Scientific Letter
Colonization by multidrug-resistant microorganisms in ICU patients during the COVID-19 pandemic
Colonización por microorganismos multirresistentes en pacientes de UCI durante la pandemia de la COVID-19
P. Fernándeza,
, L. Morenoa, G. Yagüea,b,c, E. Andreud, R. Jarad, M. Segoviaa,b,c
Corresponding author
a Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
b Departamento de Genética y Microbiología, Universidad de Murcia, Murcia, Spain
c Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
d Unidad de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
Read
4110
Timeswas read the article
1493
Total PDF
2617
Total HTML
Share statistics
array:24 [ "pii" => "S2173572721000436" "issn" => "21735727" "doi" => "10.1016/j.medine.2021.04.006" "estado" => "S300" "fechaPublicacion" => "2021-06-01" "aid" => "1641" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Intensiva. 2021;45:313-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210569121000358" "issn" => "02105691" "doi" => "10.1016/j.medin.2021.02.015" "estado" => "S300" "fechaPublicacion" => "2021-06-01" "aid" => "1641" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Intensiva. 2021;45:313-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Colonización por microorganismos multirresistentes en pacientes de UCI durante la pandemia de la COVID-19" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "315" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Colonization by multidrug-resistant microorganisms in ICU patients during the COVID-19 pandemic" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Fernández, L. Moreno, G. Yagüe, E. Andreu, R. Jara, M. Segovia" "autores" => array:6 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Fernández" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Moreno" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Yagüe" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Andreu" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Jara" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Segovia" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572721000436" "doi" => "10.1016/j.medine.2021.04.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572721000436?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569121000358?idApp=WMIE" "url" => "/02105691/0000004500000005/v1_202105120840/S0210569121000358/v1_202105120840/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173572721000424" "issn" => "21735727" "doi" => "10.1016/j.medine.2021.04.005" "estado" => "S300" "fechaPublicacion" => "2021-06-01" "aid" => "1628" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Intensiva. 2021;45:315-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Non-invasive ventilatory support in patients with COVID-19 pneumonia: A Spanish multicenter registry" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "315" "paginaFinal" => "317" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Soporte ventilatorio no invasivo en pacientes con neumonía por COVID-19: un registro multicéntrico español" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1388 "Ancho" => 2175 "Tamanyo" => 227225 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of the rates of intubation (white area), mortality (solid area), and mortality in patients on mechanical ventilation (stripped area) for each type of ventilatory support used and their different associations.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Fernández, F.J. González de Molina, M. Batlle, M.M. Fernández, S. Hernandez, A. Villagra" "autores" => array:7 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Fernández" ] 1 => array:2 [ "nombre" => "F.J." "apellidos" => "González de Molina" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Batlle" ] 3 => array:2 [ "nombre" => "M.M." "apellidos" => "Fernández" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Hernandez" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Villagra" ] 6 => array:1 [ "colaborador" => "Grupo Semicríticos Covid" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569121000188" "doi" => "10.1016/j.medin.2021.02.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569121000188?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572721000424?idApp=WMIE" "url" => "/21735727/0000004500000005/v1_202105290657/S2173572721000424/v1_202105290657/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173572721000382" "issn" => "21735727" "doi" => "10.1016/j.medine.2021.04.002" "estado" => "S300" "fechaPublicacion" => "2021-06-01" "aid" => "1599" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "pgl" "cita" => "Med Intensiva. 2021;45:298-312" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Consensus document</span>" "titulo" => "Summary of recommendations and key points of the consensus of Spanish scientific societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the use of non-invasive ventilation and high-flow oxygen therapy with nasal cannulas in adult, pediatric, and neonatal patients with severe acute respiratory failure" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "298" "paginaFinal" => "312" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sumario de las recomendaciones y puntos clave del Consenso de las Sociedades Científicas Españolas (SEPAR, SEMICYUC, SEMES; SECIP, SENeo, SEDAR, SENP) para la utilización de la ventilación no invasiva y terapia de alto flujo con cánulas nasales en el paciente adulto, pediátrico y neonatal con insuficiencia respiratoria aguda grave" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Luján, Ó. Peñuelas, C. Cinesi Gómez, A. García-Salido, J. Moreno Hernando, A. Romero Berrocal, I. Gutiérrez Ibarluzea, J.F. Masa Jiménez, A. Mas, J.M. Carratalá Perales, M. Gaboli, A. Concheiro Guisán, J. García Fernández, J. Escámez, J. Parrilla Parrilla, E. Farrero Muñoz, M. González, S.B. Heili-Frades, M.