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la presencia de signos o s&#237;ntomas cl&#237;nicos espec&#237;ficos de dicha infecci&#243;n&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La etiolog&#237;a de las IU-SU en pacientes cr&#237;ticos ingresados en UCI presenta algunas diferencias respecto a las infecciones urinarias del resto de pacientes hospitalizados debido a la presencia de determinados pat&#243;genos&#44; presentes tanto en el propio paciente como en su entorno&#44; seleccionados por la frecuente utilizaci&#243;n de antibi&#243;ticos<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; El incremento de las resistencias de estos pat&#243;genos puede condicionar cambios en los tratamientos emp&#237;ricos de esta infecci&#243;n&#46; La informaci&#243;n respecto a este problema infeccioso en pacientes cr&#237;ticos es escasa&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Espa&#241;ola de Medicina Intensiva&#44; Cr&#237;tica y Unidades Coronarias &#40;GTEI-SEMICYUC&#41; ha promovido la vigilancia de la infecciones adquiridas en UCI y relacionadas con dispositivos desde hace a&#241;os&#46; El Estudio Nacional de Vigilancia de Infecci&#243;n Nosocomial adquirida en UCI &#40;ENVIN-UCI&#41; ha registrado esta infecci&#243;n en las UCI espa&#241;olas desde el a&#241;o 1994<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Los resultados de la evoluci&#243;n de las tasas de las IU-SU&#44; de sus etiolog&#237;as&#44; as&#237; como de los marcadores de multirresistencia de los pat&#243;genos m&#225;s comunes&#44; se presentan en este estudio&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="par0020" class="elsevierStylePara elsevierViewall">Estudio observacional&#44; prospectivo&#44; de participaci&#243;n voluntaria y multic&#233;ntrico&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Pacientes de estudio</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se han incluido de forma prospectiva todos los pacientes portadores de sonda urinaria durante m&#225;s de 24 horas&#44; ingresados en las UCI participantes&#44; desde el 1 de abril al 30 de junio entre los a&#241;os 2005 y 2010 &#40;ambos inclusives&#41;&#46; El n&#250;mero de pacientes incluidos en el registro cada a&#241;o&#44; las UCI participantes y el n&#250;mero total de pacientes-d&#237;a en UCI se incluyen en la <a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Metodolog&#237;a de la vigilancia</span><p id="par0030" class="elsevierStylePara elsevierViewall">Los pacientes ingresados antes del primer d&#237;a del periodo de control y que permanecieron ingresados durante la fase de estudio&#44; no han sido objeto de seguimiento&#46; La vigilancia de los pacientes incluidos en el estudio ha sido continua y fueron seguidos hasta su alta de UCI o hasta un m&#225;ximo de 60 d&#237;as&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">De todos los pacientes seleccionados se han recogido variables demogr&#225;ficas&#44; patolog&#237;a de base&#44; instrumentaciones recibidas &#40;intubaci&#243;n y ventilaci&#243;n mec&#225;nica&#44; sondaje uretral&#44; cat&#233;teres venosos centrales y cat&#233;teres arteriales&#41;&#44; estancia hospitalaria previa al ingreso en UCI&#44; estancia en UCI y situaci&#243;n cl&#237;nica en el momento del alta de UCI&#46; Los enfermos fueron clasificados por motivo de ingreso&#58; &#171;coronarios&#187;&#44; cuando el motivo de ingreso fue una patolog&#237;a isqu&#233;mica coronaria o cardiaca&#59; &#171;traum&#225;ticos&#187;&#44; cuando la causa de ingreso fue un traumatismo en cualquier localizaci&#243;n&#59; &#171;quir&#250;rgicos&#187;&#44; cuando ingresaron en el postoperatorio inmediato de una cirug&#237;a programada y&#44; &#171;m&#233;dicos&#187;&#44; en el resto de casos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La gravedad de los pacientes ha sido valorada mediante la combinaci&#243;n de la puntuaci&#243;n del sistema APACHE II<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; La necesidad de cirug&#237;a urgente&#44; fue definida como la necesidad de intervenci&#243;n quir&#250;rgica no electiva&#44; antes o durante la estancia en UCI&#46; La mortalidad cruda se defini&#243; como aquella que se produjo durante la estancia en UCI por cualquier motivo&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagn&#243;stico de IU-SU</span><p id="par0045" class="elsevierStylePara elsevierViewall">Los criterios utilizados para definir esta infecci&#243;n han sido los publicados en el manual del proyecto ENVIN<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#44; siguiendo las indicaciones del CDC<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; Para su diagn&#243;stico fue necesario que los signos cl&#237;nicos y&#47;o microbiol&#243;gicos no estuvieran presentes ni en periodo de incubaci&#243;n en el momento del sondaje uretral&#46; Los pacientes deben tener uno de los 3 s&#237;ntomas y&#47;o signos cl&#237;nicos siguientes&#58; fiebre superior a 38&#176; C&#44; tensi&#243;n en la zona suprap&#250;bica o urgencia urinaria y piuria&#46; Esta &#250;ltima fue definida como m&#225;s de 10 leucocitos&#47;ml de orina o m&#225;s de 3 leucocitos&#47;ml en una muestra no centrifugada&#46; As&#237; mismo&#44; deben cumplir uno de los 2 criterios microbiol&#243;gicos&#58; a&#41; en los pacientes sin antibi&#243;ticos&#44; cultivo de orina con aislamiento de &#8805; 10<span class="elsevierStyleSup">5</span> ufc&#47;ml de no m&#225;s de 2 microorganismos&#44; y b&#41; en los pacientes con antibi&#243;ticos&#44; cultivo de orina con &#60;10<span class="elsevierStyleSup">5</span> ufc&#47;ml de un &#250;nico microorganismo&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Las IU-SU fueron diagnosticadas por los m&#233;dicos responsables de los pacientes y documentadas como tal en la historia cl&#237;nica&#46; Los responsables de la vigilancia de infecci&#243;n nosocomial fueron m&#233;dicos especialistas en medicina intensiva con especial inter&#233;s y formaci&#243;n en enfermedades infecciosas&#46; Estos m&#233;dicos registraron de forma prospectiva las infecciones pero no intervinieron de forma directa en su diagn&#243;stico&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La respuesta sist&#233;mica de las IU-SU fue valorada como sepsis&#44; sepsis grave y shock s&#233;ptico siguiendo los criterios de la conferencia de consenso del 2001<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Para el diagn&#243;stico etiol&#243;gico fueron aceptados los procedimientos seguidos en los laboratorios de los hospitales participantes&#46; La susceptibilidad a los distintos antibi&#243;ticos de los pat&#243;genos identificados como responsables de las infecciones&#44; se realiz&#243; siguiendo las especificaciones &#40;m&#233;todo y valores&#41; del National Comitee for Clinical Laboratory Standards &#40;NCCLS&#44; 1995&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> del Clinical and Laboratory Standards Institute &#40;CLSI&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> y m&#225;s recientemente del European Committee on Antimicrobial Susceptibility Testing &#40;EUCAST&#41;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Se han definido marcadores de resistencia de los pat&#243;genos m&#225;s frecuentes&#58; en <span class="elsevierStyleItalic">Escherichia coli &#40;E&#46; coli&#41;</span> y <span class="elsevierStyleItalic">Proteus mirabilis &#40;P&#46; mirabilis&#41;</span>&#44; cefotaxima y ciprofloxacina&#44; en <span class="elsevierStyleItalic">Pseudomonas aeruginosa &#40;P&#46; aeruginosa&#41;</span>&#44; imipenem&#44; ciprofloxacino y amikacina&#44; en <span class="elsevierStyleItalic">Enterococcus faecalis &#40;E&#46; faecalis&#41;</span>&#44; vancomicina y ampicilina y en <span class="elsevierStyleItalic">Candida albicans &#40;C&#46; albicans&#41;</span>&#44; fluconazol&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Factores de riesgo</span><p id="par0065" class="elsevierStylePara elsevierViewall">Los factores de riesgo se han calculado de forma global para todos los enfermos ingresados durante el periodo de vigilancia&#44; seg&#250;n los criterios utilizados en el NNIS<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Para ello se han contabilizado diariamente los pacientes con sonda uretral&#46; Se ha calculado el ratio de utilizaci&#243;n de sonda uretral definido como el cociente entre el n&#250;mero de d&#237;as de utilizaci&#243;n de la sonda uretral y los d&#237;as de riesgo &#40;d&#237;as de estancia&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medidas de incidencia</span><p id="par0070" class="elsevierStylePara elsevierViewall">Se han calculado la incidencia acumulada &#40;IA&#41; y la densidad de incidencia &#40;DI&#41;&#46; La incidencia acumulada se calcula dividiendo el n&#250;mero episodios de IU-SU por el total de pacientes incluidos en el periodo de vigilancia y se expresa en porcentajes&#46; La densidad de incidencia se calcula dividiendo el n&#250;mero de IU-SU por el total de d&#237;as de exposici&#243;n de SU&#46; Se expresa como el n&#250;mero de episodios de IU-SU por 1&#46;000 d&#237;as de exposici&#243;n a SU&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis estad&#237;stico</span><p id="par0075" class="elsevierStylePara elsevierViewall">La recogida de datos se ha realizado utilizando la aplicaci&#243;n inform&#225;tica ENVIN-UCI que est&#225; ubicada en un servidor web y a la cual se accede mediante Internet&#46; La base de datos &#40;en SQL Server&#41; est&#225; en el mismo servidor&#46; El programa dispone de sistemas de seguridad que obligan a cumplimentar las variables definidas como b&#225;sicas e imposibilitan la introducci&#243;n de valores il&#243;gicos&#46; Las variables cualitativas se describen con el porcentaje de distribuci&#243;n de cada una de las categor&#237;as&#46; Las variables cuantitativas se describen con la media y la desviaci&#243;n est&#225;ndar cuando siguen una distribuci&#243;n normal&#59; con la mediana y rango intercuart&#237;lico&#44; en caso contrario&#46; El estudio de la comparaci&#243;n de la incidencia de la IU-SU en funci&#243;n de variables cualitativas &#40;como la patolog&#237;a de base o la presencia de cirug&#237;a urgente&#41; se ha realizado mediante la prueba del chi-cuadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41;&#46; En el caso de variables ordinales &#40;edad o APACHE II categorizadas&#41; se ha calculado tambi&#233;n el chi-cuadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41; para tendencia lineal&#46; El nivel de significaci&#243;n estad&#237;stica aceptado ha sido del 5&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">Durante los 6 a&#241;os analizados se han incluido 78&#46;863 pacientes de los que 2&#46;329 &#40;2&#44;95&#37;&#41; han presentado una o m&#225;s IU-SU durante su estancia en UCI&#46; Las caracter&#237;sticas de los pacientes dependiendo de la presencia o no de una IU-SU se incluyen en la <a class="elsevierStyleCrossRef" href="#tbl2">tabla 2</a>&#46; La presencia de esta infecci&#243;n ha sido m&#225;s frecuente en mujeres&#44; en los pacientes m&#225;s graves al ingreso y en aquellos clasificados como m&#233;dicos o quir&#250;rgicos&#46; De igual manera ha predominado entre los pacientes con dispositivos invasores&#44; tratamientos sustitutivos &#40;nutrici&#243;n parenteral&#44; depuraci&#243;n extrarrenal&#41; y en aquellos con factores de riesgo relacionados con su enfermedad &#40;neutropenia&#44; inmunosupresi&#243;n e inmunodepresi&#243;n&#44; haciendo referencia esta &#250;ltima a la adquirida y VIH&#41;&#46;</p><elsevierMultimedia ident="tbl2"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl3">tabla 3</a> se incluye el n&#250;mero de IU-SU detectadas en cada uno de los a&#241;os controlados&#44; as&#237; como el n&#250;mero de pacientes en los que se han identificado estas infecciones&#44; el n&#250;mero de pacientes con sonda uretral y el n&#250;mero total de paciente-d&#237;a con sonda uretral&#46; Con estas variables se calculan las 4 formas de expresar la frecuencia de estas infecciones&#46; La relaci&#243;n entre el n&#250;mero de d&#237;as de pacientes ingresados en UCI con sonda uretral y el n&#250;mero total de d&#237;as de pacientes ingresados en UCI se ha mantenido a lo largo de los a&#241;os constante&#44; en torno a 0&#44;85 &#40;IC 95&#37;&#58; 0&#44;83-0&#44;86&#41;&#44; mientras que los diferentes indicadores de frecuencia de IU-SU han disminuido de forma significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl3">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl3"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl4">tabla 4</a> se incluye la etiolog&#237;a de todos los episodios de IU-SU&#46; Han predominado en los a&#241;os analizados los bacilos gramnegativos&#44; oscilando entre el 55 y 60&#37; de todos los aislados&#44; en especial <span class="elsevierStyleItalic">E&#46; coli</span>&#46; El segundo lugar lo ocupan los hongos&#44; entre el 19 y 25&#37; de los aislados&#44; todos ellos del g&#233;nero Candida&#44; destacando <span class="elsevierStyleItalic">C&#46; albicans</span> en la mitad de los episodios&#46; Entre los cocos grampositivos han predominado de forma mayoritaria los enterococos&#44; en especial <span class="elsevierStyleItalic">E&#46; faecalis</span>&#46;</p><elsevierMultimedia ident="tbl4"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">La respuesta sist&#233;mica asociada con las IU-SU se incluye en la <a class="elsevierStyleCrossRef" href="#tbl5">tabla 5</a>&#46; En la mitad de los casos no existe respuesta inflamatoria sist&#233;mica y en menos del 15&#37; de los casos la respuesta se ha clasificado como de gravedad&#46;</p><elsevierMultimedia ident="tbl5"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Los marcadores de multirresistencia de los principales pat&#243;genos responsables de IU-SU demuestran importantes diferencias entre ellos &#40;<a class="elsevierStyleCrossRef" href="#tbl6">tabla 6</a>&#41;&#46; Mientras que en <span class="elsevierStyleItalic">E&#46; coli</span> se observa un progresivo incremento de las cepas resistentes a ciprofloxacino&#44; no se observan este incremento frente a cefotaxima&#46; En <span class="elsevierStyleItalic">P&#46; aeruginosa</span> la resistencia frente a ciprofloxacino e imipenem superan el 30&#37; mientras que es pr&#225;cticamente inexistente la resistencias de ampicilina y vancomicina en <span class="elsevierStyleItalic">E&#46; faecalis</span>&#46; Tampoco se ha detectado la presencia de cepas <span class="elsevierStyleItalic">C&#46; albicans</span> resistentes a fluconazol&#46;</p><elsevierMultimedia ident="tbl6"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Los pacientes con IU-SU han tenido una mayor estancia en UCI &#40;25&#44;59 frente a 4&#44;39 d&#237;as&#41; y una mayor mortalidad global intra-UCI &#40;22&#44;4 frente a 8&#44;6&#37;&#41; sin que los datos disponibles permitan establecer una relaci&#243;n entre dichas variables y la presencia de IU-SU&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0110" class="elsevierStylePara elsevierViewall">La principal aportaci&#243;n de este estudio ha sido describir las tasas&#44; etiolog&#237;as y marcadores de multirresistencias de las IU-SU desarrolladas en pacientes cr&#237;ticos ingresados en UCI en los &#250;ltimos 6 a&#241;os &#40;2005-2010&#41;&#46; Los datos evolutivos de las tasas demuestran una disminuci&#243;n significativa de las IU-SU independientemente de la tasa utilizada para expresarlas&#46; En el &#250;ltimo a&#241;o considerado&#44; la tasa expresada como densidad de incidencia fue de 4&#44;18 episodios por 1&#46;000 d&#237;as de SU&#46; Esta tasa se encuentra dentro de los l&#237;mites publicados por el National Healthcare Safety Network &#40;NHSN&#41; en diciembre del 2009 con los datos acumulados entre los a&#241;os 2006 y 2008 en UCI americanas<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; La DI de IU-SU oscil&#243; entre 7&#44;4 episodios por 1&#46;000 d&#237;as de SU en UCI de pacientes quemados o neurol&#243;gicos y 3&#44;1 episodios por 1&#46;000 d&#237;as de SU en UCI m&#233;dico-quir&#250;rgicas de m&#225;s de 15 camas&#44; siendo la media nacional calculada a partir de sus datos de 4&#44;08 episodios por 1&#46;000 d&#237;as de SU&#46; Las referencias de IU-SU en la literatura oscilan entre 1&#44;4 episodios por 1&#46;000 d&#237;as de SU en 12 UCI en la India<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#44; 5&#44;1 episodios por 1&#46;000 d&#237;as de SU en 4 UCI de Per&#250;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#44; hasta la m&#225;s reciente publicada de 15&#44;7 episodios por 1&#46;000 d&#237;as de SU en 4 UCI de Alejandr&#237;a &#40;Egipto&#41;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Las tasas de IU-SU en las UCI espa&#241;olas han disminuido significativamente en los &#250;ltimos a&#241;os sin que se haya aplicado ning&#250;n proyecto nacional de prevenci&#243;n espec&#237;fico para estas infecciones&#46; Durante este periodo se han desarrollado campa&#241;as espec&#237;ficas para promover el lavado de manos entre el personal sanitario de la mayor&#237;a de hospitales espa&#241;oles<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#44; se ha iniciado una campa&#241;a nacional para prevenir las bacteriemias relacionadas con cat&#233;teres en las UCI &#40;proyecto bacteriemia zero&#41; mediante la aplicaci&#243;n de un paquete de medidas multifactoriales &#40;una de ellas era el lavado de manos antes y despu&#233;s de manipular un cat&#233;ter&#41;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> y se ha extendido el concepto de seguridad integral de los pacientes mediante cursos y casos pr&#225;cticos&#46; Es posible que el conjunto de actividades encaminadas a promover un entorno seguro en las UCI haya contribuido a mejorar las tasas de esta infecci&#243;n&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La etiolog&#237;a de las IU-SU no se ha modificado en estos a&#241;os manteni&#233;ndose en primer lugar los bacilos gramnegativos y en especial el <span class="elsevierStyleItalic">E&#46; coli</span>&#44; seguido de otros microorganismos como <span class="elsevierStyleItalic">E&#46; faecalis</span> y <span class="elsevierStyleItalic">C&#46; albicans</span><a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#44; siendo mucho menos frecuentes otros pat&#243;genos que pueden ser end&#233;micos en las UCI y permanecer en el ambiente como <span class="elsevierStyleItalic">S&#46; aureus</span> resistente a meticilina&#44; <span class="elsevierStyleItalic">P&#46; aeruginosa</span> y <span class="elsevierStyleItalic">Acinetobacter baumannii</span> &#40;<span class="elsevierStyleItalic">A&#46; baumannii&#41;</span>y que son los principales responsables de otras infecciones nosocomiales como las neumon&#237;as relacionadas con ventilaci&#243;n mec&#225;nica<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; Ello reafirma la importancia de la flora ent&#233;rica en el origen de estas infecciones y la necesidad de extremar todas las medidas que limiten o dificulten la contaminaci&#243;n de las sondas uretrales<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#8211;23</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El tratamiento de estas infecciones est&#225; condicionado por la evoluci&#243;n de las resistencias de los pat&#243;genos m&#225;s frecuentes&#46; Hasta hace poco las quinolonas y las penicilinas semisint&#233;ticas eran el tratamiento de primera elecci&#243;n ante la presencia de BGN en una tinci&#243;n de orina&#46; Actualmente en los casos en los que la IU-SU se acompa&#241;e de signos de sepsis grave o shock s&#233;ptico el tratamiento emp&#237;rico debe considerar la presencia de <span class="elsevierStyleItalic">E&#46; coli</span> productor de betalactamasas de especto extendido &#40;resistente a cefalosporinas&#41; o de un bacilo gramnegativo no fermentador &#40;BGNNF&#41; por los que una combinaci&#243;n de un carbapen&#233;mico y un aminogluc&#243;sido activo frente a los BGNNF podr&#237;a ser un tratamiento de elecci&#243;n&#46; Esta combinaci&#243;n no se puede mantener durante todo el tratamiento y debe ajustarse lo antes posible a la sensibilidad del pat&#243;geno responsable&#46; En casos de presencia de levaduras el tratamiento de elecci&#243;n es fluconazol&#46; Por el contrario&#44; en aquellas situaciones en las que la IU-SU no se asocie con respuesta inflamatoria sist&#233;mica podr&#237;a evaluarse el no iniciar tratamiento antimicrobiano&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La mortalidad y la estancia en UCI en los pacientes con IU-SU es superior a la de aquellos sin este tipo de infecci&#243;n&#44; pero de la informaci&#243;n aportada en este estudio no puede deducirse que la IU-SU incremente la mortalidad o la estancia&#46; Para ello son necesarios estudios m&#225;s complejos&#44; basados en una metodolog&#237;a caso-control&#44; con poblaciones de pacientes m&#225;s homog&#233;neas que las incluidas en este an&#225;lisis&#46; Los datos publicados con respecto a la mortalidad son contradictorios&#46; Recientemente se ha publicado un metaan&#225;lisis que aunque sugiere un impacto estad&#237;sticamente significativo sobre la mortalidad&#44; la estancia en UCI e intrahospitalaria&#44; no se confirma si se utilizan los estudios que realizan ajustes de las variables inclu&#237;das&#46; Se identifica una probabilidad de mortalidad en UCI de 1&#44;94 &#40;IC 95&#37;&#58; 1&#44;61-2&#44;34&#41;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Como todos los estudios multic&#233;ntricos&#44; de participaci&#243;n voluntaria existe un sesgo de selecci&#243;n de pacientes que se ve compensado por la amplia participaci&#243;n de UCI y el volumen de pacientes acumulados&#46; Por otro lado&#44; la aplicaci&#243;n de la definici&#243;n de IU-SU en el paciente cr&#237;tico&#44; a menudo sedado y&#47;o analgesiado&#44; es dif&#237;cil en especial para su diferenciaci&#243;n con las bacteriurias asintom&#225;ticas&#44; por lo que las tasas reales pueden estar sobreestimadas&#46; Este hecho se ve agravado por la tendencia&#44; cada vez mayor&#44; de realizar estudios de vigilancia activa de flora multirresistente&#44; que incluye muestras de orina en pacientes asintom&#225;ticos o con otros focos de infecci&#243;n&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Se puede concluir que en nuestro pa&#237;s existe una tendencia significativa a disminuir las IU-SU sin que se haya realizado una intervenci&#243;n espec&#237;fica para ello&#46; Las etiolog&#237;as se mantienen estables predominando los BGN&#44; en especial <span class="elsevierStyleItalic">E&#46; coli</span>&#46; El tratamiento emp&#237;rico en las situaciones de mayor gravedad debe considerar la cobertura de los pat&#243;genos multirresistentes que han aumentado especialmente en <span class="elsevierStyleItalic">E&#46; coli</span> y <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#44; mientras que en aquellas sin respuesta sist&#233;mica podr&#237;an plantearse el no iniciar tratamiento antimicrobiano&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los autores han declarado no tener ning&#250;n conflicto de intereses en la realizaci&#243;n de este estudio&#46;</p></span></span>"
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          "titulo" => array:9 [
            0 => "Resumen"
            1 => "Objetivo"
            2 => "Dise&#241;o"
            3 => "Ambito"
            4 => "Pacientes"
            5 => "Intervenci&#243;n"
            6 => "Variables de inter&#233;s"
            7 => "Resultados"
            8 => "Conclusiones"
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          "identificador" => "xpalclavsec72261"
          "titulo" => "Palabras clave"
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        2 => array:2 [
          "identificador" => "xres84101"
          "titulo" => array:9 [
            0 => "Abstract"
            1 => "Objective"
            2 => "Design"
            3 => "Setting"
            4 => "Patients"
            5 => "Intervention"
            6 => "Variables of interest"
            7 => "Results"
            8 => "Conclusions"
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        3 => array:2 [
          "identificador" => "xpalclavsec72260"
          "titulo" => "Keywords"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introducci&#243;n"
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        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Pacientes y m&#233;todos"
          "secciones" => array:7 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Dise&#241;o"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Pacientes de estudio"
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            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Metodolog&#237;a de la vigilancia"
