Case report
A Case Report: Pseudomonas Stutzeri, An Unusual Cause of Septic Arthritis
A propósito de un caso: pseudomonas stutzeri, una causa inusual de artritis séptica
a Sección Reumatología, Hospital General Universitario de Alicante-ISABIAL, Alicante, Spain
b Servicio Reumatología, Hospital Universitario Torrevieja, Spain
c Servicio Nefrología, Hospital General Universitario de Alicante, Spain
d Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Spain
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Ranieri, S. López-Salguero, Y. González Galván, M. Andrés" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Ranieri" "email" => array:1 [ 0 => "Laura.ranieri.c@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "López-Salguero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Y." "apellidos" => "González Galván" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "M." 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The patient has a history of multifactorial origin chronic kidney disease, undergoing hemodialysis and calciphylaxis, with a chronic right lower limb ulcer. Additionally, the patient presents with high blood pressure, diabetes mellitus type 2, asymptomatic hyperuricemia receiving treatment with alopurinol, and gonarthrosis, who has been experiencing increasing mechanical pain over the past 2 months. The patient was treated one month before with an intra-articular infiltration of hyaluronic acid (with negligible improvement). She was admitted with right lower limb erythema and knee pain, with minor inflammatory signs and suspicious cellulitis. At home, the patient did not control her temperature. The examination revealed discrete localized fever of the right knee, and the laboratory tests showed a C-reactive protein of 28.34 mg/dL, with normal CBC. The knee X-ray showed severe joint space narrowing (grade III–IV arthrosis). The patient underwent arthrocentesis, from which 1 ml of macroscopically inflammatory synovial fluid was obtained; under the microscope, the fluid presented abundant leukocytes and intracellular pyrophosphate crystals. Due to the small fluid sample obtained, no urgent biochemistry analysis was performed. Empiric antibiotic therapy was initiated while waiting for the results of the microbiological cultures, due to the potential of septic arthritis (immunosuppressed patient). The synovial fluid culture isolated <span class="elsevierStyleItalic">P. stutzeri</span> sensitive to meropenem and quinolones, and resistant to piperacillin, with negative synovial fluid and blood cultures. The patient remained thermodynamically stable during her hospital admission, and evolved favorably with antibiotic therapy: 2 weeks of IV meropenem 1 g/day, followed by 4 weeks of oral ciprofloxacin 500 mg every 12 h. No intra-articular drainage was required. Another option for the differential diagnosis is a pyrophosphate monoarthritis (presence of crystals under the microscope and chronic kidney disease with probable associated hyperparathyroidism). Nevertheless, the good response to antibiotic therapy, without the use of corticoids or NSAIDs, is supportive of the septic origin of the condition in this particular patient.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">P. stutzeri</span> is usually found as a saprophyte on the floor and in hospital environments, but seldom leads to severe community or hospital acquired infection. The cases of <span class="elsevierStyleItalic">P. stutzeri</span> infection normally present in immunocompromised patients, with underlying diseases, or previous surgery. They have been more frequently isolated in surgical wounds, blood, respiratory tract and urine.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The treatment of choice is ciprofloxacin or carbapenem,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> but piperacillin-tazobactam and ceftazidime may be other options.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Gram-positive bacteria (specifically <span class="elsevierStyleItalic">Staphylococcus aureus and Streptococcus</span>) are the most frequent aetiology in septic arthritis, and the empirical therapy of choice is ceftriaxone 2 g every 24 h and cloxacillin 2 g every 4 h. Other etiological possibilities should be considered in immunosuppressed patients (such as gram-negatives) and the usual empiric antibiotic regimen may not be enough.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">As far as we know, this is the sixth case of septic arthritis due to <span class="elsevierStyleItalic">P. stutzeri,</span> reported in the literature, as illustrated in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The first case reported,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> is a 78-year old male with a history of psoriasis and pulmonary emphysema, who developed septic arthritis following an intra-articular corticoid infiltration. The second case reported<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> is a 37-year old patient with hip septic arthritis and a history of diabetes mellitus and alcohol abuse. The third case is a prosthetic knee infection in a 73-year old patient with pancytopenia. The fourth case<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> is a 6-year old child with septic arthritis of the knee, secondary to a knife wound. The last case reported<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> is a 70-year old male, with prosthetic infection and a history of diabetes mellitus and renal neoplasm. Three cases of osteomyelitis have also been reported.