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Infecciones del tracto urinario en personas mayores: etiología y susceptibilidades antimicrobianas en un área del sur de España
Urinary tract infections in older adults: Etiology and antimicrobial susceptibilities in a southern area of Spain
Francisco Miguel Escandell Ricoa,
Autor para correspondencia
francisco.escandell@ua.es

Autor para correspondencia.
, Lucía Pérez Fernándezb
a Departamento de Enfermería, Universidad de Alicante, Alicante, España
b Centro de Salud Almoradí, Departamento de Salud 21 SNS, Orihuela, Almoradí, Alicante, España
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Etiolog&#237;a de la infecci&#243;n urinaria comunitaria &#40;periodo de estudio 2020-2021&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La infecci&#243;n del tracto urinario &#40;ITU&#41; es una de las enfermedades m&#225;s prevalentes en la pr&#225;ctica cl&#237;nica&#44; encontr&#225;ndose en pacientes tanto hospitalizados como ambulatorios de todo el mundo<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a>&#46; La incidencia aumenta en pacientes mayores de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os en comparaci&#243;n con pacientes de mediana edad&#44; donde la incidencia de ITU es m&#225;s baja<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a>&#46; La prevalencia de bacteriuria asintom&#225;tica tambi&#233;n aumenta en los ancianos<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a>&#46; Este desarrollo se correlaciona con pacientes geri&#225;tricos que tambi&#233;n necesitan cat&#233;teres urinarios con mayor frecuencia o que presentan incontinencia urinaria&#44; lo que los hace m&#225;s propensos a tener infecciones urinarias<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a>&#46; Despu&#233;s de todo&#44; el 20&#37; de los ingresos hospitalarios en pacientes mayores de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os se deben a infecciones urinarias<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Se ha descrito que la mayor&#237;a de las ITU son causadas por miembros de la familia <span class="elsevierStyleItalic">Enterobacteriaceae</span>&#44; principalmente <span class="elsevierStyleItalic">Escherichia coli</span> en el 69-90&#37; de los casos&#44; seguido de <span class="elsevierStyleItalic">Klebsiella</span> spp&#44; <span class="elsevierStyleItalic">Staphylococcus saprophyticus</span> y <span class="elsevierStyleItalic">Proteus&#46;</span> Algunos estudios refieren que la resistencia de las bacterias aisladas supera el 20&#37; para trimetoprim&#47;sulfametoxazol y cefalosporinas de primera generaci&#243;n y el 50&#37; para amoxicilina<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En un estudio llevado a cabo recientemente en Europa las tasas m&#225;s altas de resistencia a los antimicrobianos acontecieron en el anciano&#46; En Espa&#241;a&#44; los mayores de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os ya superan el 16&#37; de la poblaci&#243;n total y&#44; seg&#250;n las estimaciones&#44; alcanzar&#225;n aproximadamente el 32&#37; antes de 2050<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo del estudio es describir la etiolog&#237;a de las infecciones urinarias y el perfil de sensibilidad antibi&#243;tica de los microorganismos responsables en las personas mayores del departamento de salud<span class="elsevierStyleHsp" style=""></span>21&#44; correspondiente con una zona rural del sur del Mediterr&#225;neo&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o y &#225;mbito de estudio</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio transversal&#44; descriptivo y retrospectivo del 1 de enero de 2020 al 31 de diciembre de 2021 en el que se incluyeron los microorganismos aislados con recuento significativo en muestras de orina de pacientes con ITU&#46; El departamento de salud<span class="elsevierStyleHsp" style=""></span>21 da cobertura a 180&#46;000 habitantes&#46; Se analiz&#243; la etiolog&#237;a de ITU global en funci&#243;n de la edad &#40;mayores de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os y mayores de 85&#41;&#44; &#225;mbito de estudio y sexo de los pacientes&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedimiento</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se consider&#243; &#250;nicamente una muestra de orina por paciente y episodio de ITU&#46; El cultivo se realiz&#243; mediante siembra cuantitativa de la orina en medio