Scientific Letter
Is azithromycin really a therapeutic option in intestinal salmonellosis?
¿Es realmente la azitromicina una opción terapéutica en la salmonelosis intestinal?
Read
9894
Timeswas read the article
2166
Total PDF
7728
Total HTML
Share statistics
array:24 [ "pii" => "S234128791500191X" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.09.019" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "1863" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2015;83:346-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1965 "formatos" => array:3 [ "EPUB" => 147 "HTML" => 1402 "PDF" => 416 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1695403315001435" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2015.04.004" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "1863" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2015;83:346-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 14092 "formatos" => array:3 [ "EPUB" => 138 "HTML" => 13280 "PDF" => 674 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "¿Es realmente la azitromicina una opción terapéutica en la salmonelosis intestinal?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "346" "paginaFinal" => "347" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Is azithromycin really a therapeutic option in intestinal salmonellosis?" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Pérez-Doñate, M. Borrás-Máñez, V. Domínguez-Márquez, D. Navalpotro-Rodríguez, J. Colomina-Rodríguez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Pérez-Doñate" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Borrás-Máñez" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Domínguez-Márquez" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Navalpotro-Rodríguez" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Colomina-Rodríguez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S234128791500191X" "doi" => "10.1016/j.anpede.2015.09.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128791500191X?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315001435?idApp=UINPBA00005H" "url" => "/16954033/0000008300000005/v1_201510300037/S1695403315001435/v1_201510300037/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341287915001970" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.09.024" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "1856" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2015;83:347-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 8811 "formatos" => array:3 [ "EPUB" => 157 "HTML" => 8248 "PDF" => 406 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Focal nodular hyperplasia: A diagnosis to consider in a hepatic mass" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "347" "paginaFinal" => "349" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hiperplasia nodular focal: diagnóstico a considerar ante una masa hepática" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1100 "Ancho" => 1401 "Tamanyo" => 318186 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histology of focal nodular hyperplasia of the liver. Liver biopsy corresponding to a case of FNH: (A) normal cellularity without atypia. (B) Absence of portal triads (characteristic of FNH). Presence of bile canaliculi (inconsistent with hepatic adenoma). (C) Presence of fibrosis (Masson's trichrome stain).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E.E. Moreno Medinilla, O. Escobosa Sánchez, L. García Hidalgo, T. Acha García" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E.E." "apellidos" => "Moreno Medinilla" ] 1 => array:2 [ "nombre" => "O." "apellidos" => "Escobosa Sánchez" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "García Hidalgo" ] 3 => array:2 [ "nombre" => "T." "apellidos" => "Acha García" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403315001216" "doi" => "10.1016/j.anpedi.2015.03.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315001216?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001970?idApp=UINPBA00005H" "url" => "/23412879/0000008300000005/v1_201512040119/S2341287915001970/v1_201512040119/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287915001738" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.09.010" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "1821" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;83:341-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3180 "formatos" => array:3 [ "EPUB" => 155 "HTML" => 2502 "PDF" => 523 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Surgical management of aplasia cutis congenita" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "341" "paginaFinal" => "345" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manejo quirúrgico de la aplasia cutis congénita" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.E. Betancourth-Alvarenga, F. Vázquez-Rueda, V. Vargas-Cruz, R.M. Paredes-Esteban, J. Ayala-Montoro" "autores" => array:5 [ 0 => array:2 [ "nombre" => "J.E." "apellidos" => "Betancourth-Alvarenga" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Vázquez-Rueda" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Vargas-Cruz" ] 3 => array:2 [ "nombre" => "R.M." "apellidos" => "Paredes-Esteban" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Ayala-Montoro" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S169540331500065X" "doi" => "10.1016/j.anpedi.2015.02.