Candida norvegensis fungemia in a liver transplant recipient

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"117" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Gemma Sanclemente, Francesc Marco, Carlos Cervera, Irma Hoyo, Jordi Colmenero, Cristina Pitart, Manuel Almela, Miquel Navasa, Asunción Moreno" "autores" => array:9 [ 0 => array:3 [ "nombre" => "Gemma" "apellidos" => "Sanclemente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Francesc" "apellidos" => "Marco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Carlos" "apellidos" => "Cervera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Irma" "apellidos" => "Hoyo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Jordi" "apellidos" => "Colmenero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Cristina" "apellidos" => "Pitart" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "Manuel" "apellidos" => "Almela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 7 => array:3 [ "nombre" => "Miquel" "apellidos" => "Navasa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 8 => array:4 [ "nombre" => "Asunción" "apellidos" => "Moreno" "email" => array:1 [ 0 => "amoreno@clinic.ub.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Microbiology, “Centre Diagnòstic Biomèdic” (CDB), Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, University of Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Hepatology, Hospital Clínic de Barcelona, University of Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fungemia por Candida norvegensis en un receptor de trasplante hepático" ] ] "textoCompleto" => "Candida is the leading cause of invasive fungal infection in organ transplant recipients.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> The main risk factors for invasive candidiasis in liver transplant recipients are previous use of broad spectrum antibiotics, the need of post-transplant dialysis and retransplantation.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> Recent studies show a trend toward an increasing incidence of infections caused by non-Candida albicans Candida species, and this seems to be related to the use of prophylaxis with fluconazole.<a class="elsevierStyleCrossRef" href="#bib0065">13</a>Candida norvegensis is an unusual pathogen, with high rates of fluconazole resistance, and it has been described as a potential pathogen in immunocompromised patients. Herein, we describe a case of C. norvegensis fungemia in a liver transplant patient under fluconazole prophylaxis successfully treated with anidulafungin.Case reportIn June 2008, a 61-year-old man underwent liver transplantation because of an end-stage liver disease caused by hepatitis C and B viruses coinfection and hepatocellular carcinoma. During the surgical procedure, hepatic artery thrombosis was found but it was not possible to completely recanalize the artery. Immunosuppressive scheme included tacrolimus, mofetil mycophenolate and prednisone. In February 2009 he was diagnosed with ischemic cholangiopathy. An arteriography did not show additional vascular complications. Since diagnosis the patient presented recurrent episodes of acute cholangitis. In April 2009, a hepaticojejunostomy was performed, but cholestasis persisted. Two months later the patient underwent a second liver transplantation. The postoperative course was complicated with surgical site bleeding, requiring liver packing and multiple blood transfusions. Because of the primary graft dysfunction, the patient received a third liver transplantation 7 days later. During the surgical procedure he developed hepatic artery thrombosis. In the post-transplant period he presented multiple episodes of acute cholangitis secondary to ischemic cholangiopathy.In November 2009 he was admitted to the hospital because of Escherichia coli and Enterococcus faecium cholangitis. Initial treatment included meropenem, vancomycin, amikacin and prophylactic fluconazole (at a dose of 100mg/d). During admission he developed multiple liver abscesses that required percutaneous drainage. Several blood cultures grew multidrug resistant Pseudomonas aeruginosa, E. faecium, Enterococcus faecalis and extended-spectrum betalactamase producing E. coli. He received multiple antibiotic regimens depending on the susceptibilities of the isolates (including vancomycin, ceftazidime, amikacin, metronidazole, fosfomycin, colistin, doripenem, meropenem, ampicillin, teicoplanin and piperacillin/tazobactam). In February 2010, as liver abscesses persisted, he was proposed to receive prolonged treatment with piperacillin/tazobactam plus amikacin in our outpatient parenteral antimicrobial therapy program. As broad-spectrum antibiotic therapy was administered, prophylactic fluconazole was maintained during outpatient antibiotic treatment.Two weeks after hospital discharge, the fever reappeared and breakthrough candidemia due to C. norvegensis was diagnosed. Blood cultures were processed by the BACTEC 9240 system (Becton-Dickinson, MD, USA). The method used for the identification of the Candida strain was MALDI-TOF MS.<a class="elsevierStyleCrossRefs" href="#bib0080">16,25</a> The patient was hemodynamically stable and with good general status. Intravenous anidulafungin treatment (200mg loading dose and thereafter 100mg/d) was started in the first 36h after the extraction of blood cultures and the patient was not readmitted to hospital. In vitro susceptibilities of the isolate to several antifungal agents, determined by CLSI microdilution method, were as follows: amphotericin B MIC 0.5mg/l, flucytosine 64mg/l, fluconazole 64mg/l, itraconazole 4mg/l; voriconazole 0.75mg/l and caspofungin 0.047mg/l, so the treatment with anidulafungin was maintained. The patient became afebrile and blood cultures performed 48h after starting the antifungal treatment were negative. Anidulafungin was maintained for 14 days. After the resolution of candidemia the patient developed progressive ascites and peripheral edema and was readmitted to the hospital. Persistence of liver abscess was seen on abdominal ultrasonogram. Blood cultures were negative. Despite intravenous antibiotics, the patient's general condition worsened. He died 40 days after hospital admission due to end-stage liver disease and multiorgan failure.DiscussionCandida is an increasing cause of bloodstream infections, being the fourth microorganism to be isolated frequently in blood cultures in the United States<a class="elsevierStyleCrossRef" href="#bib0145">29</a> and the seventh cause of nosocomial infection in our center.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> The increasing risk of invasive candidiasis may be explained by a rise in the use of invasive procedures, intravenous catheters, total parenteral nutrition and broad spectrum antibiotics.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Although C. albicans is the most common single species identified, the incidence of non-C. albicans candidemia has been progressively increasing.<a class="elsevierStyleCrossRefs" href="#bib0060">12,19</a>Solid organ transplant recipients are at risk to develop invasive fungal infection due to a combination of aggressive surgery and requirement of immunosuppressive therapy. The incidence of fungal infection varies depending on the transplanted organ, being highest in small bowel transplantation (40–59%) and lowest in renal recipients (1–14%).<a class="elsevierStyleCrossRefs" href="#bib0045">9,20</a> Invasive candidiasis in organ transplant recipients is associated with candidemia in more than half of the episodes.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> In our country, candidemia represents 8% of all cases of bloodstream infections in organ transplant recipients,<a class="elsevierStyleCrossRef" href="#bib0085">17</a> with 46% of them caused by species with potential fluconazole resistance (Candida krusei and Candida glabrata).C. norvegensis was first isolated in Norway from the sputum of three patients with asthma in 1954.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> The first described clinically relevant infection by this pathogen was in a renal transplant recipient who developed C. norvegensis peritonitis associated with the use of peritoneal dialysis.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Since then, scarce cases of C. norvegensis infections have been described, most of them in patients with malignancies or HIV infection.<a class="elsevierStyleCrossRefs" href="#bib0055">11,14,26</a> A recent study reported that the rate of isolation of C. norvegensis has increased by 5–10-folds during the last 10 years.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> In the same study the susceptibility of C. norvegensis to fluconazole and voriconazole was tested, with 41% of the isolates being resistant to fluconazole and 91.5% susceptible to voriconazole, although an increased percentage of voriconazole-resistant strains has been observed during the last years. Although the level of evidence is very low due to infrequent descriptions of infection in humans, amphotericin B has been considered the treatment of choice for C. norvegensis infections.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> However, the associated toxicity of amphotericin B could limit its use in solid organ transplant recipients. Several studies have demonstrated susceptibility of C. norvegensis to echinocandins.