cromog&#233;nico&#46; La identificaci&#243;n microbiol&#243;gica se realiz&#243; seg&#250;n el aspecto macrosc&#243;pico de las colonias en el medio cromog&#233;nico y espectrometr&#237;a de masas&#46; La determinaci&#243;n de la sensibilidad antimicrobiana se realiz&#243; mediante la t&#233;cnica Kirby-Bauer en agar Mueller-Hinton&#46; La inclusi&#243;n de antibi&#243;ticos&#44; las pruebas fenot&#237;picas de detecci&#243;n de mecanismos de resistencia&#44; as&#237; como la interpretaci&#243;n de la sensibilidad&#44; se realizaron siguiendo las recomendaciones del <span class="elsevierStyleItalic">Clinical and Laboratory Standards Institute</span><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La recogida de informaci&#243;n se realiz&#243; desde la historia cl&#237;nica a trav&#233;s de un cuaderno de recogida de datos electr&#243;nico con acceso exclusivo del investigador principal y en el que se omiten los datos de car&#225;cter personal&#46; En todo momento los participantes estuvieron identificados con un c&#243;digo propio del estudio&#44; de forma que todos llevaron las siglas ITUM y a continuaci&#243;n tres n&#250;meros de forma correlativa &#40;ITUM001&#44; ITUM002&#8230;&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0040" class="elsevierStylePara elsevierViewall">Realizamos un an&#225;lisis descriptivo de todas las variables calculando sus frecuencias y porcentajes&#46; Se aplic&#243; la prueba de chi-cuadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41; para las variables categ&#243;ricas&#46; Los programas utilizados fueron Excel para la base de datos y el software SPSS &#40;versi&#243;n 25&#46;0&#59; IBM Corp&#46;&#44; Armonk&#44; NY&#41; y los resultados se consideraron significativos si p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Consideraciones &#233;ticas</span><p id="par0045" class="elsevierStylePara elsevierViewall">Para la realizaci&#243;n del estudio se solicit&#243; la autorizaci&#243;n del Comit&#233; de &#201;tica e Investigaci&#243;n &#40;CEI&#41; del departamento de salud<span class="elsevierStyleHsp" style=""></span>21 &#40;c&#243;digo de registro PI-2022-015&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se consideraron los principios &#233;ticos para las investigaciones m&#233;dicas en seres humanos dispuestos por la Declaraci&#243;n de Helsinki de la 18&#46;&#176; Asamblea de la Asociaci&#243;n M&#233;dica Mundial&#44; de junio de 1964&#44; como modo de participaci&#243;n en el estudio&#46; Se respetaron a su vez la confidencialidad y el uso de datos personales seg&#250;n la Ley org&#225;nica 3&#47;2018&#44; de 5<span class="elsevierStyleHsp" style=""></span>de diciembre&#44; de protecci&#243;n de datos personales y garant&#237;a de los derechos digitales&#46; No precis&#243; el consentimiento informado de los pacientes&#44; puesto que es un estudio epidemiol&#243;gico retrospectivo en el que se utilizaron fuentes secundarias de informaci&#243;n&#46; Los datos estuvieron protegidos de uso no permitido a personas ajenas a la investigaci&#243;n y por tanto fueron considerados estrictamente confidenciales&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="par0055" class="elsevierStylePara elsevierViewall">Durante el periodo de estudio se analizaron los urocultivos de 8&#46;493 pacientes&#44; aisl&#225;ndose 5&#46;193 urocultivos positivos &#40;61&#44;1&#37;&#41;&#46; De ellos&#44; 3&#46;399 correspondieron a mujeres &#40;65&#44;5&#37;&#41; y 1&#46;794 a hombres &#40;34&#44;5&#37;&#41;&#46; La media de edad fue de 80 &#40;DE&#58; 7&#44;7&#41; a&#241;os&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En la obtenci&#243;n y la recogida de la muestra destacamos la micci&#243;n espont&#225;nea en el 70&#37;&#44; seguido del sondaje urinario &#40;25&#37;&#41; y de las nefrostom&#237;as &#40;5&#37;&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se muestra la etiolog&#237;a de la ITU en nuestra poblaci&#243;n de estudio&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> recoge la frecuencia de aislamiento de los principales microorganismos&#44; seg&#250;n la unidad de atenci&#243;n sanitaria&#44; el sexo y la edad de los pacientes&#46; Respecto a la procedencia de la muestra&#44; la mayor proporci&#243;n fue en atenci&#243;n primaria&#44; con 4&#46;853 urocultivos &#40;51&#44;6&#37; de urocultivos positivos&#44; correspondientes a 9 centros a de salud y 8 consultorios auxiliares&#41;&#44; seguido de atenci&#243;n hospitalaria&#44; con 