Á. Sánchez Quiroga, G. Rialp Cervera, G. Hernández, A. Sánchez Torres, R. Uña, C.F. Ortolà, M. Ferrer Monreal, C. Egea Santaolalla" "autores" => array:26 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Luján" ] 1 => array:2 [ "nombre" => "Ó." "apellidos" => "Peñuelas" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Cinesi Gómez" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "García-Salido" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Moreno Hernando" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Romero Berrocal" ] 6 => array:2 [ "nombre" => "I." "apellidos" => "Gutiérrez Ibarluzea" ] 7 => array:2 [ "nombre" => "J.F." "apellidos" => "Masa Jiménez" ] 8 => array:2 [ "nombre" => "A." "apellidos" => "Mas" ] 9 => array:2 [ "nombre" => "J.M." "apellidos" => "Carratalá Perales" ] 10 => array:2 [ "nombre" => "M." "apellidos" => "Gaboli" ] 11 => array:2 [ "nombre" => "A." "apellidos" => "Concheiro Guisán" ] 12 => array:2 [ "nombre" => "J." "apellidos" => "García Fernández" ] 13 => array:2 [ "nombre" => "J." "apellidos" => "Escámez" ] 14 => array:2 [ "nombre" => "J." "apellidos" => "Parrilla Parrilla" ] 15 => array:2 [ "nombre" => "E." "apellidos" => "Farrero Muñoz" ] 16 => array:2 [ "nombre" => "M." "apellidos" => "González" ] 17 => array:2 [ "nombre" => "S.B." "apellidos" => "Heili-Frades" ] 18 => array:2 [ "nombre" => "M.Á." "apellidos" => "Sánchez Quiroga" ] 19 => array:2 [ "nombre" => "G." "apellidos" => "Rialp Cervera" ] 20 => array:2 [ "nombre" => "G." "apellidos" => "Hernández" ] 21 => array:2 [ "nombre" => "A." "apellidos" => "Sánchez Torres" ] 22 => array:2 [ "nombre" => "R." "apellidos" => "Uña" ] 23 => array:2 [ "nombre" => "C.F." "apellidos" => "Ortolà" ] 24 => array:2 [ "nombre" => "M." "apellidos" => "Ferrer Monreal" ] 25 => array:2 [ "nombre" => "C." "apellidos" => "Egea Santaolalla" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569120303338" "doi" => "10.1016/j.medin.2020.08.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569120303338?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572721000382?idApp=WMIE" "url" => "/21735727/0000004500000005/v1_202105290657/S2173572721000382/v1_202105290657/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Colonization by multidrug-resistant microorganisms in ICU patients during the COVID-19 pandemic" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "315" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "P. Fernández, L. Moreno, G. Yagüe, E. Andreu, R. Jara, M. Segovia" "autores" => array:6 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Fernández" "email" => array:1 [ 0 => "Ilpach@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "G." "apellidos" => "Yagüe" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Andreu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "R." "apellidos" => "Jara" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "M." "apellidos" => "Segovia" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Genética y Microbiología, Universidad de Murcia, Murcia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Unidad de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Colonización por microorganismos multirresistentes en pacientes de UCI durante la pandemia de la COVID-19" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The outbreak of SARS-CoV-2 has been a huge obstacle for the normal functioning of nosocomial infection (NI) control programs including the active surveillance of multidrug-resistant microorganisms (MDRM). COVID-19 has increased healthcare pressure and precipitated changes in the routine workload both at hospital and microbiology lab level. Also, the current clinical guidelines on the management of patients with COVID-19 do not include recommendations on how to perform surveillance cultures or implement special control measures to avoid MDRM related NIs in these patients.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite all difficulties, the low prevalence of COVID-19 during the first stage of the pandemic in our region allowed us to continue with the active surveillance programs of MDRM in our center as we had been doing before the beginning of the pandemic.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective of this study is to analyze the impact COVID-19 has had on MDRM colonization in patients referred to the ICU setting from a tertiary center.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We present a descriptive and retrospective study that analyzed the isolation of MDRM within the surveillance program of antibiotic resistance of our hospital adult ICU from March 1, 2020 through May 31, 2020.</p><p id="par0025" class="elsevierStylePara elsevierViewall">MDRM colonization studies were conducted periodically once a week at the patient’s admission to the ICU during his stay following the protocol of the Zero Resistance project.