<a class="elsevierStyleCrossRefs" href="#bib0010">2,5,28</a> Although our patient died due to end-stage liver disease and other complications, C. norvegensis fungemia was successfully cleared with intravenous anidulafungin. In our patient, the in vitro susceptibility of C. norvegensis to echinocandins was tested only for caspofungin. When yeasts were isolated in blood cultures, and before having an identification of the species, a treatment with anidulafungin was prescribed because the patient was receiving fluconazole as prophylaxis. Although antifungal in vitro tests were not performed to establish the MIC value to anidulafungin, as the patient was doing well under this therapeutic regimen we maintained the same treatment. Previous reports have described that all three echinocandins have similar MICs against the majority of Candida species.<a class="elsevierStyleCrossRefs" href="#bib0040">8,23</a> However, the MIC correlation between the three echinocandins has not been studied in C. norvegensis. In addition to the good response to treatment, we decided to maintain anidulafungin because while caspofungin decreases the concentration of tacrolimus, anidulafungin and micafungin have fewer interactions with immunosuppressants.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>Non-C. albicans candidal infections represent an emerging problem in immunosuppressed patients in general and in organ transplant recipients in particular. The broad use of fluconazole for antifungal prophylaxis may lead to an increase in fluconazole-resistant Candida infections,<a class="elsevierStyleCrossRef" href="#bib0085">17</a> with C. norvegensis as a possible emerging pathogen in organ transplant recipients. In the case we report, the patient received fluconazole as prophylaxis due to the multiple history of abdominal surgery, the need for a central venous catheter, and the use of broad spectrum antibiotics during a long period of time, all of them being risk factors for the development of candidemia.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> There are some studies that have analyzed the efficacy of fluconazole prophylaxis in patients at high risk for invasive candidiasis, especially surgical and critically ill patients. The majority of them used a dose of 400mg per day, but one study describes a reduction of invasive fungal infections using a dose of 100mg per day.<a class="elsevierStyleCrossRefs" href="#bib0005">1,7,10,22</a> There are no studies comparing different doses of fluconazole for prophylaxis. European guidelines currently recommend the dose of 400mg/day for prophylaxis in non-neutropenic adults.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> For antifungal prophylaxis in liver transplant patients at high risk of invasive candidiasis, the IDSA guidelines recommend fluconazole at a dose between 200 and 400mg.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> However, the interaction of fluconazole with calcineurin inhibitors limits the safety of high-dose fluconazole prophylaxis in this subgroup of patients.In conclusion, C. norvegensis must be taken into account as a possible emergent pathogen in organ transplant patients receiving prophylaxis with fluconazole.Conflict of interestNothing to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres496436" "titulo" => "Abstract" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Case report" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec517691" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres496435" "titulo" => "Resumen" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Caso clínico" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec517690" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-05-02" "fechaAceptado" => "2013-11-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec517691" "palabras" => array:4 [ 0 => "Candida norvegensis" 1 => "Fungemia" 2 => "Liver transplant" 3 => "Fluconazole" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec517690" "palabras" => array:4 [ 0 => "Candida norvegensis" 1 => "Fungemia" 2 => "Trasplante hepático" 3 => "Fluconazol" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundThe incidence of candidemia due to non-Candida albicans Candida species has been progressively increasing in recent years. The use of fluconazole as antifungal prophylaxis has been described as a risk factor for the development of infections by fluconazole resistant Candida strains. We report a case of Candida norvegensis bloodstream infection in a liver transplant recipient. Case reportA 61-year-old man, who received a third liver allograft and became worse with the onset of ischemic cholangiopathy and recurrent episodes of cholangitis, was admitted to our hospital due to the development of intra-abdominal abscesses. He received multiple antibiotic schemes, and after 3 months he was discharged, maintaining parenteral antibiotic at home. While he was on fluconazole prophylaxis, a breakthrough candidemia due to C. norvegensis occurred. In vitro susceptibilities of the isolate to several antifungal agents were as follows: amphotericin B MIC 0.5mg/l, flucytosine 64mg/l, fluconazole 64mg/l, itraconazole 4mg/l, voriconazole 0.75mg/l, and caspofungin 0.047mg/l. He was treated with anidulafungin with resolution of candidemia. ConclusionsThe use of fluconazole for antifungal prophylaxis may lead to the emergence of fluconazole-resistant Candida infections, with C. norvegensis being a possible emerging pathogen in organ transplant recipients." "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Case report" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "AntecedentesEn los últimos años ha aumentado la incidencia de candidemia causada por especies del género Candida distintas de Candida albicans. Se ha descrito el uso de profilaxis antifúngica con fluconazol como factor de riesgo para el desarrollo de infecciones por cepas de Candida resistentes a este antifúngico. Se describe un caso de fungemia por Candida norvegensis en un receptor de un trasplante hepático. Caso clínicoUn varón de 61 años, receptor de un tercer trasplante hepático que se complica con una colangiopatía isquémica y episodios de colangitis de repetición, ingresó en nuestro hospital por presentar abscesos intraabdominales. Recibió múltiples esquemas antibióticos y, tras 3 meses de ingreso, se dio de alta manteniendo un tratamiento antibiótico parenteral en domicilio. Mientras recibía profilaxis con fluconazol, desarrolló una candidemia de brecha por C. norvegensis. Los valores de CMI in vitro del aislamiento para algunos antifúngicos fueron los siguientes: anfotericina B 0,5mg/l, flucitosina 64mg/l, fluconazol 64mg/l, itraconazol 4mg/l, voriconazol 0,75mg/l y caspofungina 0,047mg/l. El paciente recibió tratamiento con anidulafungina, con resolución de la candidemia. ConclusionesEl uso de fluconazol como profilaxis antifúngica puede conllevar la aparición de infecciones por especies de Candida resistentes a este antifúngico, siendo C. norvegensis un posible patógeno emergente en pacientes receptores de un órgano sólido." 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Palesch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Inf Dis Clin Prac" "fecha" => "2000" "volumen" => "9" "paginaInicial" => "169" "paginaFinal" => "175" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "In vitro activity of caspofungin compared to amphotericin B, fluconazole and itraconazole against Candida strains isolated in a Turkish University Hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Arikan" 1 => "B. Sancak" 2 => "G. Hascelik" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Mycol" "fecha" => "2005" "volumen" => "43" "paginaInicial" => "171" "paginaFinal" => "178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15832560" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for candidal bloodstream infections in surgical intensive care unit patients: the NEMIS prospective multicenter study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.M. Blumberg" 1 => "W.R. Jarvis" 2 => "J.M. Soucie" 3 => "J.E. Edwards" 4 => "J.E. Patterson" 5 => "M.A. Pfaller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/321811" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2001" "volumen" => "33" "paginaInicial" => "177" "paginaFinal" => "266" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11418877" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ESCMID guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "for the ESCMID Fungal Infection Study Group (EFISG)" "etal" => true "autores" => array:6 [ 0 => "O.A. Cornely" 1 => "M. Bassetti" 2 => "T. Calandra" 3 => "J. Garbino" 4 => "B.J. Kullberg" 5 => "O. Lortholary" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1469-0691.12039" "Revista" => array:7 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2012" "volumen" => "18" "numero" => "Suppl. 