3&#46;565 urocultivos &#40;46&#44;4&#37; de urocultivos positivos&#41;&#44; y en tercer lugar 94 urocultivos en las residencias de ancianos &#40;2&#37; de urocultivos positivos&#41;&#46; La ITU se desarroll&#243; con mayor frecuencia en mujeres y en atenci&#243;n primaria&#46; La menor frecuencia de ITU fue en residencias&#44; donde el departamento de estudio se corresponde con una zona rural que cuenta con 4 residencias con un total de 400 residentes &#40;100 usuarios&#47;as por residencia y a&#241;o&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">E&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">coli</span> &#40;54&#37;&#41; fue el microorganismo m&#225;s frecuentemente aislado&#44; tanto en el conjunto de la poblaci&#243;n como por sexo y por unidad de atenci&#243;n sanitaria &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#44; <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Hubo importantes diferencias en cuanto a su frecuencia de aislamiento&#44; seg&#250;n el sexo&#44; oscilando entre el 37&#44;5&#37; &#40;hombres&#41; y el 55&#44;8&#37; &#40;mujeres&#41;&#46; Comparando la frecuencia de aislamiento de <span class="elsevierStyleItalic">E&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">coli</span> seg&#250;n el sexo&#44; se observ&#243; que el porcentaje de <span class="elsevierStyleItalic">E&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">coli</span> aislado en mujeres fue significativamente superior que el aislado en hombres &#40;&#967;<span class="elsevierStyleSup">2</span>&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;044&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Klebsiella pneumoniae</span> fue el segundo microorganismo m&#225;s frecuente en ambos sexos y edad &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#44; seguido de <span class="elsevierStyleItalic">Enterococcus faecalis</span> en el tercer lugar en ambos grupos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Respecto a la sensibilidad antibi&#243;tica de los uropat&#243;genos m&#225;s frecuentemente aislados&#44; <span class="elsevierStyleItalic">E&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">coli</span> mostr&#243; un amplio rango de sensibilidad&#44; desde el 75&#44;2&#37; frente a amoxicilina-&#225;cido clavul&#225;nico hasta &#62;<span class="elsevierStyleHsp" style=""></span>90&#37; frente a fosfomicina&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Con relaci&#243;n a las resistencias&#44; <span class="elsevierStyleItalic">E&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">coli</span> fue la bacteria m&#225;s frecuentemente aislada en ambos grupos de edad&#44; por sexo y por &#225;mbito de estudio&#46; Pese a las resistencias analizadas&#44; algunos&#44; como fosfomicina&#44; nitrofuranto&#237;na&#44; cefotaxima&#44; gentamicina y piperacilina-tazobactam&#44; mantienen buena actividad en cepas comunitarias y hospitalarias&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La tasa de resistencia a quinolonas fue cercana al 31&#37; en cepas comunitarias y super&#243; el 40&#37; en las hospitalarias y en las residencias&#46; El 50&#37; de resistencia de <span class="elsevierStyleItalic">E&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">coli</span> correspondi&#243; a las aminopenicilinas &#40;ampicilina y amoxicilina&#41; en el &#225;mbito comunitario y en las residencias&#44; y el 53&#37; se dio en el &#225;mbito hospitalario&#46; La tasa de resistencia media al cotrimoxazol es tambi&#233;n elevada&#44; del 26&#37;&#46; El porcentaje medio de resistencia a la tobramicina ha sido del 19&#37; en cepas hospitalarias&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Se observ&#243; una mayor tasa de sensibilidad a los antibi&#243;ticos en las mujeres&#44; respecto a la de los hombres&#46; En relaci&#243;n con la tasa de sensibilidad en los quimioter&#225;picos urinarios&#44; la fosfomicina es superior al 93&#44;5&#37; en mujeres y al 87&#44;7&#37; en hombres&#44; mientras que la nitrofuranto&#237;na es superior al 82&#44;5&#37;&#44; en mujeres y superior al 73&#44;1&#37; en hombres&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">Este estudio permite conocer la etiolog&#237;a actual de la ITU&#44; as&#237; como los perfiles de sensibilidad y de resistencia de los microorganismos en las personas mayores del departamento de salud<span class="elsevierStyleHsp" style=""></span>21 correspondiente con una zona rural del sur