COVID-19
Regístrese
metricas
covid
Revista Argentina de Microbiología
Buscar en
Revista Argentina de Microbiología
Toda la web
Inicio Revista Argentina de Microbiología Reduction in the incidence of invasive infections caused by encapsulated bacteri...
Journal Information
Back to article

Statistics

Follow this link to access the full text of the article

Original article
Reduction in the incidence of invasive infections caused by encapsulated bacteria after the onset of the COVID-19 pandemic
Reducción de la incidencia de infecciones invasivas por bacterias capsuladas luego del inicio de la Pandemia por COVID-19
Leda Guzzia,b,
Corresponding author
ledaguzzi@hotmail.com

Corresponding author.
, Juan Manuel Sambadea, Martin Diego Christina, Federico Rodriguez Cairolic, Alejandra Rodriguezd, Silvia Vicariod, Miriam Hinojosa Del Carpioa, Juan Molinosa, Pablo Dimitroffa
a Clínica Olivos, Swiss Medical Group, Vicente López, Argentina
b Sociedad Argentina de Infectología, Argentina
c Instituto de Efectividad Clínica y Sanitaria (IECS), Argentina
d Servicio de Microbiología Clínica, Swiss Medical Group, Ciudad Autónoma de Buenos Aires, Argentina
Read
2441
Times
was read the article
190
Total PDF
2251
Total HTML
Share statistics
 array:23 [
  "pii" => "S0325754123000548"
  "issn" => "03257541"
  "doi" => "10.1016/j.ram.2023.06.003"
  "estado" => "S300"
  "fechaPublicacion" => "2024-01-01"
  "aid" => "554"
  "copyright" => "Asociación Argentina de Microbiología"
  "copyrightAnyo" => "2023"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Rev Argent Microbiol. 2024;56:62-8"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S0325754123000585"
    "issn" => "03257541"
    "doi" => "10.1016/j.ram.2023.07.002"
    "estado" => "S300"
    "fechaPublicacion" => "2024-01-01"
    "aid" => "558"
    "copyright" => "Asociación Argentina de Microbiología"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Argent Microbiol. 2024;56:69-73"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">INFORME BREVE</span>"
      "titulo" => "Asociaci&#243;n del consumo de drogas il&#237;citas en mujeres embarazadas y s&#237;filis cong&#233;nita en un Hospital P&#250;blico de M&#233;xico"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:3 [
        0 => "es"
        1 => "es"
        2 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "69"
          "paginaFinal" => "73"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Association of illicit drug use in pregnant women and congenital syphilis in a public hospital in Mexico"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Luc&#237;a Miramontes-Buiza, Juan Carlos Lona-Reyes, Rene Oswaldo P&#233;rez-Ram&#237;rez, Diego Magall&#243;n-Picazo, Araceli Cordero-Zamora, Larissa Mar&#237;a G&#243;mez-Ruiz, Tania Alejandra Cruz-Ch&#225;vez"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Luc&#237;a"
              "apellidos" => "Miramontes-Buiza"
            ]
            1 => array:2 [
              "nombre" => "Juan Carlos"
              "apellidos" => "Lona-Reyes"
            ]
            2 => array:2 [
              "nombre" => "Rene Oswaldo"
              "apellidos" => "P&#233;rez-Ram&#237;rez"
            ]
            3 => array:2 [
              "nombre" => "Diego"
              "apellidos" => "Magall&#243;n-Picazo"
            ]
            4 => array:2 [
              "nombre" => "Araceli"
              "apellidos" => "Cordero-Zamora"
            ]
            5 => array:2 [
              "nombre" => "Larissa Mar&#237;a"
              "apellidos" => "G&#243;mez-Ruiz"
            ]
            6 => array:2 [
              "nombre" => "Tania Alejandra"
              "apellidos" => "Cruz-Ch&#225;vez"
            ]
          ]
        ]
      ]
      "resumen" => array:1 [
        0 => array:3 [
          "titulo" => "Highlights"
          "clase" => "author-highlights"
          "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0005" class="elsevierStylePara elsevierViewall">La incidencia de s&#237;filis cong&#233;nita fue 10&#44;5 eventos&#47;1000 RN en un Hospital de M&#233;xico&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0010" class="elsevierStylePara elsevierViewall">El consumo de drogas il&#237;citas en la madre se asoci&#243; a s&#237;filis cong&#233;nita&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0015" class="elsevierStylePara elsevierViewall">Las drogas il&#237;citas de mayor uso fueron las metanfetaminas&#44; marihuana y coca&#237;na&#46;</p></li></ul></p></span>"
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754123000585?idApp=UINPBA00004N"
    "url" => "/03257541/0000005600000001/v1_202403171031/S0325754123000585/v1_202403171031/es/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S0325754124000014"
    "issn" => "03257541"
    "doi" => "10.1016/j.ram.2023.12.001"
    "estado" => "S300"
    "fechaPublicacion" => "2024-01-01"
    "aid" => "573"
    "copyright" => "Asociaci&#243;n Argentina de Microbiolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Argent Microbiol. 2024;56:33-61"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>"
      "titulo" => "Comparison of two MALDI-TOF MS systems for the identification of clinically relevant anaerobic bacteria in Argentina"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:3 [
        0 => "en"
        1 => "en"
        2 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "33"
          "paginaFinal" => "61"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Comparaci&#243;n de dos sistemas MALDI-TOF MS en la identificaci&#243;n de bacterias anaerobias de relevancia cl&#237;nica en Argentina"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Mirta Litterio, Liliana Castello, Mar&#237;a Elena Venuta, Sof&#237;a Abel, Liliana Fern&#225;ndez-Canigia, Mar&#237;a Cristina Legaria, Raquel Rollet, Daniela Vaustat, Natalia Azula, B&#225;rbara Fox, Silvina Otero, Mar&#237;a Laura Maldonado, Natalia Alejandra Mangieri, Mar&#237;a Adelaida Rossetti, Silvia Carla Predari, Daniela Cejas, Claudia Barberis"
          "autores" => array:17 [
            0 => array:2 [
              "nombre" => "Mirta"
              "apellidos" => "Litterio"
            ]
            1 => array:2 [
              "nombre" => "Liliana"
              "apellidos" => "Castello"
            ]
            2 => array:2 [
              "nombre" => "Mar&#237;a Elena"
              "apellidos" => "Venuta"
            ]
            3 => array:2 [
              "nombre" => "Sof&#237;a"
              "apellidos" => "Abel"
            ]
            4 => array:2 [
              "nombre" => "Liliana"
              "apellidos" => "Fern&#225;ndez-Canigia"
            ]
            5 => array:2 [
              "nombre" => "Mar&#237;a Cristina"
              "apellidos" => "Legaria"
            ]
            6 => array:2 [
              "nombre" => "Raquel"
              "apellidos" => "Rollet"
            ]
            7 => array:2 [
              "nombre" => "Daniela"
              "apellidos" => "Vaustat"
            ]
            8 => array:2 [
              "nombre" => "Natalia"
              "apellidos" => "Azula"
            ]
            9 => array:2 [
              "nombre" => "B&#225;rbara"
              "apellidos" => "Fox"
            ]
            10 => array:2 [
              "nombre" => "Silvina"
              "apellidos" => "Otero"
            ]
            11 => array:2 [
              "nombre" => "Mar&#237;a Laura"
              "apellidos" => "Maldonado"
            ]
            12 => array:2 [
              "nombre" => "Natalia Alejandra"
              "apellidos" => "Mangieri"
            ]
            13 => array:2 [
              "nombre" => "Mar&#237;a Adelaida"
              "apellidos" => "Rossetti"
            ]
            14 => array:2 [
              "nombre" => "Silvia Carla"
              "apellidos" => "Predari"
            ]
            15 => array:2 [
              "nombre" => "Daniela"
              "apellidos" => "Cejas"
            ]
            16 => array:2 [
              "nombre" => "Claudia"
              "apellidos" => "Barberis"
            ]
          ]
        ]
      ]
      "resumen" => array:1 [
        0 => array:3 [
          "titulo" => "Highlights"
          "clase" => "author-highlights"
          "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0005" class="elsevierStylePara elsevierViewall">MALDI-TOF MS is especially useful for the identification of anaerobic bacteria&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0010" class="elsevierStylePara elsevierViewall">It is useful for slow-growing microorganisms that are difficult to identify by traditional methods&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0015" class="elsevierStylePara elsevierViewall">It is essential to update the databases by increasing the number of spectrum&#46;</p></li></ul></p></span>"
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754124000014?idApp=UINPBA00004N"
    "url" => "/03257541/0000005600000001/v1_202403171031/S0325754124000014/v1_202403171031/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Reduction in the incidence of invasive infections caused by encapsulated bacteria after the onset of the COVID-19 pandemic"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "62"
        "paginaFinal" => "68"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Leda Guzzi, Juan Manuel Sambade, Martin Diego Christin, Federico Rodriguez Cairoli, Alejandra Rodriguez, Silvia Vicario, Miriam Hinojosa Del Carpio, Juan Molinos, Pablo Dimitroff"
        "autores" => array:9 [
          0 => array:4 [
            "nombre" => "Leda"
            "apellidos" => "Guzzi"
            "email" => array:1 [
              0 => "ledaguzzi@hotmail.com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Juan Manuel"
            "apellidos" => "Sambade"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Martin Diego"