7" "paginaInicial" => "19" "paginaFinal" => "37" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23137135" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Activity profile in vitro of micafungin against Spanish clinical isolates of common and emerging species of yeasts and molds" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Cuenca-Estrella" 1 => "A. Gomez-Lopez" 2 => "E. Mellado" 3 => "A. Monzon" 4 => "M.J. Buitrago" 5 => "J.L. Rodriguez-Tudela" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/AAC.01543-08" "Revista" => array:6 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "2009" "volumen" => "53" "paginaInicial" => "2192" "paginaFinal" => "2195" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19223630" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Study of a Norwegian collection of yeasts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. Dietrichson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Parasitol Hum Comp" "fecha" => "1954" "volumen" => "29" "paginaInicial" => "460" "paginaFinal" => "498" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13218481" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Eggimann" 1 => "P. Francioli" 2 => "J. Bille" 3 => "R. Schneider" 4 => "M. Wu" 5 => "G. Chapuis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "1999" "volumen" => "27" "paginaInicial" => "1066" "paginaFinal" => "1072" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10397206" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of echinocandin antifungals" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Eschenauer" 1 => "D.D. DePestel" 2 => "P.L. Carver" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ther Clin Risk Manag" "fecha" => "2007" "volumen" => "3" "paginaInicial" => "71" "paginaFinal" => "97" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18360617" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Invasive fungal infections and antifungal therapies in solid organ transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Gabardi" 1 => "D.W. Kubiak" 2 => "A.K. Chandraker" 3 => "S.G. Tullius" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1432-2277.2007.00511.x" "Revista" => array:6 [ "tituloSerie" => "Transpl Int" "fecha" => "2007" "volumen" => "20" "paginaInicial" => "993" "paginaFinal" => "1015" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17617181" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevention of severe Candida infections in nonneutropenic, high-risk, critically ill patients: a randomized, double-blind, placebo controlled trial in patients treated by selective digestive decontamination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Garbino" 1 => "D.P. Lew" 2 => "J.A. Romand" 3 => "S. Hugonnet" 4 => "R. Auckenthaler" 5 => "D. Pittet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-002-1540-y" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2002" "volumen" => "28" "paginaInicial" => "1708" "paginaFinal" => "1717" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12447512" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Isolation of Candida norvegensis from clinical specimens: four case reports" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.V. Hood" 1 => "C.B. Moore" 2 => "D.W. Denning" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "1996" "volumen" => "23" "paginaInicial" => "1185" "paginaFinal" => "1187" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8922831" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.L. Horn" 1 => "D. Neofytos" 2 => "E.J. Anaissie" 3 => "J.A. Fishman" 4 => "W.J. Steinbach" 5 => "A.J. Olyaei" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/599039" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2009" "volumen" => "48" "paginaInicial" => "1695" "paginaFinal" => "1703" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19441981" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Changes in the spectrum and risk factors for invasive candidiasis in liver transplant recipients: prospective, multicenter, case-controlled study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Husain" 1 => "J. Tollemar" 2 => "E.A. Dominguez" 3 => "K. Baumgarten" 4 => "A. Humar" 5 => "D.L. Paterson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.TP.0000065178.93741.72" "Revista" => array:6 [ "tituloSerie" => "Transplantation" "fecha" => "2003" "volumen" => "75" "paginaInicial" => "2023" "paginaFinal" => "2029" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12829905" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Candida norvegensis fungaemia in a neutropenic patient with acute non-lymphoblastic leukaemia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Kiraz" 1 => "O.M. Akay" 2 => "Y. Sen" 3 => "V. Aslan" 4 => "Y. Akgun" 5 => "Z. Gulbas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1439-0507.2009.01724.x" "Revista" => array:6 [ "tituloSerie" => "Mycoses" "fecha" => "2010" "volumen" => "53" "paginaInicial" => "460" "paginaFinal" => "462" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19496937" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-albicans Candida spp. causing fungaemia: pathogenicity and antifungal resistance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "V. Krcmery" 1 => "A.J. Barnes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/jhin.2001.1151" "Revista" => array:6 [ "tituloSerie" => "J Hosp Infect" "fecha" => "2002" "volumen" => "50" "paginaInicial" => "243" "paginaFinal" => "260" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12014897" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of two matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) systems for the identification of Candida species" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Lacroix" 1 => "A. Gicquel" 2 => "B. Sendid" 3 => "J. Meyer" 4 => "I. Accoceberry" 5 => "N. François" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2013" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11866852" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bloodstream infections among transplant recipients: results of a nationwide surveillance in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Moreno" 1 => "C. Cervera" 2 => "J. Gavaldá" 3 => "M. Rovira" 4 => "R. de la Cámara" 5 => "I. Jarque" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-6143.2007.01964.x" "Revista" => array:6 [ "tituloSerie" => "Am J Transplant" "fecha" => "2007" "volumen" => "7" "paginaInicial" => "2579" "paginaFinal" => "2586" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17868067" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Candida norvegensis peritonitis and invasive disease in a patient on continuous ambulatory peritoneal dialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Nielsen" 1 => "J. Stenderup" 2 => "B. Bruun" 3 => "J. Ladefoged" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "1990" "volumen" => "28" "paginaInicial" => "1664" "paginaFinal" => "1665" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2380389" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Candida species bloodstream infection: epidemiology and outcome in a single institution from 1991 to 2008" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Ortega" 1 => "F. Marco" 2 => "A. Soriano" 3 => "M. Almela" 4 => "J.A. Martínez" 5 => "J. López" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhin.2010.09.026" "Revista" => array:6 [ "tituloSerie" => "J Hosp Infect" "fecha" => "2011" "volumen" => "77" "paginaInicial" => "157" "paginaFinal" => "161" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21216030" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.G. Pappas" 1 => "B.D. Alexander" 2 => "D.R. Andes" 3 => "S. Hadley" 4 => "C.A. Kauffman" 5 => "A. Freifeld" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/651262" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2010" "volumen" => "50" "paginaInicial" => "1101" "paginaFinal" => "1111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20218876" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.G. Pappas" 1 => "C.A. Kauffman" 2 => "D. Andes" 3 => "D.K. Benjamin" 4 => "T.F. Calandra" 5 => "J.E. Edwards" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/596757" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2009" "volumen" => "48" "paginaInicial" => "503" "paginaFinal" => "535" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19191635" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Double-blind placebo-controlled trial of fluconazole to prevent candidal infections in critically ill surgical patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.K. Pelz" 1 => "C.W. Hendrix" 2 => "S.M. Swoboda" 3 => "M. Diener-West" 4 => "W.G. Merz" 5 => "J. Hammond" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2001" "volumen" => "233" "paginaInicial" => "542" "paginaFinal" => "548" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11303137" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "In vitro susceptibility of invasive isolates of Candida spp. to anidulafungin, caspofungin and micafungin: six years of global surveillance" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Pfaller" 1 => "L. Boyken" 2 => "R.J. Hollis" 3 => "J. Kroeger" 4 => "S.A. Messer" 5 => "S. Tendolkar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.01901-07" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2008" "volumen" => "46" "paginaInicial" => "150" "paginaFinal" => "156" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18032613" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: a 10.5-year analysis of susceptibilities of Candida species to fluconazole and voriconazole as determined by CLSI