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          1 => array:3 [
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        "titulo" => "Invasive device-related infections after heart surgery"
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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">Los pacientes que precisan de cirug&#237;a cardiaca han aumentado en los &#250;ltimos a&#241;os&#46; El postoperatorio de este tipo de cirug&#237;a requiere inicialmente la aplicaci&#243;n de un conjunto de medidas terap&#233;uticas y&#47;o de monitorizaci&#243;n que obliga a los pacientes a permanecer ingresados&#44; en los d&#237;as siguientes a la cirug&#237;a&#44; en unidades especializadas como los servicios o unidades de cuidados intensivos &#40;UCI&#41;&#46; La gran mayor&#237;a suelen evolucionar de forma favorable&#44; pero un peque&#241;o grupo de ellos pueden presentar diferentes complicaciones&#46; Una de las posibles complicaciones en el postoperatorio inmediato es la aparici&#243;n de infecciones relacionadas con los dispositivos invasivos &#40;tubo traqueal&#44; respirador&#44; sonda uretral&#44; cat&#233;teres vasculares&#41; utilizados durante la cirug&#237;a y en los siguientes d&#237;as&#46; La presencia de estas infecciones se ha relacionado con un incremento de la morbilidad y mortalidad<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La vigilancia de las infecciones adquiridas en UCI se realiza mayoritariamente en Espa&#241;a utilizando el registro ENVIN-HELICS&#44; desarrollado por el Grupo de Trabajo de Enfermedades Infecciosas de la SEMICYUC<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; En este registro se controla de forma longitudinal&#44; desde hace a&#241;os&#44; a los pacientes ingresados en UCI durante m&#225;s de 24<span class="elsevierStyleHsp" style=""></span>h&#44; con el objetivo de identificar infecciones relacionadas con dispositivos invasivos as&#237; como para conocer el consumo de antimicrobianos durante la estancia en UCI&#46; Una de sus opciones es clasificar a los pacientes por la patolog&#237;a de base existiendo un c&#243;digo espec&#237;fico para los pacientes postoperados de cirug&#237;a cardiaca &#40;POCC&#41;&#46; En este estudio se presentan las tasas&#44; caracter&#237;sticas y etiolog&#237;a de las infecciones relacionadas con dispositivos en los POCC&#44; as&#237; como los factores de riesgo relacionados con la aparici&#243;n de estas infecciones en este subgrupo de pacientes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Pacientes de estudio</span><p id="par0015" class="elsevierStylePara elsevierViewall">Se han seleccionado los pacientes incluidos en el registro ENVIN-HELICS&#44; entre los a&#241;os 2005 y 2011 &#40;ambos incluidos&#41;&#44; cuyo diagn&#243;stico principal fue &#171;postoperatorio de cirug&#237;a cardiaca&#187; &#40;identificado con el c&#243;digo 113&#41;&#46; Este registro es de participaci&#243;n voluntaria&#44; acceso libre &#40;mediante un c&#243;digo para cada UCI&#41; y gratuito a trav&#233;s de la direcci&#243;n de internet&#58; <a href="http://hws.vhebron.net/envin-helics/">http&#58;&#47;&#47;hws&#46;vhebron&#46;net&#47;envin-helics&#47;</a>&#46; En &#233;l se incluyen todos los pacientes ingresados m&#225;s de 24<span class="elsevierStyleHsp" style=""></span>h en las UCI participantes durante los meses de abril a junio de cada a&#241;o&#46; La informaci&#243;n se introduce directamente en una base de datos centralizada que dispone de un programa de an&#225;lisis el cual permite conocer a cada UCI participante sus propios resultados y los del conjunto nacional&#46; El informe nacional de cada a&#241;o se presenta en un documento que se distribuye por todos los hospitales espa&#241;oles y se encuentra disponible en la p&#225;gina web de la SEMICYUC&#58; <a href="http://www.semicyuc.org/">http&#58;&#47;&#47;www&#46;semicyuc&#46;org&#47;</a><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Metodolog&#237;a de la vigilancia</span><p id="par0020" 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 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 30 d&#237;as&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">De todos los pacientes seleccionados se han analizado variables demogr&#225;ficas&#44; patolog&#237;a de base&#44; instrumentaciones recibidas &#40;intubaci&#243;n y ventilaci&#243;n mec&#225;nica &#91;VM&#93;&#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&#46; 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="#bib0020"><span class="elsevierStyleSup">4</span></a>&#44; y opcionalmente con el sistema SAPS II<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> en las primeras 24<span class="elsevierStyleHsp" style=""></span>h de ingreso en UCI y la necesidad de cirug&#237;a urgente&#44; definida como la 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="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Infecciones estudiadas</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se han analizado las infecciones asociadas de forma directa con dispositivos invasivos como son la neumon&#237;a relacionada con ventilaci&#243;n mec&#225;nica &#40;N-VM&#41;&#44; la infecci&#243;n urinaria relacionada con sonda uretral &#40;IU-SU&#41;&#44; la bacteriemia primaria y relacionada con cat&#233;ter vascular &#40;BP-BCV&#41; y las bacteriemias adquiridas en UCI secundarias a otros focos &#40;BS&#41;&#46; Los cat&#233;teres vasculares considerados de riesgo en este estudio han sido los cat&#233;teres venosos centrales y los cat&#233;teres arteriales&#46; Los criterios utilizados para definir estas infecciones han sido los publicados en el manual del proyecto ENVIN<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#44; siguiendo las indicaciones del CDC<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; No se han registrado las infecciones superficiales o profundas relacionadas con la herida operatoria excepto en el caso de que fueran bacteri&#233;micas&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Las infecciones relacionadas con dispositivos invasivos fueron diagnosticadas por los m&#233;dicos responsables de los pacientes y documentadas como tal en la historia cl&#237;nica&#46; Los m&#233;dicos responsables de la vigilancia de infecci&#243;n nosocomial fueron 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="par0040" class="elsevierStylePara elsevierViewall">Para el diagn&#243;stico etiol&#243;gico fueron aceptados los criterios utilizados por cada