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            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Diagn&#243;stico de IU-SU"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Factores de riesgo"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Medidas de incidencia"
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            6 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "An&#225;lisis estad&#237;stico"
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          "titulo" => "Resultados"
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        7 => array:2 [
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          "titulo" => "Discusi&#243;n"
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          "titulo" => "Conflicto de intereses"
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        9 => array:1 [
          "titulo" => "Bibliograf&#237;a"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-12-12"
    "fechaAceptado" => "2012-02-21"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec72261"
          "palabras" => array:5 [
            0 => "Infecci&#243;n urinaria"
            1 => "Sonda uretral"
            2 => "Paciente cr&#237;tico"
            3 => "UCI"
            4 => "ENVIN"
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      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec72260"
          "palabras" => array:5 [
            0 => "Urinary tract infection"
            1 => "urinary catheter"
            2 => "Critically ill patient"
            3 => "ICU"
            4 => "ENVIN"
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    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Describir la evoluci&#243;n de las tasas nacionales de las infecciones urinarias relacionada con sonda uretral &#40;IU-SU&#41;&#44; as&#237; como la de sus etiolog&#237;as y marcadores de multirresistencia&#46;</p> <span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; prospectivo&#44; de participaci&#243;n voluntaria y multic&#233;ntrico desde el 1 de abril al 30 de junio entre los a&#241;os 2005 y 2010&#46;</p> <span class="elsevierStyleSectionTitle">Ambito</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Unidades de Cuidados Intensivos &#40;UCI&#41; que participaron en el registro ENVIN-UCI en el periodo de estudio&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se han incluido todos los pacientes ingresados en las UCI participantes y portadores de sonda urinaria durante m&#225;s de 24 horas &#40;78&#46;863 pacientes&#41;</p> <span class="elsevierStyleSectionTitle">Intervenci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La vigilancia de los pacientes ha sido continua hasta el alta de UCI o un m&#225;ximo de 60 d&#237;as&#46;</p> <span class="elsevierStyleSectionTitle">Variables de inter&#233;s</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se han definido las IU-SU siguiendo los criterios del CDC y su frecuencia se expresa como densidad de incidencia &#40;DI&#41; en relaci&#243;n al n&#250;mero de d&#237;as de paciente-SU&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Han presentado una o m&#225;s IU-SU 2&#46;329 &#40;2&#44;95&#37;&#41; pacientes&#46; La DI de IU-SU ha disminuido desde 6&#44;69 a 4&#44;18 episodios por 1&#46;000 d&#237;as de SU desde el a&#241;o 2005 al a&#241;o 2010 &#40;p&#60;0&#44;001&#41;&#46; En la etiolog&#237;a han predominado los bacilos gramnegativos &#40;55&#44;6-61&#44;6&#37;&#41;&#44; seguido de hongos &#40;18&#44;7-25&#44;2&#41; y de los cocos grampositivos &#40;17&#44;1-25&#44;9&#37;&#41;&#46; En el a&#241;o 2010&#44; han aumentado las cepas de <span class="elsevierStyleItalic">E&#46; coli</span> resistentes a ciprofloxacino &#40;37&#44;1&#37;&#41; y de <span class="elsevierStyleItalic">P&#46; aeruginosa</span> resistente a imipenem &#40;36&#44;4&#37;&#41; y ciprofloxacino &#40;37&#44;1&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Disminuci&#243;n de las tasas de IU-SU&#44; manteni&#233;ndose la misma distribuci&#243;n de etiolog&#237;a e increment&#225;ndose las resistencia en los BGN&#44; en especial el <span class="elsevierStyleItalic">E&#46; coli</span> y <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To describe trends in national catheter-related urinary tract infection &#40;CRUTI&#41; rates&#44; as well as etiologies and multiresistance markers&#46;</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">An observational&#44; prospective&#44; multicenter voluntary participation study was conducted from 1 April to 30 June in the period between 2005 and 2010&#46;</p> <span class="elsevierStyleSectionTitle">Setting</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Intensive Care Units &#40;ICUs&#41; that participated in the ENVIN-ICU registry during the study period&#46;</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">We included all patients admitted to the participating ICUs and patients with urinary catheter placement for more than 24<span class="elsevierStyleHsp" style=""></span>hours &#40;78&#44;863 patients&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Intervention</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Patient monitoring was continued until discharge from the ICU or up to 60 days&#46;</p> <span class="elsevierStyleSectionTitle">Variables of interest</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CRUTIs were defined according to the CDC system&#44; and frequency is expressed as incidence density &#40;ID&#41; in relation to the number of urinary catheter-patients days&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A total of 2329 patients &#40;2&#46;95&#37;&#41; developed one or more CRUTI&#46; The ID decreased from 6&#46;69 to 4&#46;18 episodes per 1000 days of urinary catheter between 2005 and 2010 &#40;p&#60;0&#46;001&#41;&#46; In relation to the underlying etiology&#44; gramnegative bacilli predominated &#40;55&#46;6 to 61&#46;6&#37;&#41;&#44; followed by fungi &#40;18&#46;7 to 25&#46;2&#37;&#41; and grampositive cocci &#40;17&#46;1 to 25&#46;9&#37;&#41;&#46; In 2010&#44; ciprofloxacin-resistant <span class="elsevierStyleItalic">E&#46; coli</span> strains &#40;37&#46;1&#37;&#41; increased&#44; as well as imipenem-resistant &#40;36&#46;4&#37;&#41; and ciprofloxacin-resistant &#40;37&#46;1&#37;&#41; strains of <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">A decrease was observed in CRUTI rates&#44; maintaining the same etiological distribution and showing increased resistances in gramnegative pathogens&#44; especially <span class="elsevierStyleItalic">E&#46; coli</span> and <span class="elsevierStyleItalic">P&#46; aeruginosa&#46;</span></p>"
      ]
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">2005&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" style="border-bottom: 2px solid black">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2007&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" style="border-bottom: 2px solid black">2008&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" style="border-bottom: 2px solid black">2009&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" style="border-bottom: 2px solid black">2010&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" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Pacientes-UCI &#62;24 horas&#44; n&#46;&#176;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#46;969&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&#46;684&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#46;453&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">13&#46;824&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">14&#46;983&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">16&#46;950&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">78&#46;863&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">UCI&#44; n&#46;&#176;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">121&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">147&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Pacientes-UCI-d&#237;as&#44; n&#46;&#176;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ventilaci&#243;n mec&#225;nica&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">162 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Depuraci&#243;n extrarrenal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inmunodepresi&#243;n &#40;HIV&#41;&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">22&#46;976 &#40;49&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&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="elsevierStyleHsp" style=""></span>Nutrici&#243;n parenteral&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;241 &#40;9&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&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">Estancia en UCI&#44; d&#237;as&#44; media &#40;DE&#41;</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
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                  \t\t\t\t">25&#44;59 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;39 &#40;4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&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"><span class="elsevierStyleItalic">Mortalidad&#44; n&#46;&#176; &#40;&#37;&#41;</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">424 &#40;22&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;519 &#40;8&#44;6&#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">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&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" style="border-bottom: 2px solid black">2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2008&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" style="border-bottom: 2px solid black">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2010&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">Variables</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \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
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                  \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
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&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="elsevierStyleHsp" style=""></span>IU-SU&#44; n&#46;&#176;&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">393&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">401&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">403&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">438&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">451&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">470&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pacientes con IU-SU&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">352&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">372&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">370&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">394&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">404&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">418&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pacientes con SU&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&#46;520&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&#46;437&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;024&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&#46;421&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&#46;258&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&#46;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D&#237;as-UCI-SU&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">58&#46;716&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">78&#46;406&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;941&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">92&#46;098&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">105&#46;398&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">112&#46;452&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ratios</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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" 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="elsevierStyleHsp" style=""></span>Ratio D&#237;as-UCI-SU &#47;D&#237;as estancia en UCI&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;85&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;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;86&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;84&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;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tasas de IU-SU</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</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="" 