standardized disk diffusion" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Pfaller" 1 => "D.J. Diekema" 2 => "D.L. Gibbs" 3 => "V.A. Newell" 4 => "D. Ellis" 5 => "V. Tullio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.02117-09" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2010" "volumen" => "48" "paginaInicial" => "1366" "paginaFinal" => "1377" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20164282" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid and reliable MALDI-TOF mass spectrometry identification of Candida non-albicans isolates from bloodstream infections" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Pulcrano" 1 => "D.V. Iula" 2 => "A. Vollaro" 3 => "A. Tucci" 4 => "M. Cerullo" 5 => "M. Esposito" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.mimet.2013.07.001" "Revista" => array:6 [ "tituloSerie" => "J Microbiol Methods" "fecha" => "2013" "volumen" => "94" "paginaInicial" => "262" "paginaFinal" => "266" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23845229" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Candida norvegensis: a fluconazole-resistant species" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Sandven" 1 => "K. Nilsen" 2 => "A. Digranes" 3 => "T. Yjade" 4 => "J. Lassen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "1997" "volumen" => "41" "paginaInicial" => "1375" "paginaFinal" => "1376" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9174202" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fungal infections in solid organ transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F.P. Silveira" 1 => "S. 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Candida norvegensis fungemia in a liver transplant recipient

Fungemia por Candida norvegensis en un receptor de trasplante hepático

Gemma Sanclementea, Francesc Marcob, Carlos Cerveraa, Irma Hoyoa, Jordi Colmeneroc, Cristina Pitartb, Manuel Almelab, Miquel Navasac, Asunción Morenoa,

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amoreno@clinic.ub.es

Corresponding author.

a Department of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Spain

b Department of Microbiology, “Centre Diagnòstic Biomèdic” (CDB), Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, University of Barcelona, Spain

c Department of Hepatology, Hospital Clínic de Barcelona, University of Barcelona, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Candida</span> is the leading cause of invasive fungal infection in organ transplant recipients&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The main risk factors for invasive candidiasis in liver transplant recipients are previous use of broad spectrum antibiotics&#44; the need of post-transplant dialysis and retransplantation&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Recent studies show a trend toward an increasing incidence of infections caused by non-<span class="elsevierStyleItalic">Candida albicans Candida</span> species&#44; and this seems to be related to the use of prophylaxis with fluconazole&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleItalic">Candida norvegensis</span> is an unusual pathogen&#44; with high rates of fluconazole resistance&#44; and it has been described as a potential pathogen in immunocompromised patients&#46; Herein&#44; we describe a case of <span class="elsevierStyleItalic">C&#46; norvegensis</span> fungemia in a liver transplant patient under fluconazole prophylaxis successfully treated with anidulafungin&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">In June 2008&#44; a 61-year-old man underwent liver transplantation because of an end-stage liver disease caused by hepatitis C and B viruses coinfection and hepatocellular carcinoma&#46; During the surgical procedure&#44; hepatic artery thrombosis was found but it was not possible to completely recanalize the artery&#46; Immunosuppressive scheme included tacrolimus&#44; mofetil mycophenolate and prednisone&#46; In February 2009 he was diagnosed with ischemic cholangiopathy&#46; An arteriography did not show additional vascular complications&#46; Since diagnosis the patient presented recurrent episodes of acute cholangitis&#46; In April 2009&#44; a hepaticojejunostomy was performed&#44; but cholestasis persisted&#46; Two months later the patient underwent a second liver transplantation&#46; The postoperative course was complicated with surgical site bleeding&#44; requiring liver packing and multiple blood transfusions&#46; Because of the primary graft dysfunction&#44; the patient received a third liver transplantation 7 days later&#46; During the surgical procedure he developed hepatic artery thrombosis&#46; In the post-transplant period he presented multiple episodes of acute cholangitis secondary to ischemic cholangiopathy&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In November 2009 he was admitted to the hospital because of <span class="elsevierStyleItalic">Escherichia coli</span> and <span class="elsevierStyleItalic">Enterococcus faecium</span> cholangitis&#46; Initial treatment included meropenem&#44; vancomycin&#44; amikacin and prophylactic fluconazole &#40;at a dose of 100<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#41;&#46; During admission he developed multiple liver abscesses that required percutaneous drainage&#46; Several blood cultures grew multidrug resistant <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; <span class="elsevierStyleItalic">E&#46; faecium</span>&#44; <span class="elsevierStyleItalic">Enterococcus faecalis</span> and extended-spectrum betalactamase producing <span class="elsevierStyleItalic">E&#46; coli</span>&#46; He received multiple antibiotic regimens depending on the susceptibilities of the isolates &#40;including vancomycin&#44; ceftazidime&#44; amikacin&#44; metronidazole&#44; fosfomycin&#44; colistin&#44; doripenem&#44; meropenem&#44; ampicillin&#44; teicoplanin and piperacillin&#47;tazobactam&#41;&#46; In February 2010&#44; as liver abscesses persisted&#44; he was proposed to receive prolonged treatment with piperacillin&#47;tazobactam plus amikacin in our outpatient parenteral antimicrobial therapy program&#46; As broad-spectrum antibiotic therapy was administered&#44; prophylactic fluconazole was maintained during outpatient antibiotic treatment&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Two weeks after hospital discharge&#44; the fever reappeared and breakthrough candidemia due to <span class="elsevierStyleItalic">C&#46; norvegensis</span> was diagnosed&#46; Blood cultures were processed by the BACTEC 9240 system &#40;Becton-Dickinson&#44; MD&#44; USA&#41;&#46; The method used for the identification of the <span class="elsevierStyleItalic">Candida</span> strain was MALDI-TOF MS&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;25</span></a> The patient was hemodynamically stable and with good general status&#46; Intravenous anidulafungin treatment &#40;200<span class="elsevierStyleHsp" style=""></span>mg loading dose and thereafter 100<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#41; was started in the first 36<span class="elsevierStyleHsp" style=""></span>h after the extraction of blood cultures and the patient was not readmitted to hospital&#46; <span class="elsevierStyleItalic">In vitro</span> susceptibilities of the isolate to several antifungal agents&#44; determined by CLSI microdilution method&#44; were as follows&#58; amphotericin B MIC 0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#44; flucytosine 64<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#44; fluconazole 64<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#44; itraconazole 4<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#59; voriconazole 0&#46;75<span class="elsevierStyleHsp" style=""></span>mg&#47;l and caspofungin 0&#46;047<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#44; so the treatment with anidulafungin was maintained&#46; The patient became afebrile and blood cultures performed 48<span class="elsevierStyleHsp" style=""></span>h after starting the antifungal treatment were negative&#46; Anidulafungin was maintained for 14 days&#46; After the resolution of candidemia the patient developed progressive ascites and peripheral edema and was readmitted to the hospital&#46; Persistence of liver abscess was seen on abdominal ultrasonogram&#46; Blood cultures were negative&#46; Despite intravenous antibiotics&#44; the patient&#39;s general condition worsened&#46; He died 40 days after hospital admission due to end-stage liver disease and multiorgan failure&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Candida</span> is an increasing cause of bloodstream infections&#44; being the fourth microorganism to be isolated frequently in blood cultures in the United States<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> and the seventh cause of nosocomial infection in our center&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> The increasing risk of invasive candidiasis may be explained by a rise in the use of invasive procedures&#44; intravenous catheters&#44; total parenteral nutrition and broad spectrum antibiotics&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Although <span class="elsevierStyleItalic">C&#46; albicans</span> is the most common single species identified&#44; the