UCI participante&#46; La susceptibilidad a los distintos antibi&#243;ticos&#44; 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 Clinical and Laboratory Standards Institute<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> y m&#225;s recientemente del European Committee on Antimicrobial Susceptibility Testing&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Factores de riesgo</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se han incluido los siguientes factores considerados como de riesgo para desarrollar infecciones&#58; <span class="elsevierStyleItalic">Inmunosupresi&#243;n</span>&#58; cuando el paciente ha recibido tratamiento que disminuye la resistencia a la infecci&#243;n &#40;quimioterapia&#44; radiaci&#243;n&#44; esteroides durante un per&#237;odo largo de tiempo o a altas dosis&#41; o tiene una enfermedad suficientemente avanzada como para suprimir las defensas contra la infecci&#243;n &#40;leucemia o linfoma&#41;&#46; <span class="elsevierStyleItalic">Neutropenia</span><span class="elsevierStyleBold">&#58;</span> recuento de neutr&#243;filos inferior a 500 por ml&#46; <span class="elsevierStyleItalic">Inmunodeficiencia&#58;</span> cuando el paciente ha sido diagnosticado de infecci&#243;n por VIH u otra inmunodeficiencia cong&#233;nita u adquirida&#46; <span class="elsevierStyleItalic">Colonizaci&#243;n o infecci&#243;n por un pat&#243;geno multirresistente</span> incluidos <span class="elsevierStyleItalic">Staphylococcus aureus &#40;S&#46; aureus&#41;</span> resistente a meticilina &#40;SARM&#41;&#44; enterococo resistente a vancomicina&#44; <span class="elsevierStyleItalic">Pseudomonas aeruginosa &#40;P&#46; aeruginosa&#41;</span> resistentes a tres o m&#225;s familias de antibi&#243;ticos&#44; <span class="elsevierStyleItalic">Acinetobacter baumannii &#40;A&#46; baumannii&#41;</span> resistente a imipenem y enterobacterias productoras de betalactamasas de espectro extendido &#40;BLEE&#41; definidas como la identificaci&#243;n de algunos de los pat&#243;genos anteriores durante su ingreso en UCI</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medidas de incidencia</span><p id="par0050" class="elsevierStylePara elsevierViewall">Para cada una de las infecciones estudiadas &#40;neumon&#237;as o infecciones urinarias o bacteriemias&#41; se han estimado la incidencia acumulada y la densidad de incidencia&#46; La incidencia acumulada se calcula dividiendo el n&#250;mero de infecciones por el total de pacientes que cumpl&#237;an los criterios de inclusi&#243;n y se expresa en porcentajes&#46; La densidad de incidencia se calcula dividiendo el n&#250;mero de infecciones por el total de d&#237;as de exposici&#243;n al dispositivo de riesgo&#59; se expresa como el n&#250;mero de infecciones por 1&#46;000 d&#237;as de exposici&#243;n&#46; Los d&#237;as de exposici&#243;n a los dispositivos invasivos 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="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Para ello se han contabilizado diariamente los pacientes con VM&#44; sonda uretral&#44; cat&#233;ter arterial y cat&#233;ter venoso central &#40;incluidos los cat&#233;teres de arteria pulmonar&#44; nutrici&#243;n parenteral&#44; hemodi&#225;lisis&#44; y los que incorporan reservorios&#41;&#46; Para cada uno de ellos se ha calculado el ratio de utilizaci&#243;n&#44; definido como el cociente entre el n&#250;mero de d&#237;as de utilizaci&#243;n de cada t&#233;cnica invasiva y los d&#237;as de riesgo &#40;d&#237;as de estancia&#41;&#46; Para el c&#225;lculo del ratio de cat&#233;teres vasculares se ha contabilizado como d&#237;as de instrumentalizaci&#243;n la suma de los d&#237;as de cat&#233;teres venosos centrales y la de cat&#233;teres arteriales&#46; Para el c&#225;lculo de la densidad de incidencia de las BS se ha contabilizado el n&#250;mero total de d&#237;as de estancia en UCI&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Consumo de antimicrobianos</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se han registrado todos los antimicrobianos utilizados durante la estancia en UCI que se han clasificado dependiendo del motivo de su prescripci&#243;n en profilaxis&#44; tratamiento de una infecci&#243;n comunitaria&#44; tratamiento de una infecci&#243;n nosocomial adquirida fuera de UCI y tratamiento de una infecci&#243;n nosocomial adquirida en UCI&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis estad&#237;stico</span><p id="par0060" 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&#44; en caso contrario&#46; El estudio de la comparaci&#243;n de las distintas variables dependiendo de la presencia de una o m&#225;s de las infecciones controladas se realiza para variables cualitativas 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 &#967;<span class="elsevierStyleSup">2</span>&#41; para tendencia lineal&#46; Para identificar las variables relacionadas de forma independiente con una de las infecciones controladas se ha aplicado una regresi&#243;n log&#237;stica incluyendo aquellas variables que en el an&#225;lisis univariante lograron una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#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="par0065" class="elsevierStylePara elsevierViewall">Se han incluido 97&#46;692 pacientes a lo largo de los 7 a&#241;os estudiados&#44; de los que 9&#46;089 &#40;9&#44;3&#37;&#41; fueron POCC&#46; El n&#250;mero de POCC incluidos cada a&#241;o y el n&#250;mero de hospitales y UCI que han aportado casos a este subgrupo de pacientes se incluyen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Mientras que la proporci&#243;n de hospitales con POCC no ha aumentado&#44; s&#237; lo ha hecho la proporci&#243;n de POCC incluidos en el registro que ha pasado del 8&#44;8&#37; en el a&#241;o 2005 al 9&#44;9&#37; en el a&#241;o 2011 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Tasas de infecci&#243;n</span><p id="par0070" class="elsevierStylePara elsevierViewall">En 440 &#40;4&#44;8&#37;&#41; POCC se identificaron una o m&#225;s infecciones relacionadas con dispositivos invasivos y&#47;o bacteriemias secundarias&#46; Las tasas de cada una de las infecciones controladas se incluyen en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> de forma diferenciada entre los pacientes con o sin cirug&#237;a cardiaca&#46; Todas las infecciones han sido menos frecuentes de forma significativa entre los POCC&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas demogr&#225;ficas&#44; patolog&#237;a de