del Mediterr&#225;neo&#46; Estos datos podr&#237;an ser esenciales para evaluar y establecer pautas de tratamiento emp&#237;rico adaptadas a nuestro medio&#46; No se observaron diferencias significativas en funci&#243;n del sexo&#44; la edad y la procedencia de la muestra&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En nuestro medio&#44; al igual que en otros estudios&#44; <span class="elsevierStyleItalic">E&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">coli</span> contin&#250;a siendo el microorganismo con mayor frecuencia de aislamiento &#40;54&#37;&#41;&#46; La frecuencia de aislamiento de cada una de las enterobacterias depende de las caracter&#237;sticas de una infecci&#243;n complicada&#44; asociada generalmente a diabetes&#44; inmunosupresi&#243;n&#44; uropat&#237;a obstructiva&#44; cateterizaci&#243;n de vejiga&#44; infecciones de repetici&#243;n&#44; patolog&#237;as urinarias y&#47;o tratamientos antibi&#243;ticos previos<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">La frecuencia de aislamiento de <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> &#40;15&#37;&#41; est&#225; en segundo lugar&#44; y se observa una similar distribuci&#243;n por sexo y por edad&#46; Estos resultados fueron similares a un estudio realizado por Thiesemann et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a>&#44; que tambi&#233;n mostr&#243; un rango bacteriano diferente en pacientes mayores &#40;17&#37;&#41;&#44; donde la aparici&#243;n de este germen se increment&#243; en las residencias y en las cl&#237;nicas&#44; especialmente en el caso de enfermedades graves&#44; largas estancias y alto consumo de antibi&#243;ticos&#46; La frecuencia de aislamiento de <span class="elsevierStyleItalic">Enterococcus faecalis</span> &#40;7&#37;&#41; tambi&#233;n ocupa cifras elevadas&#44; y es m&#225;s frecuente y parece estar asociada a pacientes con factores de riesgo&#58; portadores de sondas&#44; inmunodeficientes&#44; relacionados con centros de larga estancia o asistencia sanitaria o presi&#243;n antibi&#243;tica<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A diferencia de los grupos de antibi&#243;ticos previamente mostrados&#44; la sensibilidad de <span class="elsevierStyleItalic">E&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">coli</span> a la fosfomicina y a la nitrofuranto&#237;na contin&#250;a siendo mayor del 80&#37;&#46; Al igual que otros estudios&#44; consideramos que estos f&#225;rmacos podr&#237;an ser muy &#250;tiles como tratamiento emp&#237;rico de la ITU no complicada y en mujeres<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a>&#46; En otro estudio multic&#233;ntrico espa&#241;ol realizado en 9 comunidades aut&#243;nomas se comunica un rango de sensibilidad de <span class="elsevierStyleItalic">E&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">coli</span> a la fosfomicina que var&#237;a del 95&#44;6&#37; al 99&#44;4&#37; seg&#250;n las diferentes comunidades incluidas<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Una limitaci&#243;n del estudio podr&#237;a ser la obtenci&#243;n de la muestra de un &#250;nico departamento de salud&#44; y el hecho de que los datos del &#225;mbito residencial no se pueden extrapolar&#46; Una de las fortalezas del estudio es que incluye los datos anuales de ITU comunitaria&#44; residencial y hospitalaria de un departamento de salud que est&#225; en consonancia con las gu&#237;as nacionales de tratamiento de infecciones urinarias seg&#250;n los Programas de Optimizaci&#243;n de Uso de los Antibi&#243;ticos &#40;PROA&#41;&#44; imprescindibles para establecer un tratamiento emp&#237;rico actualizado&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">E&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">coli</span> contin&#250;a siendo el microorganismo m&#225;s frecuentemente aislado en las ITU&#44; con una tasa de sensibilidad a la fosfomicina superior al 80&#37; y a la amoxicilina-&#225;cido clavul&#225;nico del 75&#37;&#46; Por ello&#44; el tratamiento emp&#237;rico de las ITU en nuestro medio deber&#237;a recomendar fosfomicina o amoxicilina-&#225;cido clavul&#225;nico&#44; independientemente de la unidad de atenci&#243;n sanitaria&#44; de la edad y del sexo&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Consideraciones &#233;ticas</span><p id="par0130" class="elsevierStylePara elsevierViewall">La aprobaci&#243;n del estudio se obtuvo del Comit&#233; de &#201;tica en Investigaci&#243;n del