incidence of non-<span class="elsevierStyleItalic">C&#46; albicans</span> candidemia has been progressively increasing&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;19</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Solid organ transplant recipients are at risk to develop invasive fungal infection due to a combination of aggressive surgery and requirement of immunosuppressive therapy&#46; The incidence of fungal infection varies depending on the transplanted organ&#44; being highest in small bowel transplantation &#40;40&#8211;59&#37;&#41; and lowest in renal recipients &#40;1&#8211;14&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;20</span></a> Invasive candidiasis in organ transplant recipients is associated with candidemia in more than half of the episodes&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> In our country&#44; candidemia represents 8&#37; of all cases of bloodstream infections in organ transplant recipients&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> with 46&#37; of them caused by species with potential fluconazole resistance &#40;<span class="elsevierStyleItalic">Candida krusei</span> and <span class="elsevierStyleItalic">Candida glabrata</span>&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">C&#46; norvegensis</span> was first isolated in Norway from the sputum of three patients with asthma in 1954&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The first described clinically relevant infection by this pathogen was in a renal transplant recipient who developed <span class="elsevierStyleItalic">C&#46; norvegensis</span> peritonitis associated with the use of peritoneal dialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Since then&#44; scarce cases of <span class="elsevierStyleItalic">C&#46; norvegensis</span> infections have been described&#44; most of them in patients with malignancies or HIV infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;14&#44;26</span></a> A recent study reported that the rate of isolation of <span class="elsevierStyleItalic">C&#46; norvegensis</span> has increased by 5&#8211;10-folds during the last 10 years&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> In the same study the susceptibility of <span class="elsevierStyleItalic">C&#46; norvegensis</span> to fluconazole and voriconazole was tested&#44; with 41&#37; of the isolates being resistant to fluconazole and 91&#46;5&#37; susceptible to voriconazole&#44; although an increased percentage of voriconazole-resistant strains has been observed during the last years&#46; Although the level of evidence is very low due to infrequent descriptions of infection in humans&#44; amphotericin B has been considered the treatment of choice for <span class="elsevierStyleItalic">C&#46; norvegensis</span> infections&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> However&#44; the associated toxicity of amphotericin B could limit its use in solid organ transplant recipients&#46; Several studies have demonstrated susceptibility of <span class="elsevierStyleItalic">C&#46; norvegensis</span> to echinocandins&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5&#44;28</span></a> Although our patient died due to end-stage liver disease and other complications&#44; <span class="elsevierStyleItalic">C&#46; norvegensis</span> fungemia was successfully cleared with intravenous anidulafungin&#46; In our patient&#44; the <span class="elsevierStyleItalic">in vitro</span> susceptibility of <span class="elsevierStyleItalic">C&#46; norvegensis</span> to echinocandins was tested only for caspofungin&#46; When yeasts were isolated in blood cultures&#44; and before having an identification of the species&#44; a treatment with anidulafungin was prescribed because the patient was receiving fluconazole as prophylaxis&#46; Although antifungal <span class="elsevierStyleItalic">in vitro</span> tests were not performed to establish the MIC value to anidulafungin&#44; as the patient was doing well under this therapeutic regimen we maintained the same treatment&#46; Previous reports have described that all three echinocandins have similar MICs against the majority of <span class="elsevierStyleItalic">Candida</span> species&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;23</span></a> However&#44; the MIC correlation between the three echinocandins has not been studied in <span class="elsevierStyleItalic">C&#46; norvegensis</span>&#46; In addition to the good response to treatment&#44; we decided to maintain anidulafungin because while caspofungin decreases the concentration of tacrolimus&#44; anidulafungin and micafungin have fewer interactions with immunosuppressants&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Non-<span class="elsevierStyleItalic">C&#46; albicans</span> candidal infections represent an emerging problem in immunosuppressed patients in general and in organ transplant recipients in particular&#46; The broad use of fluconazole for antifungal prophylaxis may lead to an increase in fluconazole-resistant <span class="elsevierStyleItalic">Candida</span> infections&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> with <span class="elsevierStyleItalic">C&#46; norvegensis</span> as a possible emerging pathogen in organ transplant recipients&#46; In the case we report&#44; the patient received fluconazole as prophylaxis due to the multiple history of abdominal surgery&#44; the need for a central venous catheter&#44; and the use of broad spectrum antibiotics during a long period of time&#44; all of them being risk factors for the development of candidemia&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There are some studies that have analyzed the efficacy of fluconazole prophylaxis in patients at high risk for invasive candidiasis&#44; especially surgical and critically ill patients&#46; The majority of them used a dose of 400<span class="elsevierStyleHsp" style=""></span>mg per day&#44; but one study describes a reduction of invasive fungal infections using a dose of 100<span class="elsevierStyleHsp" style=""></span>mg per day&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7&#44;10&#44;22</span></a> There are no studies comparing different doses of fluconazole for prophylaxis&#46; European guidelines currently recommend the dose of 400<span class="elsevierStyleHsp" style=""></span>mg&#47;day for prophylaxis in non-neutropenic adults&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> For antifungal prophylaxis in liver transplant patients at high risk of invasive candidiasis&#44; the IDSA guidelines recommend fluconazole at a dose between 200 and 400<span class="elsevierStyleHsp" style=""></span>mg&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> However&#44; the interaction of fluconazole with calcineurin inhibitors limits the safety of high-dose fluconazole prophylaxis in this subgroup of patients&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion&#44; <span class="elsevierStyleItalic">C&#46; norvegensis</span> must be taken into account as a possible emergent pathogen in organ transplant patients receiving prophylaxis with fluconazole&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">Nothing to declare&#46;</p></span></span>"
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            0 => "<span class="elsevierStyleItalic">Candida norvegensis</span>"
            1 => "Fungemia"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The incidence of candidemia due to non-<span class="elsevierStyleItalic">Candida albicans Candida</span> species has been progressively increasing in recent years&#46; The use of fluconazole as antifungal prophylaxis has been described as a risk factor for the development of infections by fluconazole resistant <span class="elsevierStyleItalic">Candida</span> strains&#46; We report a case of <span class="elsevierStyleItalic">Candida norvegensis</span> bloodstream infection in a liver transplant recipient&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A 61-year-old man&#44; who received a third liver allograft and became worse with the onset of ischemic cholangiopathy and recurrent episodes of cholangitis&#44; was admitted to our hospital due to the development of intra-abdominal abscesses&#46; He received multiple antibiotic schemes&#44; and after 3 months he was discharged&#44; maintaining parenteral antibiotic at home&#46; While he was on fluconazole prophylaxis&#44; a breakthrough candidemia due to <span class="elsevierStyleItalic">C&#46; norvegensis</span> occurred&#46; <span class="elsevierStyleItalic">In vitro</span> susceptibilities of the isolate to several antifungal agents were as follows&#58; amphotericin B MIC 0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#44; flucytosine 64<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#44; fluconazole 64<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#44; itraconazole 4<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#44; voriconazole 0&#46;75<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#44; and caspofungin 0&#46;047<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#46; He was treated with anidulafungin with resolution of candidemia&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusions</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The use of fluconazole for antifungal prophylaxis may lead to the emergence of fluconazole-resistant <span class="elsevierStyleItalic">Candida</span> infections&#44; with <span class="elsevierStyleItalic">C&#46; norvegensis</span> being a possible emerging pathogen in organ transplant recipients&#46;</p></span>"