base&#44; marcadores de gravedad&#44; factores de riesgo&#44; d&#237;as de estancia en UCI y utilizaci&#243;n de dispositivos invasivos de los POCC dependiendo de la presencia o no de una infecci&#243;n relacionada con dispositivos invasivos y&#47;o de una bacteriemia adquirida en UCI se incluyen en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; En el an&#225;lisis de regresi&#243;n log&#237;stica se han identificado como factores con riesgo individual para desarrollar una nueva infecci&#243;n la estancia en UCI &#40;OR 1&#44;18&#59; IC95&#37; 1&#44;16-1&#44;20&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; el APACHE II al ingreso en UCI &#40;OR 1&#44;05&#59; IC95&#37; 1&#44;03-1&#44;07&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; cirug&#237;a de urgencia &#40;OR 1&#44;67&#59; IC95&#37; 1&#44;13-2&#44;47&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;010&#41;&#44; tratamiento antibi&#243;tico previo &#40;OR 1&#44;38&#59; IC95&#37; 1&#44;04-1&#44;83&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;025&#41;&#44; colonizaci&#243;n por <span class="elsevierStyleItalic">P aeruginosa</span> &#40;OR 18&#44;25&#59; IC95&#37; 3&#44;74-89&#44;06&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; o de enterobacterias productoras de BLEE &#40;OR 16&#44;97&#59; IC95&#37; 5&#44;4-53&#44;2&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Etiolog&#237;a de las infecciones</span><p id="par0080" class="elsevierStylePara elsevierViewall">Se han identificado 555 microorganismos en las infecciones relacionadas con dispositivos invasivos en los POCC&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> se incluyen los principales pat&#243;genos responsables en las infecciones controladas de forma comparativa entre los pacientes con y sin CC&#46; En las N-VM destaca en ambos subgrupo la presencia de <span class="elsevierStyleItalic">P&#46; aeruginosa</span> mientras son menos frecuentes entre los POCC las infecciones producidas por <span class="elsevierStyleItalic">S&#46; aureus</span> y <span class="elsevierStyleItalic">A&#46; baumannii</span>&#46; En las IU-SU y BP-CV predominan en ambos grupos <span class="elsevierStyleItalic">Escherichia coli</span> y <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> respectivamente&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Consumo de antimicrobianos</span><p id="par0085" class="elsevierStylePara elsevierViewall">Se utilizaron 132&#46;820 antimicrobianos en los 97&#46;692 pacientes incluidos en el registro y de ellos 11&#46;780 &#40;8&#44;7&#37;&#41; fueron empleados en POCC &#40;1&#44;29 antimicrobianos por POCC&#41;&#46; La distribuci&#243;n de los antimicrobianos m&#225;s utilizados en funci&#243;n del motivo de su prescripci&#243;n para los POCC se incluye en la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#46; Destaca en los POCC el predominio de utilizaci&#243;n de antimicrobianos de forma profil&#225;ctica &#40;75&#44;6&#37;&#41;&#44; en particular de cefazolina &#40;42&#44;9&#37;&#41;&#44; cefuroxima &#40;29&#44;4&#37;&#41; y vancomicina &#40;10&#44;8&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Mortalidad</span><p id="par0090" class="elsevierStylePara elsevierViewall">En el periodo estudiado fallecieron 373 POCC &#40;4&#44;1&#37;&#41;&#46; La mortalidad de los que desarrollaron una o m&#225;s infecciones relacionadas con dispositivos invasivos fue del 32&#44;2&#37; mientras que fue del 2&#44;9&#37; en aquellos que no presentaron ninguna infecci&#243;n &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">Una de las principales aportaciones de este trabajo ha sido cuantificar la proporci&#243;n de POCC en el conjunto de pacientes ingresados en UCI de nuestro pa&#237;s que representan alrededor del 10&#37; del total de ingresados m&#225;s de 24<span class="elsevierStyleHsp" style=""></span>h&#46; En este subgrupo de POCC&#44; las infecciones relacionadas con dispositivos invasivos &#40;incluidas las bacteriemias adquiridas en UCI por otras causas&#41; han afectado al 4&#44;8&#37; de estos pacientes siendo su presencia menos frecuente significativamente que en el resto de los ingresados en UCI&#46; Los datos de este estudio permitir&#225;n que las UCI espa&#241;olas que atienden POCC comparen sus propias tasas con las tasas nacionales&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Kollef et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> en un estudio prospectivo de un solo hospital identificaron una o m&#225;s infecciones nosocomiales en el 21&#37; de los POCC mientras que afectaron al 9&#44;2&#37; de los pacientes intervenidos de cirug&#237;a cardiotor&#225;cica en un hospital espa&#241;ol<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; Estos 2 estudios fueron realizados hace m&#225;s de 10 a&#241;os y desde entonces se han producido cambios en el manejo de estos pacientes que dificultan la comparaci&#243;n&#46; En un estudio multic&#233;ntrico europeo<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44; realizado en el a&#241;o 2007 por el European Study Group of Nosocomial Infection y el European Society of Clinical Microbiology and Infectious Diseases&#44; en el que participaron 17 UCI de siete pa&#237;ses y controlaron 11&#46;915 POCC&#44; demostraron que el 9&#44;9&#37; de los pacientes desarrollaron una o m&#225;s infecciones nosocomiales&#46; Este mismo grupo realiza un nuevo registro durante un mes en el a&#241;o 2008&#44; con la participaci&#243;n de 35 hospitales de ocho pa&#237;ses&#44; en el que el n&#250;mero de pacientes con una o m&#225;s infecciones nosocomiales se redujo al 4&#44;4&#37;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> en la l&#237;nea de nuestros resultados&#46; Las principales diferencias con los estudios comentados fueron que en nuestro caso solo se controlaron las infecciones relacionadas con dispositivos invasivos y las bacteriemias adquiridas en UCI de otros focos&#44; pero no las infecciones no bacteri&#233;micas relacionadas con la cirug&#237;a &#40;infecciones superficiales de herida operatoria&#44; mediastinitis&#41;&#44; y adem&#225;s que el periodo de observaci&#243;n se limit&#243; a la estancia en UCI&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Los POCC en los que se ha desarrollado alguna infecci&#243;n nosocomial relacionada con dispositivos han tenido una mayor estancia en UCI aunque probablemente en el alargamiento de la estancia han contribuido otros factores no controlados &#40;mayor gravedad&#44; complicaciones