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><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" 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="elsevierStyleHsp" style=""></span>N&#46;&#176; IU-SU &#47; N&#46;&#176; de pacientes UCI &#62; 24 h x100 &#40;IC&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</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">4&#44;38 &#40;3&#44;9-4&#44;8&#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">3&#44;43 &#40;3&#44;1-3&#44;8&#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">3&#44;24 &#40;2&#44;9-3&#44;6&#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">3&#44;17 &#40;2&#44;8-3&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;01 &#40;2&#44;7-3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;77 &#40;2&#44;53-3&#44;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#46;&#176; IU-SU &#47; N&#46;&#176; de pac&#46; en UCI &#62; 24 h con SU x100 &#40;IC&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</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">6&#44;03 &#40;5&#44;4-6&#44;6&#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">4&#44;75 &#40;4&#44;3-5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;47 &#40;4&#44;0-4&#44;9&#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">4&#44;20 &#40;3&#44;8-4&#44;6&#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">4&#44;01 &#40;3&#44;6-4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;90 &#40;3&#44;56-4&#44;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#46;&#176; IU-SU &#47; N&#46;&#176; de paciente-d&#237;a en UCI x 1&#46;000 &#40;IC&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</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">5&#44;68 &#40;5&#44;1-6&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;26 &#40;3&#44;8-4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;91 &#40;3&#44;5-4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;07 &#40;3&#44;6-4&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;58 &#40;3&#44;3-3&#44;9&#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
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                  \t\t\t\t" style="border-bottom: 2px solid black">2005&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">2006&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">2007&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IU-SU&#44; n&#46;&#176;</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">393&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">401&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">403&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">438&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">451&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">470&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;556&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No respuesta sist&#233;mica&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">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">209 &#40;52&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">187 &#40;46&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">175 &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">193 &#40;42&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">141 &#40;30&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">905&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sepsis&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">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">163 &#40;40&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">164 &#40;40&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">205 &#40;46&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">200 &#40;44&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">263 &#40;56&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">995&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sepsis grave&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">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;8&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;9&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;8&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">178&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Shock s&#233;ptico&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">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;3&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;4&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab160252.png"
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar2115" class="elsevierStyleSimplePara elsevierViewall">Respuesta sist&#233;mica de los pacientes con IU-SU &#40;n&#46;&#176;&#44; &#37;&#41;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl6"
        "etiqueta" => "Tabla 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">N&#46;&#176;r&#58; n&#250;mero de cepas resistentes al antibi&#243;tico marcador&#59; N&#46;&#176;t&#58; n&#250;mero de cepas totales en las que se ha suministrado informaci&#243;n de resistencias&#46;</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"><td 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" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Marcadores de mltirresistencia&#44; N&#46;&#176;r&#47;N&#46;&#176;t &#40;&#37;&#41;</span></td></tr><tr title="table-row"><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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Escherichia coli</span> R a cefotaxima&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&#47;81 &#40;13&#44;6&#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">10&#47;96 &#40;10&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;81 &#40;12&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;92 &#40;13&#44;0&#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">16&#47;99 &#40;16&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;99 &#40;12&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Escherichia coli</span> R a ciprofloxacino&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&#47;79 &#40;30&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#47;102 &#40;30&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#47;82 &#40;35&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#47;101 &#40;31&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#47;101 &#40;36&#44;6&#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">39&#47;105 &#40;37&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> R a imipenem&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&#47;36 &#40;30&#44;6&#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">9&#47;31 &#40;29&#44;0&#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">8&#47;31 &#40;25&#44;8&#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">13&#47;50 &#40;26&#44;0&#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">11&#47;36 &#40;30&#44;6&#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">12&#47;33 &#40;36&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> R a ciprofloxacino&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&#47;37 &#40;32&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;34 &#40;35&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#47;39 &#40;43&#44;6&#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">18&#47;53 &#40;34&#44;0&#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">14&#47;34 &#40;41&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#47;40 &#40;37&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> R a amikacina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#47;36 &#40;25&#44;0&#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">7&#47;34 &#40;20&#44;6&#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&#47;37 &#40;13&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#47;50 &#40;26&#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">7&#47;32 &#40;21&#44;6&#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">4&#47;32 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Proteus mirabilis</span> R a cefotaxima&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&#47;5 &#40;0&#41;&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">0&#47;8 &#40;0&#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">0&#47;9 &#40;0&#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">1&#47;23 &#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;15 &#40;0&#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
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                  \t\t\t\t">2&#47;10 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Proteus mirabilis</span> R a ciprofloxacino&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&#47;5 &#40;0&#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">0&#47;9 &#40;0&#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">2&#47;12 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;20 &#40;10&#44;0&#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">2&#47;14 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;10 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enterococcus faecalis</span> R a vancomicina&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&#47;42 &#40;0&#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">0&#47;35 &#40;0&#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">0&#47;24 &#40;0&#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">0&#47;46 &#40;0&#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">0&#47;48 &#40;0&#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">1&#47;28 &#40;3&#44;6&#41;&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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enterococcus faecalis</span> R a ampicilina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#47;24<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a> &#40;37&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;39 &#40;0&#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
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                  \t\t\t\t">0&#47;33 &#40;0&#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
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                  \t\t\t\t">0&#47;36 &#40;0&#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">0&#47;50 &#40;0&#41;&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">3&#47;34 &#40;8&#44;8&#41;&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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Candida albicans</span> R a fluconazol&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">0&#47;6 &#40;0&#41;&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">0&#47;14 &#40;0&#41;&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&#47;13 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;24 &#40;0&#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
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                  \t\t\t\t">1&#47;17 &#40;5&#44;9&#41;&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&#47;19 &#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar3115" class="elsevierStyleSimplePara elsevierViewall">Evoluci&#243;n de los marcadores de multirresistencia de los pat&#243;genos m&#225;s frecuentes en IU-SU</p>"
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                    0 => array:2 [
                      "titulo" => "Catheter-associated urinary tract infections in intensive care units"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Leone"
                            1 => "F&#46; Garnier"
                            2 => "M&#46; Avidan"
                            3 => "C&#46; Martin"
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                    0 => array:2 [
                      "doi" => "10.1016/j.micinf.2004.05.016"
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                        "tituloSerie" => "Microbes Infect"
                        "fecha" => "2004"
                        "volumen" => "6"
                        "paginaInicial" => "1026"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15345235"
                            "web" => "Medline"
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Infección urinaria relacionada con sonda uretral en pacientes críticos ingresados en UCI. Datos descriptivos del estudio ENVIN-UCI
Urethral catheter-related urinary infection in critical patients admitted to the ICU. Descriptive data of the ENVIN-UCI STUDY
F. Álvarez-Lermaa,
Autor para correspondencia
Falvarez@hospitaldelmar.cat

Autor para correspondencia.