        "secciones" => array:3 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
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          1 => array:2 [
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            "titulo" => "Case report"
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          2 => array:2 [
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        "resumen" => "<span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Antecedentes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En los &#250;ltimos a&#241;os ha aumentado la incidencia de candidemia causada por especies del g&#233;nero <span class="elsevierStyleItalic">Candida</span> distintas de <span class="elsevierStyleItalic">Candida albicans</span>&#46; Se ha descrito el uso de profilaxis antif&#250;ngica con fluconazol como factor de riesgo para el desarrollo de infecciones por cepas de <span class="elsevierStyleItalic">Candida</span> resistentes a este antif&#250;ngico&#46; Se describe un caso de fungemia por <span class="elsevierStyleItalic">Candida norvegensis</span> en un receptor de un trasplante hep&#225;tico&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Caso cl&#237;nico</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Un var&#243;n de 61 a&#241;os&#44; receptor de un tercer trasplante hep&#225;tico que se complica con una colangiopat&#237;a isqu&#233;mica y episodios de colangitis de repetici&#243;n&#44; ingres&#243; en nuestro hospital por presentar abscesos intraabdominales&#46; Recibi&#243; m&#250;ltiples esquemas antibi&#243;ticos y&#44; tras 3 meses de ingreso&#44; se dio de alta manteniendo un tratamiento antibi&#243;tico parenteral en domicilio&#46; Mientras recib&#237;a profilaxis con fluconazol&#44; desarroll&#243; una candidemia de brecha por <span class="elsevierStyleItalic">C&#46; norvegensis</span>&#46; Los valores de CMI <span class="elsevierStyleItalic">in vitro</span> del aislamiento para algunos antif&#250;ngicos fueron los siguientes&#58; anfotericina B 0&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#44; flucitosina 64<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#44; fluconazol 64<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#44; itraconazol 4<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#44; voriconazol 0&#44;75<span class="elsevierStyleHsp" style=""></span>mg&#47;l y caspofungina 0&#44;047<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#46; El paciente recibi&#243; tratamiento con anidulafungina&#44; con resoluci&#243;n de la candidemia&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El uso de fluconazol como profilaxis antif&#250;ngica puede conllevar la aparici&#243;n de infecciones por especies de <span class="elsevierStyleItalic">Candida</span> resistentes a este antif&#250;ngico&#44; siendo <span class="elsevierStyleItalic">C&#46; norvegensis</span> un posible pat&#243;geno emergente en pacientes receptores de un &#243;rgano s&#243;lido&#46;</p></span>"
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          "bibliografiaReferencia" => array:29 [
            0 => array:3 [
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                    0 => array:2 [
                      "titulo" => "Fluconazole prophylaxis of severe Candida infection in trauma and postsurgical patients&#58; a prospective&#44; double-blind&#44; randomized&#44; placebo-controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;Z&#46; Ables"
                            1 => "N&#46;A&#46; Blumer"
                            2 => "G&#46;T&#46; Valainis"
                            3 => "M&#46;T&#46; Godenick"
                            4 => "D&#46;K&#46; Kajdasz"
                            5 => "Y&#46;Y&#46; Palesch"
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                        "tituloSerie" => "Inf Dis Clin Prac"
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                        "volumen" => "9"
                        "paginaInicial" => "169"
                        "paginaFinal" => "175"
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              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "In vitro activity of caspofungin compared to amphotericin B&#44; fluconazole and itraconazole against Candida strains isolated in a Turkish University Hospital"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Arikan"
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                            2 => "G&#46; Hascelik"
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                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Mycol"
                        "fecha" => "2005"
                        "volumen" => "43"
                        "paginaInicial" => "171"
                        "paginaFinal" => "178"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15832560"
                            "web" => "Medline"
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              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Risk factors for candidal bloodstream infections in surgical intensive care unit patients&#58; the NEMIS prospective multicenter study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;M&#46; Blumberg"
                            1 => "W&#46;R&#46; Jarvis"
                            2 => "J&#46;M&#46; Soucie"
                            3 => "J&#46;E&#46; Edwards"
                            4 => "J&#46;E&#46; Patterson"
                            5 => "M&#46;A&#46; Pfaller"
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/321811"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2001"
                        "volumen" => "33"
                        "paginaInicial" => "177"
                        "paginaFinal" => "266"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11418877"
                            "web" => "Medline"
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                      ]
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                  ]
                ]
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            ]
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              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ESCMID guideline for the diagnosis and management of Candida diseases 2012&#58; non-neutropenic adult patients"
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                          "colaboracion" => "for the ESCMID Fungal Infection Study Group &#40;EFISG&#41;"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "O&#46;A&#46; Cornely"
                            1 => "M&#46; Bassetti"
                            2 => "T&#46; Calandra"
                            3 => "J&#46; Garbino"
                            4 => "B&#46;J&#46; Kullberg"
                            5 => "O&#46; Lortholary"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1111/1469-0691.12039"
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Microbiol Infect"
                        "fecha" => "2012"
                        "volumen" => "18"
                        "numero" => "Suppl&#46; 7"
                        "paginaInicial" => "19"
                        "paginaFinal" => "37"
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                            "web" => "Medline"
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                  ]
                ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Activity profile in vitro of micafungin against Spanish clinical isolates of common and emerging species of yeasts and molds"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Cuenca-Estrella"
                            1 => "A&#46; Gomez-Lopez"
                            2 => "E&#46; Mellado"
                            3 => "A&#46; Monzon"
                            4 => "M&#46;J&#46; Buitrago"
                            5 => "J&#46;L&#46; Rodriguez-Tudela"
                          ]
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/AAC.01543-08"
                      "Revista" => array:6 [
                        "tituloSerie" => "Antimicrob Agents Chemother"
                        "fecha" => "2009"
                        "volumen" => "53"
                        "paginaInicial" => "2192"
                        "paginaFinal" => "2195"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19223630"
                            "web" => "Medline"
                          ]
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                      ]
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                ]
              ]
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            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Study of a Norwegian collection of yeasts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46; Dietrichson"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Parasitol Hum Comp"
                        "fecha" => "1954"
                        "volumen" => "29"
                        "paginaInicial" => "460"