quir&#250;rgicas&#44; comorbilidades&#41;&#46; La mayor&#237;a de los POCC permanece en UCI entre dos y tres d&#237;as como ha puesto de manifiesto el registro espa&#241;ol de Cirug&#237;a Cardiaca en Medicina Intensiva<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; En nuestro caso la estancia media ha sido de seis d&#237;as&#44; lo que se justifica por el hecho de que no se han incluido aquellos POCC con estancias menores de 24<span class="elsevierStyleHsp" style=""></span>h&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">La infecci&#243;n m&#225;s frecuentemente detectada en nuestro estudio entre los POCC fue la N-VM &#40;9&#44;94 episodios por 1&#46;000 d&#237;as de VM&#41; siendo su tasa inferior a la del resto de pacientes controlados &#40;14&#44;9 episodios por 1&#46;000 d&#237;as de VM&#41;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; La N-VM tambi&#233;n fue la principal infecci&#243;n identificada en la mayor&#237;a de los estudios realizados por otros autores en este subgrupo de pacientes<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;10&#44;11&#44;14&#44;15</span></a>&#46; La tasa de N-VM en nuestro caso fue inferior a la de otro estudio observacional realizado&#44; entre los a&#241;os 2003-2006&#44; en una UCI de nuestro pa&#237;s que atiende predominantemente pacientes postoperados de cirug&#237;a cardiaca y que no participa en el registro nacional ENVIN-HELICS&#44; que ha reportado tasas de N-VM superiores a 22 episodios por 1&#46;000 d&#237;as de VM<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> y a la del &#250;ltimo estudio europeo del a&#241;o 2008&#44; 13&#44;9 episodios por 1&#46;000 d&#237;as de VM<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Es posible que ello se deba al impacto de diferentes proyectos de intervenci&#243;n realizados en las UCI espa&#241;olas a partir del a&#241;o 2009 que han reducido significativamente las infecciones relacionadas con dispositivos en las UCI espa&#241;olas<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Un estudio multic&#233;ntrico europeo de prevalencia &#40;en un solo d&#237;a&#41;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#44; en el que han participado 42 hospitales de 13 pa&#237;ses&#44; ha analizado las infecciones postoperatorias en POCC&#46; Se incluyeron 321 pacientes con dicho diagn&#243;stico ingresados en el d&#237;a de la vigilancia &#40;164 de los cuales utilizaban VM&#41; y en el 26&#44;8&#37; de ellos se detect&#243; la presencia de una o m&#225;s infecciones nosocomiales&#44; en especial infecciones del tracto respiratorio inferior &#40;57&#37;&#41; seguido de bacteriemias relacionadas con cat&#233;ter &#40;2&#44;8&#37;&#41;&#44; infecciones en la herida operatoria &#40;2&#44;2&#37;&#41;&#44; infecciones del tracto urinario &#40;0&#44;9&#37;&#41; y mediastinitis &#40;0&#44;9&#37;&#41;&#46; Estos datos&#44; que deben tomarse con precauci&#243;n al proceder de un estudio transversal&#44; se&#241;alan el predominio de las infecciones respiratorias en este grupo de pacientes y la baja proporci&#243;n de otras infecciones no controladas en nuestro registro&#46; En ese mismo estudio se analiz&#243; mediante una encuesta paralela el grado de utilizaci&#243;n de medidas preventivas de N-VM en las UCI participantes&#44; demostr&#225;ndose una escasa aplicaci&#243;n de dichas medidas lo que en parte justifica la elevada tasa de estas infecciones&#46; La introducci&#243;n de tubos orotraqueales con sistemas de aspiraci&#243;n de secreciones subgl&#243;ticas en una UCI de cirug&#237;a cardiaca se ha acompa&#241;ado de una importante reducci&#243;n de sus tasas de N-VM y del consumo de antimicrobianos&#44; aunque la tasa final&#44; en dicha unidad&#44; contin&#250;a siendo elevada<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Aunque el protocolo quir&#250;rgico de la cirug&#237;a cardiaca incluye&#44; como m&#237;nimo&#44; la intubaci&#243;n y VM&#44; el sondaje uretral y la cateterizaci&#243;n venosa central&#44; algunos pacientes cuando ingresan en UCI ya no son portadores de alguno de dichos dispositivos invasivos&#44; en especial el tubo orotraqueal&#46; En nuestro estudio la proporci&#243;n de pacientes portadores de tubo traqueal fue superior en los POCC comparada con el conjunto nacional de pacientes ingresados en UCI&#44; aunque el n&#250;mero de d&#237;as de intubaci&#243;n fue menor&#46; La tasa de N-VM en los POCC tambi&#233;n fue menor&#44; lo que confirma la influencia de la duraci&#243;n de la VM en el desarrollo de la N-VM<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> y la necesidad de acortar el periodo de ventilaci&#243;n al m&#225;ximo de lo posible como prevenci&#243;n de esta infecci&#243;n&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Aunque la mayor&#237;a de los POCC han utilizado uno o m&#225;s antimicrobianos&#44; estos han sido indicados preferentemente como profilaxis&#46; Llama la atenci&#243;n la utilizaci&#243;n de vancomicina en el 9&#44;5&#37; de las profilaxis de cirug&#237;a cardiaca&#44; ya que en la medida de lo posible deber&#237;a evitarse la utilizaci&#243;n de este antibi&#243;tico en la profilaxis quir&#250;rgica para evitar la selecci&#243;n de flora resistente a los glucop&#233;ptidos como ha sucedido en otros pa&#237;ses<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46; Solo estar&#237;a justificado en aquellos pacientes al&#233;rgicos a la penicilina&#44; en los colonizados previamente por cocos grampositvos multirresistentes o en aquellas UCI en las que exista endemia por SARM&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La mortalidad as&#237; como el alargamiento de estancia en la UCI fue significativamente superior en los pacientes con una o m&#225;s infecciones nosocomiales lo que se ha repetido en todos los estudios que lo han analizado<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;9&#44;10</span></a>&#46; La mortalidad y la estancia en UCI de los pacientes que no presentan ninguna infecci&#243;n es baja&#44; inferior a la esperada por el nivel de gravedad al ingreso en UCI &#40;APACHE de 13&#41;&#44; sin embargo la mortalidad de los pacientes que presentan una o m&#225;s infecciones nosocomiales oscila en torno al 24&#37;&#44; en el rango superior a la mortalidad esperada por la gravedad en el momento de ingreso en UCI &#40;APACHE 17&#41;&#44; y su estancia es superior a las 3 semanas&#46; El impacto de la infecci&#243;n en este grupo de pacientes tambi&#233;n ha sido observado