="elsevierStyleItalic">Bacillus cereus</span>" 1 => "Bacteriemia" 2 => "Unidad de cuidados intensivos" 3 => "Herida por arma blanca" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Bacillus cereus</span> is a gram positive microorganism commonly involved in gastrointestinal infection but capable of causing severe infections and bacteremia. We describe here a case of bacteremia caused by <span class="elsevierStyleItalic">B. cereus</span> in a previously healthy young woman admitted to the intensive care unit following emergency surgery due to a penetrating abdominal stab wound and subsequent hepatic lesion. She developed fever during admission and cultures were taken. <span class="elsevierStyleItalic">B. cereus</span> was isolated in blood and hepatic fluid collection cultures. Treatment was adjusted according to the isolate, with good clinical results. It is important to highlight the pathogenic potential of this microorganism and not underestimate it as a contaminant when it is isolated from blood samples.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Bacillus cereus</span> es un microorganismo gram positivo comúnmente involucrado en infecciones gastrointestinales, pero capaz de causar infecciones graves y bacteriemia. Presentamos un caso de bacteriemia por <span class="elsevierStyleItalic">B. cereus</span> en una mujer joven previamente sana que ingresa en la unidad de cuidados intensivos luego de una cirugía de emergencia, debido a una herida abdominal por arma blanca con lesión hepática. La paciente desarrolla fiebre durante la internación, por lo que se toman cultivos. Se aísla <span class="elsevierStyleItalic">B. cereus</span> en hemocultivos y material de colección hepática. Se ajusta el tratamiento según los hallazgos, con buena evolución clínica. Esta comunicación ilustra una fuente poco común de bacteriemia por <span class="elsevierStyleItalic">B. cereus.</span> Asimismo, destaca el potencial patogénico de este microorganismo, cuyo hallazgo en muestras de sangre no siempre debe conducir a su rápida desjerarquización como contaminante.</p></span>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Bacillus cereus</span>: a significant pathogen in postoperative and post-traumatic wounds on orthopaedic wards" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Akesson" 1 => "S A Hedström" 2 => "T. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 1 | 6 |
| 2024 October | 40 | 5 | 45 |
| 2024 September | 86 | 6 | 92 |
| 2024 August | 60 | 2 | 62 |
| 2024 July | 58 | 6 | 64 |
| 2024 June | 53 | 6 | 59 |
| 2024 May | 80 | 9 | 89 |
| 2024 April | 62 | 11 | 73 |
| 2024 March | 82 | 1 | 83 |
| 2024 February | 68 | 9 | 77 |
| 2024 January | 78 | 3 | 81 |
| 2023 December | 78 | 16 | 94 |
| 2023 November | 93 | 11 | 104 |
| 2023 October | 113 | 12 | 125 |
| 2023 September | 98 | 14 | 112 |
| 2023 August | 79 | 11 | 90 |
| 2023 July | 60 | 5 | 65 |
| 2023 June | 78 | 5 | 83 |
| 2023 May | 120 | 6 | 126 |
| 2023 April | 97 | 8 | 105 |
| 2023 March | 64 | 11 | 75 |
| 2023 February | 49 | 4 | 53 |
| 2023 January | 39 | 5 | 44 |
| 2022 December | 50 | 14 | 64 |
| 2022 November | 49 | 15 | 64 |
| 2022 October | 74 | 8 | 82 |
| 2022 September | 59 | 8 | 67 |
| 2022 August | 81 | 11 | 92 |
| 2022 July | 45 | 15 | 60 |
| 2022 June | 34 | 12 | 46 |
| 2022 May | 44 | 6 | 50 |
| 2022 April | 41 | 12 | 53 |
| 2022 March | 48 | 9 | 57 |
| 2022 February | 56 | 9 | 65 |
| 2022 January | 60 | 13 | 73 |
| 2021 December | 43 | 14 | 57 |
| 2021 November | 46 | 12 | 58 |
| 2021 October | 54 | 28 | 82 |
| 2021 September | 60 | 14 | 74 |
| 2021 August | 80 | 4 | 84 |
| 2021 July | 46 | 16 | 62 |
| 2021 June | 33 | 8 | 41 |
| 2021 May | 38 | 11 | 49 |
| 2021 April | 91 | 25 | 116 |
| 2021 March | 28 | 19 | 47 |
| 2021 February | 23 | 13 | 36 |
| 2021 January | 27 | 20 | 47 |
| 2020 December | 21 | 13 | 34 |
| 2020 November | 18 | 9 | 27 |
| 2020 October | 17 | 6 | 23 |
| 2020 September | 34 | 26 | 60 |
| 2020 August | 33 | 21 | 54 |
| 2020 July | 29 | 16 | 45 |
| 2020 June | 26 | 20 | 46 |
| 2020 May | 8 | 9 | 17 |
| 2020 April | 8 | 5 | 13 |
| 2020 March | 8 | 6 | 14 |
| 2020 February | 4 | 4 | 8 |
| 2020 January | 6 | 11 | 17 |
| 2019 December | 6 | 8 | 14 |
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