                        "paginaFinal" => "498"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13218481"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Eggimann"
                            1 => "P&#46; Francioli"
                            2 => "J&#46; Bille"
                            3 => "R&#46; Schneider"
                            4 => "M&#46; Wu"
                            5 => "G&#46; Chapuis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "1999"
                        "volumen" => "27"
                        "paginaInicial" => "1066"
                        "paginaFinal" => "1072"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10397206"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of echinocandin antifungals"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Eschenauer"
                            1 => "D&#46;D&#46; DePestel"
                            2 => "P&#46;L&#46; Carver"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ther Clin Risk Manag"
                        "fecha" => "2007"
                        "volumen" => "3"
                        "paginaInicial" => "71"
                        "paginaFinal" => "97"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18360617"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Invasive fungal infections and antifungal therapies in solid organ transplant recipients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Gabardi"
                            1 => "D&#46;W&#46; Kubiak"
                            2 => "A&#46;K&#46; Chandraker"
                            3 => "S&#46;G&#46; Tullius"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1432-2277.2007.00511.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Transpl Int"
                        "fecha" => "2007"
                        "volumen" => "20"
                        "paginaInicial" => "993"
                        "paginaFinal" => "1015"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17617181"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of severe Candida infections in nonneutropenic&#44; high-risk&#44; critically ill patients&#58; a randomized&#44; double-blind&#44; placebo controlled trial in patients treated by selective digestive decontamination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Garbino"
                            1 => "D&#46;P&#46; Lew"
                            2 => "J&#46;A&#46; Romand"
                            3 => "S&#46; Hugonnet"
                            4 => "R&#46; Auckenthaler"
                            5 => "D&#46; Pittet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-002-1540-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2002"
                        "volumen" => "28"
                        "paginaInicial" => "1708"
                        "paginaFinal" => "1717"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12447512"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Isolation of <span class="elsevierStyleItalic">Candida norvegensis</span> from clinical specimens&#58; four case reports"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;V&#46; Hood"
                            1 => "C&#46;B&#46; Moore"
                            2 => "D&#46;W&#46; Denning"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "1996"
                        "volumen" => "23"
                        "paginaInicial" => "1185"
                        "paginaFinal" => "1187"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8922831"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0060"
              "etiqueta" => "12"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology and outcomes of candidemia in 2019 patients&#58; data from the prospective antifungal therapy alliance registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;L&#46; Horn"
                            1 => "D&#46; Neofytos"
                            2 => "E&#46;J&#46; Anaissie"
                            3 => "J&#46;A&#46; Fishman"
                            4 => "W&#46;J&#46; Steinbach"
                            5 => "A&#46;J&#46; Olyaei"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/599039"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2009"
                        "volumen" => "48"
                        "paginaInicial" => "1695"
                        "paginaFinal" => "1703"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19441981"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changes in the spectrum and risk factors for invasive candidiasis in liver transplant recipients&#58; prospective&#44; multicenter&#44; case-controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Husain"
                            1 => "J&#46; Tollemar"
                            2 => "E&#46;A&#46; Dominguez"
                            3 => "K&#46; Baumgarten"
                            4 => "A&#46; Humar"
                            5 => "D&#46;L&#46; Paterson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.TP.0000065178.93741.72"
                      "Revista" => array:6 [
                        "tituloSerie" => "Transplantation"
                        "fecha" => "2003"
                        "volumen" => "75"
                        "paginaInicial" => "2023"
                        "paginaFinal" => "2029"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12829905"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Candida norvegensis</span> fungaemia in a neutropenic patient with acute non-lymphoblastic leukaemia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46; Kiraz"
                            1 => "O&#46;M&#46; Akay"
                            2 => "Y&#46; Sen"
                            3 => "V&#46; Aslan"
                            4 => "Y&#46; Akgun"
                            5 => "Z&#46; Gulbas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1439-0507.2009.01724.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mycoses"
                        "fecha" => "2010"
                        "volumen" => "53"
                        "paginaInicial" => "460"
                        "paginaFinal" => "462"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19496937"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-albicans <span class="elsevierStyleItalic">Candida</span> spp&#46; causing fungaemia&#58; pathogenicity and antifungal resistance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "V&#46; Krcmery"
                            1 => "A&#46;J&#46; Barnes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/jhin.2001.1151"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hosp Infect"
                        "fecha" => "2002"
                        "volumen" => "50"
                        "paginaInicial" => "243"
                        "paginaFinal" => "260"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12014897"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of two matrix-assisted laser desorption ionization-time of flight mass spectrometry &#40;MALDI-TOF MS&#41; systems for the identification of <span class="elsevierStyleItalic">Candida</span> species"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Lacroix"
                            1 => "A&#46; Gicquel"
                            2 => "B&#46; Sendid"
                            3 => "J&#46; Meyer"
                            4 => "I&#46; Accoceberry"
                            5 => "N&#46; Fran&#231;ois"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Clin Microbiol Infect"
                        "fecha" => "2013"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11866852"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bloodstream infections among transplant recipients&#58; results of a nationwide surveillance in Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Moreno"
                            1 => "C&#46; Cervera"
                            2 => "J&#46; Gavald&#225;"
                            3 => "M&#46; Rovira"
                            4 => "R&#46; de la C&#225;mara"
                            5 => "I&#46; Jarque"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1600-6143.2007.01964.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Transplant"
                        "fecha" => "2007"
                        "volumen" => "7"
                        "paginaInicial" => "2579"
                        "paginaFinal" => "2586"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17868067"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Candida norvegensis</span> peritonitis and invasive disease in a patient on continuous ambulatory peritoneal dialysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Nielsen"
                            1 => "J&#46; Stenderup"
                            2 => "B&#46; Bruun"
                            3 => "J&#46; Ladefoged"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "1990"
                        "volumen" => "28"
                        "paginaInicial" => "1664"
                        "paginaFinal" => "1665"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2380389"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Candida species bloodstream infection&#58; epidemiology and outcome in a single institution from 1991 to 2008"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Ortega"