por otros investigadores espa&#241;oles que demuestran que la mortalidad en aquellos POCC var&#237;a del 2&#44;8 al 45&#44;7&#37; y la estancia en UCI desde 3 a 25&#44;5 d&#237;as&#44; dependiendo de la presencia de una N-VM en el postoperatorio inmediato<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Aunque no existen datos para atribuir la muerte a la presencia de la N-VM&#44; deben de extremarse todas las medidas necesarias para disminuir y evitar estas infecciones que se asocian claramente con un peor pron&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;10&#44;12&#44;14&#44;22</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Este estudio presenta como limitaci&#243;n su dise&#241;o multic&#233;ntrico&#44; por lo que los criterios para definir las infecciones pueden variar a pesar de la existencia de definiciones previas consensuadas e incluidas en el manual del registro&#46; Por otro lado&#44; no se han incluido en el registro el an&#225;lisis de otras infecciones no relacionadas con dispositivos como son las infecciones de herida operatoria superficial y profundas &#40;mediastinitis&#41; que pueden haber influido en el consumo de antimicrobianos y en la evoluci&#243;n&#44; aunque dicho sesgo se ha aplicado de igual manera en los 2 grupos de pacientes comparados&#46; As&#237; mismo&#44; no se han incluido en el an&#225;lisis otras variables de riesgo en esta poblaci&#243;n &#40;complejidad de la cirug&#237;a&#44; duraci&#243;n de la intervenci&#243;n&#44; complicaciones quir&#250;rgicas&#44; valoraci&#243;n del EuroSCORE<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#41; que permitan diferenciar con mayor precisi&#243;n aquellos pacientes en los que es probable la aparici&#243;n de una de estas infecciones&#46; Finalmente&#44; al tratarse de un estudio observacional no intervencionista las medidas de prevenci&#243;n de las infecciones no fueron previamente estandarizadas ni controladas&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Como conclusi&#243;n de este estudio se puede afirmar que un n&#250;mero importante de pacientes ingresados en las UCI de nuestro pa&#237;s son POCC con caracter&#237;sticas y evoluci&#243;n diferentes con respecto al resto de los pacientes&#46; La aparici&#243;n de una o m&#225;s infecciones se ha asociado con un importante alargamiento en la estancia y un considerable incremento de la mortalidad&#44; por lo que una de las estrategias que deben aplicarse en estos pacientes es la prevenci&#243;n de las infecciones relacionadas con la actividad hospitalaria&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar las infecciones en Pacientes cr&#237;ticos postOperados de Cirug&#237;a Cardiaca &#40;POCC&#41;&#46;</p> <span class="elsevierStyleSectionTitle">&#193;mbito</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Unidades de cuidados intensivos &#40;UCI&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; prospectivo y multic&#233;ntrico&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron los pacientes POCC incluidos en el registro ENVIN-HELICS entre los a&#241;os 2005-2011&#46;</p> <span class="elsevierStyleSectionTitle">Variables de inter&#233;s principal</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Neumon&#237;as relacionadas con ventilaci&#243;n mec&#225;nica &#40;N-VM&#41;&#44; infecciones urinarias relacionadas con sonda uretral &#40;IU-SU&#41;&#44; bacteriemias primarias y&#47;o relacionadas con cat&#233;teres vasculares &#40;BP-BCV&#41; y bacteriemias secundarias &#40;BS&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">De los 97&#46;692 pacientes registrados 9&#46;089 &#40;9&#44;3&#37;&#41; fueron POCC&#46; En 440 &#40;4&#44;8&#37;&#41; POCC se identificaron una o m&#225;s de las infecciones controladas&#46; La densidad de infecci&#243;n fue de 9&#44;94 episodios de N-VM por 1&#46;000 d&#237;as de VM&#59; 3&#44;4 episodios de IU-SU por 1&#46;000 d&#237;as de SU&#44; 3&#44;10 episodios de BP-BCV por 1&#46;000 d&#237;as de CVC&#59; y 1&#44;84 episodios de BS por 1&#46;000 d&#237;as de estancia en UCI&#46; Los factores de riesgo estad&#237;sticamente significativos fueron estancia en UCI &#40;OR 1&#44;18&#59; IC95&#37; 1&#44;16-1&#44;20&#41;&#44; APACHE II al ingreso en UCI &#40;OR 1&#44;05&#59; IC95&#37; 1&#44;03-1&#44;07&#41;&#44; cirug&#237;a urgente &#40;OR 1&#44;67&#59; IC95&#37; 1&#44;13-2&#44;47&#41;&#44; tratamiento antibi&#243;tico previo &#40;OR 1&#44;38&#59; IC95&#37; 1&#44;04- 1&#44;83&#41;&#44; colonizaci&#243;n previa de <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> &#40;OR 18&#44;25&#59; IC95&#37; 3&#44;74-89&#44;06&#41; o enterobacterias productoras de betalactamasas de espectro extendido &#40;OR 16&#44;97&#59; IC95&#37; 5&#44;4-53&#44;2&#41;&#46; La mortalidad intra-UCI fue del 4&#44;1&#37;&#59; del 32&#44;2&#37; en aquellos que desarrollaron una o m&#225;s infecciones y del 2&#44;9&#37; en los pacientes sin infecci&#243;n &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El 9&#44;3&#37; de los pacientes incluidos en el registro fueron POCC&#46; La mortalidad global de los POCC es baja pero aumenta significativamente en aquellos que desarrollaron una o m&#225;s infecciones&#46;</p>"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To analyze postoperative infections in critically ill patients undergoing heart surgery&#46;</p> <span class="elsevierStyleSectionTitle">Setting</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Intensive care units &#40;ICUs&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">An observational&#44; prospective&#44; multicenter study was carried out&#46;</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patients in the postoperative period of heart surgery admitted to the ICU and included in the ENVIN-HELICS registry between 2005 and 2011&#46;</p> <span class="elsevierStyleSectionTitle">Main outcome variables</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Mechanical ventilation associated pneumonia &#40;MVP&#41;&#44; urinary catheter-related infection &#40;UCI&#41;&#44; primary bacteremia &#40;PB&#41;&#44; PB related to vascular catheters &#40;PB-VC&#41; and secondary bacteremia&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Of a total of 97&#44;692 patients included in the study&#44; 9089 &#40;9&#46;3&#37;&#41; had undergone heart surgery&#46; In 440 patients &#40;4&#46;8&#37;&#41;&#44; one or more infections were recorded&#46; Infection rates were 9&#46;94 episodes of MVP per 1000 days of mechanical ventilation&#44; 