            "apellidos" => "Christin"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Federico"
            "apellidos" => "Rodriguez Cairoli"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Alejandra"
            "apellidos" => "Rodriguez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Silvia"
            "apellidos" => "Vicario"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Miriam"
            "apellidos" => "Hinojosa Del Carpio"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Juan"
            "apellidos" => "Molinos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Pablo"
            "apellidos" => "Dimitroff"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Cl&#237;nica Olivos&#44; Swiss Medical Group&#44; Vicente L&#243;pez&#44; Argentina"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Sociedad Argentina de Infectolog&#237;a&#44; Argentina"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Instituto de Efectividad Cl&#237;nica y Sanitaria &#40;IECS&#41;&#44; Argentina"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Microbiolog&#237;a Cl&#237;nica&#44; Swiss Medical Group&#44; Ciudad Aut&#243;noma de Buenos Aires&#44; Argentina"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Reducci&#243;n de la incidencia de infecciones invasivas por bacterias capsuladas luego del inicio de la Pandemia por COVID-19"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1070
            "Ancho" => 2341
            "Tamanyo" => 113607
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cumulative incidence according to pathogen and total incidence per 100<span class="elsevierStyleHsp" style=""></span>000 samples for each period&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0025" class="elsevierStylePara elsevierViewall">Invasive bacterial infections such as bacteremic pneumonia&#44; empyema&#44; meningitis&#44; and sepsis are life threatening conditions&#46; Encapsulated bacteria&#44; namely <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>&#44; <span class="elsevierStyleItalic">Haemophilus influenzae</span> and <span class="elsevierStyleItalic">Neisseria meningitidis</span> are among the most common pathogens&#44; causing a high burden of disease&#44; especially in children under 5 years of age&#44; adults over 65 years of age and in individuals with comorbidities&#46; Mortality rates reaching up to 36&#37; for invasive pneumococcal disease &#40;IPD&#41; in winter&#44; made prevention of invasive infections a priority for WHO&#44; leading to the development of effective vaccines<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">9&#44;10&#44;12</span></a>&#46; Bacterial pathogens habitually colonize the respiratory tract&#44; particularly in children&#44; presenting a commensal relationship with the host unless local or systemic immune deficiencies facilitate invasion into sterile tissues<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a>&#46; Although transmission mechanisms are still under investigation&#44; person-to-person spread through exposure to infectious secretions is widely accepted as the main source&#46; Recent animal models have shown airborne transmission also occurs between close contacts&#44; enhanced by coinfection with respiratory viruses<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a>&#46; A paradigmatic example is synergism between influenza viruses and <span class="elsevierStyleItalic">S&#46; pneumoniae</span> contributing to pulmonary superinfection<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">25</span></a>&#46; Since December 2019&#44; emergence of a novel severe acute respiratory syndrome coronavirus 2 &#40;SARS-CoV-2&#41; causing coronavirus disease 2019 &#40;COVID-19&#41; has threatened global health&#46; On March 3&#44; 2020&#44; the first case was reported in Argentina and on March 11&#44; WHO declared COVID-19 a global pandemic&#46; To control spread of the virus&#44; compulsory containment measures were established in Argentina on March 20&#44; including discontinuation of non-essential services such as schools&#44; public or private social gatherings&#44; and restricted use of public transport&#46; Essential workers &#40;in healthcare&#44; security services&#44; among others&#41; were excluded<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">2&#44;7</span></a>&#46; Social distancing&#44; use of face masks and adequate ventilation of indoor spaces were recommended&#46; Individuals over the age 60 and&#47;or immunocompromised individuals were encouraged to stay at home<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">2&#44;23</span></a>&#46; Although adherence to these measures declined as the epidemic evolved&#44; use of face masks was sustained over time&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Large-scale application of containment measures&#44; as shown by various studies&#44; led to a significant reduction in incidence of other viral infections such as influenza&#44; Respiratory Syncytial Virus and Enterovirus<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;6&#44;11&#44;14&#44;22&#44;28</span></a>&#46; Interaction between SARS-CoV-2 and encapsulated bacteria is still under investigation&#44; and frequency of coinfection has yet to be established&#46; Other questions of interest include&#44; whether health strategies for pandemic containment and mitigation influenced incidence of invasive infections due to encapsulated bacteria &#40;IIEB&#41;&#44; as occurs with other viral pathogens&#44; and whether coinfection increased case fatality rates&#46; The main objective of this study was to evaluate IIEB rates during the COVID-19 pandemic and compare incidence levels to the ones reported during the year prior to the pandemic&#46; As a secondary objective&#44; incidence of COVID-19&#47;IIEB coinfection and case fatality rate were also examined&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">A cross-sectional study was performed&#46; Data from a centralized microbiology laboratory serving a network of privately administered healthcare institutions in Buenos Aires City &#40;CABA&#41; and the greater Buenos Aires Metropolitan Area &#40;BAMA&#41; were collected&#46; The network includes 713 inpatient beds for children and adults&#44; which were expanded by 20&#37; during the pandemic&#46; Three periods were evaluated&#58; &#40;1&#41; pre-pandemic&#58; March 1&#44; 2019&#8211;February 29&#44; 2020&#59; &#40;2&#41; pandemic year 1&#58; March 1&#44; 2020&#8211;February 28&#44; 2021&#59; and &#40;3&#41; pandemic year 2&#58; March 1&#44; 2021&#8211;July 31&#44; 2021&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Biological samples collected from sterile sites &#40;blood&#44; cerebrospinal fluid&#44; pleural fluid&#44; synovial fluid&#44; etc&#46;&#41; of patients attending the emergency departments&#44; general wards and intensive care units of the network centers were analyzed&#46; Samples positive for <span class="elsevierStyleItalic">S&#46; pneumoniae</span>&#44; <span class="elsevierStyleItalic">H&#46; influenzae</span>&#44; and <span class="elsevierStyleItalic">N&#46; meningitidis</span> were identified&#44; and clinical characteristics&#44; laboratory results&#44; and outcome of patients with IIEB collected from medical records&#46; During the second and third period&#44; occurrence of COVID-19 &#40;confirmed by positive RT-PCR&#41; and IIEB coinfection was investigated and considered primary &#40;when simultaneous to IIEB&#41; or secondary &#40;diagnosed at least 3 days after hospital admission&#41;&#46; In-hospital case fatality rate of IIEB was determined&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Descriptive statistical analysis was conducted&#46; Categorical variables were expressed as absolute and relative frequencies&#46; Continuous variables were characterized with measures of central tendency &#40;mean and median&#41; and measures of dispersion &#40;ranges&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The study was approved by the Institutional Review Board&#46; Sensitive patient data were protected by confidentiality and coding&#46; Only investigators directly related to the research and competent authorities had access to the information&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">Between March 1&#44; 2019 and July 31&#44; 2021&#44; a total of 56<span class="elsevierStyleHsp" style=""></span>502 biological samples belonging to 27<span class="elsevierStyleHsp" style=""></span>224 patients were assessed&#59; 54<span class="elsevierStyleHsp" style=""></span>403 &#40;96&#37;&#41; were blood cultures and 2099 &#40;4&#37;&#41; from other sterile sites&#46; Fifty-four samples from 54 subjects were positive for encapsulated bacteria&#44; of which 50 were <span class="elsevierStyleItalic">S&#46; pneumoniae</span> and 4 <span class="elsevierStyleItalic">H&#46; influenzae</span>&#46; <span class="elsevierStyleItalic">N&#46; meningitidis</span> was not found during the study period &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Demographics of the study population and risk factors for IIEB are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The most common causes for hospitalization were&#58; pneumonia &#40;28 cases&#41; and diarrhea &#40;2&#41; during period 1&#59; suspected SARS-CoV-2 infection &#40;3&#41;&#44; pneumonia &#40;1&#41;&#44; acute-on-chronic kidney disease &#40;1&#41; and febrile neutropenia and abdominal pain &#40;1&#41; during period 2&#59; and SARS-CoV-2 infection &#40;4&#41; in period 3&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Global cumulative incidence of IIEB was 95&#46;57 per 100<span class="elsevierStyleHsp" style=""></span>000 samples&#46; Comparative analysis showed incidence varied by period &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Between the first and second period&#44; cumulative incidence of <span class="elsevierStyleItalic">S&#46; pneumoniae</span> infections decreased by 136&#46;21 cases per 