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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The Enterobacteriaceae family constitutes an important and heterogeneous subgroup in the greater group of the gram-negative bacteria&#46; They are facultative anaerobic microorganisms that live as saprophytes in the gastrointestinal tract&#44; although they are also characterised by their ubiquity&#44; as they are commonly found in the environment as well as in the GI tract of many animals&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">At present&#44; Enterobacteriaceae are an important problem in many hospitals&#44; as they are benefitting from several factors&#44; such as the excessive use of antibiotics or prolonged hospital stays&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> There have been numerous reports of <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> outbreaks in neonatal intensive care units &#40;NICUs&#41; in hospitals of different care levels throughout the world&#46; This is indicative of the substantial complexity of preventing healthcare-associated infections &#40;HAI&#41; in these settings&#44; which is compounded by the high morbidity and mortality associated with them&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Articles on the subject published in recent years have identified several risk factors&#44; described different strategies for outbreak control and reported morbidity and mortality rates with significant variations between studies&#46; For instance&#44; an outbreak that occurred in China in 2012 affected 103 newborns&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a> an outbreak in India in 2010 had an associated mortality of 57&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> and an outbreak in Germany in 2015 resulted in the permanent closure of the affected NICU&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</span></a> In addition&#44; a systematic review published in 2016 by Stapleton et al&#46; identified understaffing as the most important risk factor&#44; and reported a median outbreak duration of 6&#46;5 months&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In November 2014&#44; an extended-spectrum &#946;-lactamase &#40;ESBL&#41;-producing <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> outbreak was detected in the NICU of a tertiary hospital&#46; The outbreak was terminated in January 2015 and involved a total of 17 cases &#40;13 of colonisation and 4 of infection&#41;&#44; none of which resulted in death&#46; The control measures that were implemented achieved termination of the outbreak in less than 3 months&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of this work is to analyse the clinical&#44; epidemiological and microbiological characteristics of the outbreak and the associated risk factors&#44; and to describe the measures of prevention and control that were implemented for its termination&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methodology</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study setting</span><p id="par0030" class="elsevierStylePara elsevierViewall">The setting was a tertiary referral hospital located in the north of Spain&#46; The Department of Neonatology operates under the Paediatrics Clinical Management Unit and is the reference unit for its geographical region&#46; The department has a total of 32 beds&#44; of which 14 belong to the NICU&#44; and 2 are equipped for patient isolation&#46; The usual occupancy rate is 50&#37;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study design</span><p id="par0035" class="elsevierStylePara elsevierViewall">We conducted an observational and analytical case&#8211;control study&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Case definition</span><p id="par0040" class="elsevierStylePara elsevierViewall">We established the following case definitions<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Infection by ESBL-producing <span class="elsevierStyleItalic">K&#46; pneumoniae</span>&#58; isolation of ESBL-producing <span class="elsevierStyleItalic">K&#46; pneumoniae</span> from biological samples and features of infection that supported that this bacterium was the aetiological agent&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Colonisation by ESBL-producing <span class="elsevierStyleItalic">K&#46; pneumoniae</span>&#58; isolation of ESBL-producing <span class="elsevierStyleItalic">K&#46; pneumoniae</span> from biological samples in the absence of features of infection&#46;</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Selection of controls</span><p id="par0055" class="elsevierStylePara elsevierViewall">We selected two controls for each case&#46; We used stratified sampling to maximise the homogeneity of cases and controls in relation to sex and birth weight&#46; The period under study went from November 3&#44; 2014 &#40;when the first case was detected&#41; to February 20&#44; 2015 &#40;when the last affected patient was discharged&#41;&#46; Consequently&#44; we selected the controls from the set of newborns admitted to the NICU in the same time interval&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">We selected the controls from the patients admitted to the unit in the same time period as the cases using a random number generator known as <span class="elsevierStyleItalic">nosetup</span>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Selection and definition of variables</span><p id="par0065" class="elsevierStylePara elsevierViewall">We performed a search of the PubMed database for articles on the subject of interest published in English in the past 10 years&#46; We identified and reviewed 41 articles&#44; and selected those variables found to be relevant in at least 25&#37; of the articles for analysis&#46; These variables were mainly related to placement of invasive