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Axillary, pharyngeal, and rectal exudates were collected to rule out the presence of multi-drug resistant gram-negative bacilli followed by a nasal exudate to rule out the presence of linezolid-resistant <span class="elsevierStyleItalic">Staphylococcus spp</span>. and methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients who had tested positive for SARS-CoV-2 on the reverse transcriptase polymerase chain reaction (RT-PCR) test were included in the COVID-19 group. On the other hand, patients without a RT-PCR test or who had tested negative to this test were included in the non-COVID-19 group.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Data were expressed as mean ± interquartile range for the quantitative variables. The qualitative ones were expressed as frequencies and percentages. The Mann–Whitney <span class="elsevierStyleItalic">U</span> test was used for the quantitative variables while Fisher’s exact test was used for the categorical ones. The 95% confidence interval was used for the statistics.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The study was approved by the research committee and no informed consent form was required to handle the anonymous data because of the descriptive and observational nature of the study.</p><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 2139 specimens from 354 patients were analyzed. Of these, 361 came from 24 patients with a positive RT-PCR test for SARS-CoV-2 while 1778 specimens came from 330 patients without COVID-19. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the clinical and demographic characteristics of the patients.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The MDRM most often found were extended spectrum beta-lactamase (ESBL)-producing enterobacteriaceae. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the MDRM isolated. Patients colonized with more than one species of MDRM were found in both groups. The positivity of the specimens analyzed (axillary, pharyngeal, nasal, and rectal exudates) was 2%, 2.4%, 0.9%, and 8.2%, respectively. The latter were the most cost-effective specimens for the detection of ESBL-producing enterobacteriaceae.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">This study analyzed patients with COVID-19 admitted to the ICU who have higher chances of MDRM colonization compared to patients admitted for other reasons (20.8% vs 1.2%, respectively). This can be due to the special characteristics of these hospitalized patients. One of these differences is longer ICU stays (14 days on average compared to just 2 days for non-COVID-19 patients). Former studies proved that extended hospital stays are one of the predisposing factors for MDRM colonization.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The greater use of invasive techniques, common in this type of patients, is another factor associated with MDRM colonization.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In our case, 68% of the patients with COVID-19 required mechanical ventilation within the first 24 h and 80% within the first 48 h.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Another aspect we should take into account is that most of these patients are on antibiotic treatment. In our case, 84% of the patients with COVID-19 received azithromycin during their ICU stay.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Added to all these factors there is a series of changes in how hospitals were organized, which may have led to worse detection control and management of MDRM.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In the first place, the tremendous workload sustained has precipitated the hiring of new personnel and the fact that part of the multidisciplinary teams dedicated to multi-drug resistance surveillance systems have had to assist patients with COVID-19. The increased pressure exerted on the healthcare system and the adoption of new safety measures like the use of personal protection equipment (PPE) can complicate the performance of certain techniques, among other, specimen extraction from patients with COVID-19 for the detection of MDRM.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Secondly, the saturated healthcare system has produced a lack of hospital and ICU beds that has complicated the implementation of isolation measures necessary in MDRM colonized patients or in case of other possible outbreaks.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Conversely, the hygiene measures implemented to prevent SARS-CoV-2 infections like frequent hand washing or use of hydroalcoholic gel are also valid to reduce the number of NIs and improve the surveillance of MDRM at the hospital setting.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conclusions</span><p id="par0090" class="elsevierStylePara elsevierViewall">Patients with COVID-19 admitted to the UCI are more susceptible to MDRM colonization compared to other patients hospitalized in these units because of their special characteristics and the fact that most of them require long stays. However, given the limited number of patients recruited during this first pandemic wave, it would be interesting to conduct more studies including other areas of hospitalization.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conclusions" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Fernández P, Moreno L, Yagüe G, Andreu E, Jara R, Segovia M. Colonización por microorganismos multirresistentes en pacientes de UCI durante la pandemia de la COVID-19. Med Intensiva. 2021;45:313–315.