3&#46;4 episodes of UCI per 1000 days of urinary catheterization&#44; 3&#46;10 episodes of BP-VC per 1000 days of central venous catheter&#44; and 1&#46;84 episodes of secondary bacteremia per 1000 days of ICU stay&#46; Statistically significant risk factors for infection were ICU stay &#40;odds ratio &#91;OR&#93; 1&#46;18&#44; 95&#37;CI 1&#46;16-1&#46;20&#41;&#44; APACHE II upon admission to the ICU &#40;OR 1&#46;05&#44; 95&#37;CI 1&#46;03-1&#46;07&#41;&#44; emergency surgery &#40;OR 1&#46;67&#44; 95&#37;CI 1&#46;13-2&#46;47&#41;&#44; previous antibiotic treatment &#40;OR 1&#46;38&#44; 95&#37;CI 1&#46;04-1&#46;83&#41;&#44; and previous colonization by <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> &#40;OR 18&#46;25&#44; 95&#37;CI 3&#46;74-89&#46;06&#41; or extended spectrum beta-lactamase producing enterobacteria &#40;OR 16&#46;97&#44; 95&#37;CI 5&#46;4-53&#46;2&#41;&#46; The overall ICU mortality rate was 4&#46;1&#37; &#40;32&#46;2&#37; in patients who developed one or more infections and 2&#46;9&#37; in uninfected patients&#41; &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Of the patients included in the ENVIN-HELICS registry&#44; 9&#46;3&#37; were postoperative heart surgery patients&#46; The overall mortality was low but increased significantly in patients who developed one or more infection episodes&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9674;"
        "nota" => "<p class="elsevierStyleNotepara">Los miembros del grupo de Estudio ENVIN-HELICS que han aportado datos de pacientes &#171;postoperados de cirug&#237;a cardiaca&#187; figuran en el anexo 1 al final del texto&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Mar&#237;a Carrasco</span>&#44; Hospital General Vall d&#8217;Hebr&#243;n&#44; &#40;UPCC&#41;&#44; Barcelona &#40;658&#41;&#59; <span class="elsevierStyleItalic">Lisardo Iglesias</span>&#44; Hospital Central de Asturias &#40;UCI HGA&#41;&#44; Oviedo &#40;641&#41;&#59; <span class="elsevierStyleItalic">Antonio Mart&#237;nez Pell&#250;s</span>&#44; Hospital Virgen de la Arrixaca&#44; Murcia &#40;616&#41;&#59; <span class="elsevierStyleItalic">&#193;ngel Arenzana</span>&#44; Hospital Virgen de la Macarena&#44; Sevilla &#40;613&#41;&#59; <span class="elsevierStyleItalic">Juan Carlos Ballesteros</span>&#44; Hospital Cl&#237;nico de Salamanca &#40;613&#41;&#59; <span class="elsevierStyleItalic">Eva Mar&#237;a Santafosta</span>&#44; Hospital de Bellvitge &#40;UCC&#41;&#44; Hospitalet de Llobregat &#40;Barcelona&#41; &#40;507&#41;&#59; <span class="elsevierStyleItalic">Jos&#233; Ram&#243;n Iruretagoyena</span>&#44; Hospital de Cruces&#44; Barakaldo &#40;Bilbao&#41; &#40;484&#41;&#59; <span class="elsevierStyleItalic">Joaqu&#237;n Lobo</span>&#44; Hospital de Navarra&#44; Pamplona &#40;460&#41;&#59; <span class="elsevierStyleItalic">Mercedes Nieto</span>&#44; Hospital Cl&#237;nico Universitario San Carlos &#40;UCI Cardiovascular&#41;&#44; Madrid &#40;424&#41;&#59; <span class="elsevierStyleItalic">Mercedes Barranco</span>&#44; Hospital M&#233;dico Quir&#250;rgico Virgen de las Nieves &#40;UC y UCC&#41;&#44; Granada &#40;386&#41;&#59; <span class="elsevierStyleItalic">C&#233;sar Arag&#243;n</span>&#44; Hospital General Carlos Haya&#44; Malaga &#40;330&#41;&#59; Sandra <span class="elsevierStyleItalic">Barbadillo</span>&#44; Capio Hospital General de Catalunya&#44; Sant Cugat del Valles &#40;Barcelona&#41; &#40;269&#41;&#59; <span class="elsevierStyleItalic">Asunci&#243;n Colomar</span>&#44; Hospital Son Espases&#44; Palma de Mallorca &#40;242&#41;&#59; <span class="elsevierStyleItalic">Rafael Sierra</span>&#44; Hospital Universitario Puerta de Mar&#44; C&#225;diz &#40;236&#41;&#59; <span class="elsevierStyleItalic">Benito Almirante</span>&#44; Hospital General Vall d&#8217;Hebr&#243;n &#40;UCC&#41;&#44; Barcelona &#40;236&#41;&#59; <span class="elsevierStyleItalic">Nieves Carrasco</span>&#44; Hospital de la Princesa&#44; Madrid &#40;225&#41;&#59; <span class="elsevierStyleItalic">Miguel &#193;ngel Pereira</span>&#44; Hospital Meixoeiro-C&#46; Hosp&#46; Universitario de Vigo &#40;UCC&#41; &#40;222&#41;&#59; <span class="elsevierStyleItalic">Josep Costa</span>&#44; Hospital de Barcelona &#40;SCIAS&#41; &#40;154&#41;&#59; <span class="elsevierStyleItalic">Javier Ruiz</span>&#44; Hospital del Sagrat Cor&#44; Barcelona &#40;153&#41;&#59; <span class="elsevierStyleItalic">Mar&#237;a del Mar Jim&#233;nez</span>&#44; Hospital M&#233;dico-Quir&#250;rgico &#40;UCI&#41; Virgen de las Nieves&#44; Granada &#40;149&#41;&#59; <span class="elsevierStyleItalic">Jos&#233; Luis Romero</span>&#44; Hospital Universitario de Gran Canaria Dr Negr&#237;n &#40;147&#41;&#59; <span class="elsevierStyleItalic">Rafael Garc&#233;s</span>&#44; Hospital de la Ribera&#44; Valencia &#40;136&#41;&#59; <span class="elsevierStyleItalic">Juan Carlos Pozo</span>&#44; Hospital Reina Sof&#237;a&#44; Cordoba &#40;132&#41;&#59; <span class="elsevierStyleItalic">Primitivo Arribas</span>&#44; Hospital Universitario 12 de Octubre &#40;UCP&#41; &#40;115&#41;&#59; <span class="elsevierStyleItalic">Josep Mar&#237;a Sirvent</span>&#44; Hospital Universitario Josep Trueta&#44; Girona &#40;112&#41;&#59; <span class="elsevierStyleItalic">Ricard Jord&#225;</span>&#44; Cl&#237;nica Rotger&#44; Palma de Mallorca &#40;106&#41;&#59; <span class="elsevierStyleItalic">Ana Gamo</span>&#44; Fundaci&#243;n Jim&#233;nez D&#237;az&#44; Madrid &#40;106&#41;&#59; <span class="elsevierStyleItalic">Salom&#233; Palmero</span>&#44; Hospital Universitario de Canarias&#44; La Laguna &#40;Tenerife&#41; &#40;96&#41;&#59; <span class="elsevierStyleItalic">Gerardo Aguilar</span>&#44; Hospital Cl&#237;nico Universitario de Valencia &#40;U Reanimaci&#243;n&#41; &#40;68&#41;&#59; <span class="elsevierStyleItalic">Ana Mar&#237;a D&#237;az</span>&#44; Complexo Hospitalario Universitario de a Coru&#241;a&#44; A Coru&#241;a &#40;51&#41;&#59; <span class="elsevierStyleItalic">F&#225;tima Mart&#237;n</span>&#44; Cl&#237;nica Moncloa&#44; Madrid &#40;47&#41;&#59; <span class="elsevierStyleItalic">Jos&#233; Mar&#237;a Borrell</span>&#44; Cl&#237;nica Palmaplanas&#44; &#40;USP&#41;&#44; Palma de Mallorca &#40;40&#41;&#59; <span class="elsevierStyleItalic">Juan Fajardo</span>&#44; Cl&#237;nica Santa Isabel&#44; Sevilla &#40;40&#41;&#59; <span class="elsevierStyleItalic">Daniel Fontaneda</span>&#44; Hospital de Le&#243;n&#44; UCI polivalente &#40;39&#41;&#46; <span class="elsevierStyleItalic">Mercedes Palomar</span>&#44; Hospital General Vall d&#8217;Hebr&#243;n&#44; Barcelona &#40;35&#41;&#59; Hospital General Universitario de Alicante &#40;Reanimaci&#243;n&#41; &#40;29&#41;&#59; Hospital Militar Gomez Ulla&#44; Madrid &#40;29&#41;&#59; Hospital de Le&#243;n &#40;UCC&#41; &#40;28&#41;&#46;</p>"