devices&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2&#44;4&#44;8&#8211;10</span></a> We also thought it would be of interest to include the variable &#8216;continuous positive airway pressure&#8217; &#40;CPAP&#41; on account of its recent introduction in our NICUs&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Preventive and control measures</span><p id="par0070" class="elsevierStylePara elsevierViewall">With the aim of improving control of infection transmission and putting an end to the outbreak as quickly as possible&#44; the Department of Preventive Medicine and Public Health developed a document compiling current recommendations for healthcare workers and relatives of patients&#46;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">1&#46;</span><p id="par0075" class="elsevierStylePara elsevierViewall">An epidemic curve was produced to identify the primary case and to track the epidemiological evolution of the outbreak &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">2&#46;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Maps of the prevalence of multi-drug resistant microorganisms were drawn periodically to collect information on the evolution of the outbreak at specific time points&#46; The maps covered both inpatient wards and NICU areas&#46; They were shared with the medical and nursing management teams of the hospital and with physicians involved in any of the clinical departments of the hospital&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">3&#46;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Communication strategy for health care professionals and relatives of patients&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">a&#46;</span><p id="par0090" class="elsevierStylePara elsevierViewall">A document containing general recommendations for outbreak control was developed and given out to professionals involved in NICU operations and other workers&#46; The document addressed aspects related to effective communication&#44; the microbiological strategy&#44; contact isolation and standard precautions&#44; safety of health care procedures&#44; health care clothing&#44; the physical distribution of the space&#44; routine work protocols&#44; cleaning protocol&#44; hands hygiene and management of patient visits&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">b&#46;</span><p id="par0095" class="elsevierStylePara elsevierViewall">The Department of Preventive Medicine and Public Health of the hospital held 2 information sessions for the families of the patients involved in the outbreak to explain the situation and the preventive measures that it was going to implement&#46; The purpose of these sessions was to provide direct information about the interventions that were going to be implemented and to ask for their collaboration in minimising the transmission of these sessions was to present first-hand the actions that would be carried out and to achieve their collaboration in minimising pathogen transmission&#46;</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">4&#46;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Patients in the NICU were transferred to an alternative location to allow environmental decontamination of the unit with vaporised 35&#37; hydrogen peroxide&#46;</p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Microbiological investigation</span><p id="par0105" class="elsevierStylePara elsevierViewall">To determine the magnitude of the outbreak&#44; pharyngeal and rectal samples were obtained from every patient that was staying in the NICU when the second case was detected&#46; After that&#44; samples were collected on a weekly basis from every patient whose previous results had been negative&#46; Clinical samples were submitted to the National Centre of Microbiology for analysis&#46; This laboratory characterised ESBL-producing <span class="elsevierStyleItalic">K&#46; pneumoniae</span> isolates using phenotypic and molecular methods&#44; including pulsed-field gel electrophoresis&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Samples of high-contact environmental surfaces&#44; the hands of health care workers and disinfectants were obtained with sterile swabs and kept in liquid Amies medium&#46; They were processed according to the recommendations of the Sociedad Espa&#241;ola de Enfermedades Infecciosas y Microbiolog&#237;a Cl&#237;nica in no 42 of its series of scientific documents on microbiological procedures&#44; devoted to environmental microbiological control&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Statistical analysis</span><p id="par0115" class="elsevierStylePara elsevierViewall">We performed a descriptive analysis of each variable &#40;univariate analysis&#41;&#44; calculating the absolute and relative frequencies for qualitative variables&#46; For quantitative variables&#44; we obtained the mean as the measure of central tendency &#40;with the corresponding standard deviation&#41; as well as the minimum and maximum values&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">We performed a bivariate analysis to assess potential associations in the variables under study&#46; We used the Fisher exact test for dichotomous qualitative variables&#44; as the sample was small and did not fulfil the necessary conditions for application of the chi square test&#46; We used the non-parametric Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test for quantitative variables&#44; as the data did not follow a normal distribution based on the Shapiro&#8211;Wilk test &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001 in all four criteria and overall&#41; and there were fewer than 30 individuals in the case group&#46; We defined statistical significance as a <span class="elsevierStyleItalic">P</span>-value of less than &#46;05&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">We performed the analyses with the <span class="elsevierStyleItalic">Statistical Package for