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–11</span></a> Therefore, in all of the cases mentioned, there is a history of local joint invasion or a condition of immunosuppression. In this particular case, the patient was undergoing renal replacement therapy with hemodialysis and she had a history of intra-articular infiltration one month prior to the development of arthritis. All patients evolved satisfactorily with antibiotic therapy. This search was conducted in Medline, Embase, Google Scholar, BVSalud and Scielo, using the kew word “arthritis” and “<span class="elsevierStyleItalic">Pseudomonas stutzeri</span>”; we could not find any cases reported in Latin America.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">P. stutzeri</span> is a rare cause of septic arthritis, but it must be kept in mind in patients with septic arthritis and a history of local joint invasions or immunosuppression. Because of its sensitivity profile, the usual empiric antibiotic therapy for septic arthritis may not be helpful in this cases.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interests</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to disclose.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1412781" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1292908" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1412782" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1292909" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-03-20" "fechaAceptado" => "2019-09-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1292908" "palabras" => array:4 [ 0 => "Arthritis" 1 => "Pseudomonas stutzeri" 2 => "Haemodialysis" 3 => "Immunosuppression" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1292909" "palabras" => array:4 [ 0 => "Artritis" 1 => "Pseudomonas stutzeri" 2 => "Hemodialísis" 3 => "Inmunosupresión" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A case is presented of septic knee arthritis caused by Pseudomonas stutzeri, which is an aerobic gram-negative bacillus widely distributed in nature and rarely causes serious infections in humans. The patient is an 84-year-old woman on haemodialysis, who developed a septic arthritis of the right knee after a hyaluronic acid injection. There was a favourable outcome after antibiotic therapy. This aetiology should be taken into account when there is a history of local invasion of the joint and in states of immunosuppression, as occurred in this patient.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se presenta un caso de artritis séptica de rodilla por <span class="elsevierStyleItalic">Pseudomonas stutzeri,</span> bacilo gramnegativo aerobio ampliamente distribuido en la naturaleza y que rara vez ocasiona infecciones graves en el ser humano. Se trata de una mujer de 84 años, hemodializada, que desarrolla una artritis séptica de rodilla derecha tras una inflitración con ácido hialurónico y que evoluciona favorablemente tras terapia antibiótica. Se debe tener en cuenta esta etiología cuando hay antecedentes de invasión local de la articulación y en estados de inmunosupresión tal y como sucede en nuestra paciente.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ranieri L, López-Salguero S, González Galván Y, Andrés M. A propósito de un caso: pseudomonas stutzeri, una causa inusual de artritis séptica. Rev Colomb Reumatol. 2020;27:215–217.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case \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">Infection \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">Country of Origin \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">Predisposing Factors \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">Bacteremia \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">Age/Sex \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">Treatment \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">Madhavan<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> \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">Right knee \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">USA \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">Intra-articular infiltration \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">No \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">78, male \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">IV Carbenicillin + articular drainage \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">Thangkhiew<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> \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">Right hip \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">UK \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">Diabetes mellitus Alcohol abuse \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">No \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">37, male \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">IV Ceftazidime \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">Bishara et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> \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">Right knee \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">Israel \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">Prosthesis. Pancytopenia. \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">Si \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">73, male \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">IV Ceftazidime + oral Ciprofloxacin \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">Miron et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> \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">Right knee \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">Israel \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">Wound \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">No \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, male \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">IV Sulfamethoxazole + Trimethoprim 12 mg/kg \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">Bonares et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> \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">Prosthesis infection \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">Canada \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">Diabetes + renal neoplasm \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">No \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">70, male \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">IV Ceftazidime \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">Current case \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">Right knee \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">Spain \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">Intra-articular infiltration Hemodialysis. \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">No \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">84, female \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">IV Meropenem + Ciprofloxacin \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2423855.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Reported cases of septic arthritis from <span class="elsevierStyleItalic">Pseudomonas stutzeri</span>.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biology of <span class="elsevierStyleItalic">Pseudomonas stutzeri</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. 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"fecha" => "2016" "volumen" => "6" "paginaInicial" => "106" "paginaFinal" => "108" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27942461" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community-acquired <span class="elsevierStyleItalic">Pseudomonas stutzeri</span> vertebral osteomyelitis in a previously healthy patient: case report and review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.B. Reisler" 1 => "H. Blumberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/598650" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis." 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"fecha" => "1987" "volumen" => "6" "paginaInicial" => "296" "paginaFinal" => "297" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3575015" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infrequently encountered <span class="elsevierStyleItalic">Pseudomonas</span> species causing infection in humans" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.L. Gilardi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/0003-4819-77-2-211" "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med." "fecha" => "1972" "volumen" => "77" "paginaInicial" => "211" "paginaFinal" => "215" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4641655" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24444405/0000002700000003/v1_202011130741/S2444440520300728/v1_202011130741/en/main.assets" "Apartado" => array:4 [ "identificador" => "53647" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24444405/0000002700000003/v1_202011130741/S2444440520300728/v1_202011130741/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444440520300728?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 37 | 3 | 40 |
| 2024 September | 70 | 16 | 86 |
| 2024 August | 84 | 19 | 103 |
| 2024 July | 62 | 17 | 79 |
| 2024 June | 51 | 7 | 58 |
| 2024 May | 52 | 6 | 58 |
| 2024 April | 53 | 11 | 64 |
| 2024 March | 62 | 1 | 63 |
| 2024 February | 79 | 7 | 86 |
| 2024 January | 85 | 14 | 99 |
| 2023 December | 87 | 2 | 89 |
| 2023 November | 87 | 3 | 90 |
| 2023 October | 112 | 10 | 122 |
| 2023 September | 64 | 3 | 67 |
| 2023 August | 64 | 2 | 66 |
| 2023 July | 63 | 2 | 65 |
| 2023 June | 37 | 10 | 47 |
| 2023 May | 97 | 6 | 103 |
| 2023 April | 106 | 0 | 106 |
| 2023 March | 106 | 0 | 106 |
| 2023 February | 88 | 4 | 92 |
| 2023 January | 66 | 3 | 69 |
| 2022 December | 72 | 16 | 88 |
| 2022 November | 71 | 5 | 76 |
| 2022 October | 49 | 8 | 57 |
| 2022 September | 57 | 8 | 65 |
| 2022 August | 48 | 10 | 58 |
| 2022 July | 32 | 5 | 37 |
| 2022 June | 32 | 10 | 42 |
| 2022 May | 41 | 17 | 58 |
| 2022 April | 38 | 4 | 42 |
| 2022 March | 46 | 5 | 51 |
| 2022 February | 45 | 4 | 49 |
| 2022 January | 78 | 15 | 93 |
| 2021 December | 83 | 9 | 92 |
| 2021 November | 99 | 5 | 104 |
| 2021 October | 339 | 14 | 353 |
| 2021 September | 81 | 16 | 97 |
| 2021 August | 86 | 9 | 95 |
| 2021 July | 51 | 11 | 62 |
| 2021 June | 34 | 5 | 39 |
| 2021 May | 33 | 9 | 42 |
| 2021 April | 56 | 5 | 61 |
| 2021 March | 2 | 4 | 6 |
| 2021 February | 0 | 3 | 3 |
| 2021 January | 0 | 2 | 2 |
| 2020 December | 0 | 1 | 1 |
| 2020 November | 8 | 4 | 12 |
| 2020 October | 3 | 8 | 11 |
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