100<span class="elsevierStyleHsp" style=""></span>000 samples &#40;relative decrease 0&#46;15&#41;&#46; However&#44; between the second and third&#44; 27&#46;19 more cases per 100<span class="elsevierStyleHsp" style=""></span>000 samples &#40;relative increase 2&#46;17&#41; were observed&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Cumulative incidence of <span class="elsevierStyleItalic">H&#46; influenzae</span> infections between periods 1 and 2 showed an increase of 1&#46;33 cases per 100<span class="elsevierStyleHsp" style=""></span>000 samples &#40;relative increase 1&#46;17&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">During periods 2 and 3&#44; total number of COVID-19 hospitalizations was 12<span class="elsevierStyleHsp" style=""></span>328&#59; 12 IIEB occurred&#44; of which 10 were due to <span class="elsevierStyleItalic">S&#46; pneumoniae</span> and 2 to <span class="elsevierStyleItalic">H&#46; influenzae</span>&#46; Seven cases of SARS-CoV-2&#47;<span class="elsevierStyleItalic">S&#46; pneumoniae</span> coinfection were identified&#44; 2 primary and 5 secondary&#46; Coinfection rate was 0&#46;056&#37; in patients hospitalized for COVID-19&#44; corresponding to an incidence of 5&#46;68 per 10<span class="elsevierStyleHsp" style=""></span>000 hospitalizations for COVID-19&#46; However&#44; in a subanalysis of patients hospitalized with IPD&#44; we found that 7 of 10 subjects were co-infected with SARS-COV-2&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Overall case fatality in IIEB patients was 33&#37;&#44; &#40;31&#37;&#44; 29&#37;&#44; and 60&#37; for periods 1&#44; 2 and 3 respectively&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">All deaths occurred in patients with <span class="elsevierStyleItalic">S&#46; pneumoniae</span> infections&#44; except for 1 patient with <span class="elsevierStyleItalic">H&#46; influenzae</span> in period 1&#46; Case fatality of SARS-C0V-2&#47;<span class="elsevierStyleItalic">S&#46; pneumoniae</span> coinfection reached 43&#37; &#40;3 of 7 subjects&#41;&#44; whereas case fatality of IPD cases without COVID-19 coinfection was 32&#46;5&#37;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Overall&#44; all-cause in-hospital mortality in COVID-19 patients between March 1&#44; 2020&#44; and July 31&#44; 2021&#44; was 4&#37; &#40;492 deaths&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">A significant reduction in incidence of IPD was observed during the period 2020&#8211;2021&#44; coinciding with the implementation of large-scale containment measures to mitigate the spread of the COVID-19 pandemic&#46; This reduction was more pronounced during the first year of the pandemic &#40;period 2&#41;&#44; probably because more stringent restrictions were enforced&#46; Only 4 cases of invasive <span class="elsevierStyleItalic">H&#46; influenzae</span> infections occurred over the whole study period&#44; with no differences observed between periods&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">From March to July 2021&#44; a small increase in the incidence of IPD was observed compared to the first pandemic year&#44; coinciding with relaxing of restrictions&#46; Median age of hospitalized patients with IIEB was younger &#40;43 years&#41; during period 3 than during periods 2 &#40;70 years&#41; and 1 &#40;64 years&#41;&#44; in line with the decrease in average age of COVID-19 hospitalized patients in 2021&#44; during the second disease wave in Argentina&#44; and the launch of a vaccination program for healthcare workers and adults over 60 years of age&#44; which began in the first quarter of 2021&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">During the study period we observed a reduction in the incidence of IPD&#46; Our findings coincide with those of Brueggemann et al&#46;&#44; who conducted a large prospective laboratory surveillance study&#44; in 26 countries and territories on 6 continents&#44; finding a significant and sustained reduction in invasive <span class="elsevierStyleItalic">S&#46; pneumoniae</span> infections&#44; that reached 68&#37; in the first 4 weeks&#44; and 82&#37; in the following 8 weeks after introduction of restrictions on human mobility &#40;measured using Google COVID-19 Community Mobility Reports digital tool&#41;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a>&#46; The authors suggested interruption of person-to-person transmission of <span class="elsevierStyleItalic">S&#46; pneumoniae</span> as the most plausible explanation for this reduction&#44; in the context of pandemic-related confinement measures&#46; Since the nasopharynx of children is the natural ecological niche of <span class="elsevierStyleItalic">S&#46; pneumoniae</span>&#44; school closures&#44; in addition to strict protection measures in older adults&#44; were the most probable reasons for the fall in IPDs observed&#46; In Tuscany&#44; Italy&#44; Lastrucci et al&#46; reported a significant reduction in the incidence of hospitalizations for community-acquired pneumonia in the elderly&#44; during the first wave of COVID-19&#44; compared to the previous 3 years&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a> Less use of antimicrobials in the community was also observed during this period&#44; suggesting patients with pneumonia had not been treated in the outpatient setting&#46; The authors therefore attributed the fall in community acquired pneumonia to the indirect impact of the lockdown&#46; In Japan&#44; Hiroyuki et al&#46; also reported a significant reduction in the number of patients hospitalized for community pneumonia&#44; between August&#44; 2019 and July&#44; 2020&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">21</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Similar observations were made in younger populations&#46; Friedrich et al&#46; analyzed causes for hospital admission in children under 14 years of age in Brazil&#44; finding a significant decrease in hospitalizations for pneumonia in 2020 compared to the period 2015 to 2019&#44; for all age groups&#44; but especially in children under 9 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a> This reduction coincided with the implementation of non-pharmacological measures to contain the pandemic&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Another relevant finding of our study was the low frequency of SARS-CoV-2&#47;<span class="elsevierStyleItalic">S&#46; pneumoniae</span> coinfection&#59; the observed incidence was 5&#46;68 per 10<span class="elsevierStyleHsp" style=""></span>000 hospitalizations for COVID-19&#46; It should be clarified that only invasive <span class="elsevierStyleItalic">S&#46; pneumoniae</span> infections were considered since samples were from sterile sites&#46; Conversely&#44; in patients hospitalized for IPD during the pandemic&#44; SARS-CoV-2 coinfection rate was 70&#37;&#46; The low rate of bacterial coinfections in patients hospitalized for COVID-19 argues in favor of avoiding unnecessary early use of antimicrobial agents&#44; which predisposes to spread of multidrug-resistant gram negative bacteria both in the hospital and in the community&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#44;8&#44;15&#44;20</span></a> Lansbury et al&#46; performed a meta-analysis of 30 studies and found&#44; of a total of 3834 patients hospitalized for COVID-19&#44; 7&#37; had bacterial coinfections&#44; increasing to 14&#37; for patients admitted to the ICU&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a> The most frequent pathogens were <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span> &#40;47&#37;&#41;&#44; <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> &#40;12&#37;&#41;&#44; and <span class="elsevierStyleItalic">H&#46; influenzae</span> &#40;12&#37;&#41;&#46; Another meta-analysis carried out by Langford et al&#46; estimated 3&#46;5&#37; of patients with COVID-19 had a primary bacterial coinfection and 14&#46;3&#37; developed secondary bacterial infections during hospitalization&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a> A retrospective study performed by Hughes et al&#46; included 836 patients hospitalized for COVID-19&#44; 27 &#40;3&#46;2&#37;&#41; presented bacterial coinfection early&#44; within 5 days of admission&#44; increasing to 51 &#40;6&#46;1&#37;&#41; during the remaining hospital stay&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> No <span class="elsevierStyleItalic">S&#46; pneumoniae</span> coinfections were found&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">With respect to SARS-CoV-2 and <span class="elsevierStyleItalic">S&#46; pneumoniae</span> coinfections&#44; the largest study to date was conducted in England by Amin-Chowdhury et al&#46;&#44; between February and June&#44; 2020&#44; monitoring incidence of IPD and COVID-19 during lockdown&#46; The authors reported 30&#37; reduction in the incidence of IPD cases&#44; even after adjusting for age&#44; gender&#44; and bacterial serotype&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a> The rate of coinfection was 0&#46;025&#37; for patients diagnosed with COVID-19&#44; and 3&#46;5&#37; in those hospitalized for IPD&#46; Risk of coinfection increased with age&#44; and high blood pressure and dementia were the most common comorbidities&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In our study&#44; case fatality rate of SARS-COV-2&#47;<span class="elsevierStyleItalic">S&#46; pneumoniae</span> coinfection was high &#40;43&#37;&#41;&#44; greater than for isolated IPD cases &#40;32&#46;5&#37;&#41;&#44; and for in-hospital COVID-19 cases &#40;4&#37;&#41;&#46; These findings are similar to the Lansbury meta-analysis&#44; which reported a 5&#46;82-fold increase in the risk of dying in coinfected patients&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a> Rodriguez-Nava et al&#46;&#44; who analyzed 11 episodes of SARS-CoV-2 and <span