, M.P. Gracia-Arnillasa, M. Palomarb, P. Olaecheac, J. Insaustid, M.J. López-Pueyoe, J.J. Otalf, R. Gimenog, I. Seijash, Grupo de Investigadores del Estudio Nacional de Vigilancia de Infección Nosocomial en UCI
a Servicio de Medicina Intensiva, Hospital del Mar, Parc de Salut Mar, Barcelona, España
b Servicio de Medicina Intensiva, Hospital de la Vall d‘Hebrón, Barcelona, España
c Servicio de Medicina Intensiva, Hospital de Galdakao, Vizcaya, España
d Servicio de Medicina Intensiva, Hospital de Navarra, Pamplona, España
e Servicio de Medicina Intensiva, Hospital General Yagüe, Burgos, España
f Servicio de Epidemiología y Medicina Preventiva, Hospital Vall d‘Hebrón, Barcelona, España
g Servicio de Medicina Intensiva, Hospital la Fe, Valencia, España
h Servicio de Medicina Intensiva, Hospital de Cruces, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La infecci&#243;n urinaria relacionada con sonda uretral &#40;IU-SU&#41; es una de las infecciones m&#225;s frecuente identificada en los pacientes ingresados en los Servicios o Unidades de Cuidados Intensivos &#40;UCI&#41;&#44; despu&#233;s de la neumon&#237;a relacionada con ventilaci&#243;n mec&#225;nica y la bacteriemia primaria o relacionada con cat&#233;teres vasculares<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; En la mayor&#237;a de los casos&#44; su diagn&#243;stico se basa en el aislamiento de un n&#250;mero significativo de bacterias u hongos por mililitro de orina en pacientes con signos cl&#237;nicos de respuesta inflamatoria sist&#233;mica&#44; siendo menos frecuente&#44; la presencia de signos o s&#237;ntomas cl&#237;nicos espec&#237;ficos de dicha infecci&#243;n&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La etiolog&#237;a de las IU-SU en pacientes cr&#237;ticos ingresados en UCI presenta algunas diferencias respecto a las infecciones urinarias del resto de pacientes hospitalizados debido a la presencia de determinados pat&#243;genos&#44; presentes tanto en el propio paciente como en su entorno&#44; seleccionados por la frecuente utilizaci&#243;n de antibi&#243;ticos<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; El incremento de las resistencias de estos pat&#243;genos puede condicionar cambios en los tratamientos emp&#237;ricos de esta infecci&#243;n&#46; La informaci&#243;n respecto a este problema infeccioso en pacientes cr&#237;ticos es escasa&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Espa&#241;ola de Medicina Intensiva&#44; Cr&#237;tica y Unidades Coronarias &#40;GTEI-SEMICYUC&#41; ha promovido la vigilancia de la infecciones adquiridas en UCI y relacionadas con dispositivos desde hace a&#241;os&#46; El Estudio Nacional de Vigilancia de Infecci&#243;n Nosocomial adquirida en UCI &#40;ENVIN-UCI&#41; ha registrado esta infecci&#243;n en las UCI espa&#241;olas desde el a&#241;o 1994<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Los resultados de la evoluci&#243;n de las tasas de las IU-SU&#44; de sus etiolog&#237;as&#44; as&#237; como de los marcadores de multirresistencia de los pat&#243;genos m&#225;s comunes&#44; se presentan en este estudio&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="par0020" class="elsevierStylePara elsevierViewall">Estudio observacional&#44; prospectivo&#44; de participaci&#243;n voluntaria y multic&#233;ntrico&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Pacientes de estudio</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se han incluido de forma prospectiva todos los pacientes portadores de sonda urinaria durante m&#225;s de 24 horas&#44; ingresados en las UCI participantes&#44; desde el 1 de abril al 30 de junio entre los a&#241;os 2005 y 2010 &#40;ambos inclusives&#41;&#46; El n&#250;mero de pacientes incluidos en el registro cada a&#241;o&#44; las UCI participantes y el n&#250;mero total de pacientes-d&#237;a en UCI se incluyen en la <a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Metodolog&#237;a de la vigilancia</span><p id="par0030" class="elsevierStylePara elsevierViewall">Los pacientes ingresados antes del primer d&#237;a del periodo de control y que permanecieron ingresados durante la fase de estudio&#44; no han sido objeto de seguimiento&#46; La vigilancia de los pacientes incluidos en el estudio ha sido continua y fueron seguidos hasta su alta de UCI o hasta un m&#225;ximo de 60 d&#237;as&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">De todos los pacientes seleccionados se han recogido variables demogr&#225;ficas&#44; patolog&#237;a de base&#44; instrumentaciones recibidas &#40;intubaci&#243;n y ventilaci&#243;n mec&#225;nica&#44; sondaje uretral&#44; cat&#233;teres venosos centrales y cat&#233;teres arteriales&#41;&#44; estancia hospitalaria previa al ingreso en UCI&#44; estancia en UCI y situaci&#243;n cl&#237;nica en el momento del alta de UCI&#46; Los enfermos fueron clasificados por motivo de ingreso&#58; &#171;coronarios&#187;&#44; cuando el motivo de ingreso fue una patolog&#237;a isqu&#233;mica coronaria o cardiaca&#59; &#171;traum&#225;ticos&#187;&#44; cuando la causa de ingreso fue un traumatismo en cualquier localizaci&#243;n&#59; &#171;quir&#250;rgicos&#187;&#44; cuando ingresaron en el postoperatorio inmediato de una cirug&#237;a programada y&#44; &#171;m&#233;dicos&#187;&#44; en el resto de casos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La gravedad de los pacientes ha sido valorada mediante la combinaci&#243;n de la puntuaci&#243;n del sistema APACHE II<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; La necesidad de cirug&#237;a urgente&#44; fue definida como la necesidad de intervenci&#243;n quir&#250;rgica no electiva&#44; antes o durante la estancia en UCI&#46; La mortalidad cruda se defini&#243; como aquella que se produjo durante la estancia en UCI por cualquier motivo&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagn&#243;stico de IU-SU</span><p id="par0045" class="elsevierStylePara elsevierViewall">Los criterios utilizados para definir esta infecci&#243;n han sido los publicados en el manual del proyecto ENVIN<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#44; siguiendo las indicaciones del CDC<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; Para su diagn&#243;stico fue necesario que los signos cl&#237;nicos y&#47;o microbiol&#243;gicos no estuvieran presentes ni en periodo de incubaci&#243;n en el momento del sondaje uretral&#46; Los pacientes deben tener uno de los 3 s&#237;ntomas y&#47;o signos cl&#237;nicos siguientes&#58; fiebre superior a 38&#176; C&#44; tensi&#243;n en la zona suprap&#250;bica o urgencia urinaria y piuria&#46; Esta &#250;ltima fue definida como m&#225;s de 10 leucocitos&#47;ml de orina o m&#225;s de 3 leucocitos&#47;ml en una muestra no centrifugada&#46; As&#237; mismo&#44; deben cumplir uno de los 2 criterios microbiol&#243;gicos&#58; a&#41; en los pacientes sin antibi&#243;ticos&#44; cultivo de orina con aislamiento de &#8805; 10<span class="elsevierStyleSup">5</span> ufc&#47;ml de no m&#225;s de 2 microorganismos&#44; y b&#41; en los pacientes con antibi&#243;ticos&#44; cultivo de orina con &#60;10<span class="elsevierStyleSup">5</span> ufc&#47;ml de un &#250;nico microorganismo&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Las IU-SU fueron diagnosticadas por los m&#233;dicos responsables de los pacientes y documentadas como tal en la historia cl&#237;nica&#46; Los responsables de la vigilancia de infecci&#243;n nosocomial fueron m&#233;dicos especialistas en medicina intensiva con especial inter&#233;s y formaci&#243;n en enfermedades infecciosas&#46; Estos m&#233;dicos registraron de forma prospectiva las infecciones pero no intervinieron de forma directa en su diagn&#243;stico&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La respuesta sist&#233;mica de las IU-SU fue valorada como sepsis&#44; sepsis grave y shock s&#233;ptico siguiendo los criterios de la conferencia de consenso del 2001<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Para el diagn&#243;stico etiol&#243;gico fueron aceptados los procedimientos seguidos en los laboratorios de los hospitales participantes&#46; La susceptibilidad a los distintos antibi&#243;ticos de los pat&#243;genos identificados como responsables de las infecciones&#44; se realiz&#243; siguiendo las especificaciones &#40;m&#233;todo y valores&#41; del National Comitee for Clinical Laboratory Standards &#40;NCCLS&#44; 1995&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> del Clinical and Laboratory Standards Institute &#40;CLSI&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> y m&#225;s recientemente del European Committee on Antimicrobial Susceptibility Testing &#40;EUCAST&#41;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Se han definido marcadores de resistencia de los pat&#243;genos m&#225;s frecuentes&#58; en <span class="elsevierStyleItalic">Escherichia coli &#40;E&#46; coli&#41;</span> y <span class="elsevierStyleItalic">Proteus mirabilis &#40;P&#46; mirabilis&#41;</span>&#44; cefotaxima y ciprofloxacina&#44; en <span class="elsevierStyleItalic">Pseudomonas aeruginosa &#40;P&#46; aeruginosa&#41;</span>&#44; imipenem&#44; ciprofloxacino y amikacina&#44; en <span class="elsevierStyleItalic">Enterococcus faecalis &#40;E&#46; faecalis&#41;</span>&#44; vancomicina y ampicilina y en <span class="elsevierStyleItalic">Candida albicans &#40;C&#46; albicans&#41;</span>&#44; fluconazol&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Factores de riesgo</span><p id="par0065" class="elsevierStylePara elsevierViewall">Los factores de riesgo se han calculado de forma global para todos los enfermos ingresados durante el periodo de vigilancia&#44; seg&#250;n los criterios utilizados en el NNIS<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Para ello se han contabilizado diariamente los pacientes con sonda uretral&#46; Se ha calculado el ratio de utilizaci&#243;n de sonda uretral definido como el cociente entre el n&#250;mero de d&#237;as de utilizaci&#243;n de la sonda uretral y los d&#237;as de riesgo &#40;d&#237;as de estancia&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medidas de incidencia</span><p id="par0070" class="elsevierStylePara elsevierViewall">Se han calculado la incidencia acumulada &#40;IA&#41; y la densidad de incidencia &#40;DI&#41;&#46; La incidencia acumulada se calcula dividiendo el n&#250;mero episodios de IU-SU por el total de pacientes incluidos en el periodo de vigilancia y se expresa en porcentajes&#46; La densidad de incidencia se calcula dividiendo el n&#250;mero de IU-SU por el total de d&#237;as de exposici&#243;n de SU&#46; Se expresa como el n&#250;mero de episodios de IU-SU por 1&#46;000 d&#237;as de exposici&#243;n a SU&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis estad&#237;stico</span><p id="par0075" class="elsevierStylePara elsevierViewall">La recogida de datos se ha realizado utilizando la aplicaci&#243;n inform&#225;tica ENVIN-UCI que est&#225; ubicada en un servidor web y a la cual se accede mediante Internet&#46; La base de datos &#40;en SQL Server&#41; est&#225; en el mismo servidor&#46; El programa dispone de sistemas de seguridad que obligan a cumplimentar las variables definidas como b&#225;sicas e imposibilitan la introducci&#243;n de valores il&#243;gicos&#46; Las variables cualitativas se describen con el porcentaje de distribuci&#243;n de cada una de las categor&#237;as&#46; Las variables cuantitativas se describen con la media y la desviaci&#243;n est&#225;ndar cuando siguen una distribuci&#243;n normal&#59; con la mediana y rango intercuart&#237;lico&#44; en caso contrario&#46; El estudio de la comparaci&#243;n de la incidencia de la IU-SU en funci&#243;n de variables cualitativas &#40;como la patolog&#237;a de base o la presencia de cirug&#237;a urgente&#41; se ha realizado mediante la prueba del chi-cuadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41;&#46; En el caso de variables ordinales &#40;edad o APACHE II categorizadas&#41; se ha calculado tambi&#233;n el chi-cuadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41; para tendencia lineal&#46; El nivel de significaci&#243;n estad&#237;stica aceptado ha sido del 5&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">Durante los 6 a&#241;os analizados se han incluido 78&#46;863 pacientes de los que 2&#46;329 &#40;2&#44;95&#37;&#41; han presentado una o m&#225;s IU-SU durante su estancia en UCI&#46; Las caracter&#237;sticas de los pacientes dependiendo de la presencia o no de una IU-SU se incluyen en la <a class="elsevierStyleCrossRef" href="#tbl2">tabla 2</a>&#46; La presencia de esta infecci&#243;n ha sido m&#225;s frecuente en mujeres&#44; en los pacientes m&#225;s graves al ingreso y en aquellos clasificados