the Social Sciences</span>&#44; version 18&#46;0&#44; and the software EPIDAT&#44; version 3&#46;1&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Results</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">General description</span><p id="par0130" class="elsevierStylePara elsevierViewall">The sample consisted of 51 newborns&#44; out of who 17 corresponded to cases and the remaining 34 to controls&#46; The sex distribution of the sample was 59&#37; female and 41&#37; male&#46; The primary case&#44; which was also the index case&#44; was detected on November 22&#44; 2014&#44; and the last case on January 19&#44; 2015&#46; Of the 17 cases&#44; 12 &#40;70&#46;5&#37;&#41; were of colonisation and 5 &#40;29&#46;4&#37;&#41; of infection &#40;bacteraemia&#41;&#46; Seven newborns in the case group &#40;41&#46;2&#37;&#41; had been delivered by caesarean section&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">As for invasive medical procedures&#44; umbilical venous catheters were used in 12 cases &#40;70&#46;6&#37;&#41;&#44; umbilical catheters in 9 &#40;52&#46;9&#37;&#41;&#44; parenteral nutrition &#40;PN&#41; in 13 &#40;76&#46;5&#37;&#41;&#44; invasive mechanical ventilation &#40;IMV&#41; in 6 &#40;35&#46;3&#37;&#41;&#44; continuous positive airway pressure &#40;CPAP&#41; in 12 &#40;70&#46;6&#37;&#41; and urinary catheterization &#40;UC&#41; in 15 &#40;88&#46;2&#37;&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">When it came to intravenous therapy&#44; 11 patients in the case group &#40;64&#46;7&#37;&#41; received intravenous antibiotherapy&#44; and 11 fluid therapy&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The distribution of patients with positive results for ESBL-producing <span class="elsevierStyleItalic">K&#46; pneumoniae</span> was the following&#58; 10 with a positive sample from a single location &#40;58&#46;8&#37;&#41;&#44; 5 with detection of the bacteria in samples from 2 locations &#40;29&#46;4&#37;&#41;&#44; and 2 with detection of the bacteria in samples from 3 or more locations &#40;11&#46;8&#37;&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The distribution of cases by birth weight was&#58; 2 &#40;11&#46;8&#37;&#41; with birth weights greater than 2500<span class="elsevierStyleHsp" style=""></span>g&#44; 4 &#40;23&#46;5&#37;&#41; with weights between 1500 and 2500<span class="elsevierStyleHsp" style=""></span>g&#44; 5 &#40;29&#46;4&#37;&#41; with weights between 1000 and 1500<span class="elsevierStyleHsp" style=""></span>g and 5 &#40;29&#46;4&#37;&#41; with weights of less than 1000<span class="elsevierStyleHsp" style=""></span>g&#46; In 1 case&#44; there was no record of the birth weight in the chart&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The distribution by gestational age was as follows&#58; 6 &#40;35&#46;3&#37;&#41; full term&#44; 2 &#40;11&#46;8&#37;&#41; early term&#44; 8 &#40;47&#46;1&#37;&#41; late preterm and 1 &#40;5&#46;9&#37;&#41; extremely preterm&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Last of all&#44; the mean length of stay was 45&#46;4 days &#40;SD&#44; &#177;23&#46;6&#41; for the overall stay in hospital and 34&#46;5 days &#40;SD&#44; &#177;20&#46;2&#41; for the NICU stay&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Risk factors</span><p id="par0165" class="elsevierStylePara elsevierViewall">The risk factors with a statistically significant association with colonisation or infection by ESBL-producing <span class="elsevierStyleItalic">K&#46; pneumoniae</span> were&#58; CVC &#40;OR&#44; 5&#46;0 &#91;95&#37; CI&#44; 1&#46;4&#8211;17&#46;8&#93;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;016&#93;&#44; PN &#40;OR&#44; 6&#46;8 &#91;95&#37; CI&#44; 1&#46;8&#8211;25&#46;7&#93;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;006&#41;&#59; UC &#40;OR&#44; 5&#46;9 &#91;95&#37; CI&#44; 1&#46;2&#8211;30&#46;0&#93;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;028&#41; and birth weight &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;035&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">We also found statistically significant differences in the mean overall length of stay and the mean length of stay in the NICU between cases and controls&#44; with stays that were longer in the case group&#44; by a mean of 20 days for the total hospitalisation &#40;25 vs 45 days&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41; and a mean of 16 days for the stay at the NICU &#40;18 vs 34 days&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Preventive and control measures</span><p id="par0175" class="elsevierStylePara elsevierViewall">The main measures implemented were the following&#58;</p><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Information and communication management</span><p id="par0180" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0185" class="elsevierStylePara elsevierViewall">A working group was appointed to manage the situation&#46; It consisted of professionals from the NICU&#44; the Department of Preventive Medicine and Public Health&#44; the Department of Microbiology Department and the Cleaning Service&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Communication strategy&#58; immediately after the outbreak was detected&#44; the situation was assessed in the course of several meetings that included the families of affected patients and professionals working in the involved units of the hospital&#46; In these early meetings&#44; families were informed about the characteristics of the outbreak&#44; transmission mechanisms and the preventive measures that were going to be implemented&#44; and they were asked to cooperate during the implementation phase&#46; Meetings of parents&#44; health care professionals and hospital management continued to be held regularly to share relevant information about the evolution of the outbreak and the measures taken to control