departamento de salud<span class="elsevierStyleHsp" style=""></span>21 &#40;c&#243;digo de registro PI-2022-015&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Financiaci&#243;n</span><p id="par0135" class="elsevierStylePara elsevierViewall">Este trabajo no ha recibido ning&#250;n tipo de financiaci&#243;n&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicto de intereses</span><p id="par0140" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La infecci&#243;n del tracto urinario &#40;ITU&#41; es una de las enfermedades m&#225;s prevalentes en la pr&#225;ctica cl&#237;nica y aumenta en pacientes mayores de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os en comparaci&#243;n con pacientes de mediana edad&#46; Con el fin de mejorar el tratamiento emp&#237;rico se ha estudiado la etiolog&#237;a y el perfil de sensibilidad antibi&#243;tica de las bacterias m&#225;s frecuentes productoras de ITU en personas mayores&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal&#44; descriptivo y retrospectivo en el que se incluyeron los microorganismos aislados con recuento significativo en muestras de orina de pacientes con ITU&#46; Se analiz&#243; la etiolog&#237;a global y en funci&#243;n del sexo&#46; Se consider&#243; &#250;nicamente una muestra de orina por paciente y episodio de ITU&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Respecto a la procedencia de la muestra&#44; la mayor proporci&#243;n fue en atenci&#243;n primaria&#44; con 4&#46;853 urocultivos &#40;51&#44;6&#37; de urocultivos positivos&#41;&#44; seguido de atenci&#243;n hospitalaria&#44; con 3&#46;565 urocultivos &#40;46&#44;4&#37; de urocultivos positivos&#41; y 94 urocultivos en las residencias de ancianos &#40;2&#37; de urocultivos positivos&#41;&#46; <span class="elsevierStyleItalic">Escherichia coli</span> fue el microorganismo m&#225;s aislado tanto en el conjunto de la poblaci&#243;n &#40;54&#37;&#41; como en cada uno de los grupos analizados&#46; Se observ&#243; que <span class="elsevierStyleItalic">E&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">coli</span> aislado en mujeres fue significativamente superior que en hombres &#40;&#967;<span class="elsevierStyleSup">2</span>&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;044&#41;&#46; Su sensibilidad fue&#58; fosfomicina 80&#37; y 75&#37; amoxicilina-&#225;cido clavul&#225;nico&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">E&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">coli</span> contin&#250;a siendo el microorganismo m&#225;s frecuentemente aislado en ITU&#46; El tratamiento emp&#237;rico de las ITU en nuestro medio deber&#237;a incluir fosfomicina o amoxicilina-&#225;cido clavul&#225;nico&#44; independientemente de la unidad de atenci&#243;n sanitaria y del sexo&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Urinary tract infection &#40;UTI&#41; is one of the most prevalent diseases in clinical practice and increases in patients older than 65<span class="elsevierStyleHsp" style=""></span>years compared to middle-aged patients&#46; In order to improve empirical treatment&#44; the etiology and antibiotic sensitivity profile of the most frequent bacteria that produce UTIs in older people have been studied&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional&#44; descriptive and retrospective study in which isolated micro-organisms with significant counts in urine samples from patients with UTI were included&#46; The global etiology and according to sex were analyzed&#46; Only one urine sample per patient and UTI episode was considered&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Regarding the origin of the sample&#44; the highest proportion was in primary care with 4853 urine cultures &#40;51&#46;6&#37; of positive urine cultures&#41;&#44; followed by hospital care with 3565 urine cultures &#40;46&#46;4&#37; of positive urine cultures&#41; and 94 urine cultures in nursing homes elderly &#40;2&#37; positive urine cultures&#41;&#46; <span class="elsevierStyleItalic">Escherichia coli</span> was the most isolated micro-organism both in the population as a whole &#40;54&#37;&#41; and in each of the analyzed groups&#46; It was observed that <span class="elsevierStyleItalic">E&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">coli</span> isolated in women was significantly higher than in men &#40;&#967;<span class="elsevierStyleSup">2</span>&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;044&#41;&#46; Their