            "etiqueta" => "Anexo 1"
            "titulo" => "Responsables del registro ENVIN-HELICS&#44; en el a&#241;o 2011&#44; de las UCI y&#47;o Unidades de Cr&#237;ticos que han aportado al estudio m&#225;s de 20 pacientes con el diagn&#243;stico de &#8220;postoperatorio de cirug&#237;a cardiaca&#8221; &#40;n&#176; de casos&#41;&#58;"
            "identificador" => "sec0085"
          ]
        ]
      ]
    ]
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        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
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                  \t\t\t\t" style="border-bottom: 2px solid black">Pacientes incluidos en el registro ENVIN&#44; n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Pacientes operados de cirug&#237;a cardiaca<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Hospitales con cirug&#237;a cardiaca&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">37 &#40;28&#44;5&#41;&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-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">18&#46;829&nbsp;\t\t\t\t\t\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">1&#46;859 &#40;9&#44;87&#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
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                  \t\t\t\t">167&nbsp;\t\t\t\t\t\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">147&nbsp;\t\t\t\t\t\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">38 &#40;25&#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">TOTAL&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">97&#46;692&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#46;089 &#40;9&#44;3&#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</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
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                  """
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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>Por 100 pacientes con VM&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">3&#44;23&nbsp;\t\t\t\t\t\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">14&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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>Por 1&#46;000 d&#237;as de VM&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">9&#44;94&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">14&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>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  " colspan="4" align="left" valign="\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
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                  \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">173&nbsp;\t\t\t\t\t\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;924&nbsp;\t\t\t\t\t\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>Por 100 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;97&nbsp;\t\t\t\t\t\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">4&#44;72&nbsp;\t\t\t\t\t\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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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>Por 1&#46;000 d&#237;as de 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;39&nbsp;\t\t\t\t\t\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">5&#44;26&nbsp;\t\t\t\t\t\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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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  " colspan="4" 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">Bacteriemia primaria o relacionada con CV&#44; n</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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">161&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;561&nbsp;\t\t\t\t\t\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>Por 100 pacientes CVC&nbsp;\t\t\t\t\t\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">1&#44;87&nbsp;\t\t\t\t\t\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">4&#44;47&nbsp;\t\t\t\t\t\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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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>Por 1&#46;000 d&#237;as de CVC&nbsp;\t\t\t\t\t\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">3&#44;10&nbsp;\t\t\t\t\t\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">4&#44;73&nbsp;\t\t\t\t\t\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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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  " colspan="4" 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">Bacteriemias secundarias a otro foco&#44; intra-UCI</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a><span class="elsevierStyleItalic">&#44; n</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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">102&nbsp;\t\t\t\t\t\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">1&#46;505&nbsp;\t\t\t\t\t\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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Colonizaci&#243;n&#47;infecci&#243;n por</span> P&#46; aeruginosa <span class="elsevierStyleItalic">MR&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Colonizaci&#243;n&#47;infecci&#243;n por</span> Acinetobacter <span class="elsevierStyleItalic">R-IMP sp&#46;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Traum&#225;tica&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>Ventilaci&#243;n mec&#225;nica<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&#44; pacientes n &#40;&#37;&#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>Ventilaci&#243;n mec&#225;nica&#44;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a> d&#237;as totales&#44; n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;434&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>Ventilaci&#243;n mec&#225;nica<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&#44; d&#237;as por paciente&#44; media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sonda uretral<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&#44; pacientes&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#46;365 &#40;96&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sonda uretral<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a> d&#237;as totales&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>Sonda uretral<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&#44; d&#237;as por paciente&#44; media &#40;DE&#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"><span class="elsevierStyleHsp" style=""></span>Cat&#233;ter venoso central<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a>&#44; pacientes&#44; n &#40;&#37;&#41;&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<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a>&#44; d&#237;as&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">51&#46;887&nbsp;\t\t\t\t\t\t\n