it&#46;</p></li></ul></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Specific measures to minimise cross-contamination</span><p id="par0195" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0200" class="elsevierStylePara elsevierViewall">Training plan and educational measures with participation of parents and other relatives of the patients&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0205" class="elsevierStylePara elsevierViewall">Collection of a total of 27 samples for microbiological testing&#58; from work surfaces&#44; hands of health care workers and cleaning and antiseptic products&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8226;</span><p id="par0210" class="elsevierStylePara elsevierViewall">Transfer of patients in the NICU to an alternative location&#58; the infants were temporarily moved to a different location&#46; Cases and controls were isolated separately&#46; The NICU was disinfected though vaporisation of 35&#37; hydrogen peroxide once the patients had been moved&#46;</p></li></ul></p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Microbiological results</span><p id="par0215" class="elsevierStylePara elsevierViewall">Testing found microbial resistance through production of ESBL type CTX-M-14 in all 17 cases&#46; The molecular weight marker used in the pulsed-field gel electrophoresis tests led to the identification of 3 different profiles in the samples&#58; 1 sample in group 1&#44; 15 in group 2 and 1 in group 3&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">All cultures of environmental samples were negative except for the cultures of a sample of topical gel and a sample taken from the hands of a health care worker&#44; which grew the same microorganism involved in the outbreak&#58; ESBL CTX-M-14-producing <span class="elsevierStyleItalic">K&#46; pneumoniae</span>&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Discussion</span><p id="par0225" class="elsevierStylePara elsevierViewall">In this article&#44; and in line with the initial objectives of our study&#44; we have described a nosocomial outbreak that occurred in the NICU of a tertiary care hospital&#46; We have analysed risk factors that may have been involved in the outbreak and detailed the measures implemented to control the outbreak in the shortest possible time&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">The risk factors for infection or colonisation by ESBL-producing <span class="elsevierStyleItalic">K&#46; pneumoniae</span> that we identified were birth weight and the use of any of 3 invasive procedures &#40;CVC insertion&#44; PN and UC&#41;&#46; Our results were consistent with those of Maltezou et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a> and Gonz&#225;lez et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a> which found an association between low birth weight and infection by <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> in outbreaks that developed in NICUs&#46; However&#44; other studies we reviewed had not found evidence of this association&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</span></a> It would make sense for low birth weight to be a risk factor for developing a HAI&#44; as low birth weight newborns have lower T cell counts at birth and therefore could be more vulnerable to infection&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">The outbreak under study took place over a total of 57 days between November 22&#44; 2014 and January 19&#44; 2015&#46; This is a relevant fact&#44; since the final duration of the outbreak in our unit was considerably shorter compared to the findings of the only systematic review on infections by Enterobacteriaceae in NICU settings published in the literature&#44; which reported a median outbreak duration of 6&#46;2 months&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a> We found several articles in our literature review that reported durations of even more than 6&#46;2 months&#46; In this sense&#44; we ought to mention an outbreak that occurred in Greece in 2012&#44; which lasted a total of 9 months&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> an outbreak in that occurred in New Guinea in 2007 with a duration of 13 months&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a> and an outbreak in Italy in 2008 that lasted 26 months&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a> In the last case&#44; it should be taken into account that the outbreak affected 127 newborn infants&#44; due to which it was extremely difficult to control&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">We also ought to highlight an outbreak that occurred in Germany in 2015 that could not be controlled and resulted in the permanent closure of the affected NICU&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">On the other hand&#44; a number of outbreaks of shorter or similar duration compared to the one in our unit have also been described&#44; although the number of cases was lower in all of them&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">5&#44;12&#44;17&#44;18</span></a> To measure the impact of the outbreak it is important to refer to mortality&#46; None of the patients in our unit died&#44; which differentiated this outbreak from most other outbreaks controlled within 2 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">5&#44;12&#44;17&#44;18</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">Measures of prevention and control are the cornerstone of outbreak eradication&#46; Therein lies the importance of strict adherence by all relevant parties and of effective communication between different work teams&#46; It is also important to involve the families by keeping them updated and urging them to adhere to the recommended measures&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">The rapid termination of the outbreak was possible thanks to the urgency with which the Department of Preventive Medicine and Public