como m&#233;dicos o quir&#250;rgicos&#46; De igual manera ha predominado entre los pacientes con dispositivos invasores&#44; tratamientos sustitutivos &#40;nutrici&#243;n parenteral&#44; depuraci&#243;n extrarrenal&#41; y en aquellos con factores de riesgo relacionados con su enfermedad &#40;neutropenia&#44; inmunosupresi&#243;n e inmunodepresi&#243;n&#44; haciendo referencia esta &#250;ltima a la adquirida y VIH&#41;&#46;</p><elsevierMultimedia ident="tbl2"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl3">tabla 3</a> se incluye el n&#250;mero de IU-SU detectadas en cada uno de los a&#241;os controlados&#44; as&#237; como el n&#250;mero de pacientes en los que se han identificado estas infecciones&#44; el n&#250;mero de pacientes con sonda uretral y el n&#250;mero total de paciente-d&#237;a con sonda uretral&#46; Con estas variables se calculan las 4 formas de expresar la frecuencia de estas infecciones&#46; La relaci&#243;n entre el n&#250;mero de d&#237;as de pacientes ingresados en UCI con sonda uretral y el n&#250;mero total de d&#237;as de pacientes ingresados en UCI se ha mantenido a lo largo de los a&#241;os constante&#44; en torno a 0&#44;85 &#40;IC 95&#37;&#58; 0&#44;83-0&#44;86&#41;&#44; mientras que los diferentes indicadores de frecuencia de IU-SU han disminuido de forma significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl3">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl3"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl4">tabla 4</a> se incluye la etiolog&#237;a de todos los episodios de IU-SU&#46; Han predominado en los a&#241;os analizados los bacilos gramnegativos&#44; oscilando entre el 55 y 60&#37; de todos los aislados&#44; en especial <span class="elsevierStyleItalic">E&#46; coli</span>&#46; El segundo lugar lo ocupan los hongos&#44; entre el 19 y 25&#37; de los aislados&#44; todos ellos del g&#233;nero Candida&#44; destacando <span class="elsevierStyleItalic">C&#46; albicans</span> en la mitad de los episodios&#46; Entre los cocos grampositivos han predominado de forma mayoritaria los enterococos&#44; en especial <span class="elsevierStyleItalic">E&#46; faecalis</span>&#46;</p><elsevierMultimedia ident="tbl4"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">La respuesta sist&#233;mica asociada con las IU-SU se incluye en la <a class="elsevierStyleCrossRef" href="#tbl5">tabla 5</a>&#46; En la mitad de los casos no existe respuesta inflamatoria sist&#233;mica y en menos del 15&#37; de los casos la respuesta se ha clasificado como de gravedad&#46;</p><elsevierMultimedia ident="tbl5"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Los marcadores de multirresistencia de los principales pat&#243;genos responsables de IU-SU demuestran importantes diferencias entre ellos &#40;<a class="elsevierStyleCrossRef" href="#tbl6">tabla 6</a>&#41;&#46; Mientras que en <span class="elsevierStyleItalic">E&#46; coli</span> se observa un progresivo incremento de las cepas resistentes a ciprofloxacino&#44; no se observan este incremento frente a cefotaxima&#46; En <span class="elsevierStyleItalic">P&#46; aeruginosa</span> la resistencia frente a ciprofloxacino e imipenem superan el 30&#37; mientras que es pr&#225;cticamente inexistente la resistencias de ampicilina y vancomicina en <span class="elsevierStyleItalic">E&#46; faecalis</span>&#46; Tampoco se ha detectado la presencia de cepas <span class="elsevierStyleItalic">C&#46; albicans</span> resistentes a fluconazol&#46;</p><elsevierMultimedia ident="tbl6"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Los pacientes con IU-SU han tenido una mayor estancia en UCI &#40;25&#44;59 frente a 4&#44;39 d&#237;as&#41; y una mayor mortalidad global intra-UCI &#40;22&#44;4 frente a 8&#44;6&#37;&#41; sin que los datos disponibles permitan establecer una relaci&#243;n entre dichas variables y la presencia de IU-SU&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0110" class="elsevierStylePara elsevierViewall">La principal aportaci&#243;n de este estudio ha sido describir las tasas&#44; etiolog&#237;as y marcadores de multirresistencias de las IU-SU desarrolladas en pacientes cr&#237;ticos ingresados en UCI en los &#250;ltimos 6 a&#241;os &#40;2005-2010&#41;&#46; Los datos evolutivos de las tasas demuestran una disminuci&#243;n significativa de las IU-SU independientemente de la tasa utilizada para expresarlas&#46; En el &#250;ltimo a&#241;o considerado&#44; la tasa expresada como densidad de incidencia fue de 4&#44;18 episodios por 1&#46;000 d&#237;as de SU&#46; Esta tasa se encuentra dentro de los l&#237;mites publicados por el National Healthcare Safety Network &#40;NHSN&#41; en diciembre del 2009 con los datos acumulados entre los a&#241;os 2006 y 2008 en UCI americanas<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; La DI de IU-SU oscil&#243; entre 7&#44;4 episodios por 1&#46;000 d&#237;as de SU en UCI de pacientes quemados o neurol&#243;gicos y 3&#44;1 episodios por 1&#46;000 d&#237;as de SU en UCI m&#233;dico-quir&#250;rgicas de m&#225;s de 15 camas&#44; siendo la media nacional calculada a partir de sus datos de 4&#44;08 episodios por 1&#46;000 d&#237;as de SU&#46; Las referencias de IU-SU en la literatura oscilan entre 1&#44;4 episodios por 1&#46;000 d&#237;as de SU en 12 UCI en la India<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#44; 5&#44;1 episodios por 1&#46;000 d&#237;as de SU en 4 UCI de Per&#250;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#44; hasta la m&#225;s reciente publicada de 15&#44;7 episodios por 1&#46;000 d&#237;as de SU en 4 UCI de Alejandr&#237;a &#40;Egipto&#41;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Las tasas de IU-SU en las UCI espa&#241;olas han disminuido significativamente en los &#250;ltimos a&#241;os sin que se haya aplicado ning&#250;n proyecto nacional de prevenci&#243;n espec&#237;fico para estas infecciones&#46; Durante este periodo se han desarrollado campa&#241;as espec&#237;ficas para promover el lavado de manos entre el personal sanitario de la mayor&#237;a de hospitales espa&#241;oles<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#44; se ha iniciado una campa&#241;a nacional para prevenir las bacteriemias relacionadas con cat&#233;teres en las UCI &#40;proyecto bacteriemia zero&#41; mediante la aplicaci&#243;n de un paquete de medidas multifactoriales &#40;una de ellas era el lavado de manos antes y despu&#233;s de manipular un cat&#233;ter&#41;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> y se ha extendido el concepto de seguridad integral de los pacientes mediante cursos y casos pr&#225;cticos&#46; Es posible que el conjunto de actividades encaminadas a promover un entorno seguro en las UCI haya contribuido a mejorar las tasas de esta infecci&#243;n&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La etiolog&#237;a de las IU-SU no se ha modificado en estos a&#241;os manteni&#233;ndose en primer lugar los bacilos gramnegativos y en especial el <span class="elsevierStyleItalic">E&#46; coli</span>&#44; seguido de otros microorganismos como <span class="elsevierStyleItalic">E&#46; faecalis</span> y <span class="elsevierStyleItalic">C&#46; albicans</span><a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#44; siendo mucho menos frecuentes otros pat&#243;genos que pueden ser end&#233;micos en las UCI y permanecer en el ambiente como <span class="elsevierStyleItalic">S&#46; aureus</span> resistente a meticilina&#44; <span class="elsevierStyleItalic">P&#46; aeruginosa</span> y <span class="elsevierStyleItalic">Acinetobacter baumannii</span> &#40;<span class="elsevierStyleItalic">A&#46; baumannii&#41;</span>y que son los principales responsables de otras infecciones nosocomiales como las neumon&#237;as relacionadas con ventilaci&#243;n mec&#225;nica<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; Ello reafirma la importancia de la flora ent&#233;rica en el origen de estas infecciones y la necesidad de extremar todas las medidas que limiten o dificulten la contaminaci&#243;n de las sondas uretrales<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#8211;23</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El tratamiento de estas infecciones est&#225; condicionado por la evoluci&#243;n de las resistencias de los pat&#243;genos m&#225;s frecuentes&#46; Hasta hace poco las quinolonas y las penicilinas semisint&#233;ticas eran el tratamiento de primera elecci&#243;n ante la presencia de BGN en una tinci&#243;n de orina&#46; Actualmente en los casos en los que la IU-SU se acompa&#241;e de signos de sepsis grave o shock s&#233;ptico el tratamiento emp&#237;rico debe considerar la presencia de <span class="elsevierStyleItalic">E&#46; coli</span> productor de betalactamasas de especto extendido &#40;resistente a cefalosporinas&#41; o de un bacilo gramnegativo no fermentador &#40;BGNNF&#41; por los que una combinaci&#243;n de un carbapen&#233;mico y un aminogluc&#243;sido activo frente a los BGNNF podr&#237;a ser un tratamiento de elecci&#243;n&#46; Esta combinaci&#243;n no se puede mantener durante todo el tratamiento y debe ajustarse lo antes posible a la sensibilidad del pat&#243;geno responsable&#46; En casos de presencia de levaduras el tratamiento de elecci&#243;n es fluconazol&#46; Por el contrario&#44; en aquellas situaciones en las que la IU-SU no se asocie con respuesta inflamatoria sist&#233;mica podr&#237;a evaluarse el no iniciar tratamiento antimicrobiano&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La mortalidad y la estancia en UCI en los pacientes con IU-SU es superior a la de aquellos sin este tipo de infecci&#243;n&#44; pero de la informaci&#243;n aportada en este estudio no puede deducirse que la IU-SU incremente la mortalidad o la estancia&#46; Para ello son necesarios estudios m&#225;s complejos&#44; basados en una metodolog&#237;a caso-control&#44; con poblaciones de pacientes m&#225;s homog&#233;neas que las incluidas en este an&#225;lisis&#46; Los datos publicados con respecto a la mortalidad son contradictorios&#46; Recientemente se ha publicado un metaan&#225;lisis que aunque sugiere un impacto estad&#237;sticamente significativo sobre la mortalidad&#44; la estancia en UCI e intrahospitalaria&#44; no se confirma si se utilizan los estudios que realizan ajustes de las variables inclu&#237;das&#46; Se identifica una probabilidad de mortalidad en UCI de 1&#44;94 &#40;IC 95&#37;&#58; 1&#44;61-2&#44;34&#41;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Como todos los estudios multic&#233;ntricos&#44; de participaci&#243;n voluntaria existe un sesgo de selecci&#243;n de pacientes que se ve compensado por la amplia participaci&#243;n de UCI y el volumen de pacientes acumulados&#46; Por otro lado&#44; la aplicaci&#243;n de la definici&#243;n de IU-SU en el paciente cr&#237;tico&#44; a menudo sedado y&#47;o analgesiado&#44; es dif&#237;cil en especial para su diferenciaci&#243;n con las bacteriurias asintom&#225;ticas&#44; por lo que las tasas reales pueden estar sobreestimadas&#46; Este hecho se ve agravado por la tendencia&#44; cada vez mayor&#44; de realizar estudios de vigilancia activa de flora multirresistente&#44; que incluye muestras de orina en pacientes asintom&#225;ticos o con otros focos de infecci&#243;n&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Se puede concluir que en nuestro pa&#237;s existe una tendencia significativa a disminuir las IU-SU sin que se haya realizado una intervenci&#243;n espec&#237;fica para ello&#46; Las etiolog&#237;as se mantienen estables predominando los BGN&#44; en especial <span class="elsevierStyleItalic">E&#46; coli</span>&#46; El tratamiento emp&#237;rico en las situaciones de mayor gravedad debe considerar la cobertura de los pat&#243;genos multirresistentes que han aumentado especialmente en <span class="elsevierStyleItalic">E&#46; coli</span> y <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#44; mientras que en aquellas sin respuesta sist&#233;mica podr&#237;an plantearse el no iniciar tratamiento antimicrobiano&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los autores han declarado no tener ning&#250;n conflicto de intereses en la realizaci&#243;n de este estudio&#46;</p></span></span>"
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          "identificador" => "xres84102"
          "titulo" => array:9 [
            0 => "Resumen"
            1 => "Objetivo"
            2 => "Dise&#241;o"
            3 => "Ambito"
            4 => "Pacientes"
            5 => "Intervenci&#243;n"
            6 => "Variables de inter&#233;s"
            7 => "Resultados"
            8 => "Conclusiones"
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          "identificador" => "xpalclavsec72261"