class="elsevierStyleItalic">S&#46; pneumoniae</span> coinfection&#44; also found high mortality rate &#40;64&#37;&#41; during hospitalization&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a> In the surveillance study conducted by Amin-Chowdhury&#44; 30-day mortality was 3&#46;88 times higher in patients who developed COVID-19 after IPD and 7&#46;75 times higher in those with primary coinfection&#44; compared to those with IPD alone&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Limitations to our study include the fact that patients originated from the Buenos Aires metropolitan area &#40;CABA and BAMA&#41; exclusively&#44; with access to private healthcare or social security&#46; Although this region has one of the highest incidences of COVID-19 in the country&#44; no patients from the public health system were included&#46; Furthermore&#44; information on pneumococcal vaccination status of patients was not available&#44; and the third study period was shorter than the first two&#46; Finally&#44; because of its observational nature&#44; statistical results presented are descriptive only&#46; Lack of data precluded further analysis since univariate analysis without adjusting for other variables could have led to incorrect conclusions&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="par0145" class="elsevierStylePara elsevierViewall">This study is the first in Argentina to assess the incidence of IIEB&#44; particularly due to <span class="elsevierStyleItalic">S&#46; pneumoniae</span>&#44; in the context of the COVID-19 pandemic&#46; Significant reduction compared to the pre-pandemic year was observed&#44; coinciding with implementation of public health strategies for pandemic containment and mitigation&#46; The potential impact of these measures on other health conditions beyond COVID-19&#44; such as IPD&#44; is remarkable&#46; Based on these findings&#44; we believe that people with risk factors for IPD would strongly benefit from continued use of face masks and social distancing&#44; beyond the pandemic&#44; in particular during winter&#46; We also observed low rates of SARS-CoV-2 and invasive <span class="elsevierStyleItalic">S&#46; pneumoniae</span> coinfection&#44; supporting the concept that early antimicrobial treatment in COVID-19 patients is unnecessary&#46; Finally&#44; case fatality was higher in coinfected patients than in those presenting IPD&#44; or in-hospital COVID-19 alone&#44; suggesting a potential adverse synergistic interaction between pathogens&#44; although further studies will be needed to confirm this hypothesis&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Funding</span><p id="par0150" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that there are no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres2109214"
          "titulo" => "Highlights"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:3 [
          "identificador" => "xres2109212"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        2 => array:2 [
          "identificador" => "xpalclavsec1796964"
          "titulo" => "Keywords"
        ]
        3 => array:3 [
          "identificador" => "xres2109213"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0015"
            ]
          ]
        ]
        4 => array:2 [
          "identificador" => "xpalclavsec1796965"
          "titulo" => "Palabras clave"
        ]
        5 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        6 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
        ]
        7 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        8 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        9 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conclusions"
        ]
        10 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Funding"
        ]
        11 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conflicts of interest"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-04-29"
    "fechaAceptado" => "2023-06-13"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1796964"
          "palabras" => array:7 [
            0 => "Encapsulated bacteria"
            1 => "<span class="elsevierStyleItalic">S&#46; pneumoniae</span>"
            2 => "COVID-19"
            3 => "Incidence"
            4 => "Case fatality"
            5 => "SARS-CoV-2&#47;<span class="elsevierStyleItalic">S&#46; pneumoniae</span> coinfection"
            6 => "Invasive pneumococcal disease"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1796965"
          "palabras" => array:7 [
            0 => "Microorganismos capsulados"
            1 => "<span class="elsevierStyleItalic">S&#46; pneumoniae</span>"
            2 => "COVID-19"
            3 => "Incidencia"
            4 => "Letalidad"
            5 => "Coinfecci&#243;n SARS-CoV-2&#47;<span class="elsevierStyleItalic">S&#46; pneumoniae</span> coinfecci&#243;n"
            6 => "Enfermedad neumoc&#243;cica invasiva"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "highlights" => array:2 [
      "titulo" => "Highlights"
      "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0005" class="elsevierStylePara elsevierViewall">IIEB incidence dropped dramatically during the COVID-19 pandemic&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0010" class="elsevierStylePara elsevierViewall">Reduction coincided with public health measures to contain the pandemic&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0015" class="elsevierStylePara elsevierViewall">We observed low rates of SARS-COV2 and invasive <span class="elsevierStyleItalic">S&#46; pneumoniae</span> coinfection&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0020" class="elsevierStylePara elsevierViewall">Case fatality was higher in coinfected patients than in those presenting IPD&#46;</p></li></ul></p></span>"
    ]
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Interaction between severe acute respiratory coronavirus 2 &#40;SARS-CoV-2&#41; and IIEB remains under investigation&#46; Objective&#58; to compare IIEB incidence before and during COVID-19 pandemic&#44; and assess incidence of coinfection with COVID-19 and case fatality&#46; A cross-sectional study was performed on data from a centralized microbiology laboratory serving a network of healthcare centers comprising 713 pediatric and adult inpatient beds&#44; expanded by 20&#37; during the pandemic&#46; Three periods were evaluated&#58; &#40;1&#41; pre-pandemic&#58; March 1&#44; 2019&#8211;February 29&#44; 2020&#59; &#40;2&#41; pandemic year 1&#58; March 1&#44; 2020&#8211;February 28&#44; 2021&#59; &#40;3&#41; pandemic year 2&#58; March 1&#44; 2021&#8211;July 31&#44; 2021&#46; Descriptive statistical analysis was performed&#46; 56 502 samples &#40;96&#37; blood cultures&#41; from 27<span class="elsevierStyleHsp" style=""></span>224 patients were analyzed&#46; Of these&#44; 54 samples &#40;from 54 patients&#41; were positive for encapsulated bacteria&#46; IIEB incidence was&#58; 167&#46;4&#44; 32&#46;6&#44; and 50&#46;4 per 100<span class="elsevierStyleHsp" style=""></span>000 samples for periods 1&#44; 2&#44; and 3&#44; respectively&#46; Twelve IIEB episodes occurred during the pandemic period&#58; 10 <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>&#44; and 2 <span class="elsevierStyleItalic">Haemophilus influenzae</span>&#44; of which 7 were SARS-CoV-2&#47;<span class="elsevierStyleItalic">S&#46; pneumoniae</span> coinfections&#44; with an incidence of 5&#46;68 per 10<span class="elsevierStyleHsp" style=""></span>000 COVID-19-related hospitalizations &#40;0&#46;056&#37;&#41;&#46; IIEB case fatality was 31&#37;&#44; 29&#37;&#44; and 60&#37; for each period&#44; respectively&#44; 3&#47;7 patients with coinfection died &#40;43&#37;&#41;&#46; Case fatality for invasive pneumococcal disease &#40;IPD&#41; in patients without COVID-19&#44; was 32&#46;5&#37;&#46; Significant reduction in IIEB incidence was observed during the pandemic&#44; coinciding with implementation of containment measures&#46; The incidence of SARS-CoV-2&#47;<span class="elsevierStyleItalic">S&#46; pneumoniae</span> coinfection was low&#44; with higher case fatality than IPD patients without COVID-19&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La interacci&#243;n entre SARS-CoV-2 e infecciones invasivas por bacterias capsuladas &#40;IIBC&#41; contin&#250;a bajo estudio&#46; Objetivos&#58; comparar la incidencia de IIBC antes y durante la pandemia por COVID-19&#44; evaluar la incidencia de coinfecci&#243;n con COVID-19 y la letalidad&#46; Estudio transversal de registros de un laboratorio centralizado de Microbiolog&#237;a&#44; que asiste a una red de centros asistenciales con 713 camas de internaci&#243;n para adultos y pedi&#225;tricos&#44; expandida 20&#37; durante la pandemia&#46; Tres periodos evaluados&#58; 1&#41; Pre-pandemia&#58; 1-Marzo-2019 al 29-Febrero-2020&#59; 2&#41; Primer a&#241;o de Pandemia&#58; 1-Marzo-2020 al 28-Febrero-2021&#59; 3&#41; Pandemia 2021&#58; 1-Marzo-2021 al 31-Julio-2021&#46; An&#225;lisis estad&#237;stico descriptivo&#58; Se analizaron 56&#46;502 muestras &#40;96&#37; hemocultivos&#41; correspondientes a 27&#46;224 pacientes&#46; De estas&#44; 54 muestras &#40;de 54 pacientes&#41; fueron positivas para bacterias capsuladas&#46; La incidencia de IIBC fue 167&#44;4&#44; 32&#44;6 y 50&#44;4 por cada 100&#46;000 muestras para los periodos 1&#44; 2 y 3&#44; respectivamente&#46; Doce IIBC ocurrieron durante la pandemia&#58; 10 <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> y dos <span class="elsevierStyleItalic">Haemophilus influenzae</span>&#44; siete de ellos corresponden a coinfecci&#243;n SARS-CoV-2&#47;<span class="elsevierStyleItalic">S&#46; pneumoniae</span>&#44; con una incidencia de 5&#44;68 por cada 10&#46;000 internaciones por COVID 19 &#40;0&#44;056&#37;&#41;&#46; La letalidad de las IIBC fue de 31&#44; 29 y 60&#37; para los tres periodos&#44; respectivamente&#44; 3&#47;7 coinfectados fallecieron &#40;43&#37;&#41;&#46; La letalidad por enfermedad neumoc&#243;cica invasiva &#40;ENI&#41;&#44; sin COVID fue de 32&#44;5&#37;&#46; Se evidenci&#243; una reducci&#243;n significativa de la incidencia de IIBC luego del comienzo de la pandemia&#44; coincidente con la implementaci&#243;n de las medidas sanitarias de contenci&#243;n de la pandemia&#46; La incidencia de coinfecci&#243;n de SARS-CoV-2&#47;<span class="elsevierStyleItalic">S&#46; pneumoniae</span> fue baja y present&#243; mayor letalidad que las ENI sin COVID-19&#46;</p></span>"