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                  \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"><span class="elsevierStyleHsp" style=""></span>Cat&#233;ter venosos central<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a>&#44; d&#237;as por paciente&#44; media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Microorganismos en pacientes POCC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Microorganismos en pacientes sin CC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pseudomonas aeruginosa&#44; n &#40;&#37;&#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">53 &#40;24&#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">990 &#40;18&#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>Escherichia coli&#44; n &#40;&#37;&#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">21 &#40;9&#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">388 &#40;7&#44;3&#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>Staphylococcus aureus&#44; n &#40;&#37;&#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">19 &#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">897 &#40;16&#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>Klebsiella pneumoniae&#44; n &#40;&#37;&#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 &#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">290 &#40;5&#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>Haemophilus influenzae&#44; n &#40;&#37;&#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 &#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">309 &#40;5&#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>Serratia marcescens&#44; n &#40;&#37;&#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 &#40;6&#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">143 &#40;2&#44;7&#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>Stenotrophomonas maltophilia&#44; n &#40;&#37;&#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 &#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">209 &#40;3&#44;9&#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>Acinetobacter baumannii&#44; n &#40;&#37;&#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">6 &#40;2&#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">564 &#40;10&#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  " colspan="3" 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">Infecci&#243;n urinaria relacionada con sonda uretral&#44; n</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">165&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#46;957&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>Escherichia coli&#44; n &#40;&#37;&#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">55 &#40;33&#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">765 &#40;24&#46;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>Pseudomonas aeruginosa&#44; n &#40;&#37;&#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">19 &#40;11&#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">338 &#40;11&#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>Candida albicans&#44; n &#40;&#37;&#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 &#40;10&#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">368 &#40;12&#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>Klebsiella pneumoniae&#44; n &#40;&#37;&#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 &#40;8&#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">151 &#40;5&#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>Enterococcus faecalis&#44; n &#40;&#37;&#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 &#40;7&#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">336 &#40;11&#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  " colspan="3" 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">Bacteriemia relacionada con cat&#233;ter y bacteriemia primaria&#44; n &#40;&#37;&#41;</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">169&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#46;660&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>Staphylococcus epidermidis&#44; n &#40;&#37;&#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 &#40;23&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">654 &#40;24&#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>SCN&#44; n &#40;&#37;&#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 &#40;6&#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">410 &#40;15&#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>Enterococcus faecalis&#44; n &#40;&#37;&#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">22 &#40;13&#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">191 &#40;7&#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>Pseudomonas aeruginosa&#44; n &#40;&#37;&#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 &#40;8&#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">134 &#40;5&#44;0&#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>Escherichia coli&#44; n &#40;&#37;&#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 &#40;8&#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">100 &#40;3&#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>Serratia marcescens&#44; n &#40;&#37;&#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 &#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">51 &#40;2&#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>Klebsiella pneumoniae&#44; n &#40;&#37;&#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 &#40;7&#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="left" valign="\n
                  \t\t\t\t\ttop\n
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                0 => array:1 [
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