          "titulo" => "Palabras clave"
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        2 => array:2 [
          "identificador" => "xres84101"
          "titulo" => array:9 [
            0 => "Abstract"
            1 => "Objective"
            2 => "Design"
            3 => "Setting"
            4 => "Patients"
            5 => "Intervention"
            6 => "Variables of interest"
            7 => "Results"
            8 => "Conclusions"
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        3 => array:2 [
          "identificador" => "xpalclavsec72260"
          "titulo" => "Keywords"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introducci&#243;n"
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        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Pacientes y m&#233;todos"
          "secciones" => array:7 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Dise&#241;o"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Pacientes de estudio"
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            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Metodolog&#237;a de la vigilancia"
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            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Diagn&#243;stico de IU-SU"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Factores de riesgo"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Medidas de incidencia"
            ]
            6 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "An&#225;lisis estad&#237;stico"
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        6 => array:2 [
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          "titulo" => "Resultados"
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        7 => array:2 [
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          "titulo" => "Discusi&#243;n"
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        8 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conflicto de intereses"
        ]
        9 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-12-12"
    "fechaAceptado" => "2012-02-21"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec72261"
          "palabras" => array:5 [
            0 => "Infecci&#243;n urinaria"
            1 => "Sonda uretral"
            2 => "Paciente cr&#237;tico"
            3 => "UCI"
            4 => "ENVIN"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec72260"
          "palabras" => array:5 [
            0 => "Urinary tract infection"
            1 => "urinary catheter"
            2 => "Critically ill patient"
            3 => "ICU"
            4 => "ENVIN"
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    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Describir la evoluci&#243;n de las tasas nacionales de las infecciones urinarias relacionada con sonda uretral &#40;IU-SU&#41;&#44; as&#237; como la de sus etiolog&#237;as y marcadores de multirresistencia&#46;</p> <span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; prospectivo&#44; de participaci&#243;n voluntaria y multic&#233;ntrico desde el 1 de abril al 30 de junio entre los a&#241;os 2005 y 2010&#46;</p> <span class="elsevierStyleSectionTitle">Ambito</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Unidades de Cuidados Intensivos &#40;UCI&#41; que participaron en el registro ENVIN-UCI en el periodo de estudio&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se han incluido todos los pacientes ingresados en las UCI participantes y portadores de sonda urinaria durante m&#225;s de 24 horas &#40;78&#46;863 pacientes&#41;</p> <span class="elsevierStyleSectionTitle">Intervenci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La vigilancia de los pacientes ha sido continua hasta el alta de UCI o un m&#225;ximo de 60 d&#237;as&#46;</p> <span class="elsevierStyleSectionTitle">Variables de inter&#233;s</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se han definido las IU-SU siguiendo los criterios del CDC y su frecuencia se expresa como densidad de incidencia &#40;DI&#41; en relaci&#243;n al n&#250;mero de d&#237;as de paciente-SU&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Han presentado una o m&#225;s IU-SU 2&#46;329 &#40;2&#44;95&#37;&#41; pacientes&#46; La DI de IU-SU ha disminuido desde 6&#44;69 a 4&#44;18 episodios por 1&#46;000 d&#237;as de SU desde el a&#241;o 2005 al a&#241;o 2010 &#40;p&#60;0&#44;001&#41;&#46; En la etiolog&#237;a han predominado los bacilos gramnegativos &#40;55&#44;6-61&#44;6&#37;&#41;&#44; seguido de hongos &#40;18&#44;7-25&#44;2&#41; y de los cocos grampositivos &#40;17&#44;1-25&#44;9&#37;&#41;&#46; En el a&#241;o 2010&#44; han aumentado las cepas de <span class="elsevierStyleItalic">E&#46; coli</span> resistentes a ciprofloxacino &#40;37&#44;1&#37;&#41; y de <span class="elsevierStyleItalic">P&#46; aeruginosa</span> resistente a imipenem &#40;36&#44;4&#37;&#41; y ciprofloxacino &#40;37&#44;1&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Disminuci&#243;n de las tasas de IU-SU&#44; manteni&#233;ndose la misma distribuci&#243;n de etiolog&#237;a e increment&#225;ndose las resistencia en los BGN&#44; en especial el <span class="elsevierStyleItalic">E&#46; coli</span> y <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To describe trends in national catheter-related urinary tract infection &#40;CRUTI&#41; rates&#44; as well as etiologies and multiresistance markers&#46;</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">An observational&#44; prospective&#44; multicenter voluntary participation study was conducted from 1 April to 30 June in the period between 2005 and 2010&#46;</p> <span class="elsevierStyleSectionTitle">Setting</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Intensive Care Units &#40;ICUs&#41; that participated in the ENVIN-ICU registry during the study period&#46;</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">We included all patients admitted to the participating ICUs and patients with urinary catheter placement for more than 24<span class="elsevierStyleHsp" style=""></span>hours &#40;78&#44;863 patients&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Intervention</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Patient monitoring was continued until discharge from the ICU or up to 60 days&#46;</p> <span class="elsevierStyleSectionTitle">Variables of interest</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CRUTIs were defined according to the CDC system&#44; and frequency is expressed as incidence density &#40;ID&#41; in relation to the number of urinary catheter-patients days&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A total of 2329 patients &#40;2&#46;95&#37;&#41; developed one or more CRUTI&#46; The ID decreased from 6&#46;69 to 4&#46;18 episodes per 1000 days of urinary catheter between 2005 and 2010 &#40;p&#60;0&#46;001&#41;&#46; In relation to the underlying etiology&#44; gramnegative bacilli predominated &#40;55&#46;6 to 61&#46;6&#37;&#41;&#44; followed by fungi &#40;18&#46;7 to 25&#46;2&#37;&#41; and grampositive cocci &#40;17&#46;1 to 25&#46;9&#37;&#41;&#46; In 2010&#44; ciprofloxacin-resistant <span class="elsevierStyleItalic">E&#46; coli</span> strains &#40;37&#46;1&#37;&#41; increased&#44; as well as imipenem-resistant &#40;36&#46;4&#37;&#41; and ciprofloxacin-resistant &#40;37&#46;1&#37;&#41; strains of <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">A decrease was observed in CRUTI rates&#44; maintaining the same etiological distribution and showing increased resistances in gramnegative pathogens&#44; especially <span class="elsevierStyleItalic">E&#46; coli</span> and <span class="elsevierStyleItalic">P&#46; aeruginosa&#46;</span></p>"
      ]
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2010&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" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Pacientes-UCI &#62;24 horas&#44; n&#46;&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8&#46;969&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11&#46;684&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cat&#233;ter venoso central&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="elsevierStyleHsp" style=""></span>Depuraci&#243;n extrarrenal&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">Estancia en UCI&#44; d&#237;as&#44; media &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mortalidad&#44; n&#46;&#176; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Variables</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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" 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="elsevierStyleHsp" style=""></span>IU-SU&#44; n&#46;&#176;&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">393&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">401&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">403&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">438&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">451&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">470&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pacientes con IU-SU&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">352&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">372&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">370&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">394&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">404&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">418&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pacientes con SU&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&#46;520&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&#46;437&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;024&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&#46;421&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&#46;258&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&#46;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D&#237;as-UCI-SU&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">58&#46;716&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">78&#46;406&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;941&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">92&#46;098&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">105&#46;398&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">112&#46;452&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ratios</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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" 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="elsevierStyleHsp" style=""></span>Ratio D&#237;as-UCI-SU &#47;D&#237;as estancia en UCI&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;85&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;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;86&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;84&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;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tasas de IU-SU</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</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="" 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><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" 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="elsevierStyleHsp" style=""></span>N&#46;&#176; IU-SU &#47; N&#46;&#176; de pacientes UCI &#62; 24 h x100 &#40;IC&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</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">4&#44;38 &#40;3&#44;9-4&#44;8&#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">3&#44;43 &#40;3&#44;1-3&#44;8&#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">3&#44;24 &#40;2&#44;9-3&#44;6&#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">3&#44;17 &#40;2&#44;8-3&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;01 &#40;2&#44;7-3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;77 &#40;2&#44;53-3&#44;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#46;&#176; IU-SU &#47; N&#46;&#176; de pac&#46; en UCI &#62; 24 h con SU x100 &#40;IC&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</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">6&#44;03 &#40;5&#44;4-6&#44;6&#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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#46;&#176; IU-SU &#47; N&#46;&#176; de paciente-d&#237;a con SU x 1&#46;000 &#40;IC&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">2005&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" style="border-bottom: 2px solid black">2006&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">2007&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  