                            1 => "F&#46; Marco"
                            2 => "A&#46; Soriano"
                            3 => "M&#46; Almela"
                            4 => "J&#46;A&#46; Mart&#237;nez"
                            5 => "J&#46; L&#243;pez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jhin.2010.09.026"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hosp Infect"
                        "fecha" => "2011"
                        "volumen" => "77"
                        "paginaInicial" => "157"
                        "paginaFinal" => "161"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21216030"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Invasive fungal infections among organ transplant recipients&#58; results of the Transplant-Associated Infection Surveillance Network &#40;TRANSNET&#41; Database"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;G&#46; Pappas"
                            1 => "B&#46;D&#46; Alexander"
                            2 => "D&#46;R&#46; Andes"
                            3 => "S&#46; Hadley"
                            4 => "C&#46;A&#46; Kauffman"
                            5 => "A&#46; Freifeld"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/651262"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2010"
                        "volumen" => "50"
                        "paginaInicial" => "1101"
                        "paginaFinal" => "1111"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20218876"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical practice guidelines for the management of candidiasis&#58; 2009 update by the Infectious Diseases Society of America"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;G&#46; Pappas"
                            1 => "C&#46;A&#46; Kauffman"
                            2 => "D&#46; Andes"
                            3 => "D&#46;K&#46; Benjamin"
                            4 => "T&#46;F&#46; Calandra"
                            5 => "J&#46;E&#46; Edwards"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/596757"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2009"
                        "volumen" => "48"
                        "paginaInicial" => "503"
                        "paginaFinal" => "535"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19191635"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Double-blind placebo-controlled trial of fluconazole to prevent candidal infections in critically ill surgical patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;K&#46; Pelz"
                            1 => "C&#46;W&#46; Hendrix"
                            2 => "S&#46;M&#46; Swoboda"
                            3 => "M&#46; Diener-West"
                            4 => "W&#46;G&#46; Merz"
                            5 => "J&#46; Hammond"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2001"
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                        "paginaInicial" => "542"
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                      "titulo" => "In vitro susceptibility of invasive isolates of <span class="elsevierStyleItalic">Candida</span> spp&#46; to anidulafungin&#44; caspofungin and micafungin&#58; six years of global surveillance"
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                        "paginaInicial" => "150"
                        "paginaFinal" => "156"
                        "link" => array:1 [
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                        "fecha" => "2010"
                        "volumen" => "48"
                        "paginaInicial" => "1366"
                        "paginaFinal" => "1377"
                        "link" => array:1 [
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                        0 => array:2 [
                          "etal" => true
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                            4 => "M&#46; Cerullo"
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                        ]
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                    ]
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                    0 => array:2 [
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                        "fecha" => "2013"
                        "volumen" => "94"
                        "paginaInicial" => "262"
                        "paginaFinal" => "266"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23845229"
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                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0130"
              "etiqueta" => "26"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Candida norvegensis</span>&#58; a fluconazole-resistant species"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            4 => "J&#46; Lassen"
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                        ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Antimicrob Agents Chemother"
                        "fecha" => "1997"
                        "volumen" => "41"
                        "paginaInicial" => "1375"
                        "paginaFinal" => "1376"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9174202"
                            "web" => "Medline"
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                    ]
                  ]
                ]
              ]
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                    0 => array:2 [
                      "titulo" => "Fungal infections in solid organ transplantation"
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                            0 => "F&#46;P&#46; Silveira"
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                        "tituloSerie" => "Med Mycol"
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                        "paginaInicial" => "305"
                        "paginaFinal" => "320"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17510855"
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                      "titulo" => "Fluconazole-resistant pathogens <span class="elsevierStyleItalic">Candida inconspicua</span> and <span class="elsevierStyleItalic">C&#46; norvegensis</span>&#58; DNA sequence diversity of the rRNA intergenic spacer region&#44; antifungal drug susceptibility&#44; and extracellular enzyme production"
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                        "paginaFinal" => "766"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15502409"
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                            4 => "R&#46;P&#46; Wenzel"
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                        "link" => array:1 [
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Article information

ISSN: 11301406
Original language: English

DOI:10.1016/j.riam.2013.11.005

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Year/Month	Html	Pdf	Total

2024 October	24	4	28
2024 September	55	5	60
2024 August	61	7	68
2024 July	69	5	74
2024 June	62	11	73
2024 May	81	5	86
2024 April	53	7	60
2024 March	54	9	63
2024 February	67	5	72
2024 January	67	4	71
2023 December	46	4	50
2023 November	64	4	68
2023 October	70	17	87
2023 September	40	9	49
2023 August	49	6	55
2023 July	54	6	60
2023 June	55	27	82
2023 May	66	24	90
2023 April	57	12	69
2023 March	45	3	48
2023 February	27	0	27
2023 January	29	14	43
2022 December	39	7	46
2022 November	44	8	52
2022 October	39	8	47
2022 September	36	13	49
2022 August	49	12	61
2022 July	31	7	38
2022 June	38	14	52
2022 May	34	21	55
2022 April	36	18	54
2022 March	66	22	88
2022 February	33	7	40
2022 January	52	17	69
2021 December	28	13	41
2021 November	45	31	76
2021 October	63	24	87
2021 September	42	31	73
2021 August	34	18	52
2021 July	22	13	35
2021 June	20	12	32
2021 May	32	11	43
2021 April	73	22	95
2021 March	34	13	47
2021 February	20	12	32
2021 January	42	17	59
2020 December	50	26	76
2020 November	42	21	63
2020 October	33	10	43
2020 September	16	14	30
2020 August	19	16	35
2020 July	23	17	40
2020 June	22	12	34
2020 May	31	17	48
2020 April	24	12	36
2020 March	42	11	53
2020 February	27	15	42
2020 January	35	16	51
2019 December	27	11	38
2019 November	29	11	40
2019 October	25	16	41
2019 September	19	18	37
2019 August	21	10	31
2019 July	16	35	51
2019 June	34	28	62
2019 May	64	47	111
2019 April	52	31	83
2019 March	8	7	15
2019 February	15	9	24
2019 January	13	10	23
2018 December	14	9	23
2018 November	11	12	23
2018 October	15	19	34
2018 September	23	5	28
2018 August	6	13	19
2018 July	3	15	18
2018 June	13	7	20
2018 May	12	6	18
2018 April	14	6	20
2018 March	4	3	7
2018 February	9	8	17
2018 January	4	9	13
2017 December	16	4	20
2017 November	3	4	7
2017 October	17	5	22
2017 September	9	3	12
2017 August	20	11	31
2017 July	21	8	29
2017 June	22	9	31
2017 May	18	5	23
2017 April	12	4	16
2017 March	22	7	29
2017 February	16	2	18
2017 January	9	6	15
2016 December	12	7	19
2016 November	13	0	13
2016 October	30	13	43
2016 September	18	9	27
2016 August	17	4	21
2016 July	14	4	18
2016 June	36	12	48
2016 May	20	8	28
2016 April	31	11	42
2016 February	1	0	1
2015 October	2	1	3
2015 September	0	1	1
2015 July	2	2	4
2015 May	2	2	4

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