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1070
            "Ancho" => 2341
            "Tamanyo" => 113607
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cumulative incidence according to pathogen and total incidence per 100<span class="elsevierStyleHsp" style=""></span>000 samples for each period&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Period 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Period 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Period 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2019&#8211;2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2020&#8211;2021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;March&#8211;July 2021&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Samples</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Blood cultures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24<span class="elsevierStyleHsp" style=""></span>042&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20<span class="elsevierStyleHsp" style=""></span>781&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9580&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1043&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">723&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">333&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25<span class="elsevierStyleHsp" style=""></span>085&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21<span class="elsevierStyleHsp" style=""></span>504&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9913&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Subjects</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12<span class="elsevierStyleHsp" style=""></span>041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10<span class="elsevierStyleHsp" style=""></span>380&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4803&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:1.0px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S&#46; pneumoniae</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Blood cultures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cerebrospinal fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pleural fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Incidence</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">159&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:1.0px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">H&#46; influenzae</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Blood cultures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cerebrospinal fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pleural fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Incidence</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3488998.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Cumulative incidence per 100<span class="elsevierStyleHsp" style=""></span>000 samples&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Samples and culture results according to time period&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Period 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Period 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Period 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2019&#8211;2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2020&#8211;2021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2021 &#40;March&#8211;July&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Population</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Age&#58; mean&#47;median&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;5&#47;64&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;1&#47;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;4&#47;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;5&#47;63&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Minimum age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Maximum age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Male&#47;female ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Risk factor for IIEB</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Older than 64 years of age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Chronic obstructive pulmonary disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Chronic heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Smoking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Leukemia&#44; lymphoma and Hodgkin disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Chronic kidney disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Functional or anatomic asplenia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Younger than 2 years of age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Alcoholism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Chronic liver disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; HIV infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Congenital or acquired immunodeficiencies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Hematopoietic cell transplant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Multimorbidity &#40;2 or more comorbidities&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3488996.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the study population by time period&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Incidence<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Period 12019&#8211;2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Period 22020&#8211;2021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Period 3March&#8211;July 2021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S&#46; pneumoniae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">159&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">H&#46; influenzae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">167&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3488995.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Expressed as cumulative incidence per 100<span class="elsevierStyleHsp" style=""></span>000 samples&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">IIEB incidence according to time period and pathogen&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Period 1&#40;pre pandemic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Period 2&#40;pandemic year 1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Period 3&#40;pandemic year 2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Overall case fatality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#37; &#40;13&#47;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#37; &#40;2&#47;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#37; &#40;3&#47;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#47;54 &#40;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Invasive <span class="elsevierStyleItalic">S&#46; pneumoniae</span> infections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#37; &#40;12&#47;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#37; &#40;2&#47;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#37; &#40;3&#47;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#37; &#40;17&#47;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SARS-CoV-2&#47;<span class="elsevierStyleItalic">S&#46; pneumoniae</span> coinfection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#95;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#37; &#40;1&#47;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#37; &#40;2&#47;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#37; &#40;3&#47;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S&#46; pneumoniae</span> without COVID-19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#37; &#40;12&#47;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#37; &#40;1&#47;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37; &#40;1&#47;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;5&#37; &#40;14&#47;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3488997.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Case fatality of IIEB according to pathogen and time period&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:28 [
            0 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low rate of bacterial co-infection in patients with COVID-19"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46; Adler"
                            1 => "R&#46; Ball"
                            2 => "M&#46; Fisher"
                            3 => "K&#46; Mortimer"
                            4 => "M&#46;S&#46; Vardhan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2666-5247(20)30036-7"
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet Microbe"
                        "fecha" => "2020"
                        "volumen" => "1"
                        "paginaInicial" => "e62"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32835331"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Boletin Oficial de la Rep&#250;blica Argentina&#46; Decreto 297&#47;2020&#46; DECNU-2020-297-APN-PTE &#8211; Disposiciones"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Aislamiento Social Preventivo y Obligatorio"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2020"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of the coronavirus disease 2019 &#40;COVID-19&#41; pandemic on invasive pneumococcal disease and risk of pneumococcal coinfection with severe acute respiratory syndrome coronavirus 2 &#40;SARS-CoV-2&#41;&#58; prospective national cohort study&#44; England"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:9 [