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S169540331500065X?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001738?idApp=UINPBA00005H" "url" => "/23412879/0000008300000005/v1_201512040119/S2341287915001738/v1_201512040119/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Is azithromycin really a therapeutic option in intestinal salmonellosis?" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "346" "paginaFinal" => "347" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "V. Pérez-Doñate, M. Borrás-Máñez, V. Domínguez-Márquez, D. Navalpotro-Rodríguez, J. Colomina-Rodríguez" "autores" => array:5 [ 0 => array:3 [ "nombre" => "V." "apellidos" => "Pérez-Doñate" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Borrás-Máñez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "V." "apellidos" => "Domínguez-Márquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "D." "apellidos" => "Navalpotro-Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:4 [ "nombre" => "J." "apellidos" => "Colomina-Rodríguez" "email" => array:1 [ 0 => "jcolomina@hospital-ribera.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital Universitario de la Ribera, Alzira, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital General Universitario de Castellón, Castellón, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Microbiología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es realmente la azitromicina una opción terapéutica en la salmonelosis intestinal?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acute gastroenteritis (AGE) is a common disease and a major cause of morbidity and mortality in children, and it is the most frequent reason for paediatric emergency room visits following respiratory infections. In Spain, the bacteria most frequently involved in AGE are <span class="elsevierStyleItalic">Campylobacter</span> and <span class="elsevierStyleItalic">Salmonella</span> species, which are also the most frequently involved in cases of foodborne illness in developed countries.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> While antibiotic treatment is not always indicated, the growing resistance to antimicrobial drugs calls for the surveillance of in vitro susceptibility and for the periodical review of sensitivity data to update treatment guidelines.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) and the European Society for Paediatric Infectious Diseases (ESPID) recently published an update to the Guidelines for the Management of Acute Gastroenteritis in Children that featured azithromycin as an alternative treatment against nontyphoidal <span class="elsevierStyleItalic">Salmonella</span> (NTS) species.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Azithromycin is a semisynthetic macrolide antibiotic of the azalide class that acts by inhibiting bacterial protein synthesis, and has shown a similar or superior efficacy than third-generation cephalosporins and fluoroquinolones in the treatment of uncomplicated typhoid fever in several clinical trials.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> The scarceness of data on bacterial sensitivity to this antibiotic in Spain, and the lack of clinical breakpoints for interpreting minimum inhibitory concentration (MIC) values for azithromycin against <span class="elsevierStyleItalic">Salmonella</span> species mean that we have no information on the actual effectiveness of this antimicrobial agent in the treatment of salmonellosis. The aim of our study was to assess the in vitro activity of azithromycin against clinical isolates of NTS.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We conducted a descriptive, prospective multicentre study with the participation of three hospitals of the Autonomous Community of Valencia. Each participating hospital was randomly selected and submitted NTS clinical isolates from patients with suspected AGE to the microbiology department of the Hospital Universitario de La Ribera in the first four months of 2014. The coordinating hospital confirmed the bacterial identification by means of NC52 panels for the MicroScan<span class="elsevierStyleSup">®</span> WalkAway<span class="elsevierStyleSup">®</span> system (Siemens, Germany). Then, antibiotic sensitivity was assessed by determining the MIC for azithromycin using E-test<span class="elsevierStyleSup">®</span> strips (bioMerieux, Spain); the results were interpreted applying the epidemiological cut-off value established by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) for NTS (MIC<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>16<span class="elsevierStyleHsp" style=""></span>mg/L).