Health developed adequate measures for control and&#44; needless to say&#44; to their correct implementation by health care professionals&#46; Control was achieved through a health education plan implemented through the scheduling of multidisciplinary meetings whose purpose was to promote team work and emphasise the seriousness of the situation&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Health education and reinforcement of hand hygiene and other contact precautions were the interventions reported interventions in the reviewed literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2&#44;4&#8211;6&#44;12&#44;18&#44;20</span></a></p><p id="par0265" class="elsevierStylePara elsevierViewall">The reason is that they are effective and easily implemented interventions&#44; and therefore their use for control of HAIs is a given&#46; It is also of paramount importance to emphasise the need for hand hygiene routines using alcohol-based solutions&#44; since currently this measure is only implemented in approximately 40&#37; of the instances where it applies&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall">On the other hand&#44; organisational measures also played an important role&#44; such as increasing the nurse-to-patient ratio&#44; with some nurses allocated exclusively to the care of hospitalised patients affected by the outbreak&#44; transfer of patients outside the NICU&#44; screening of multi-drug resistant microorganisms in all newly-admitted patients&#44; and physical isolation of patient cohorts&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">It is also important to remember that family members that visit the NICU can also contribute to the spread of infection&#46; Although the evidence on this aspect is mostly focused on respiratory infections caused by viruses&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> cases of transmission of Enterobacteriaceae through the hands of visitors have also been described in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a> For this reason&#44; we believe it may be beneficial to restrict access to the NICU&#44; maintaining only the contact between the newborns and their parents&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Before concluding&#44; we ought to note that there are limitations to our study&#46; First of all&#44; it was a case-control study&#44; and therefore there is potential for information bias&#46; Furthermore&#44; due to the small sample size&#44; the results of our study cannot be generalised&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">In brief&#44; invasive medical interventions such as insertion of CVCs&#44; PN and UC together with low birth weight are risk factors for acquiring ESBL-producing <span class="elsevierStyleItalic">K&#46; pneumoniae</span>&#44; while colonisation or infection by ESBL-producing <span class="elsevierStyleItalic">K&#46; pneumoniae</span> is associated with increases in the length of stay&#44; with a mean increase of 20 days in overall hospital stay and 16 days in the NICU stay&#46; Measures aimed at patient safety need to be reinforced in health care settings&#44; with emphasis on those that address practices that may increase the extrinsic risk of colonisation or infection by ESBL-producing <span class="elsevierStyleItalic">K&#46; pneumoniae</span> in NICUs&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflicts of interest</span><p id="par0290" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In November 2014&#44; an extended-spectrum beta-lactamase producing <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> outbreak was detected in the neonatal intensive care unit of a tertiary care hospital&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Our aim was to determine the clinical&#44; epidemiological and microbiological characteristics of the outbreak&#44; to analyse the identified risk factors and to describe the preventive and control measures implemented for its eradication&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We conducted a case-control study&#46; We performed univariate and bivariate analyses&#44; defining statistical significance as a <span class="elsevierStyleItalic">P</span>-value of less than 0&#46;05&#46; The implemented preventive and control measures were aimed at establishing the magnitude of the outbreak&#44; effective communication&#44; the evaluation of health care processes and education on patient safety&#46; Clinical samples were collected for molecular and phenotypic characterisation&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Findings</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The sample consisted of 51 newborns&#44; of who 17 were cases and the remaining 34 controls&#46; The distribution of cases by birth weight was&#58; 2 cases &#40;11&#46;8&#37;&#41; greater than 2500<span class="elsevierStyleHsp" style=""></span>g&#44; 4 cases &#40;23&#46;5&#37;&#41; between 1500 and 2500<span class="elsevierStyleHsp" style=""></span>g&#44; 5 cases &#40;29&#46;4&#37;&#41; between 1000 and 1500<span class="elsevierStyleHsp" style=""></span>g&#44; and 5 cases &#40;29&#46;4&#37;&#41; less than 1000<span class="elsevierStyleHsp" style=""></span>g&#46; In one case&#44; the birth weight was not documented in the health record&#46; The following risk factors for colonisation or infection were statistically significant in our study&#58; presence of a central venous catheter &#40;OR&#44; 5&#46;0 &#91;95&#37; CI&#44; 1&#46;4&#8211;17&#46;8&#93;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;016&#41;&#59; parenteral nutrition &#40;OR&#44; 6&#46;8 &#91;95&#37; CI&#44; 1&#46;8&#8211;25&#46;7&#93;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;006&#41;&#59; urinary catheterization &#40;OR&#44; 5&#46;9 &#91;95&#37; CI&#44; 1&#46;2&#8211;30&#46;0&#93;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;028&#41; and birth weight &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;035&#41;&#46; We found statistically significant differences in the mean total length of stay in hospital &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41; and length of stay in the NICU &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46; All 17 cases presented antimicrobial resistance with presence of extended-spectrum beta-lactamase type CTX-M-14&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Workplace interventions focused on patient safety need to be reinforced&#44; especially those concerning practices with the potential to increase the extrinsic risk of colonisation or infection by extended-spectrum beta-lactamase-producing <span class="elsevierStyleItalic">K&#46; pneumoniae</span> in the NICU&#44; such as the insertion&#44; care and maintenance of central venous catheter&#44; parenteral nutrition and urinary catheterization&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En noviembre de 2014&#44; se detect&#243; un brote de <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> productora de betalactamasas de espectro extendido en la unidad de cuidados intensivos neonatales de un hospital terciario&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El objetivo fue describir las caracter&#237;sticas cl&#237;nicas&#44; epidemiol&#243;gicas y microbiol&#243;gicas del brote&#44; analizar los factores de riesgo asociados y presentar las medidas preventivas y de control implementadas para su erradicaci&#243;n&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio de casos y controles&#46; Se realizaron an&#225;lisis univariantes y bivariantes&#44; consider&#225;ndose estad&#237;sticamente significativo un valour de p &#60; 0&#44;05&#46; Las medidas preventivas y de control se centraron en la necesidad de determinar la magnitud del problema&#44; en la comunicaci&#243;n efectiva&#44; la evaluaci&#243;n de los procedimientos sanitarios y la educaci&#243;n sobre la seguridad del paciente&#46; Se realiz&#243; caracterizaci&#243;n molecular y fenot&#237;pica de muestras cl&#237;nicas&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La muestra de estudio consisti&#243; en 51 neonatos&#44; de los que 17 fueron casos y los 34 restantes controles&#46; La distribuci&#243;n de casos por peso al nacer fue&#58; 2 con peso &#62; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g &#40;11&#44;8&#37;&#41;&#44; 4 con peso de 1&#46;500&#8211;2&#46;500<span class="elsevierStyleHsp" style=""></span>g &#40;23&#44;5&#37;&#41;&#44; 5 con peso de 1&#46;000&#8211;1&#46;500<span class="elsevierStyleHsp" style=""></span>g &#40;29&#44;4&#37;&#41; y 5 con peso &#60; 1&#46;000<span class="elsevierStyleHsp" style=""></span>g &#40;29&#44;4&#37;&#41;&#46; En un caso no se hab&#237;a registrado el peso al nacer en la historia cl&#237;nica&#46; Los factores de riesgo estad&#237;sticamente significativos para la colonizaci&#243;n&#47;infecci&#243;n fueron&#58; presencia de cat&#233;ter venoso &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44;0 &#91;IC 95&#37; 1&#44;4&#8211;17&#44;8&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#59; nutrici&#243;n parenteral &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#44;8 &#91;IC 95&#37;&#58; 1&#44;8&#8211;25&#44;7&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41;&#59; sondaje vesical &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44;9 &#91;IC 95&#37; 1&#44;2&#8211;30&#44;0&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;028&#41; y peso al nacer &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;035&#41;&#46; Encontramos diferencias estad&#237;sticamente significativas en la estancia hospitalaria media &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41; y los d&#237;as de estancia en la unidad de cuidados intensivos neonatales &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; Se encontr&#243; resistencia a antimicrobianos tipo betalactamasas de espectro extendido CTX-M-14 en los 17 casos&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Han de reforzarse las iniciativas de trabajo sobre la seguridad de los pacientes&#44; especialmente aquellas aplicables a intervenciones con el potencial de aumentar el riesgo de colonizaci&#243;n&#47;infecci&#243;n por <span class="elsevierStyleItalic">K&#46; pneumoniae</span> productora de betalactamasas de espectro extendido en la unidad de cuidados intensivos neonatales&#44; como las asociadas a la inserci&#243;n&#44; cuidado y mantenimiento de cat&#233;ter venoso&#44; la nutrici&#243;n parenteral y el sondaje vesical&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Fern&#225;ndez-Prada M&#44; Mart&#237;nez-Ortega C&#44; Santos-Simarro G&#44; Mor&#225;n-&#193;lvarez P&#44; Fern&#225;ndez-Verdugo A&#44; Costa-Romero M&#46; Brote de <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> productora de betalactamasas de espectro extendido en una unidad de cuidados intensivos neonatales&#58; factores de riesgo y medidas de prevenci&#243;n clave para su erradicaci&#243;n en tiempo r&#233;cord&#46; An Pediatr &#40;Barc&#41;&#46; 2019&#59;91&#58;13&#8211;20&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;000&#40;0&#46;306&#8211;3&#46;264&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\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">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">58&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\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">58&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Caesarean delivery</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\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">44&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;887&#40;0&#46;273&#8211;2&#46;884&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\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">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">58&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\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">55&#46;9&nbsp;\t\t\t\t\t\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