                            0 => "Z&#46; Amin-Chowdhury"
                            1 => "F&#46; Aiano"
                            2 => "A&#46; Mensah"
                            3 => "C&#46;L&#46; Sheppard"
                            4 => "D&#46; Litt"
                            5 => "N&#46;K&#46; Fry"
                            6 => "N&#46; Andrews"
                            7 => "M&#46;E&#46; Ramsay"
                            8 => "S&#46;N&#46; Ladhani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cid/ciaa1728"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2021"
                        "volumen" => "72"
                        "paginaInicial" => "e65"
                        "paginaFinal" => "e75"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33196783"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronavirus disease 2019 pandemic&#58; impact caused by school closure and national lockdown on pediatric visits and admissions for viral and nonviral infections &#8211; a time series analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:13 [
                            0 => "F&#46; Angoulvant"
                            1 => "N&#46; Ouldali"
                            2 => "D&#46;D&#46; Yang"
                            3 => "M&#46; Filser"
                            4 => "V&#46; Gajdos"
                            5 => "A&#46; Rybak"
                            6 => "R&#46; Guedj"
                            7 => "V&#46; Soussan-Banini"
                            8 => "R&#46; Basmaci"
                            9 => "A&#46; Lefevre-Utile"
                            10 => "D&#46; Brun-Ney"
                            11 => "L&#46; Beaujouan"
                            12 => "D&#46; Skurnik"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2021"
                        "volumen" => "72"
                        "paginaInicial" => "319"
                        "paginaFinal" => "322"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changes in the incidence of invasive disease due to <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>&#44; <span class="elsevierStyleItalic">Haemophilus influenzae</span>&#44; and <span class="elsevierStyleItalic">Neisseria meningitidis</span> during the COVID-19 pandemic in 26 countries and territories in the Invasive Respiratory Infection Surveillance Initiative&#58; a prospective analysis of surveillance data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:95 [
                            0 => "A&#46;B&#46; Brueggemann"
                            1 => "M&#46;J&#46; Jansen van Rensburg"
                            2 => "D&#46; Shaw"
                            3 => "N&#46;D&#46; McCarthy"
                            4 => "K&#46;A&#46; Jolley"
                            5 => "M&#46;C&#46;J&#46; Maiden"
                            6 => "M&#46;P&#46;G&#46; van der Linden"
                            7 => "Z&#46; Amin-Chowdhury"
                            8 => "D&#46;E&#46; Bennett"
                            9 => "R&#46; Borrow"
                            10 => "M&#46;C&#46; Brandileone"
                            11 => "K&#46; Broughton"
                            12 => "R&#46; Campbell"
                            13 => "B&#46; Cao"
                            14 => "C&#46; Casanova"
                            15 => "E&#46;H&#46; Choi"
                            16 => "Y&#46;W&#46; Chu"
                            17 => "S&#46;A&#46; Clark"
                            18 => "H&#46; Claus"
                            19 => "J&#46; Coelho"
                            20 => "M&#46; Corcoran"
                            21 => "S&#46; Cottrell"
                            22 => "R&#46;J&#46; Cunney"
                            23 => "T&#46; Dalby"
                            24 => "H&#46; Davies"
                            25 => "L&#46; de Gouveia"
                            26 => "A&#46;E&#46; Deghmane"
                            27 => "W&#46; Demczuk"
                            28 => "S&#46; Desmet"
                            29 => "R&#46;J&#46; Drew"
                            30 => "M&#46; du Plessis"
                            31 => "H&#46; Erlendsdottir"
                            32 => "N&#46;K&#46; Fry"
                            33 => "K&#46; Fuursted"
                            34 => "S&#46;J&#46; Gray"
                            35 => "B&#46; Henriques-Normark"
                            36 => "T&#46; Hale"
                            37 => "M&#46; Hilty"
                            38 => "S&#46; Hoffmann"
                            39 => "H&#46; Humphreys"
                            40 => "M&#46; Ip"
                            41 => "S&#46; Jacobsson"
                            42 => "J&#46; Johnston"
                            43 => "J&#46; Kozakova"
                            44 => "K&#46;G&#46; Kristinsson"
                            45 => "P&#46; Krizova"
                            46 => "A&#46; Kuch"
                            47 => "S&#46;N&#46; Ladhani"
                            48 => "T&#46;T&#46; L&#226;m"
                            49 => "V&#46; Lebedova"
                            50 => "L&#46; Lindholm"
                            51 => "D&#46;J&#46; Litt"
                            52 => "I&#46; Martin"
                            53 => "D&#46; Martiny"
                            54 => "W&#46; Mattheus"
                            55 => "M&#46; McElligott"
                            56 => "M&#46; Meehan"
                            57 => "S&#46; Meiring"
                            58 => "P&#46; M&#246;lling"
                            59 => "E&#46; Morfeldt"
                            60 => "J&#46; Morgan"
                            61 => "R&#46;M&#46; Mulhall"
                            62 => "C&#46; Mu&#241;oz-Almagro"
                            63 => "D&#46;R&#46; Murdoch"
                            64 => "J&#46; Murphy"
                            65 => "M&#46; Musilek"
                            66 => "A&#46; Mzabi"
                            67 => "A&#46; Perez-Arg&#252;ello"
                            68 => "M&#46; Perrin"
                            69 => "M&#46; Perry"
                            70 => "A&#46; Redin"
                            71 => "R&#46; Roberts"
                            72 => "M&#46; Roberts"
                            73 => "A&#46; Rokney"
                            74 => "M&#46; Ron"
                            75 => "K&#46;J&#46; Scott"
                            76 => "C&#46;L&#46; Sheppard"
                            77 => "L&#46; Siira"
                            78 => "A&#46; Skoczy&#324;ska"
                            79 => "M&#46; Sloan"
                            80 => "H&#46;C&#46; Slotved"
                            81 => "A&#46;J&#46; Smith"
                            82 => "J&#46;Y&#46; Song"
                            83 => "M&#46;K&#46; Taha"
                            84 => "M&#46; Toropainen"
                            85 => "D&#46; Tsang"
                            86 => "A&#46; Vainio"
                            87 => "N&#46;M&#46; van Sorge"
                            88 => "E&#46; Varon"
                            89 => "J&#46; Vlach"
                            90 => "U&#46; Vogel"
                            91 => "S&#46; Vohrnova"
                            92 => "A&#46; von Gottberg"
                            93 => "R&#46;C&#46; Zanella"
                            94 => "F&#46; Zhou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2589-7500(21)00077-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Digit Health"
                        "fecha" => "2021"
                        "volumen" => "3"
                        "paginaInicial" => "e360"
                        "paginaFinal" => "e370"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34045002"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of wearing masks&#44; hand hygiene&#44; and social distancing on influenza&#44; enterovirus&#44; and all-cause pneumonia during the coronavirus pandemic&#58; retrospective national epidemiological surveillance study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "N&#46;C&#46; Chiu"
                            1 => "H&#46; Chi"
                            2 => "Y&#46;L&#46; Tai"
                            3 => "C&#46;C&#46; Peng"
                            4 => "C&#46;Y&#46; Tseng"
                            5 => "C&#46;C&#46; Chen"
                            6 => "B&#46;F&#46; Tan"
                            7 => "C&#46;Y&#46; Lin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2196/21257"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Med Internet Res"
                        "fecha" => "2020"
                        "volumen" => "22"
                        "paginaInicial" => "e21257"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32750008"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Confirmaci&#243;n del primer caso importado de Covid-19 en la Rep&#250;blica Argentina&#46; Actualizaci&#243;n Epidemiol&#243;gica&#46; Ministerio de Salud Argentina&#46; 4 de marzo 2020 &#8211; SE 10&#46; Available from&#58; <a target="_blank" href="https://bancos.salud.gob.ar/recurso/actualizacion-epidemiologica-confirmacion-del-primer-caso-importado-de-covid-19-en-la">https&#58;&#47;&#47;bancos&#46;salud&#46;gob&#46;ar&#47;recurso&#47;actualizacion-epidemiologica-confirmacion-del-primer-caso-importado-de-covid-19-en-la</a> &#91;accessed 24&#46;02&#46;23&#93;&#46;"
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Co-infections&#58; potentially lethal and unexplored in COVID-19"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;J&#46; Cox"