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We analysed a total of 136 NTS isolates (69 came from Alzira, 15 from Valencia and 52 from Castellón). The median age of patients was 7 years (range, 1–74), and 81% were male and 58% female. When tested for azithromycin sensitivity, 99% of isolates were found to be sensitive and only one isolate was resistant. The identified MICs ranged between 1.5 and 24<span class="elsevierStyleHsp" style=""></span>mg/L. The MIC50 (concentration needed to inhibit 50% of the isolates) and the MIC90 (concentration needed to inhibit 90% of the isolates) were 6<span class="elsevierStyleHsp" style=""></span>mg/L and 8<span class="elsevierStyleHsp" style=""></span>mg/L, respectively.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The results we obtained are consistent with several European studies that have described a distribution of MICs that ranges between 4 and 8<span class="elsevierStyleHsp" style=""></span>mg/L for most isolates.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> To date, the Clinical and Laboratory Standards Institute (CLSI) has not defined breakpoints for macrolides and <span class="elsevierStyleItalic">Enterobacteriaceae</span><a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a>; in Europe, EUCAST has only established an epidemiological cut-off value for <span class="elsevierStyleItalic">Shigella</span> and <span class="elsevierStyleItalic">Salmonella typhi</span> according to which strains with a MIC of 16<span class="elsevierStyleHsp" style=""></span>mg/L or less are considered wild strains (with no resistance mechanisms) and thus susceptible to treatment with azithromycin.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In light of these MIC results, azithromycin could be used for treatment of AGE caused by NTS, although it would be preferable if international committees were to establish clinical breakpoints for <span class="elsevierStyleItalic">Salmonella enterica</span> and azithromycin. If we only take into consideration the paediatric population, azithromycin covers the two main causes of bacterial AGE with an excellent sensitivity profile; also, its easy dosage (once a day) and good tolerability make it an interesting alternative for the first-line empirical treatment of bacterial AGE in cases in which there is a strong suspicion of a NTS aetiology and microbiological tests cannot be performed.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pérez-Doñate V, Borrás-Máñez M, Domínguez-Márquez V, Navalpotro-Rodríguez D, Colomina-Rodríguez J. ¿Es realmente la azitromicina una opción terapéutica en la salmonelosis intestinal? An Pediatr (Barc). 2015;83:346–347.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gastroenteritis aguda. Hospital Clínico Universitario de San Juan" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Gavilán Martín" 1 => "B. García Avilés" 2 => "R. González Montero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Alicante" "fecha" => "2008" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Society for Paediatric Gastroenterology Hepatology, and Nutrition/European Society for Paediatric Infectious Diseases Evidence-based Guidelines for the Management of Acute Gastroenteritis in Children in Europe: Update 2014" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Guarino" 1 => "S. Ashkenazi" 2 => "D. Gendrel" 3 => "A. Lo Vecchio" 4 => "R. Shamir" 5 => "H. Szajewska" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MPG.0000000000000375" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "2014" "volumen" => "59" "paginaInicial" => "132" "paginaFinal" => "152" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24739189" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomized controlled comparison of ofloxacin, azithromycin, and an ofloxacin-azithromycin combination for treatment of multidrug-resistant and nalidixic acid-resistant typhoid fever" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.M. Parry" 1 => "V.A. Ho" 2 => "T. Phuong le" 3 => "P.V. Bay" 4 => "M.N. Lanh" 5 => "T. Tung le" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/AAC.00447-06" "Revista" => array:6 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "2007" "volumen" => "51" "paginaInicial" => "819" "paginaFinal" => "825" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17145784" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "The European Committee on Antimicrobial Susceptibility Testing. Break point tables for interpretation of MICs and zone diameters. Version 3.0. European Society of Clinical Microbiology and Infectious Diseases, 2013." ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antimicrobial susceptibility to azithromycin among <span class="elsevierStyleItalic">Salmonella enterica</span> isolates from the United States" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Sjölund-Karlsson" 1 => "K. Joyce" 2 => "K. Blickenstaff" 3 => "T. Ball" 4 => "J. Haro" 5 => "F.M. Medalla" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/AAC.00590-11" "Revista" => array:6 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "2011" "volumen" => "55" "paginaInicial" => "3985" "paginaFinal" => "3989" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21690279" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Clinical Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; Twenty-third informational supplement" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "titulo" => "CLSI Document M100-S23" "fecha" => "2013" "editorial" => "Clinical and Laboratory Standards Institute" "editorialLocalizacion" => "Wayne, PA" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008300000005/v1_201512040119/S234128791500191X/v1_201512040119/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008300000005/v1_201512040119/S234128791500191X/v1_201512040119/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128791500191X?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 25 | 13 | 38 |
| 2024 October | 131 | 34 | 165 |
| 2024 September | 126 | 35 | 161 |
| 2024 August | 180 | 68 | 248 |
| 2024 July | 203 | 32 | 235 |
| 2024 June | 203 | 47 | 250 |
| 2024 May | 159 | 37 | 196 |
| 2024 April | 126 | 34 | 160 |
| 2024 March | 133 | 28 | 161 |
| 2024 February | 126 | 27 | 153 |
| 2024 January | 148 | 23 | 171 |
| 2023 December | 160 | 20 | 180 |
| 2023 November | 151 | 36 | 187 |
| 2023 October | 129 | 24 | 153 |
| 2023 September | 103 | 17 | 120 |
| 2023 August | 120 | 19 | 139 |
| 2023 July | 161 | 25 | 186 |
| 2023 June | 122 | 31 | 153 |
| 2023 May | 211 | 23 | 234 |
| 2023 April | 102 | 17 | 119 |
| 2023 March | 172 | 23 | 195 |
| 2023 February | 128 | 19 | 147 |
| 2023 January | 120 | 24 | 144 |
| 2022 December | 95 | 22 | 117 |
| 2022 November | 115 | 29 | 144 |
| 2022 October | 156 | 48 | 204 |
| 2022 September | 119 | 25 | 144 |
| 2022 August | 107 | 53 | 160 |
| 2022 July | 83 | 33 | 116 |
| 2022 June | 71 | 30 | 101 |
| 2022 May | 66 | 40 | 106 |
| 2022 April | 81 | 38 | 119 |
| 2022 March | 94 | 50 | 144 |
| 2022 February | 80 | 26 | 106 |
| 2022 January | 137 | 54 | 191 |
| 2021 December | 108 | 47 | 155 |
| 2021 November | 111 | 51 | 162 |
| 2021 October | 108 | 46 | 154 |
| 2021 September | 81 | 38 | 119 |
| 2021 August | 72 | 50 | 122 |
| 2021 July | 82 | 31 | 113 |
| 2021 June | 74 | 56 | 130 |
| 2021 May | 96 | 27 | 123 |
| 2021 April | 217 | 68 | 285 |
| 2021 March | 105 | 15 | 120 |
| 2021 February | 92 | 19 | 111 |
| 2021 January | 62 | 22 | 84 |
| 2020 December | 68 | 17 | 85 |
| 2020 November | 62 | 17 | 79 |
| 2020 October | 60 | 20 | 80 |
| 2020 September | 64 | 21 | 85 |
| 2020 August | 90 | 8 | 98 |
| 2020 July | 57 | 15 | 72 |
| 2020 June | 68 | 16 | 84 |
| 2020 May | 81 | 21 | 102 |
| 2020 April | 45 | 13 | 58 |
| 2020 March | 55 | 19 | 74 |
| 2020 February | 55 | 19 | 74 |
| 2020 January | 35 | 16 | 51 |
| 2019 December | 66 | 16 | 82 |
| 2019 November | 55 | 14 | 69 |
| 2019 October | 80 | 9 | 89 |
| 2019 September | 37 | 25 | 62 |
| 2019 August | 49 | 17 | 66 |
| 2019 July | 53 | 31 | 84 |
| 2019 June | 39 | 31 | 70 |
| 2019 May | 72 | 11 | 83 |
| 2019 April | 94 | 23 | 117 |
| 2019 March | 41 | 17 | 58 |
| 2019 February | 47 | 24 | 71 |
| 2019 January | 52 | 15 | 67 |
| 2018 December | 47 | 29 | 76 |
| 2018 November | 75 | 22 | 97 |
| 2018 October | 89 | 32 | 121 |
| 2018 September | 35 | 23 | 58 |
| 2018 August | 1 | 0 | 1 |
| 2018 June | 3 | 0 | 3 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 32 | 0 | 32 |
| 2018 March | 18 | 0 | 18 |
| 2018 February | 7 | 0 | 7 |
| 2018 January | 20 | 0 | 20 |
| 2017 December | 17 | 0 | 17 |
| 2017 November | 24 | 0 | 24 |
| 2017 October | 17 | 0 | 17 |
| 2017 September | 14 | 0 | 14 |
| 2017 August | 16 | 0 | 16 |
| 2017 July | 16 | 0 | 16 |
| 2017 June | 23 | 10 | 33 |
| 2017 May | 15 | 5 | 20 |
| 2017 April | 8 | 2 | 10 |
| 2017 March | 9 | 6 | 15 |
| 2017 February | 5 | 0 | 5 |
| 2017 January | 6 | 3 | 9 |
| 2016 December | 26 | 4 | 30 |
| 2016 November | 21 | 5 | 26 |
| 2016 October | 29 | 7 | 36 |
| 2016 September | 30 | 5 | 35 |
| 2016 August | 27 | 4 | 31 |
| 2016 July | 18 | 0 | 18 |
Show all