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">40 &#40;10&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">45 &#40;11&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60 &#40;13&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41 &#40;9&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">51 &#40;10&#44;9&#41;&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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Klebsiella pneumoniae</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">18 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">12 &#40;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enterobacter cloacae</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">9 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;3&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;2&#44;1&#41;&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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Acinetobacter baumannii</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">15 &#40;3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;3&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Proteus mirabilis</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">9 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Coco Grampositivos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">111 &#40;25&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">68 &#40;17&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">71 &#40;18&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">85 &#40;19&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">87 &#40;20&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">81 &#40;17&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enterococcus faecalis</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">65 &#40;15&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43 &#40;10&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;9&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">46 &#40;10&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52 &#40;12&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">37 &#40;7&#44;9&#41;&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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enterococcus faecium</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">10 &#40;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">21 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enterococcus spp&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">9 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;1&#44;3&#41;&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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Staphylococcus epidermidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">13 &#40;3&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hongos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">80 &#40;18&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">85 &#40;21&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">98 &#40;25&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">103 &#40;23&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">105 &#40;24&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">119 &#40;25&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Candida albicans</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="char" valign="\n
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                  \t\t\t\t">56 &#40;13&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">49 &#40;12&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48 &#40;12&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;11&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;15&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Candida no albicans&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;5&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;9&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;12&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;11&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;11&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;10&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab160254.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar1115" class="elsevierStyleSimplePara elsevierViewall">Evoluci&#243;n de la etiolog&#237;a de las IU-SU &#40;n&#46;&#176; y &#37; respecto al total de microorganismos&#41;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl5"
        "etiqueta" => "Tabla 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "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"><td 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" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IU-SU&#44; n&#46;&#176;</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">393&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">401&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">403&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">438&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">451&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">470&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;556&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No respuesta sist&#233;mica&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">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">209 &#40;52&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">187 &#40;46&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">175 &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">193 &#40;42&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">141 &#40;30&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">905&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sepsis&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">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">163 &#40;40&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">164 &#40;40&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">205 &#40;46&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">200 &#40;44&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">263 &#40;56&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">995&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sepsis grave&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">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;8&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;9&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;8&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">178&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Shock s&#233;ptico&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">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;3&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;4&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab160252.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar2115" class="elsevierStyleSimplePara elsevierViewall">Respuesta sist&#233;mica de los pacientes con IU-SU &#40;n&#46;&#176;&#44; &#37;&#41;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl6"
        "etiqueta" => "Tabla 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">N&#46;&#176;r&#58; n&#250;mero de cepas resistentes al antibi&#243;tico marcador&#59; N&#46;&#176;t&#58; n&#250;mero de cepas totales en las que se ha suministrado informaci&#243;n de resistencias&#46;</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"><td 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" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Marcadores de mltirresistencia&#44; N&#46;&#176;r&#47;N&#46;&#176;t &#40;&#37;&#41;</span></td></tr><tr title="table-row"><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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Escherichia coli</span> R a cefotaxima&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&#47;81 &#40;13&#44;6&#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">10&#47;96 &#40;10&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;81 &#40;12&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;92 &#40;13&#44;0&#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">16&#47;99 &#40;16&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;99 &#40;12&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Escherichia coli</span> R a ciprofloxacino&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&#47;79 &#40;30&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#47;102 &#40;30&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#47;82 &#40;35&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#47;101 &#40;31&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#47;101 &#40;36&#44;6&#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">39&#47;105 &#40;37&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> R a imipenem&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&#47;36 &#40;30&#44;6&#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">9&#47;31 &#40;29&#44;0&#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">8&#47;31 &#40;25&#44;8&#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">13&#47;50 &#40;26&#44;0&#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">11&#47;36 &#40;30&#44;6&#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">12&#47;33 &#40;36&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> R a ciprofloxacino&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&#47;37 &#40;32&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;34 &#40;35&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#47;39 &#40;43&#44;6&#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">18&#47;53 &#40;34&#44;0&#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">14&#47;34 &#40;41&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#47;40 &#40;37&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> R a amikacina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#47;36 &#40;25&#44;0&#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">7&#47;34 &#40;20&#44;6&#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&#47;37 &#40;13&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#47;50 &#40;26&#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">7&#47;32 &#40;21&#44;6&#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">4&#47;32 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Proteus mirabilis</span> R a cefotaxima&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&#47;5 &#40;0&#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">0&#47;8 &#40;0&#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">0&#47;9 &#40;0&#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">1&#47;23 &#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;15 &#40;0&#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">2&#47;10 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Proteus mirabilis</span> R a ciprofloxacino&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&#47;5 &#40;0&#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">0&#47;9 &#40;0&#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">2&#47;12 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;20 &#40;10&#44;0&#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">2&#47;14 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;10 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enterococcus faecalis</span> R a vancomicina&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&#47;42 &#40;0&#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">0&#47;35 &#40;0&#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">0&#47;24 &#40;0&#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">0&#47;46 &#40;0&#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">0&#47;48 &#40;0&#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">1&#47;28 &#40;3&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enterococcus faecalis</span> R a ampicilina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#47;24<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a> &#40;37&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;39 &#40;0&#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">0&#47;33 &#40;0&#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">0&#47;36 &#40;0&#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">0&#47;50 &#40;0&#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">3&#47;34 &#40;8&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Candida albicans</span> R a fluconazol&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
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ISSN: 02105691
Idioma original: Español
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