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \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">Total number of patients (354) \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">Non-COVID-19 group (330) \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">COVID-19 group (24) \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"><span class="elsevierStyleItalic">P</span> \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">Age (years), median [IQR] \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 [53–74] \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">64.5 [54–74] \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">69.5 [45–72] \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">.331 \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">Sex (males), n (%) \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">232 (65,0) \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">217 (65.7%) \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">15 (62.5) \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">.452 \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">Days at the ICU, median [IQR] \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 [1–5] \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 [1–4] \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 [5–50] \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"><.001 \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">MDRM colonization at admission, n (%) \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">34 (9.6) \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">30 (9.1) \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 (16.6) \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">.188 \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">MDRM colonization during admission, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (2.5) \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 (1.2) \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 (20.8) \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"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2605350.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Demographic data of patients with detection studies of multidrug-resistant microorganisms (MDRM) in the intensive care setting.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">MRSA, methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \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">COVID-19 group</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">Non-COVID-19 group</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \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">MDRM colonization at admission n (%) \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">MDRM colonization during admission n (%) \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">MDRM colonization at admission n (%) \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">MDRM colonization during admission n (%) \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">ESBL-producing <span class="elsevierStyleItalic">E. coli</span> \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 (2.0) \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 (4.1) \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 (28.6) \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 (4.1) \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">ESBL-producing <span class="elsevierStyleItalic">K. pneumoniae</span> \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 (4.1) \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 (6.1) \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 (10.2) \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 (0.0) \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">MRSA \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 (4.1) \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 (0.0) \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 (6.1) \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 (0.0) \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">Stenotrophomonas maltophilia</span> \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 (0.0) \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 (2.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (14.3) \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 (2.0) \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">Other<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0.0) \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 (4.1) \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(6.1) \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 (2.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2605351.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Extended spectrum beta-lactamase (ESBL)-producing <span class="elsevierStyleItalic">Proteus mirabilis</span>, ESBL-producing <span class="elsevierStyleItalic">Enterobacter cloacae</span>, plasmid-mediated AmpC beta-lactamase-producing <span class="elsevierStyleItalic">Proteus mirabilis</span>, ESBL-producing <span class="elsevierStyleItalic">Morganella morganii</span>.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multidrug-resistant microorganisms (MDRM) isolated from patients hospitalized at the intensive care unit (ICU) from March 1, 2020 through May 31, 2020.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Prevención de la emergencia de bacterias multirresistentes en el paciente crítico «Proyecto Resistencia Zero» [Accessed 7 November 2020]. Available from: <a target="_blank" href="https://www.seguridaddelpaciente.es/resources/documentos/2019/05/resistencia-zero/PROYECTO_RZ_-_VERSION_FINAL_%2826MARZO_2014%29.pdf">https://www.seguridaddelpaciente.es/resources/documentos/2019/05/resistencia-zero/PROYECTO_RZ_-_VERSION_FINAL_%2826MARZO_2014%29.pdf</a>." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevention and control of multi-drug-resistant Gram-negative bacteria: recommendations from a Joint Working Party" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.P.R. Wilson" 1 => "D.M. Livermore" 2 => "J.A. Otter" 3 => "R.E. Warren" 4 => "P. Jenks" 5 => "D.A. Enoch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhin.2015.08.007" "Revista" => array:6 [ "tituloSerie" => "J Hosp Infect" "fecha" => "2016" "volumen" => "92" "paginaInicial" => "S1" "paginaFinal" => "S44" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26598314" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infecciones nosocomiales por Pseudomonas aeruginosa multiresistente incluido carbapenémicos: factores predictivos y pronósticos. Estudio prospectivo 2016–2017" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Hernández" 1 => "G. Yagüe" 2 => "E.G. Vázquez" 3 => "M. Simón" 4 => "L.M. Parrado" 5 => "M. Canteras" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Quimioter" "fecha" => "2018" "volumen" => "31" "paginaInicial" => "123" "paginaFinal" => "130" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29564870" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A systematic review and meta-analyses show that carbapenem use and medical devices are the leading risk factors for carbapenem-resistant <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.F. Voor in ‘t holt" 1 => "J.A. Severin" 2 => "E.M.E.H. Lesaffre" 3 => "M.C. Vos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/AAC.01758-13" "Revista" => array:6 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "2014" "volumen" => "58" "paginaInicial" => "2626" "paginaFinal" => "2637" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24550343" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Control of Gram-negative multi-drug resistant microorganisms in an Italian ICU: rapid decline as a result of a multifaceted intervention, including conservative use of antibiotics" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Frattari" 1 => "V. Savini" 2 => "E. Polilli" 3 => "G.D. Marco" 4 => "G. Lucisano" 5 => "S. Corridoni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijid.2019.04.002" "Revista" => array:6 [ "tituloSerie" => "Int J Infect Dis" "fecha" => "2019" "volumen" => "84" "paginaInicial" => "153" "paginaFinal" => "162" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31204003" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and risk factors for acquisition of carbapenem-resistant enterobacteriaceae in the setting of endemicity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Swaminathan" 1 => "S. Sharma" 2 => "S.P. Blash" 3 => "G. Patel" 4 => "D.B. Banach" 5 => "M. Phillips" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/671270" "Revista" => array:6 [ "tituloSerie" => "Infect Control Hosp Epidemiol" "fecha" => "2013" "volumen" => "34" "paginaInicial" => "809" "paginaFinal" => "817" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23838221" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medidas de prevención de la transmisión de microorganismos entre pacientes hospitalizados. Higiene de manos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Lupión" 1 => "L.E. López-Cortés" 2 => "J. Rodríguez-Baño" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Enfermedades Infecc Microbiol Clínica" "fecha" => "2014" "volumen" => "32" "paginaInicial" => "603" "paginaFinal" => "609" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004500000005/v1_202105290657/S2173572721000436/v1_202105290657/en/main.assets" "Apartado" => array:4 [ "identificador" => "15647" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004500000005/v1_202105290657/S2173572721000436/v1_202105290657/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572721000436?idApp=WMIE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 1 | 8 |
| 2024 October | 81 | 52 | 133 |
| 2024 September | 75 | 38 | 113 |
| 2024 August | 92 | 53 | 145 |
| 2024 July | 68 | 36 | 104 |
| 2024 June | 75 | 49 | 124 |
| 2024 May | 84 | 36 | 120 |
| 2024 April | 80 | 33 | 113 |
| 2024 March | 71 | 32 | 103 |
| 2024 February | 56 | 46 | 102 |
| 2024 January | 80 | 33 | 113 |
| 2023 December | 52 | 35 | 87 |
| 2023 November | 75 | 43 | 118 |
| 2023 October | 70 | 39 | 109 |
| 2023 September | 58 | 46 | 104 |
| 2023 August | 45 | 21 | 66 |
| 2023 July | 75 | 33 | 108 |
| 2023 June | 46 | 25 | 71 |
| 2023 May | 71 | 36 | 107 |
| 2023 April | 38 | 16 | 54 |
| 2023 March | 73 | 31 | 104 |
| 2023 February | 67 | 34 | 101 |
| 2023 January | 52 | 23 | 75 |
| 2022 December | 92 | 38 | 130 |
| 2022 November | 104 | 36 | 140 |
| 2022 October | 85 | 48 | 133 |
| 2022 September | 64 | 28 | 92 |
| 2022 August | 62 | 38 | 100 |
| 2022 July | 52 | 37 | 89 |
| 2022 June | 54 | 36 | 90 |
| 2022 May | 56 | 36 | 92 |
| 2022 April | 51 | 32 | 83 |
| 2022 March | 85 | 73 | 158 |
| 2022 February | 68 | 41 | 109 |
| 2022 January | 74 | 35 | 109 |
| 2021 December | 66 | 69 | 135 |
| 2021 November | 52 | 33 | 85 |
| 2021 October | 88 | 81 | 169 |
| 2021 September | 44 | 37 | 81 |
| 2021 June | 29 | 4 | 33 |
Show all