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="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  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">CVC</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\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
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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
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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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\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">32&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;018&#40;1&#46;414&#8211;17&#46;811&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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
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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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&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\ttop\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
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="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  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Umbilical catheter</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\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">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;9&nbsp;\t\t\t\t\t\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">15&nbsp;\t\t\t\t\t\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">44&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;569&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;425&#40;0&#46;443&#8211;4&#46;584&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\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">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\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">55&#46;9&nbsp;\t\t\t\t\t\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  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Parenteral nutrition</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\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">13&nbsp;\t\t\t\t\t\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">76&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\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">32&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;795&#40;1&#46;795&#8211;25&#46;725&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">23&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">67&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IMV</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\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">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;508&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;773&#40;0&#46;497&#8211;6&#46;324&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\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">11&nbsp;\t\t\t\t\t\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">64&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">76&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Urinary catheter</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\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">15&nbsp;\t\t\t\t\t\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">88&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\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">55&#46;9&nbsp;\t\t\t\t\t\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">&#46;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;921&#40;1&#46;168&#8211;30&#46;019&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">11&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\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">44&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="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  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Antibiotherapy</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\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">11&nbsp;\t\t\t\t\t\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">64&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\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">55&#46;9&nbsp;\t\t\t\t\t\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">&#46;763&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;447&#40;0&#46;435&#8211;4&#46;821&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\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">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\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">44&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="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  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fluid therapy</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\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">11&nbsp;\t\t\t\t\t\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">64&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">76&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;508&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;564&#40;0&#46;158&#8211;2&#46;012&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\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">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Continuous positive airway pressure</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\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">12&nbsp;\t\t\t\t\t\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">70&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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