                            1 => "N&#46; Loman"
                            2 => "D&#46; Bogaert"
                            3 => "J&#46; O&#8217;Grady"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2666-5247(20)30009-4"
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet Microbe"
                        "fecha" => "2020"
                        "volumen" => "1"
                        "paginaInicial" => "e11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32835323"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Unraveling the seasonal epidemiology of pneumococcus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "M&#46; Domenech de Cell&#232;s"
                            1 => "H&#46; Arduin"
                            2 => "D&#46; L&#233;vy-Bruhl"
                            3 => "S&#46; Georges"
                            4 => "C&#46; Souty"
                            5 => "D&#46; Guillemot"
                            6 => "L&#46; Watier"
                            7 => "L&#46; Opatowski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1073/pnas.1812388116"
                      "Revista" => array:6 [
                        "tituloSerie" => "Proc Natl Acad Sci U S A"
                        "fecha" => "2019"
                        "volumen" => "116"
                        "paginaInicial" => "1802"
                        "paginaFinal" => "1807"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30642967"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pneumococcal infection in adults&#58; burden of disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;J&#46; Drijkoningen"
                            1 => "G&#46;G&#46; Rohde"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/1469-0691.12461"
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Microbiol Infect"
                        "fecha" => "2014"
                        "volumen" => "20"
                        "numero" => "Suppl&#46; 5"
                        "paginaInicial" => "45"
                        "paginaFinal" => "51"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24313448"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of social distancing for severe acute respiratory syndrome coronavirus 2 on respiratory syncytial virus and influenza burden"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46;M&#46; Edwards"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cid/ciaa1543"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2021"
                        "volumen" => "72"
                        "paginaInicial" => "2076"
                        "paginaFinal" => "2078"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33038221"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> in community-acquired pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Feldman"
                            1 => "R&#46; Anderson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0036-1592074"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Respir Crit Care Med"
                        "fecha" => "2016"
                        "volumen" => "37"
                        "paginaInicial" => "806"
                        "paginaFinal" => "818"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27960205"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of nonpharmacological COVID-19 interventions in hospitalizations for childhood pneumonia in Brazil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:13 [
                            0 => "F&#46; Friedrich"
                            1 => "E&#46;L&#46;C&#46; Garcia"
                            2 => "L&#46;M&#46; Petry"
                            3 => "M&#46;P&#46; Pieta"
                            4 => "G&#46;E&#46; Carvalho"
                            5 => "G&#46; Zocche"
                            6 => "R&#46; Ongaratto"
                            7 => "M&#46;S&#46; Lumertz"
                            8 => "M&#46; Brum"
                            9 => "R&#46;T&#46; Stein"
                            10 => "M&#46;C&#46; Scotta"
                            11 => "M&#46;H&#46; Jones"
                            12 => "L&#46;A&#46; Pinto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ppul.25570"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Pulmonol"
                        "fecha" => "2021"
                        "volumen" => "56"
                        "paginaInicial" => "2818"
                        "paginaFinal" => "2824"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34265188"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early impact of social distancing in response to coronavirus disease 2019 on hospitalizations for acute bronchiolitis in infants in Brazil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:9 [
                            0 => "F&#46; Friedrich"
                            1 => "R&#46; Ongaratto"
                            2 => "M&#46;C&#46; Scotta"
                            3 => "T&#46;N&#46; Veras"
                            4 => "R&#46;T&#46; Stein"
                            5 => "M&#46;S&#46; Lumertz"
                            6 => "M&#46;H&#46; Jones"
                            7 => "T&#46; Comaru"
                            8 => "L&#46;A&#46; Pinto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cid/ciaa1458"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2021"
                        "volumen" => "72"
                        "paginaInicial" => "2071"
                        "paginaFinal" => "2075"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32986818"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of co-infections and superinfections in hospitalized patients with COVID-19&#58; a retrospective cohort study"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "COVID-19 Researchers Group"
                          "etal" => false
                          "autores" => array:24 [
                            0 => "C&#46; Garcia-Vidal"
                            1 => "G&#46; Sanjuan"
                            2 => "E&#46; Moreno-Garc&#237;a"
                            3 => "P&#46; Puerta-Alcalde"
                            4 => "N&#46; Garcia-Pouton"
                            5 => "M&#46; Chumbita"
                            6 => "M&#46; Fernandez-Pittol"
                            7 => "C&#46; Pitart"
                            8 => "A&#46; Inciarte"
                            9 => "M&#46; Bodro"
                            10 => "L&#46; Morata"
                            11 => "J&#46; Ambrosioni"
                            12 => "I&#46; Grafia"
                            13 => "F&#46; Meira"
                            14 => "I&#46; Macaya"
                            15 => "C&#46; Cardozo"
                            16 => "C&#46; Casals"
                            17 => "A&#46; Tellez"
                            18 => "P&#46; Castro"
                            19 => "F&#46; Marco"
                            20 => "F&#46; Garc&#237;a"
                            21 => "J&#46; Mensa"
                            22 => "J&#46;A&#46; Mart&#237;nez"
                            23 => "A&#46; Soriano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cmi.2020.07.041"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Infect"
                        "fecha" => "2021"
                        "volumen" => "27"
                        "paginaInicial" => "83"
                        "paginaFinal" => "88"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32745596"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bacterial and fungal coinfection among hospitalized patients with COVID-19&#58; a retrospective cohort study in a UK secondary-care setting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Hughes"
                            1 => "O&#46; Troise"
                            2 => "H&#46; Donaldson"
                            3 => "N&#46; Mughal"
                            4 => "L&#46;S&#46;P&#46; Moore"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cmi.2020.06.025"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Infect"
                        "fecha" => "2020"
                        "volumen" => "26"
                        "paginaInicial" => "1395"
                        "paginaFinal" => "1399"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32603803"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bacterial co-infection and secondary infection in patients with COVID-19&#58; a living rapid review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "B&#46;J&#46; Langford"
                            1 => "M&#46; So"
                            2 => "S&#46; Raybardhan"
                            3 => "V&#46; Leung"
                            4 => "D&#46; Westwood"
                            5 => "D&#46;R&#46; MacFadden"
                            6 => "J&#46;R&#46; Soucy"
                            7 => "N&#46; Daneman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cmi.2020.07.016"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Infect"
                        "fecha" => "2020"
                        "volumen" => "26"
                        "paginaInicial" => "1622"
                        "paginaFinal" => "1629"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32711058"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Co-infections in people with COVID-19&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Lansbury"
                            1 => "B&#46; Lim"
                            2 => "V&#46; Baskaran"
                            3 => "W&#46;S&#46; Lim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jinf.2020.05.046"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect"
                        "fecha" => "2020"
                        "volumen" => "81"
                        "paginaInicial" => "266"