sensitivity was&#58; 80&#37; fosfomycin and 75&#37; amoxicillin-clavulanic acid&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">E&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">coli</span> continues to be the most frequently isolated micro-organism in UTI&#46; Empirical treatment of UTI in our environment should include fosfomycin or amoxicillin-clavulanic acid&#44; regardless of the health care unit and gender&#46;</p></span>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="15" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hombres</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Atenci&#243;n primarian<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>738</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Atenci&#243;n hospitalarian<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;038</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Residenciasn<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Edad</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Edad</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Edad</th></tr><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Microorganismos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">65-84 a&#241;os</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#8805; 85a&#241;os</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Microorganismos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">65-84 a&#241;os</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&#8805; 85a&#241;os</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Microorganismos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">65-84 a&#241;os</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#8805; 85a&#241;os</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Escherichia coli</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">179&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Escherichia coli</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">220&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Escherichia coli</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Klebsiella pneumoniae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Klebsiella pneumoniae</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Morganella morganii</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Klebsiella oxytoca</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Streptococcus agalactiae</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Providencia stuartii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Otros microorganismos<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Otros microorganismos<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Otros microorganismos<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
            1 => array:1 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col">Microorganismos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#8805; 85a&#241;os</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Microorganismos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">65-84 a&#241;os</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#8805; 85a&#241;os</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Microorganismos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">65-84 a&#241;os</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#8805; 85a&#241;os</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Escherichia coli</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">605&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">31&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">492&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Escherichia coli</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">508&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">254&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Escherichia coli</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Klebsiella oxytoca</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Citrobacter koseri</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Providencia stuartii</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Streptococcus agalactiae</span>&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Harnwegsinfektionen im Alter &#91;Urinary tract infections in the elderly&#93;"
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ISSN: 0211139X
Idioma original: Español
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