                        "paginaFinal" => "275"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32473235"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The indirect impact of COVID-19 large-scale containment measures on the incidence of community-acquired pneumonia in older people&#58; a region-wide population-based study in Tuscany&#44; Italy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "V&#46; Lastrucci"
                            1 => "G&#46; Bonaccorsi"
                            2 => "S&#46; Forni"
                            3 => "S&#46; D&#8217;Arienzo"
                            4 => "L&#46; Bachini"
                            5 => "S&#46; Paoli"
                            6 => "C&#46; Lorini"
                            7 => "F&#46; Gemmi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijid.2021.06.058"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Infect Dis"
                        "fecha" => "2021"
                        "volumen" => "109"
                        "paginaInicial" => "182"
                        "paginaFinal" => "188"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34216731"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Co-infections of SARS-CoV-2 with multiple common respiratory pathogens in infected patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:13 [
                            0 => "D&#46; Lin"
                            1 => "L&#46; Liu"
                            2 => "M&#46; Zhang"
                            3 => "Y&#46; Hu"
                            4 => "Q&#46; Yang"
                            5 => "J&#46; Guo"
                            6 => "Y&#46; Guo"
                            7 => "Y&#46; Dai"
                            8 => "Y&#46; Xu"
                            9 => "Y&#46; Cai"
                            10 => "X&#46; Chen"
                            11 => "Z&#46; Zhang"
                            12 => "K&#46; Huang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11427-020-1668-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Sci China Life Sci"
                        "fecha" => "2020"
                        "volumen" => "63"
                        "paginaInicial" => "606"
                        "paginaFinal" => "609"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32170625"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hospitalization of mild cases of community-acquired pneumonia decreased more than severe cases during the COVID-19 pandemic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46; Nagano"
                            1 => "D&#46; Takada"
                            2 => "J&#46;H&#46; Shin"
                            3 => "T&#46; Morishita"
                            4 => "S&#46; Kunisawa"
                            5 => "Y&#46; Imanaka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijid.2021.03.074"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Infect Dis"
                        "fecha" => "2021"
                        "volumen" => "106"
                        "paginaInicial" => "323"
                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33794382"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of social distancing and travel restrictions on non-coronavirus disease 2019 &#40;non-COVID-19&#41; respiratory hospital admissions in young children in rural Alaska"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "L&#46;D&#46; Nolen"
                            1 => "S&#46; Seeman"
                            2 => "D&#46; Bruden"
                            3 => "J&#46; Klejka"
                            4 => "C&#46; Desnoyers"
                            5 => "J&#46; Tiesinga"
                            6 => "R&#46; Singleton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cid/ciaa1328"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2021"
                        "volumen" => "72"
                        "paginaInicial" => "2196"
                        "paginaFinal" => "2198"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32888007"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Plan operativo de preparaci&#243;n y respuesta al COVID-19 Argentina"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "Febrero 2020"
                        "editorial" => "Ministerio de Salud Argentina"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A retrospective study of coinfection of SARS-CoV-2 and <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> in 11 hospitalized patients with severe COVID-19 pneumonia at a single center"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46; Rodriguez-Nava"
                            1 => "M&#46;A&#46; Yanez-Bello"
                            2 => "D&#46;P&#46; Trelles-Garcia"
                            3 => "C&#46;W&#46; Chung"
                            4 => "G&#46; Egoryan"
                            5 => "H&#46;J&#46; Friedman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.12659/MSM.928754"
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Sci Monit"
                        "fecha" => "2020"
                        "volumen" => "26"
                        "paginaInicial" => "e928754"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33188161"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lethal synergism between influenza and <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;M&#46; Rudd"
                            1 => "H&#46;K&#46; Ashar"
                            2 => "V&#46;T&#46; Chow"
                            3 => "N&#46; Teluguakula"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.16966/2470-3176.114"
                      "Revista" => array:3 [
                        "tituloSerie" => "J Infect Pulm Dis"
                        "fecha" => "2016"
                        "volumen" => "2"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The fundamental link between pneumococcal carriage and disease"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Pneumococcal Carriage Group"
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46; Simell"
                            1 => "K&#46; Auranen"
                            2 => "H&#46; K&#228;yhty"
                            3 => "D&#46; Goldblatt"
                            4 => "R&#46; Dagan"
                            5 => "K&#46;L&#46; O&#8217;Brien"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1586/erv.12.53"
                      "Revista" => array:6 [
                        "tituloSerie" => "Expert Rev Vaccines"
                        "fecha" => "2012"
                        "volumen" => "11"
                        "paginaInicial" => "841"
                        "paginaFinal" => "855"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22913260"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Streptococcus pneumoniae</span>&#58; transmission&#44; colonization and invasion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;N&#46; Weiser"
                            1 => "D&#46;M&#46; Ferreira"
                            2 => "J&#46;C&#46; Paton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41579-018-0001-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Microbiol"
                        "fecha" => "2018"
                        "volumen" => "16"
                        "paginaInicial" => "355"
                        "paginaFinal" => "367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29599457"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of coronavirus disease 2019 public health measures on detections of influenza and respiratory syncytial virus in children during the 2020 Australian winter"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:10 [
                            0 => "D&#46;K&#46; Yeoh"
                            1 => "D&#46;A&#46; Foley"
                            2 => "C&#46;A&#46; Minney-Smith"
                            3 => "A&#46;C&#46; Martin"
                            4 => "A&#46;O&#46; Mace"
                            5 => "C&#46;T&#46; Sikazwe"
                            6 => "H&#46; Le"
                            7 => "A&#46; Levy"
                            8 => "C&#46;C&#46; Blyth"
                            9 => "H&#46;C&#46; Moore"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cid/ciaa1475"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2021"
                        "volumen" => "72"
                        "paginaInicial" => "2199"
                        "paginaFinal" => "2202"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32986804"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/03257541/0000005600000001/v1_202403171031/S0325754123000548/v1_202403171031/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "37861"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Microbiolog&#237;a cl&#237;nica y enfermedades infecciosas"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/03257541/0000005600000001/v1_202403171031/S0325754123000548/v1_202403171031/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754123000548?idApp=UINPBA00004N"
]
Article information
ISSN: 03257541
Original language: English
DOI:10.1016/j.ram.2023.06.003
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 2 1 3
2024 October 60 16 76
2024 September 88 16 104
2024 August 85 20 105
2024 July 55 19 74
2024 June 56 10 66
2024 May 1003 14 1017
2024 April 118 12 130
2024 March 120 8 128
2024 February 83 6 89
2024 January 101 9 110
2023 December 384 13 397
2023 November 33 8 41
2023 October 26 5 31
2023 September 14 7 21
2023 August 21 23 44
2023 July 2 3 5
Show all

Follow this link to access the full text of the article

Subscribe to our newsletter

Publish in
Revista Argentina de Microbiología
Revista Argentina de Microbiología is a member and subscribes the principles of, the Committee on Publication Ethics (COPE)
www.publicationethics.org.
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos