Skin Infections Caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus: Clinical and Microbiological Characteristics of 11 Cases

array:24 ["pii" => "S1578219014000304" "issn" => "15782190" "doi" => "10.1016/j.adengl.2013.09.005" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "893" "copyright" => "Elsevier España, S.L. and AEDV" "copyrightAnyo" => "2013" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2014;105:150-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4631 "formatos" => array:3 [ "EPUB" => 42 "HTML" => 4045 "PDF" => 544 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731013003219" "issn" => "00017310" "doi" => "10.1016/j.ad.2013.09.002" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "893" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2014;105:150-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 23010 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 20320 "PDF" => 2688 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Infecciones cutáneas causadas por Staphylococcus aureus resistente a meticilina de adquisición comunitaria: características clínico-microbiológicas en 11 pacientes" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "150" "paginaFinal" => "158" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Skin Infections Caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus: Clinical and Microbiological Characteristics of 11 Cases" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figura 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 713 "Ancho" => 950 "Tamanyo" => 156887 ] ] "descripcion" => array:1 [ "es" => "Absceso junto a tatuaje en una mujer joven." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Pulido Pérez, O. Baniandrés Rodríguez, M.C. Ceballos Rodríguez, M.D. Mendoza Cembranos, M. Campos Domínguez, R. Suárez Fernández" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Pulido Pérez" ] 1 => array:2 [ "nombre" => "O." "apellidos" => "Baniandrés Rodríguez" ] 2 => array:2 [ "nombre" => "M.C." "apellidos" => "Ceballos Rodríguez" ] 3 => array:2 [ "nombre" => "M.D." "apellidos" => "Mendoza Cembranos" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Campos Domínguez" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Suárez Fernández" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219014000304" "doi" => "10.1016/j.adengl.2013.09.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014000304?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013003219?idApp=UINPBA000044" "url" => "/00017310/0000010500000002/v1_201403120205/S0001731013003219/v1_201403120205/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219014000341" "issn" => "15782190" "doi" => "10.1016/j.adengl.2013.10.004" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "900" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2014;105:159-71" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1293 "formatos" => array:3 [ "EPUB" => 31 "HTML" => 966 "PDF" => 296 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Clinical Characteristics of Patients With Cutaneous Melanoma According to Variants in the Melanocortin 1 Receptor Gene" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "159" "paginaFinal" => "171" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Características clínicas de los pacientes con melanoma cutáneo en función de las variaciones en el gen del receptor 1 de la melanocortina (MC1R)" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.M. Peña-Vilabelda, Z. García-Casado, C. Requena, V. Traves, J.A. López-Guerrero, C. Guillén, R. Kumar, E. Nagore" "autores" => array:8 [ 0 => array:2 [ "nombre" => "M.M." "apellidos" => "Peña-Vilabelda" ] 1 => array:2 [ "nombre" => "Z." "apellidos" => "García-Casado" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Requena" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Traves" ] 4 => array:2 [ "nombre" => "J.A." "apellidos" => "López-Guerrero" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Guillén" ] 6 => array:2 [ "nombre" => "R." "apellidos" => "Kumar" ] 7 => array:2 [ "nombre" => "E." "apellidos" => "Nagore" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731013003542" "doi" => "10.1016/j.ad.2013.10.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013003542?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014000341?idApp=UINPBA000044" "url" => "/15782190/0000010500000002/v1_201403090058/S1578219014000341/v1_201403090058/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219014000092" "issn" => "15782190" "doi" => "10.1016/j.adengl.2014.01.001" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "798" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "ssu" "cita" => "Actas Dermosifiliogr. 2014;105:135-49" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3745 "formatos" => array:3 [ "EPUB" => 38 "HTML" => 3112 "PDF" => 595 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "History and Humanities in Dermatology" "titulo" => "The Beginnings of Dermatopathology and Dermatologic Microbiology in Spain" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "135" "paginaFinal" => "149" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Los comienzos de la Dermatopatología y de la Microbiología dermatológica en España" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0065" "etiqueta" => "Figure 13" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr13.jpeg" "Alto" => 2586 "Ancho" => 1583 "Tamanyo" => 810048 ] ] "descripcion" => array:1 [ "en" => "Page with figures in the monograph on pseudoepithelioma by Juan de Azúa and Claudio Sala Pons, illustrating this publication's most important contribution: pseudoepitheliomatous hyperplasia." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. del Río" "autores" => array:1 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "del Río" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731013000203" "doi" => "10.1016/j.ad.2013.01.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013000203?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014000092?idApp=UINPBA000044" "url" => "/15782190/0000010500000002/v1_201403090058/S1578219014000092/v1_201403090058/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Skin Infections Caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus: Clinical and Microbiological Characteristics of 11 Cases" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "150" "paginaFinal" => "158" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Pulido Pérez, O. Baniandrés Rodríguez, M.C. Ceballos Rodríguez, M.D. Mendoza Cembranos, M. Campos Domínguez, R. Suárez Fernández" "autores" => array:6 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Pulido Pérez" "email" => array:2 [ 0 => "ana.pulido@madrimasd.net" 1 => "apulidoperez@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "O." "apellidos" => "Baniandrés Rodríguez" ] 2 => array:2 [ "nombre" => "M.C." "apellidos" => "Ceballos Rodríguez" ] 3 => array:2 [ "nombre" => "M.D." "apellidos" => "Mendoza Cembranos" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Campos Domínguez" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Suárez Fernández" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infecciones cutáneas causadas por Staphylococcus aureus resistente a meticilina de adquisición comunitaria: características clínico-microbiológicas en 11 pacientes" ] ] "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" => 627 "Ancho" => 950 "Tamanyo" => 141217 ] ] "descripcion" => array:1 [ "en" => "Abscess and perilesional cellulitis." ] ] ] "textoCompleto" => "IntroductionThe increase in infections caused by microorganisms resistant to conventional antimicrobials represents a major therapeutic limitation in the hospital setting.Soon after the introduction of penicillin in 1941 the first strains of penicillin-resistant Staphylococcus aureus were isolated. Hospital strains of methicillin (oxacillin)-resistant S aureus appeared 2 decades later, and subsequently became one of the main bacterial causes of nosocomial infections. However, since the 1980s S aureus has also been detected in non-hospital-acquired infections,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> and its incidence has grown exponentially in many countries, including the United States, where it is the leading cause of community-acquired skin and soft tissue infections in several states.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Community-acquired methicillin-resistant S aureus (CA-MRSA) differs from its nosocomial counterpart in its clinical, epidemiological, and microbiological characteristics (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>),<a class="elsevierStyleCrossRefs" href="#bib0015">3–7</a> and thus requires radically different therapeutic management in most cases.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Given that CA-MRSA predominantly affects skin and soft tissue, we reviewed 11 cases diagnosed in our hospital in order to describe the main clinical features of the disease and the correlation with available demographic and microbiological data. Based on our findings, we propose several specific clinical criteria to improve the initial empirical treatment of skin and soft tissue infections in outpatients.Materials and MethodsThis is a descriptive, observational, retrospective study of adult patients with a microbiological diagnosis of skin and soft tissue infection caused by CA-MRSA. The data were collected between June 2009 and December 2011 from the skin infection database of the dermatology department at the Hospital General Universitario Gregorio Marañón in Madrid, Spain.All cases had been microbiologically confirmed by culture followed by antibiogram and molecular analysis.The clinical variables studied were age, sex, clinical presentation (lesion type, presence of pus, necrosis, and location), the course of the lesions, treatments received, and the response to treatment. We analyzed the origin of the patients, the presence of recurrent skin infections in the patient's family, risk practices (contact sports or activities, shared use of personal hygiene items, membership of recruiting groups or institutions), contact with the health sector (employment, previous hospital admissions), and contact with domestic or farm animals.ResultsData for the patients studied are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Of the patients studied, 91% (10/11) were younger than 40 years, and the male to female ratio was 1:1.2. The individuals were healthy, immunocompetent patients with no prior hospital admissions and no contact with the healthcare sector through either employment or family.Eight (73%) of the 11 patients presented with abscesses (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1-4</a>); half of these cases (4/8) involved perilesional cellulitis, and 63% (5/8) presented abscesses on exposed areas of the limbs. Surgical drainage removed small amounts of purulent material in 37% (3/8) of cases, and none in the remainder (63%; 5/8). Tissue necrosis, forming a cavity within the subcutaneous tissue, was the main feature of all lesions.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia>Primary follicular involvement (staphylococcal folliculitis and anthrax) was observed in 2 patients, and recurrent paronychia in another. Due to the nature of the lesions, it was not possible to clearly establish the amount of purulent exudate in these 3 patients.Thirty-six percent (4/11) of the patients were Spanish, 45% (5/11) were Latin American, and 18% (2/11) were Polish. Possible risk factors associated with the development of infection included sports (2 patients, 18%), dance (2 patients, 18%), and noninvasive cosmetic procedures (1 patient, 9%).Two patients had a history of recurrent, uncomplicated skin infections.All cases had been confirmed by culture followed by an antibiogram and molecular analysis. The bacterial strains isolated in 64% (7/11) of the cases studied were resistant to erythromycin. Levofloxacin resistance was also detected in 1 case (1/7) and inducible clindamycin resistance in another (1/7), both of which were confirmed by D-test. Genes encoding Panton-Valentine leukocidin (PVL) were expressed in all staphylococcal isolates analyzed (except 1 case in which no analysis was performed as the patient came from another health care center).Of the patients analyzed, 55% (6/11) had been previously treated with amoxicillin-clavulanate with no clinical response. Of these, 67% (4/6) experienced treatment failure after a second round of antibiotic therapy with β-lactam (cefuroxime/cloxacillin) or erythromycin.All abscesses (8/8) were surgically drained and antibiotics administered in 88% of cases. Ciprofloxacin and cotrimoxazole were the drugs of choice in 73% of patients (8/11). In 1 case treatment with oral clindamycin was discontinued due to gastrointestinal intolerance (diarrhea). Two patients with uncomplicated abscesses were treated with intravenous vancomycin as an alternative to β-lactam antibiotics. None of the patients presented systemic complications or myofascial involvement.DiscussionCA-MRSA is emerging as a causative agent of skin and soft tissue infections. Its incidence remains low in Spain, in contrast to other industrialized countries, where it constitutes one of the main community-acquired bacterial pathogens.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a>The epidemiological data presented here are similar to those reported in the scientific literature: those affected are young, healthy patients who engage in contact sports/activities or come from endemic areas such as Central or South America.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>Often, patients present single abscesses, located in areas of skin that are exposed or subject to contact during sports/activity.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Tissue necrosis is the main characteristic of these abscesses and very little pus is produced. A study evaluating the presence of eschar and perilesional cellulitis as clinical predictors in abscesses caused by CA-MRSA reported a sensitivity of 92% and a positive predictive value of 94%.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> These findings may be explained by the cytotoxic effects that PVL is thought to exert on neutrophils and epidermal cells, and by the release of proinflammatory factors secondary to granulocyte lysis.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> However, further studies are needed to confirm the role of this toxin in the pathogenesis of infections caused by CA-MRSA.The differential diagnosis of these lesions should include pyoderma gangrenosum, spider bites,<a class="elsevierStyleCrossRef" href="#bib0065">13</a> loxoscelism,<a class="elsevierStyleCrossRef" href="#bib0070">14</a> and cutaneous leishmaniasis.Other common cutaneous manifestations have been described, including folliculitis, carbuncles (recurrent infections), and impetigo (especially in children).<a class="elsevierStyleCrossRef" href="#bib0075">15</a>CA-MRSA strains have microbiological characteristics that differentiate them from nosocomial strains; they are usually resistant only to β-lactam antibiotics and carry the genes that encode the PVL subunits LukF-PV and LukS-PV. However, depending on the source of the strain CA-MRSA may be also resistant to other antibiotics, as is the case with the predominant clone in the USA, USA300 (ST8-MRSA-IV), which is highly resistant to macrolides.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> Therefore, where possible, samples should be taken in all cases for microbiological analysis of the lesions.In this series 91% of patients received antimicrobial therapy, combined with surgical abscess drainage. However, some authors claim that lesion drainage and daily local treatment is sufficient in cases of extrafacial abscesses of less than 5cm in diameter in nondiabetic, immunocompetent patients without myofascial involvement.<a class="elsevierStyleCrossRefs" href="#bib0080">16–18</a><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> summarizes the various relevant therapeutic modalities for the treatment of infections caused by CA-MRSA.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Since this bacterium mainly causes uncomplicated skin infections, treatment does not usually require hospitalization. However, cases of septic arthritis, pyomyositis, fascitis,<a class="elsevierStyleCrossRef" href="#bib0100">20</a> and necrotizing pneumonia<a class="elsevierStyleCrossRef" href="#bib0105">21</a> have been described. Necrotizing pneumonia<a class="elsevierStyleCrossRef" href="#bib0105">21</a> should be considered in patients with uncomplicated skin infections and past or simultaneous symptoms of respiratory infection.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> These cases always require antimicrobial treatment and close clinical observation.The determination of carrier status by nasal swab is not recommended as a regular procedure.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> Nasal colonization is often low in patients with lesions that are not associated with community-acquired MRSA outbreaks (the majority of cases in Spain), and the bacteria may be detected in other locations such as the inguinal/perineal area, the axillary folds, the rectum, or the pharynx.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> There is no consensus on the measures necessary to achieve decolonization of this bacteria,<a class="elsevierStyleCrossRef" href="#bib0120">24</a> although some authors have proposed showering with antiseptic soap solutions (chlorhexidine or povidone iodine, although use of the latter is limited by its staining of the skin and the risk of local sensitization or irritation<a class="elsevierStyleCrossRef" href="#bib0125">25</a>), or using topical intranasal (mupirocin) and systemic (cotrimoxazole) antibiotics,<a class="elsevierStyleCrossRefs" href="#bib0130">26,27</a> with varying results.ConclusionsUncomplicated infections of the skin and soft tissue are one of the main reasons for visits to dermatological practices and emergency health services. The epidemiology of these infections has changed in recent years, with the appearance of pathogens that were hitherto considered exclusively nosocomial. CA-MRSA represents a paradigm in dermatological practice, as its main pathogenic targets are the skin and skin adnexa. The collection of samples for culture and subsequent antibiogram remains the gold standard in diagnosis. However, while awaiting the results of microbiological tests, we believe it is essential to individualize the initial empirical antibiotic treatment and to include this pathogen in the bacterial spectrum covered.Although the small number of cases analyzed and the retrospective nature of our study do not allow us to generalize based on the results obtained, we propose that the use of β-lactam antibiotics as an initial therapeutic measure should be avoided in young, healthy patients with cutaneous abscesses with a significant necrotic component and scant purulent exudate, with or without cellulitis. Similarly, in cases of recurrent skin infections, family outbreaks of abscesses, folliculitis, and carbuncles, or treatment failure after 1 or more cycles of β-lactam antibiotics, CA-MRSA should be considered as a potential causative pathogen.Ethical DisclosuresProtection of Human and Animal SubjectsThe authors declare that no experiments were performed on humans or animals during the course of this study.Confidentiality of DataThe authors declare that they have followed the protocols of their place of work concerning the publication of patient data and that all patients included in the study were appropriately informed and gave their written informed consent.Right to Privacy and Informed ConsentThe authors declare that no private patient data are disclosed in this article.Conflicts of InterestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres318983" "titulo" => array:6 [ 0 => "Abstract" 1 => "Introduction" 2 => "Objective" 3 => "Material and methods" 4 => "Results" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec301772" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres318984" "titulo" => array:6 [ 0 => "Resumen" 1 => "Introducción" 2 => "Objetivo" 3 => "Material y métodos" 4 => "Resultados" 5 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec301771" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:3 [ "identificador" => "sec0030" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Protection of Human and Animal Subjects" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Confidentiality of Data" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Right to Privacy and Informed Consent" ] ] ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of Interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-04-04" "fechaAceptado" => "2013-09-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec301772" "palabras" => array:5 [ 0 => "Methicillin-resistant Staphylococcus aureus" 1 => "Community" 2 => "Abscess" 3 => "Necrosis" 4 => "Cotrimoxazole" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec301771" "palabras" => array:5 [ 0 => "Staphylococcus aureus resistente a meticilina" 1 => "Comunidad" 2 => "Absceso" 3 => "Necrosis" 4 => "Cotrimoxazol" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "IntroductionCommunity-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen that causes skin and soft-tissue infections. ObjectiveTo describe the clinical characteristics of skin infections caused by CA-MRSA and correlations with the available demographic and microbiological data. Material and methodsThis was a descriptive study of patients with a microbiologically confirmed diagnosis of CA-MRSA infection treated in a dermatology department between June 2009 and December 2011. We recorded demographic details, the clinical characteristics of lesions, and the treatments used. ResultsWe studied 11 patients (5 men and 6 women); 91% were under 40 years of age and had no relevant past medical history. The most common presentation was a skin abscess (with or without cellulitis). In all such cases, marked tissue necrosis and little or no purulent exudate was observed when the abscess was drained. Fifty percent of these abscesses had been treated previously with β-lactam antibiotics, and in all cases the lesions resolved after surgical drainage, which was combined in 63% of cases with quinolones or cotrimoxazole. ConclusionsToday, skin infections due to CA-MRSA affect healthy young athletes who have no contact with healthcare settings. The most common presentation is a skin abscess characterized by marked tissue necrosis and little or no purulent exudate. In cases with these characteristics in susceptible patients, the involvement of CA-MRSA as the causative agent should be suspected. The abscesses should be drained whenever possible and, if necessary, antibiotic treatment should be prescribed; empirical use of β-lactam antibiotics should be avoided." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "IntroducciónStaphylococcus aureus resistente a meticilina de adquisición comunitaria (SARM-CO) constituye un patógeno emergente como agente productor de infecciones de piel y partes blandas. ObjetivoDescribir las características clínicas de las infecciones cutáneas causadas por SARM-CO, así como su correlación con los datos demográficos y microbiológicos disponibles. Material y métodosSe realizó un estudio descriptivo de los pacientes con diagnóstico de infección microbiológicamente confirmada por SARM-CO en el Servicio de Dermatología desde junio de 2009 a diciembre de 2011. Se recogieron los datos demográficos de los pacientes, las características clínicas de las lesiones y los tratamientos realizados. ResultadosSe reclutaron 11 pacientes, 5 hombres y 6 mujeres. El 91% tenía menos de 40 años y no presentaba antecedentes médicos de interés. El absceso cutáneo (asociado o no a celulitis) fue la forma más frecuente de presentación. Tras su drenaje se observó una cantidad escasa o nula de exudado purulento junto a un componente de necrosis tisular marcado en todas estas lesiones. El 50% de los abscesos había recibido tratamiento previo con antibióticos betalactámicos y el drenaje quirúrgico, asociado en el 63% a quinolonas o cotrimoxazol, aseguró la resolución de los mismos. ConclusionesActualmente las infecciones cutáneas causadas por SARM-CO se presentan en individuos jóvenes, sanos, deportistas, sin contacto con el ámbito sanitario. Los abscesos cutáneos, su forma más frecuente de presentación, se caracterizan por una marcada necrosis tisular, con escaso o nulo exudado purulento. Ante estos hallazgos en pacientes susceptibles debe sospecharse la implicación de SARM-CO como agente causal. El drenaje de los abscesos se realizará siempre que sea posible, y cuando resulte necesario añadir tratamiento antibiótico deberá evitarse el uso de betalactámicos de forma empírica." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Pulido Pérez A, Baniandrés Rodríguez O, Ceballos Rodríguez MC, Mendoza Cembranos MD, Campos Domínguez M, Suárez Fernández R. Infecciones cutáneas causadas por Staphylococcus aureus resistente a meticilina de adquisición comunitaria: características clínico-microbiológicas en 11 pacientes. Actas Dermosifiliogr. 2014;105:150–158." ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 627 "Ancho" => 950 "Tamanyo" => 141217 ] ] "descripcion" => array:1 [ "en" => "Abscess and perilesional cellulitis." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 707 "Ancho" => 948 "Tamanyo" => 195408 ] ] "descripcion" => array:1 [ "en" => "Characteristic appearance of abscess after drainage: necrosis and absence or scarcity of purulent exudate." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 991 "Ancho" => 744 "Tamanyo" => 173496 ] ] "descripcion" => array:1 [ "en" => "Erythematous-violaceous border and fibrinous center after spontaneous drainage of an abscess on the leg." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 710 "Ancho" => 940 "Tamanyo" => 157764 ] ] "descripcion" => array:1 [ "en" => "Abscess next to a tattoo on a young woman." ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Abbreviations: HIV, human immunodeficiency virus; IVDAs, intravenous drug addicts; MRSA, methicillin-resistant Staphylococcus aureus; SCCmec, staphylococcal cassette chromosome.Source: Kowalski et al.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>aIn Spain CA-MRSA isolates frequently exhibit resistance to tetracycline and doxycycline mediated by the tet(M) gene.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Community-Acquired MRSA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Nosocomial MRSA \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Risk groups/factors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Children, athletes, membership of recruitment institutions, sexual promiscuity, IVDAs, HIV,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> tattoos,<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a> origin in endemic area (Pacific Islanders, Central/South Americans, indigenous Australians) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prolonged hospitalization, intravascular catheters, diabetes mellitus, immunosuppression, admission to intensive care unit, hemodialysis, peritoneal dialysis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mechanisms of resistance (SCCmec genes) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I, II, III \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Production of Panton-Valentine leukocidin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Frequent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Infrequent \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antimicrobial resistance pattern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Resistance to β-lactam antibiotics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multidrug resistance \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Infections of skin and soft tissue, necrotizing pneumonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bacteremia associated with endovascular devices, urinary tract infection, nosocomial pneumonia, endocarditis, surgical wound infection \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Colonization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Genital, perineal (recurrent infections) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nasal \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab465405.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Differential Characteristics of Nosocomial and Community-Acquired MRSA Strains." ] ] 5 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Abbreviations: Amox-clav, amoxicillin-clavulanate; F, female; IV, intravenous; M, male; NBA, non-β-lactam antibiotics; PVL, Panton-Valentine leukocidin; SD, surgical drainage." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient/Age/Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Origin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Lesion Type \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Lesion Location \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Purulent Exudate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Tissue Necrosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Risk Factors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Prior Treatments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">NBA Resistance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">PVL Production \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/38/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abscess + cellulitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Leg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sport (futsal) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cloxacillin, amox-clav \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythromycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD + oral ciprofloxacin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2/40/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ecuador \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abscess \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\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"> \t\t\t\t\t\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"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythromycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3/27/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abscess \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Leg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Camping in rural Thailand, \t\t\t\t\t\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"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD + oral ciprofloxacin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4/26/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cuba \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abscess \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iliac fossa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scarce \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">dance, tattoo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cloxacillin, amox-clav, cefuroxime \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythromycin, levofloxacin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD + oral clindamycin (administered in suspension due to digestive intolerance)/cotrimoxazole \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5/43/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Colombia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abscess \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abdomen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scarce \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\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"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amox-clav \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythromycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD + IV vancomycin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6/37/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anthrax \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Upper lip \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scarce \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\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"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amox-clav \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD + oral ciprofloxacin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7/35/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poland \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Paronychia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Big toe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scarce \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ingrown toenail \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amox-clav, cefuroxime \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral cotrimoxazole + deferred SD of ingrown toenail \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8/37/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poland \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abscess + cellulitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Thigh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sports (swimming, diving) \t\t\t\t\t\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"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD + oral cotrimoxazole \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9/18/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ecuador \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abscess + cellulitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abdomen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Noninvasive cosmetic procedures \t\t\t\t\t\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"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythromycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD + oral ciprofloxacin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10/18/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Colombia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Folliculitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Back \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Recurrent skin infections \t\t\t\t\t\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"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythromycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cotrimoxazole \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11/24/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abscess + cellulitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Leg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scarce \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amox-clav, erythromycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythromycin, clindamycin \t\t\t\t\t\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"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD + vancomycin \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab465404.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic, Clinical, and Microbiological Data for Patients Included in the Study." ] ] 6 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Abbreviations: AHT, arterial hypertension; INR, international normalized ratio; IM, intramuscular; IV, intravenous." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Indications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Dose<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>/Route of Administration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Adverse Effects and Precautions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Comments \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgical drainage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Should be performed for all abscesses \t\t\t\t\t\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"> \t\t\t\t\t\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"> \t\t\t\t\t\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"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cotrimoxazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Abscesses> 1 cmor < 1cm in case of infants, patients over 65 y, facial location, diabetics, immunosuppression, perilesional cellulite2. Impetigo, ecthyma, cellulitis, folliculitis, paronychia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OralAdults and patients ≥ 12 y: 800/160 mg/12 hChildren:6-12 y, 400/80 mg/12 h6 mo-5 y, 200/40 mg/12 h6 wk-5 mo, 100/20 mg/12 hIV /IMAdults and patients > 12 y: 800/160 mg/12-24 hChildren 6-12 y: 400/80 mg/12-24 hMean dose: 80/16mg /5 kg/12 hChildren > 2 mo: 6-12 mg/kg/d trimethoprim \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Toxicodermia, leukopenia, thrombocytopenia, hemolytic anemia, megaloblastic anemia, photosensitivityNot for use in case of pregnancy, lactation, infants < 2 mo, glucose-6-phosphate dehydrogenase deficiency, porphyrias, treatment with methotrexate, combination with azathioprine or metformin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High rate of resistance in infections caused by Streptococcus pyogenes: caution advised in the empirical treatment of abscesses with perilesional cellulitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clindamycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Abscesses> 5 cm or< 5cm in case of infants, patients over 65 y, facial location, diabetics, immunosuppression, perilesional cellulite2. Impetigo, ecthyma, cellulitis, folliculitis, paronychia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OralAdults: 150-450 mg/6 hChildren > 1 mo: 8-25 mg/kg/d in 3-4 dosesIV /IMAdults: 1.2-1.8 g/d in 3-4 dosesChildren > 1 mo: 20-40 mg/kg/d in 3-4 doses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diarrhea, risk of pseudomembranous colitis, unpleasant metallic tasteShould not be used in cases of pregnancy, lactation, or in combination with erythromycin or aminoglycosides \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Can presentresistance that is indetectable with standard antibiograms (confirm that D-test has been performed if conventional antibiogram indicates erythromycin resistance) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Quinolones (ciprofloxacin, levofloxacin) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Abscesses> 5 cmor < 5cm in case of infants, patients over 65 y, facial location, diabetics, immunosuppression, perilesional cellulite2. Impetigo, ecthyma, cellulitis, folliculitis, paronychia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ciprofloxacin<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>Oral: Adults, 500 mg/12 hIV: Adults, 200-400 mg/12 hLevofloxacin<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>Adults: Oral, 250-500 mg/dIV, 500 mg/d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Risk of tendinopathy, arthropathy (greater in children, the elderly, and in patients receiving long-term corticosteroid therapy)Adjust dose in cases of renal impairmentAvoid in cases of pregnancy, lactation. Should not be ingested with dairy products or calcium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rates of resistance to these drugs are currently low<a class="elsevierStyleCrossRef" href="#bib0095">19</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tetracyclines(Doxycycline, minocycline) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Abscesses> 5 cmor < 5cm in case of infants, patients over 65 y, facial location, diabetics, immunosuppression, perilesional cellulite2. Impetigo, ecthyma, cellulitis, folliculitis, paronychia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Doxycycline<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>Oral: Adults and children > 8 y (weight ≥ 45 kg), 100-200 mg/24 h in 1 or 2 dosesMinocycline<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>Oral: Adults and children > 8 y (weight ≥ 45 kg), 100 mg/12 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Photosensitivity, hepatotoxicity, benign intracranial hypertension (increased risk when administered in children or with retinoids), vestibular toxicity (minocycline), esophagitisAvoid in cases of pregnancy, lactation, children < 8 y (risk of tooth and bone metabolism disorders) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not effective in monotherapyThe ST80-MRSA-IV strains (present in Northern and Eastern Europe and in some countries of the Mediterranean basin) are resistant to tetracycline \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rifampicin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Abscesses> 5 cmor < 5cm in case of infants, patients over 65 y, facial location, diabetics, immunosuppression, perilesional cellulite2. Impetigo, ecthyma, cellulitis, folliculitis, paronychia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OralAdults: 450-600 mg/dChildren > 5 y: 10-20 mg/kg/d in 1-2 doses (maximum 600 mg/d) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hepatotoxicity, changes in color of urine/bodily secretions, multiple drug interactions (cytochrome p450 inducer) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Synergistic effect with other antimicrobials. Do not use in monotherapy (frequent emergence of resistant strains) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Daptomycin<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complicated skin and soft tissue infections \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IVAdults: 4-6mg /kg/dSafety and efficacy not established in patients < 18 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MyotoxicityDosage adjustment in case of renal diseaseAlterations in hemostatic parameters (INR/prothrombin time) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not use if there is a risk of necrotizing lung infection (action inhibited by pulmonary surfactant) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vancomycin<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complicated skin and soft tissue infections \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IVAdults: initial dose, 30-50mg /kg/d; typical dose, 1 g/12 h or 500 mg/6 hChildren > 1 mo: 10 mg/kg/6 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nephrotoxicity. Red man syndrome: avoid rapid intravenous administration (minimum 1 h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monitor serum levels in patients with renal failure or in cases of coadministration with nephrotoxic drugs \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Linezolid<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complicated skin and soft tissue infections \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral and IVAdults: 600 mg/12 hNot recommended in patients < 18 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Myelosuppression, tyramine reaction, optic nerve neuropathy, hypertension, elevated transaminase levels \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Given its high cost and adverse effects, its use must be strictly warranted. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Quinupristin-dalfopristin<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complicated skin and soft tissue infections \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Administered through central venous catheter in 5% glucose for 60 min: 7.5 mg/kg/8 h (not diluted in saline) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increased QT interval, hepatotoxicity, increased plasma levels of drugs metabolized by CYP3A4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Should be used only in case of treatment failure with other available alternatives \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab465403.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "There is no consensus on the duration of administration regimens for the majority of these drugs. In general, it is recommended to re-evaluate after 7 days of treatment and extend treatment to 14 days if necessary (treatment with quinupristin-dalfopristin should not be extended for more than 7 days)." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Valid alternatives in cases of complicated infections, bacteremia, or in cases of treatment failure with other available options." ] ] ] "descripcion" => array:1 [ "en" => "Therapeutic Modalities in Infections Caused by CA-MRSA." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The molecular evolution of methicillin-resistant Staphylococcus aureus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.H. Deurenberg" 1 => "C. Vink" 2 => "S. Kalenic" 3 => "A.W. Friedrich" 4 => "C.A. Bruggeman" 5 => "E.E. Stobberingh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1469-0691.2006.01573.x" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2007" "volumen" => "13" "paginaInicial" => "222" "paginaFinal" => "235" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17391376" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Methicillin-resistant S. aureus infections among patients in the emergency department" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.J. Moran" 1 => "A. Krishnadasan" 2 => "R.J. Gorwitz" 3 => "G.E. Fosheim" 4 => "L.K. McDougal" 5 => "R.B. Carey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa055356" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2006" "volumen" => "355" "paginaInicial" => "666" "paginaFinal" => "674" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16914702" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology, treatment, and prevention of community-acquired methicillin-resistant Staphylococcus aureus infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T.J. Kowalski" 1 => "E.F. Berbari" 2 => "D.R. Osmon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4065/80.9.1201" "Revista" => array:6 [ "tituloSerie" => "Mayo Clin Proc" "fecha" => "2005" "volumen" => "80" "paginaInicial" => "1201" "paginaFinal" => "1208" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16178500" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community-associated methicillin-resistant Staphylococcus aureus colonization burden in HIV-infected patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.J. Popovich" 1 => "B. Hota" 2 => "A. Aroutcheva" 3 => "L. Kurien" 4 => "J. Patel" 5 => "R. Lyles-Banks" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/cit010" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2013" "volumen" => "56" "paginaInicial" => "1067" "paginaFinal" => "1074" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23325428" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community-acquired methicillin-resistant Staphylococcus aureus skin infections: Implications for patients and practitioners" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.R. Cohen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Am J Clin Dermatol" "fecha" => "2007" "volumen" => "8" "paginaInicial" => "259" "paginaFinal" => "270" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17902728" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S014067361060030X" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Methicillin-resistant Staphylococcus aureus skin infections among tattoo recipients-Ohio, Kentucky, and Vermont, 2004-2005" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Centers for Disease Control and Prevention (CDC)" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "MMWR Morb Mortal Wkly Rep" "fecha" => "2006" "volumen" => "23" "paginaInicial" => "677" "paginaFinal" => "679" "itemHostRev" => array:3 [ "pii" => "S0140673612613439" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Staphylococcus aureus resistente a la meticilina de origen comunitario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Cercenado" 1 => "E. Ruiz de Gopegui" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:8 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2008" "volumen" => "26" "numero" => "Supl 13" "paginaInicial" => "19" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19195434" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673612607296" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community-acquired methicillin resistant Staphylococcus aureus skin and soft tissue infections in Madrid: Prevalence study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Casado-Verrier" 1 => "C. Gómez-Fernández" 2 => "J.R. Paño-Pardo" 3 => "R. Gómez-Gil" 4 => "J. Mingorance-Cruz" 5 => "R. Moreno-Alonso de Celada" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimc.2011.11.011" "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2012" "volumen" => "30" "paginaInicial" => "300" "paginaFinal" => "306" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22260847" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community-acquired methicillin-resistant Staphylococcus aureus in Madrid, Spain: transcontinental importation and polyclonal emergence of Panton-Valentine leukocidin-positive isolates" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Cercenado" 1 => "O. Cuevas" 2 => "M. Marín" 3 => "E. Bouza" 4 => "P. Trincado" 5 => "T. Boquete" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.diagmicrobio.2008.01.001" "Revista" => array:7 [ "tituloSerie" => "Diagn Microbiol Infect Dis" "fecha" => "2008" "volumen" => "61" "paginaInicial" => "143" "paginaFinal" => "149" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18280081" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673602119118" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical inquiries. When should you suspect community-acquired MRSA?. How should you treat it?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.J. May" 1 => "S. Safranek" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Fam Pract." "fecha" => "2009" "volumen" => "58" "paginaInicial" => "276" "paginaFinal" => "278" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19442392" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673611610866" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eschar with cellulitis as a clinical predictor in community-acquired methicillin-resistant Staphylococcus aureus (MRSA) skin abscess" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.A. Busch" 1 => "M.T. Ahern" 2 => "M. Topinka" 3 => "J.J.J2nd Jenkins" 4 => "M.A. Weiser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jemermed.2007.11.072" "Revista" => array:6 [ "tituloSerie" => "J Emerg Med" "fecha" => "2010" "volumen" => "38" "paginaInicial" => "563" "paginaFinal" => "566" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18614328" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community-acquired methicillin-resistant Staphylococcus aureus: The role of Panton-Valentine leukocidin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Boyle-Vavra" 1 => "R.S. Daum" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/labinvest.3700501" "Revista" => array:7 [ "tituloSerie" => "Lab Invest" "fecha" => "2007" "volumen" => "87" "paginaInicial" => "3" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17146447" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673612613439" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community-acquired methicillin-resistant Staphylococcus aureus: Not just a spider bite" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Vozdecky" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.FCH.0000342818.95390.9a" "Revista" => array:6 [ "tituloSerie" => "Fam Community Health" "fecha" => "2009" "volumen" => "32" "paginaInicial" => "76" "paginaFinal" => "84" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19092436" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic loxoscelism in the age of community-acquired methicillin-resistant Staphylococcus aureus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.M. Rogers" 1 => "C.R. Klotz" 2 => "M. Jack" 3 => "D. Seger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.annemergmed.2010.06.006" "Revista" => array:6 [ "tituloSerie" => "Ann Emerg Med" "fecha" => "2011" "volumen" => "57" "paginaInicial" => "138" "paginaFinal" => "140" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20817348" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin and soft-tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.E. Stryjewski" 1 => "H.F. Chambers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/533593" "Revista" => array:7 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2008" "volumen" => "46" "numero" => "Suppl 5" "paginaInicial" => "S368" "paginaFinal" => "S377" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18462092" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Gorwitz R, Jernigan DB, Powers JH, Jernigan JA and Participants in the Centers for Disease Control and Prevention-Convened Experts’ Meeting on Management of MRSA in the Community. Strategies for clinical management of MRSA in the community: Summary of an Experts’ Meeting convened by the Centers for Disease Control and Prevention. 2006. [consultado 15 Sep 2013]. Available at: http://www.cdc.gov/mrsa/pdf/MRSA-Strategies-ExpMtgSummary-2006.pdf." ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomized, double-blind, placebo-controlled trial of cephalexin for treatment of uncomplicated skin abscesses in a population at risk for community-acquired methicillin-resistant Staphylococcus aureus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.M. Rajendran" 1 => "D. Young" 2 => "T. Maurer" 3 => "H. Chambers" 4 => "F. Perdreau-Remington" 5 => "P. Ro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/AAC.00377-07" "Revista" => array:6 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "2007" "volumen" => "51" "paginaInicial" => "4044" "paginaFinal" => "4048" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17846141" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and epidemiologic characteristics as predictors of treatment failures in uncomplicated skin abscesses within seven days after incision and drainage" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.K. Olderog" 1 => "G.R. Schmitz" 2 => "D.R. Bruner" 3 => "R. Pittoti" 4 => "J. Williams" 5 => "K. Ouyang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jemermed.2011.09.037" "Revista" => array:7 [ "tituloSerie" => "J Emerg Med" "fecha" => "2012" "volumen" => "43" "paginaInicial" => "605" "paginaFinal" => "611" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22698825" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673611615365" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Emergence of multidrug- resistant, community-associated, methicillin-resistant Staphylococcus aureus clone USA300 in men who have sex with men" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.A. Diep" 1 => "H.F. Chambers" 2 => "C.J. Graber" 3 => "J.D. Szumowski" 4 => "L.G. Miller" 5 => "L.L. Han" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2008" "volumen" => "148" "paginaInicial" => "249" "paginaFinal" => "257" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18283202" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community-associated methicillin-resistant Staphylococcus aureus in acute musculoskeletal infection in children: A game changer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.L. Vander Have" 1 => "B. Karmazyn" 2 => "M. Verma" 3 => "M.S. Caird" 4 => "R.N. Hensinger" 5 => "F.A. Farley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/BPO.0b013e3181bd1e0c" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Orthop" "fecha" => "2009" "volumen" => "29" "paginaInicial" => "927" "paginaFinal" => "931" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19934711" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community-acquired methicillin-resistant Staphylococcus aureus pneumonia: A clinical audit" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Thomas" 1 => "J. Ferguson" 2 => "G. Coombs" 3 => "P.G. Gibson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1843.2011.01965.x" "Revista" => array:6 [ "tituloSerie" => "Respirology" "fecha" => "2011" "volumen" => "16" "paginaInicial" => "926" "paginaFinal" => "931" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21382130" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary infections and community associated methicillin resistant Staphylococcus aureus: A dangerous mix" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Shilo" 1 => "C. Quach" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.prrv.2010.10.007" "Revista" => array:6 [ "tituloSerie" => "Paediatr Respir Rev" "fecha" => "2011" "volumen" => "12" "paginaInicial" => "182" "paginaFinal" => "189" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21722847" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heterosexual transmission of community-associated methicillin- resistant Staphylococcus aureus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Skov" 1 => "K. Christiansen" 2 => "S.J. Dancer" 3 => "R.S. Daum" 4 => "M. Dryden" 5 => "Y.C. Huang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/510681" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2007" "volumen" => "44" "paginaInicial" => "410" "paginaFinal" => "413" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17205449" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on the prevention and control of community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Skov" 1 => "K. Christiansen" 2 => "S.J. Dancer" 3 => "R.S. Daum" 4 => "M. Dryden" 5 => "Y.C. Huang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijantimicag.2011.09.029" "Revista" => array:6 [ "tituloSerie" => "Int J Antimicrob Agents" "fecha" => "2012" "volumen" => "39" "paginaInicial" => "193" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22226649" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Allergic contact dermatitis from povidone-iodine: A re-evaluation study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.M. Lachapelle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.0105-1873.2005.00479.x" "Revista" => array:6 [ "tituloSerie" => "Contact Dermatitis" "fecha" => "2005" "volumen" => "52" "paginaInicial" => "9" "paginaFinal" => "10" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15701122" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Household versus individual approaches to eradication of community-associated Staphylococcus aureus in children: A randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.A. Fritz" 1 => "P.G. Hogan" 2 => "G. Hayek" 3 => "K.A. Eisenstein" 4 => "M. Rodriguez" 5 => "E.K. Epplin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/cir919" "Revista" => array:7 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2012" "volumen" => "54" "paginaInicial" => "743" "paginaFinal" => "751" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22198793" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673612621679" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Highly effective regimen for decolonization of methicillin-resistant Staphylococcus aureus carriers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Buehlmann" 1 => "R. Frei" 2 => "L. Fenner" 3 => "M. Dangel" 4 => "U. Fluckiger" 5 => "A.F. Widmer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/588201" "Revista" => array:6 [ "tituloSerie" => "Infect Control Hosp Epidemiol" "fecha" => "2008" "volumen" => "29" "paginaInicial" => "510" "paginaFinal" => "516" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18510460" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010500000002/v1_201403090058/S1578219014000304/v1_201403090058/en/main.assets" "Apartado" => array:4 [ "identificador" => "6155" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010500000002/v1_201403090058/S1578219014000304/v1_201403090058/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014000304?idApp=UINPBA000044"]

Statistics

Original Article

Skin Infections Caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus: Clinical and Microbiological Characteristics of 11 Cases

Infecciones cutáneas causadas por Staphylococcus aureus resistente a meticilina de adquisición comunitaria: características clínico-microbiológicas en 11 pacientes

A. Pulido Pérez

Corresponding author

ana.pulido@madrimasd.net
apulidoperez@gmail.com

Corresponding author.

, O. Baniandrés Rodríguez, M.C. Ceballos Rodríguez, M.D. Mendoza Cembranos, M. Campos Domínguez, R. Suárez Fernández

Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain

Read

12617

Times
was read the article

2356

Total PDF

10261

Total HTML

Share statistics

 array:24 [
  "pii" => "S1578219014000304"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2013.09.005"
  "estado" => "S300"
  "fechaPublicacion" => "2014-03-01"
  "aid" => "893"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
  "copyrightAnyo" => "2013"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Actas Dermosifiliogr. 2014;105:150-8"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4631
    "formatos" => array:3 [
      "EPUB" => 42
      "HTML" => 4045
      "PDF" => 544
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0001731013003219"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2013.09.002"
      "estado" => "S300"
      "fechaPublicacion" => "2014-03-01"
      "aid" => "893"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
      "documento" => "article"
      "crossmark" => 0
      "subdocumento" => "fla"
      "cita" => "Actas Dermosifiliogr. 2014;105:150-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 23010
        "formatos" => array:3 [
          "EPUB" => 2
          "HTML" => 20320
          "PDF" => 2688
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "Infecciones cut&#225;neas causadas por <span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a meticilina de adquisici&#243;n comunitaria&#58; caracter&#237;sticas cl&#237;nico-microbiol&#243;gicas en 11 pacientes"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "150"
            "paginaFinal" => "158"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Skin Infections Caused by Community-Acquired Methicillin-Resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#58; Clinical and Microbiological Characteristics of 11 Cases"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0020"
            "etiqueta" => "Figura 4"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr4.jpeg"
                "Alto" => 713
                "Ancho" => 950
                "Tamanyo" => 156887
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Absceso junto a tatuaje en una mujer joven&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "A&#46; Pulido P&#233;rez, O&#46; Baniandr&#233;s Rodr&#237;guez, M&#46;C&#46; Ceballos Rodr&#237;guez, M&#46;D&#46; Mendoza Cembranos, M&#46; Campos Dom&#237;nguez, R&#46; Su&#225;rez Fern&#225;ndez"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Pulido P&#233;rez"
              ]
              1 => array:2 [
                "nombre" => "O&#46;"
                "apellidos" => "Baniandr&#233;s Rodr&#237;guez"
              ]
              2 => array:2 [
                "nombre" => "M&#46;C&#46;"
                "apellidos" => "Ceballos Rodr&#237;guez"
              ]
              3 => array:2 [
                "nombre" => "M&#46;D&#46;"
                "apellidos" => "Mendoza Cembranos"
              ]
              4 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Campos Dom&#237;nguez"
              ]
              5 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Su&#225;rez Fern&#225;ndez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219014000304"
          "doi" => "10.1016/j.adengl.2013.09.005"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014000304?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013003219?idApp=UINPBA000044"
      "url" => "/00017310/0000010500000002/v1_201403120205/S0001731013003219/v1_201403120205/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1578219014000341"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2013.10.004"
    "estado" => "S300"
    "fechaPublicacion" => "2014-03-01"
    "aid" => "900"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Actas Dermosifiliogr. 2014;105:159-71"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1293
      "formatos" => array:3 [
        "EPUB" => 31
        "HTML" => 966
        "PDF" => 296
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Clinical Characteristics of Patients With Cutaneous Melanoma According to Variants in the Melanocortin 1 Receptor Gene"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "159"
          "paginaFinal" => "171"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Caracter&#237;sticas cl&#237;nicas de los pacientes con melanoma cut&#225;neo en funci&#243;n de las variaciones en el gen del receptor 1 de la melanocortina &#40;MC1R&#41;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46;M&#46; Pe&#241;a-Vilabelda, Z&#46; Garc&#237;a-Casado, C&#46; Requena, V&#46; Traves, J&#46;A&#46; L&#243;pez-Guerrero, C&#46; Guill&#233;n, R&#46; Kumar, E&#46; Nagore"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "M&#46;M&#46;"
              "apellidos" => "Pe&#241;a-Vilabelda"
            ]
            1 => array:2 [
              "nombre" => "Z&#46;"
              "apellidos" => "Garc&#237;a-Casado"
            ]
            2 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Requena"
            ]
            3 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Traves"
            ]
            4 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "L&#243;pez-Guerrero"
            ]
            5 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Guill&#233;n"
            ]
            6 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Kumar"
            ]
            7 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Nagore"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731013003542"
        "doi" => "10.1016/j.ad.2013.10.001"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013003542?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014000341?idApp=UINPBA000044"
    "url" => "/15782190/0000010500000002/v1_201403090058/S1578219014000341/v1_201403090058/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1578219014000092"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2014.01.001"
    "estado" => "S300"
    "fechaPublicacion" => "2014-03-01"
    "aid" => "798"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "ssu"
    "cita" => "Actas Dermosifiliogr. 2014;105:135-49"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3745
      "formatos" => array:3 [
        "EPUB" => 38
        "HTML" => 3112
        "PDF" => 595
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">History and Humanities in Dermatology</span>"
      "titulo" => "The Beginnings of Dermatopathology and Dermatologic Microbiology in Spain"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "135"
          "paginaFinal" => "149"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Los comienzos de la Dermatopatolog&#237;a y de la Microbiolog&#237;a dermatol&#243;gica en Espa&#241;a"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0065"
          "etiqueta" => "Figure 13"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr13.jpeg"
              "Alto" => 2586
              "Ancho" => 1583
              "Tamanyo" => 810048
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Page with figures in the monograph on pseudoepithelioma by Juan de Az&#250;a and Claudio Sala Pons&#44; illustrating this publication&#39;s most important contribution&#58; pseudoepitheliomatous hyperplasia&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "E&#46; del R&#237;o"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "del R&#237;o"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731013000203"
        "doi" => "10.1016/j.ad.2013.01.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013000203?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014000092?idApp=UINPBA000044"
    "url" => "/15782190/0000010500000002/v1_201403090058/S1578219014000092/v1_201403090058/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Skin Infections Caused by Community-Acquired Methicillin-Resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#58; Clinical and Microbiological Characteristics of 11 Cases"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "150"
        "paginaFinal" => "158"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "A&#46; Pulido P&#233;rez, O&#46; Baniandr&#233;s Rodr&#237;guez, M&#46;C&#46; Ceballos Rodr&#237;guez, M&#46;D&#46; Mendoza Cembranos, M&#46; Campos Dom&#237;nguez, R&#46; Su&#225;rez Fern&#225;ndez"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "A&#46;"
            "apellidos" => "Pulido P&#233;rez"
            "email" => array:2 [
              0 => "ana&#46;pulido&#64;madrimasd&#46;net"
              1 => "apulidoperez&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "O&#46;"
            "apellidos" => "Baniandr&#233;s Rodr&#237;guez"
          ]
          2 => array:2 [
            "nombre" => "M&#46;C&#46;"
            "apellidos" => "Ceballos Rodr&#237;guez"
          ]
          3 => array:2 [
            "nombre" => "M&#46;D&#46;"
            "apellidos" => "Mendoza Cembranos"
          ]
          4 => array:2 [
            "nombre" => "M&#46;"
            "apellidos" => "Campos Dom&#237;nguez"
          ]
          5 => array:2 [
            "nombre" => "R&#46;"
            "apellidos" => "Su&#225;rez Fern&#225;ndez"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital General Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Infecciones cut&#225;neas causadas por <span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a meticilina de adquisici&#243;n comunitaria&#58; caracter&#237;sticas cl&#237;nico-microbiol&#243;gicas en 11 pacientes"
      ]
    ]
    "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" => 627
            "Ancho" => 950
            "Tamanyo" => 141217
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Abscess and perilesional cellulitis&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The increase in infections caused by microorganisms resistant to conventional antimicrobials represents a major therapeutic limitation in the hospital setting&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Soon after the introduction of penicillin in 1941 the first strains of penicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> were isolated&#46; Hospital strains of methicillin &#40;oxacillin&#41;-resistant <span class="elsevierStyleItalic">S&#160;aureus</span> appeared 2 decades later&#44; and subsequently became one of the main bacterial causes of nosocomial infections&#46; However&#44; since the 1980s <span class="elsevierStyleItalic">S aureus</span> has also been detected in non-hospital-acquired infections&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and its incidence has grown exponentially in many countries&#44; including the United States&#44; where it is the leading cause of community-acquired skin and soft tissue infections in several states&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Community-acquired methicillin-resistant <span class="elsevierStyleItalic">S aureus</span> &#40;CA-MRSA&#41; differs from its nosocomial counterpart in its clinical&#44; epidemiological&#44; and microbiological characteristics &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;7</span></a> and thus requires radically different therapeutic management in most cases&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Given that CA-MRSA predominantly affects skin and soft tissue&#44; we reviewed 11 cases diagnosed in our hospital in order to describe the main clinical features of the disease and the correlation with available demographic and microbiological data&#46; Based on our findings&#44; we propose several specific clinical criteria to improve the initial empirical treatment of skin and soft tissue infections in outpatients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This is a descriptive&#44; observational&#44; retrospective study of adult patients with a microbiological diagnosis of skin and soft tissue infection caused by CA-MRSA&#46; The data were collected between June 2009 and December 2011 from the skin infection database of the dermatology department at the Hospital General Universitario Gregorio Mara&#241;&#243;n in Madrid&#44; Spain&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">All cases had been microbiologically confirmed by culture followed by antibiogram and molecular analysis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The clinical variables studied were age&#44; sex&#44; clinical presentation &#40;lesion type&#44; presence of pus&#44; necrosis&#44; and location&#41;&#44; the course of the lesions&#44; treatments received&#44; and the response to treatment&#46; We analyzed the origin of the patients&#44; the presence of recurrent skin infections in the patient&#39;s family&#44; risk practices &#40;contact sports or activities&#44; shared use of personal hygiene items&#44; membership of recruiting groups or institutions&#41;&#44; contact with the health sector &#40;employment&#44; previous hospital admissions&#41;&#44; and contact with domestic or farm animals&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Data for the patients studied are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Of the patients studied&#44; 91&#37; &#40;10&#47;11&#41; were younger than 40 years&#44; and the male to female ratio was 1&#58;1&#46;2&#46; The individuals were healthy&#44; immunocompetent patients with no prior hospital admissions and no contact with the healthcare sector through either employment or family&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Eight &#40;73&#37;&#41; of the 11 patients presented with abscesses &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1-4</a>&#41;&#59; half of these cases &#40;4&#47;8&#41; involved perilesional cellulitis&#44; and 63&#37; &#40;5&#47;8&#41; presented abscesses on exposed areas of the limbs&#46; Surgical drainage removed small amounts of purulent material in 37&#37; &#40;3&#47;8&#41; of cases&#44; and none in the remainder &#40;63&#37;&#59; 5&#47;8&#41;&#46; Tissue necrosis&#44; forming a cavity within the subcutaneous tissue&#44; was the main feature of all lesions&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Primary follicular involvement &#40;staphylococcal folliculitis and anthrax&#41; was observed in 2 patients&#44; and recurrent paronychia in another&#46; Due to the nature of the lesions&#44; it was not possible to clearly establish the amount of purulent exudate in these 3 patients&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Thirty-six percent &#40;4&#47;11&#41; of the patients were Spanish&#44; 45&#37; &#40;5&#47;11&#41; were Latin American&#44; and 18&#37; &#40;2&#47;11&#41; were Polish&#46; Possible risk factors associated with the development of infection included sports &#40;2 patients&#44; 18&#37;&#41;&#44; dance &#40;2 patients&#44; 18&#37;&#41;&#44; and noninvasive cosmetic procedures &#40;1 patient&#44; 9&#37;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Two patients had a history of recurrent&#44; uncomplicated skin infections&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">All cases had been confirmed by culture followed by an antibiogram and molecular analysis&#46; The bacterial strains isolated in 64&#37; &#40;7&#47;11&#41; of the cases studied were resistant to erythromycin&#46; Levofloxacin resistance was also detected in 1 case &#40;1&#47;7&#41; and inducible clindamycin resistance in another &#40;1&#47;7&#41;&#44; both of which were confirmed by D-test&#46; Genes encoding Panton-Valentine leukocidin &#40;PVL&#41; were expressed in all staphylococcal isolates analyzed &#40;except 1 case in which no analysis was performed as the patient came from another health care center&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Of the patients analyzed&#44; 55&#37; &#40;6&#47;11&#41; had been previously treated with amoxicillin-clavulanate with no clinical response&#46; Of these&#44; 67&#37; &#40;4&#47;6&#41; experienced treatment failure after a second round of antibiotic therapy with &#946;-lactam &#40;cefuroxime&#47;cloxacillin&#41; or erythromycin&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">All abscesses &#40;8&#47;8&#41; were surgically drained and antibiotics administered in 88&#37; of cases&#46; Ciprofloxacin and cotrimoxazole were the drugs of choice in 73&#37; of patients &#40;8&#47;11&#41;&#46; In 1 case treatment with oral clindamycin was discontinued due to gastrointestinal intolerance &#40;diarrhea&#41;&#46; Two patients with uncomplicated abscesses were treated with intravenous vancomycin as an alternative to &#946;-lactam antibiotics&#46; None of the patients presented systemic complications or myofascial involvement&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">CA-MRSA is emerging as a causative agent of skin and soft tissue infections&#46; Its incidence remains low in Spain&#44; in contrast to other industrialized countries&#44; where it constitutes one of the main community-acquired bacterial pathogens&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The epidemiological data presented here are similar to those reported in the scientific literature&#58; those affected are young&#44; healthy patients who engage in contact sports&#47;activities or come from endemic areas such as Central or South America&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Often&#44; patients present single abscesses&#44; located in areas of skin that are exposed or subject to contact during sports&#47;activity&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Tissue necrosis is the main characteristic of these abscesses and very little pus is produced&#46; A study evaluating the presence of eschar and perilesional cellulitis as clinical predictors in abscesses caused by CA-MRSA reported a sensitivity of 92&#37; and a positive predictive value of 94&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> These findings may be explained by the cytotoxic effects that PVL is thought to exert on neutrophils and epidermal cells&#44; and by the release of proinflammatory factors secondary to granulocyte lysis&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> However&#44; further studies are needed to confirm the role of this toxin in the pathogenesis of infections caused by CA-MRSA&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The differential diagnosis of these lesions should include pyoderma gangrenosum&#44; spider bites&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> loxoscelism&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and cutaneous leishmaniasis&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Other common cutaneous manifestations have been described&#44; including folliculitis&#44; carbuncles &#40;recurrent infections&#41;&#44; and impetigo &#40;especially in children&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">CA-MRSA strains have microbiological characteristics that differentiate them from nosocomial strains&#59; they are usually resistant only to &#946;-lactam antibiotics and carry the genes that encode the PVL subunits LukF-PV and LukS-PV&#46; However&#44; depending on the source of the strain CA-MRSA may be also resistant to other antibiotics&#44; as is the case with the predominant clone in the USA&#44; USA300 &#40;ST8-MRSA-IV&#41;&#44; which is highly resistant to macrolides&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Therefore&#44; where possible&#44; samples should be taken in all cases for microbiological analysis of the lesions&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In this series 91&#37; of patients received antimicrobial therapy&#44; combined with surgical abscess drainage&#46; However&#44; some authors claim that lesion drainage and daily local treatment is sufficient in cases of extrafacial abscesses of less than 5<span class="elsevierStyleHsp" style=""></span>cm in diameter in nondiabetic&#44; immunocompetent patients without myofascial involvement&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;18</span></a><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> summarizes the various relevant therapeutic modalities for the treatment of infections caused by CA-MRSA&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Since this bacterium mainly causes uncomplicated skin infections&#44; treatment does not usually require hospitalization&#46; However&#44; cases of septic arthritis&#44; pyomyositis&#44; fascitis&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> and necrotizing pneumonia<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> have been described&#46; Necrotizing pneumonia<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> should be considered in patients with uncomplicated skin infections and past or simultaneous symptoms of respiratory infection&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> These cases always require antimicrobial treatment and close clinical observation&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The determination of carrier status by nasal swab is not recommended as a regular procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Nasal colonization is often low in patients with lesions that are not associated with community-acquired MRSA outbreaks &#40;the majority of cases in Spain&#41;&#44; and the bacteria may be detected in other locations such as the inguinal&#47;perineal area&#44; the axillary folds&#44; the rectum&#44; or the pharynx&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> There is no consensus on the measures necessary to achieve decolonization of this bacteria&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> although some authors have proposed showering with antiseptic soap solutions &#40;chlorhexidine or povidone iodine&#44; although use of the latter is limited by its staining of the skin and the risk of local sensitization or irritation<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#41;&#44; or using topical intranasal &#40;mupirocin&#41; and systemic &#40;cotrimoxazole&#41; antibiotics&#44;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;27</span></a> with varying results&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0130" class="elsevierStylePara elsevierViewall">Uncomplicated infections of the skin and soft tissue are one of the main reasons for visits to dermatological practices and emergency health services&#46; The epidemiology of these infections has changed in recent years&#44; with the appearance of pathogens that were hitherto considered exclusively nosocomial&#46; CA-MRSA represents a paradigm in dermatological practice&#44; as its main pathogenic targets are the skin and skin adnexa&#46; The collection of samples for culture and subsequent antibiogram remains the gold standard in diagnosis&#46; However&#44; while awaiting the results of microbiological tests&#44; we believe it is essential to individualize the initial empirical antibiotic treatment and to include this pathogen in the bacterial spectrum covered&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Although the small number of cases analyzed and the retrospective nature of our study do not allow us to generalize based on the results obtained&#44; we propose that the use of &#946;-lactam antibiotics as an initial therapeutic measure should be avoided in young&#44; healthy patients with cutaneous abscesses with a significant necrotic component and scant purulent exudate&#44; with or without cellulitis&#46; Similarly&#44; in cases of recurrent skin infections&#44; family outbreaks of abscesses&#44; folliculitis&#44; and carbuncles&#44; or treatment failure after 1 or more cycles of &#946;-lactam antibiotics&#44; CA-MRSA should be considered as a potential causative pathogen&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical Disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Protection of Human and Animal Subjects</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals during the course of this study&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Confidentiality of Data</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their place of work concerning the publication of patient data and that all patients included in the study were appropriately informed and gave their written informed consent&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Right to Privacy and Informed Consent</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data are disclosed in this article&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of Interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:2 [
          "identificador" => "xres318983"
          "titulo" => array:6 [
            0 => "Abstract"
            1 => "Introduction"
            2 => "Objective"
            3 => "Material and methods"
            4 => "Results"
            5 => "Conclusions"
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec301772"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres318984"
          "titulo" => array:6 [
            0 => "Resumen"
            1 => "Introducci&#243;n"
            2 => "Objetivo"
            3 => "Material y m&#233;todos"
            4 => "Resultados"
            5 => "Conclusiones"
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec301771"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Materials and Methods"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conclusions"
        ]
        9 => array:3 [
          "identificador" => "sec0030"
          "titulo" => "Ethical Disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Protection of Human and Animal Subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Confidentiality of Data"
            ]
            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Right to Privacy and Informed Consent"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conflicts of Interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-04-04"
    "fechaAceptado" => "2013-09-04"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec301772"
          "palabras" => array:5 [
            0 => "Methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>"
            1 => "Community"
            2 => "Abscess"
            3 => "Necrosis"
            4 => "Cotrimoxazole"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec301771"
          "palabras" => array:5 [
            0 => "<span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a meticilina"
            1 => "Comunidad"
            2 => "Absceso"
            3 => "Necrosis"
            4 => "Cotrimoxazol"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Community-acquired methicillin-resistant Staphylococcus aureus &#40;CA-MRSA&#41; is an emerging pathogen that causes skin and soft-tissue infections&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To describe the clinical characteristics of skin infections caused by CA-MRSA and correlations with the available demographic and microbiological data&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This was a descriptive study of patients with a microbiologically confirmed diagnosis of CA-MRSA infection treated in a dermatology department between June 2009 and December 2011&#46; We recorded demographic details&#44; the clinical characteristics of lesions&#44; and the treatments used&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We studied 11 patients &#40;5 men and 6 women&#41;&#59; 91&#37; were under 40 years of age and had no relevant past medical history&#46; The most common presentation was a skin abscess &#40;with or without cellulitis&#41;&#46; In all such cases&#44; marked tissue necrosis and little or no purulent exudate was observed when the abscess was drained&#46; Fifty percent of these abscesses had been treated previously with &#946;-lactam antibiotics&#44; and in all cases the lesions resolved after surgical drainage&#44; which was combined in 63&#37; of cases with quinolones or cotrimoxazole&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Today&#44; skin infections due to CA-MRSA affect healthy young athletes who have no contact with healthcare settings&#46; The most common presentation is a skin abscess characterized by marked tissue necrosis and little or no purulent exudate&#46; In cases with these characteristics in susceptible patients&#44; the involvement of CA-MRSA as the causative agent should be suspected&#46; The abscesses should be drained whenever possible and&#44; if necessary&#44; antibiotic treatment should be prescribed&#59; empirical use of &#946;-lactam antibiotics should be avoided&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a meticilina de adquisici&#243;n comunitaria &#40;SARM-CO&#41; constituye un pat&#243;geno emergente como agente productor de infecciones de piel y partes blandas&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Describir las caracter&#237;sticas cl&#237;nicas de las infecciones cut&#225;neas causadas por SARM-CO&#44; as&#237; como su correlaci&#243;n con los datos demogr&#225;ficos y microbiol&#243;gicos disponibles&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio descriptivo de los pacientes con diagn&#243;stico de infecci&#243;n microbiol&#243;gicamente confirmada por SARM-CO en el Servicio de Dermatolog&#237;a desde junio de 2009 a diciembre de 2011&#46; Se recogieron los datos demogr&#225;ficos de los pacientes&#44; las caracter&#237;sticas cl&#237;nicas de las lesiones y los tratamientos realizados&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se reclutaron 11 pacientes&#44; 5 hombres y 6 mujeres&#46; El 91&#37; ten&#237;a menos de 40 a&#241;os y no presentaba antecedentes m&#233;dicos de inter&#233;s&#46; El absceso cut&#225;neo &#40;asociado o no a celulitis&#41; fue la forma m&#225;s frecuente de presentaci&#243;n&#46; Tras su drenaje se observ&#243; una cantidad escasa o nula de exudado purulento junto a un componente de necrosis tisular marcado en todas estas lesiones&#46; El 50&#37; de los abscesos hab&#237;a recibido tratamiento previo con antibi&#243;ticos betalact&#225;micos y el drenaje quir&#250;rgico&#44; asociado en el 63&#37; a quinolonas o cotrimoxazol&#44; asegur&#243; la resoluci&#243;n de los mismos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Actualmente las infecciones cut&#225;neas causadas por SARM-CO se presentan en individuos j&#243;venes&#44; sanos&#44; deportistas&#44; sin contacto con el &#225;mbito sanitario&#46; Los abscesos cut&#225;neos&#44; su forma m&#225;s frecuente de presentaci&#243;n&#44; se caracterizan por una marcada necrosis tisular&#44; con escaso o nulo exudado purulento&#46; Ante estos hallazgos en pacientes susceptibles debe sospecharse la implicaci&#243;n de SARM-CO como agente causal&#46; El drenaje de los abscesos se realizar&#225; siempre que sea posible&#44; y cuando resulte necesario a&#241;adir tratamiento antibi&#243;tico deber&#225; evitarse el uso de betalact&#225;micos de forma emp&#237;rica&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Pulido P&#233;rez A&#44; Baniandr&#233;s Rodr&#237;guez O&#44; Ceballos Rodr&#237;guez MC&#44; Mendoza Cembranos MD&#44; Campos Dom&#237;nguez M&#44; Su&#225;rez Fern&#225;ndez R&#46; Infecciones cut&#225;neas causadas por <span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a meticilina de adquisici&#243;n comunitaria&#58; caracter&#237;sticas cl&#237;nico-microbiol&#243;gicas en 11 pacientes&#46; Actas Dermosifiliogr&#46; 2014&#59;105&#58;150&#8211;158&#46;</p>"
      ]
    ]
    "multimedia" => array:7 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 627
            "Ancho" => 950
            "Tamanyo" => 141217
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Abscess and perilesional cellulitis&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 707
            "Ancho" => 948
            "Tamanyo" => 195408
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Characteristic appearance of abscess after drainage&#58; necrosis and absence or scarcity of purulent exudate&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 991
            "Ancho" => 744
            "Tamanyo" => 173496
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Erythematous-violaceous border and fibrinous center after spontaneous drainage of an abscess on the leg&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 710
            "Ancho" => 940
            "Tamanyo" => 157764
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Abscess next to a tattoo on a young woman&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; HIV&#44; human immunodeficiency virus&#59; IVDAs&#44; intravenous drug addicts&#59; MRSA&#44; methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#59; SCC<span class="elsevierStyleItalic">mec</span>&#44; staphylococcal cassette chromosome&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Kowalski et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span>In Spain CA-MRSA isolates frequently exhibit resistance to tetracycline and doxycycline mediated by the <span class="elsevierStyleItalic">tet</span>&#40;M&#41; gene&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Community-Acquired MRSA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Nosocomial MRSA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Risk groups&#47;factors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Children&#44; athletes&#44; membership of recruitment institutions&#44; sexual promiscuity&#44; IVDAs&#44; HIV&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> tattoos&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> origin in endemic area &#40;Pacific Islanders&#44; Central&#47;South Americans&#44; indigenous Australians&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prolonged hospitalization&#44; intravascular catheters&#44; diabetes mellitus&#44; immunosuppression&#44; admission to intensive care unit&#44; hemodialysis&#44; peritoneal dialysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mechanisms of resistance &#40;SCC<span class="elsevierStyleItalic">mec</span> genes&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I&#44; II&#44; III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Production of Panton-Valentine leukocidin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Frequent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infrequent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antimicrobial resistance pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resistance to &#946;-lactam antibiotics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multidrug resistance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinical symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infections of skin and soft tissue&#44; necrotizing pneumonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bacteremia associated with endovascular devices&#44; urinary tract infection&#44; nosocomial pneumonia&#44; endocarditis&#44; surgical wound infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colonization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Genital&#44; perineal &#40;recurrent infections&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nasal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab465405.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Differential Characteristics of Nosocomial and Community-Acquired MRSA Strains&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; Amox-clav&#44; amoxicillin-clavulanate&#59; F&#44; female&#59; IV&#44; intravenous&#59; M&#44; male&#59; NBA&#44; non-&#946;-lactam antibiotics&#59; PVL&#44; Panton-Valentine leukocidin&#59; SD&#44; surgical drainage&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patient&#47;Age&#47;Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Origin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Lesion Type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Lesion Location&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Purulent Exudate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Tissue Necrosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Risk Factors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Prior Treatments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">NBA Resistance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">PVL Production&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;38&#47;M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abscess <span class="elsevierStyleMonospace">&#43;</span> cellulitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sport &#40;futsal&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cloxacillin&#44; amox-clav&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erythromycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SD &#43; oral ciprofloxacin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;40&#47;M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ecuador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abscess&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erythromycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;27&#47;M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abscess&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Camping in rural Thailand&#44;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SD <span class="elsevierStyleMonospace">&#43;</span> oral ciprofloxacin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#47;26&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cuba&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abscess&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Iliac fossa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Scarce&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">dance&#44; tattoo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cloxacillin&#44; amox-clav&#44; cefuroxime&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erythromycin&#44; levofloxacin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SD <span class="elsevierStyleMonospace">&#43;</span> oral clindamycin &#40;administered in suspension due to digestive intolerance&#41;&#47;cotrimoxazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;43&#47;M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colombia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abscess&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abdomen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Scarce&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amox-clav&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erythromycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SD <span class="elsevierStyleMonospace">&#43;</span> IV vancomycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;37&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anthrax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Upper lip&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Scarce&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amox-clav&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SD <span class="elsevierStyleMonospace">&#43;</span> oral ciprofloxacin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#47;35&#47;M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poland&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paronychia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Big toe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Scarce&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ingrown toenail&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amox-clav&#44; cefuroxime&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral cotrimoxazole &#43; deferred SD of ingrown toenail&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#47;37&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poland&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abscess &#43; cellulitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thigh&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sports &#40;swimming&#44; diving&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SD <span class="elsevierStyleMonospace">&#43;</span> oral cotrimoxazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#47;18&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ecuador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abscess <span class="elsevierStyleMonospace">&#43;</span> cellulitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abdomen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Noninvasive cosmetic procedures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erythromycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SD <span class="elsevierStyleMonospace">&#43;</span> oral ciprofloxacin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;18&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colombia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Folliculitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Back&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Recurrent skin infections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erythromycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cotrimoxazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#47;24&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abscess <span class="elsevierStyleMonospace">&#43;</span> cellulitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Scarce&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amox-clav&#44; erythromycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erythromycin&#44; clindamycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SD <span class="elsevierStyleMonospace">&#43;</span> vancomycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab465404.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Demographic&#44; Clinical&#44; and Microbiological Data for Patients Included in the Study&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; AHT&#44; arterial hypertension&#59; INR&#44; international normalized ratio&#59; IM&#44; intramuscular&#59; IV&#44; intravenous&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Indications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Dose<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&#47;Route of Administration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Adverse Effects and Precautions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgical drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Should be performed for all abscesses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cotrimoxazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46; Abscesses&#62; 1 cmor &#60; 1<span class="elsevierStyleHsp" style=""></span>cm in case of infants&#44; patients over 65 y&#44; facial location&#44; diabetics&#44; immunosuppression&#44; perilesional cellulite2&#46; Impetigo&#44; ecthyma&#44; cellulitis&#44; folliculitis&#44; paronychia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OralAdults and patients &#8805; 12 y&#58; 800&#47;160 mg&#47;12 hChildren&#58;6-12 y&#44; 400&#47;80 mg&#47;12 h6 mo-5 y&#44; 200&#47;40 mg&#47;12 h6 wk-5 mo&#44; 100&#47;20 mg&#47;12 hIV &#47;IMAdults and patients &#62; 12 y&#58; 800&#47;160 mg&#47;12-24 hChildren 6-12 y&#58; 400&#47;80 mg&#47;12-24 hMean dose&#58; 80&#47;16<span class="elsevierStyleHsp" style=""></span>mg &#47;5 kg&#47;12 hChildren &#62; 2 mo&#58; 6-12 mg&#47;kg&#47;d trimethoprim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Toxicodermia&#44; leukopenia&#44; thrombocytopenia&#44; hemolytic anemia&#44; megaloblastic anemia&#44; photosensitivityNot for use in case of pregnancy&#44; lactation&#44; infants &#60; 2 mo&#44; glucose-6-phosphate dehydrogenase deficiency&#44; porphyrias&#44; treatment with methotrexate&#44; combination with azathioprine or metformin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High rate of resistance in infections caused by <span class="elsevierStyleItalic">Streptococcus pyogenes</span>&#58; caution advised in the empirical treatment of abscesses with perilesional cellulitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clindamycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46; Abscesses&#62; 5 cm or&#60; 5<span class="elsevierStyleHsp" style=""></span>cm in case of infants&#44; patients over 65 y&#44; facial location&#44; diabetics&#44; immunosuppression&#44; perilesional cellulite2&#46; Impetigo&#44; ecthyma&#44; cellulitis&#44; folliculitis&#44; paronychia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OralAdults&#58; 150-450 mg&#47;6 hChildren &#62; 1 mo&#58; 8-25 mg&#47;kg&#47;d in 3-4 dosesIV &#47;IMAdults&#58; 1&#46;2-1&#46;8 g&#47;d in 3-4 dosesChildren &#62; 1 mo&#58; 20-40 mg&#47;kg&#47;d in 3-4 doses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diarrhea&#44; risk of pseudomembranous colitis&#44; unpleasant metallic tasteShould not be used in cases of pregnancy&#44; lactation&#44; or in combination with erythromycin or aminoglycosides&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Can presentresistance that is indetectable with standard antibiograms &#40;confirm that D-test has been performed if conventional antibiogram indicates erythromycin resistance&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quinolones &#40;ciprofloxacin&#44; levofloxacin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46; Abscesses&#62; 5 cmor &#60; 5<span class="elsevierStyleHsp" style=""></span>cm in case of infants&#44; patients over 65 y&#44; facial location&#44; diabetics&#44; immunosuppression&#44; perilesional cellulite2&#46; Impetigo&#44; ecthyma&#44; cellulitis&#44; folliculitis&#44; paronychia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ciprofloxacin<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>Oral&#58; Adults&#44; 500 mg&#47;12 hIV&#58; Adults&#44; 200-400 mg&#47;12 hLevofloxacin<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>Adults&#58; Oral&#44; 250-500 mg&#47;dIV&#44; 500 mg&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Risk of tendinopathy&#44; arthropathy &#40;greater in children&#44; the elderly&#44; and in patients receiving long-term corticosteroid therapy&#41;Adjust dose in cases of renal impairmentAvoid in cases of pregnancy&#44; lactation&#46; Should not be ingested with dairy products or calcium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rates of resistance to these drugs are currently low<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tetracyclines&#40;Doxycycline&#44; minocycline&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46; Abscesses&#62; 5 cmor &#60; 5<span class="elsevierStyleHsp" style=""></span>cm in case of infants&#44; patients over 65 y&#44; facial location&#44; diabetics&#44; immunosuppression&#44; perilesional cellulite2&#46; Impetigo&#44; ecthyma&#44; cellulitis&#44; folliculitis&#44; paronychia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doxycycline<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>Oral&#58; Adults and children &#62; 8 y &#40;weight &#8805; 45 kg&#41;&#44; 100-200 mg&#47;24 h in 1 or 2 dosesMinocycline<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>Oral&#58; Adults and children &#62; 8 y &#40;weight &#8805; 45 kg&#41;&#44; 100 mg&#47;12 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Photosensitivity&#44; hepatotoxicity&#44; benign intracranial hypertension &#40;increased risk when administered in children or with retinoids&#41;&#44; vestibular toxicity &#40;minocycline&#41;&#44; esophagitisAvoid in cases of pregnancy&#44; lactation&#44; children &#60; 8 y &#40;risk of tooth and bone metabolism disorders&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not effective in monotherapyThe ST80-MRSA-IV strains &#40;present in Northern and Eastern Europe and in some countries of the Mediterranean basin&#41; are resistant to tetracycline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rifampicin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46; Abscesses&#62; 5 cmor &#60; 5<span class="elsevierStyleHsp" style=""></span>cm in case of infants&#44; patients over 65 y&#44; facial location&#44; diabetics&#44; immunosuppression&#44; perilesional cellulite2&#46; Impetigo&#44; ecthyma&#44; cellulitis&#44; folliculitis&#44; paronychia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OralAdults&#58; 450-600 mg&#47;dChildren &#62; 5 y&#58; 10-20 mg&#47;kg&#47;d in 1-2 doses &#40;maximum 600 mg&#47;d&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatotoxicity&#44; changes in color of urine&#47;bodily secretions&#44; multiple drug interactions &#40;cytochrome p450 inducer&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Synergistic effect with other antimicrobials&#46; Do not use in monotherapy &#40;frequent emergence of resistant strains&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Daptomycin<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complicated skin and soft tissue infections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IVAdults&#58; 4-6<span class="elsevierStyleHsp" style=""></span>mg &#47;kg&#47;dSafety and efficacy not established in patients &#60; 18 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MyotoxicityDosage adjustment in case of renal diseaseAlterations in hemostatic parameters &#40;INR&#47;prothrombin time&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Do not use if there is a risk of necrotizing lung infection &#40;action inhibited by pulmonary surfactant&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vancomycin<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complicated skin and soft tissue infections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IVAdults&#58; initial dose&#44; 30-50<span class="elsevierStyleHsp" style=""></span>mg &#47;kg&#47;d&#59; typical dose&#44; 1 g&#47;12 h or 500 mg&#47;6 hChildren &#62; 1 mo&#58; 10 mg&#47;kg&#47;6 h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nephrotoxicity&#46; Red man syndrome&#58; avoid rapid intravenous administration &#40;minimum 1 h&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Monitor serum levels in patients with renal failure or in cases of coadministration with nephrotoxic drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Linezolid<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complicated skin and soft tissue infections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral and IVAdults&#58; 600 mg&#47;12 hNot recommended in patients &#60; 18 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Myelosuppression&#44; tyramine reaction&#44; optic nerve neuropathy&#44; hypertension&#44; elevated transaminase levels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Given its high cost and adverse effects&#44; its use must be strictly warranted&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quinupristin-dalfopristin<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complicated skin and soft tissue infections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Administered through central venous catheter in 5&#37; glucose for 60 min&#58; 7&#46;5 mg&#47;kg&#47;8 h &#40;not diluted in saline&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Increased QT interval&#44; hepatotoxicity&#44; increased plasma levels of drugs metabolized by CYP3A4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Should be used only in case of treatment failure with other available alternatives&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab465403.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">There is no consensus on the duration of administration regimens for the majority of these drugs&#46; In general&#44; it is recommended to re-evaluate after 7 days of treatment and extend treatment to 14 days if necessary &#40;treatment with quinupristin-dalfopristin should not be extended for more than 7 days&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Valid alternatives in cases of complicated infections&#44; bacteremia&#44; or in cases of treatment failure with other available options&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Therapeutic Modalities in Infections Caused by CA-MRSA&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:27 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The molecular evolution of methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;H&#46; Deurenberg"
                            1 => "C&#46; Vink"
                            2 => "S&#46; Kalenic"
                            3 => "A&#46;W&#46; Friedrich"
                            4 => "C&#46;A&#46; Bruggeman"
                            5 => "E&#46;E&#46; Stobberingh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1469-0691.2006.01573.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Infect"
                        "fecha" => "2007"
                        "volumen" => "13"
                        "paginaInicial" => "222"
                        "paginaFinal" => "235"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17391376"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Methicillin-resistant <span class="elsevierStyleItalic">S&#46; aureus</span> infections among patients in the emergency department"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;J&#46; Moran"
                            1 => "A&#46; Krishnadasan"
                            2 => "R&#46;J&#46; Gorwitz"
                            3 => "G&#46;E&#46; Fosheim"
                            4 => "L&#46;K&#46; McDougal"
                            5 => "R&#46;B&#46; Carey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa055356"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2006"
                        "volumen" => "355"
                        "paginaInicial" => "666"
                        "paginaFinal" => "674"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16914702"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology&#44; treatment&#44; and prevention of community-acquired methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;J&#46; Kowalski"
                            1 => "E&#46;F&#46; Berbari"
                            2 => "D&#46;R&#46; Osmon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4065/80.9.1201"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mayo Clin Proc"
                        "fecha" => "2005"
                        "volumen" => "80"
                        "paginaInicial" => "1201"
                        "paginaFinal" => "1208"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16178500"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Community-associated methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> colonization burden in HIV-infected patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;J&#46; Popovich"
                            1 => "B&#46; Hota"
                            2 => "A&#46; Aroutcheva"
                            3 => "L&#46; Kurien"
                            4 => "J&#46; Patel"
                            5 => "R&#46; Lyles-Banks"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cid/cit010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2013"
                        "volumen" => "56"
                        "paginaInicial" => "1067"
                        "paginaFinal" => "1074"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23325428"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Community-acquired methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> skin infections&#58; Implications for patients and practitioners"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46;R&#46; Cohen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Clin Dermatol"
                        "fecha" => "2007"
                        "volumen" => "8"
                        "paginaInicial" => "259"
                        "paginaFinal" => "270"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17902728"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S014067361060030X"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Methicillin-resistant Staphylococcus aureus skin infections among tattoo recipients-Ohio&#44; Kentucky&#44; and Vermont&#44; 2004-2005"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Centers for Disease Control and Prevention &#40;CDC&#41;"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "MMWR Morb Mortal Wkly Rep"
                        "fecha" => "2006"
                        "volumen" => "23"
                        "paginaInicial" => "677"
                        "paginaFinal" => "679"
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673612613439"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a la meticilina de origen comunitario"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Cercenado"
                            1 => "E&#46; Ruiz de Gopegui"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:8 [
                        "tituloSerie" => "Enferm Infecc Microbiol Clin"
                        "fecha" => "2008"
                        "volumen" => "26"
                        "numero" => "Supl 13"
                        "paginaInicial" => "19"
                        "paginaFinal" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19195434"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673612607296"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Community-acquired methicillin resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> skin and soft tissue infections in Madrid&#58; Prevalence study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Casado-Verrier"
                            1 => "C&#46; G&#243;mez-Fern&#225;ndez"
                            2 => "J&#46;R&#46; Pa&#241;o-Pardo"
                            3 => "R&#46; G&#243;mez-Gil"
                            4 => "J&#46; Mingorance-Cruz"
                            5 => "R&#46; Moreno-Alonso de Celada"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eimc.2011.11.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Enferm Infecc Microbiol Clin"
                        "fecha" => "2012"
                        "volumen" => "30"
                        "paginaInicial" => "300"
                        "paginaFinal" => "306"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22260847"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Community-acquired methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> in Madrid&#44; Spain&#58; transcontinental importation and polyclonal emergence of Panton-Valentine leukocidin-positive isolates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Cercenado"
                            1 => "O&#46; Cuevas"
                            2 => "M&#46; Mar&#237;n"
                            3 => "E&#46; Bouza"
                            4 => "P&#46; Trincado"
                            5 => "T&#46; Boquete"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.diagmicrobio.2008.01.001"
                      "Revista" => array:7 [
                        "tituloSerie" => "Diagn Microbiol Infect Dis"
                        "fecha" => "2008"
                        "volumen" => "61"
                        "paginaInicial" => "143"
                        "paginaFinal" => "149"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18280081"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673602119118"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical inquiries&#46; When should you suspect community-acquired MRSA&#63;&#46; How should you treat it&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46;J&#46; May"
                            1 => "S&#46; Safranek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Fam Pract&#46;"
                        "fecha" => "2009"
                        "volumen" => "58"
                        "paginaInicial" => "276"
                        "paginaFinal" => "278"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19442392"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673611610866"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eschar with cellulitis as a clinical predictor in community-acquired methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;MRSA&#41; skin abscess"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46;A&#46; Busch"
                            1 => "M&#46;T&#46; Ahern"
                            2 => "M&#46; Topinka"
                            3 => "J&#46;J&#46;J2nd Jenkins"
                            4 => "M&#46;A&#46; Weiser"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jemermed.2007.11.072"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Emerg Med"
                        "fecha" => "2010"
                        "volumen" => "38"
                        "paginaInicial" => "563"
                        "paginaFinal" => "566"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18614328"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Community-acquired methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#58; The role of Panton-Valentine leukocidin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Boyle-Vavra"
                            1 => "R&#46;S&#46; Daum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/labinvest.3700501"
                      "Revista" => array:7 [
                        "tituloSerie" => "Lab Invest"
                        "fecha" => "2007"
                        "volumen" => "87"
                        "paginaInicial" => "3"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17146447"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673612613439"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Community-acquired methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#58; Not just a spider bite"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Vozdecky"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.FCH.0000342818.95390.9a"
                      "Revista" => array:6 [
                        "tituloSerie" => "Fam Community Health"
                        "fecha" => "2009"
                        "volumen" => "32"
                        "paginaInicial" => "76"
                        "paginaFinal" => "84"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19092436"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systemic loxoscelism in the age of community-acquired methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46;M&#46; Rogers"
                            1 => "C&#46;R&#46; Klotz"
                            2 => "M&#46; Jack"
                            3 => "D&#46; Seger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.annemergmed.2010.06.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Emerg Med"
                        "fecha" => "2011"
                        "volumen" => "57"
                        "paginaInicial" => "138"
                        "paginaFinal" => "140"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20817348"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin and soft-tissue infections caused by community-acquired methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;E&#46; Stryjewski"
                            1 => "H&#46;F&#46; Chambers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/533593"
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2008"
                        "volumen" => "46"
                        "numero" => "Suppl 5"
                        "paginaInicial" => "S368"
                        "paginaFinal" => "S377"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18462092"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Gorwitz R&#44; Jernigan DB&#44; Powers JH&#44; Jernigan JA and Participants in the Centers for Disease Control and Prevention-Convened Experts&#8217; Meeting on Management of MRSA in the Community&#46; Strategies for clinical management of MRSA in the community&#58; Summary of an Experts&#8217; Meeting convened by the Centers for Disease Control and Prevention&#46; 2006&#46; &#91;consultado 15 Sep 2013&#93;&#46; Available at&#58; http&#58;&#47;&#47;www&#46;cdc&#46;gov&#47;mrsa&#47;pdf&#47;MRSA-Strategies-ExpMtgSummary-2006&#46;pdf&#46;"
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Randomized&#44; double-blind&#44; placebo-controlled trial of cephalexin for treatment of uncomplicated skin abscesses in a population at risk for community-acquired methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;M&#46; Rajendran"
                            1 => "D&#46; Young"
                            2 => "T&#46; Maurer"
                            3 => "H&#46; Chambers"
                            4 => "F&#46; Perdreau-Remington"
                            5 => "P&#46; Ro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/AAC.00377-07"
                      "Revista" => array:6 [
                        "tituloSerie" => "Antimicrob Agents Chemother"
                        "fecha" => "2007"
                        "volumen" => "51"
                        "paginaInicial" => "4044"
                        "paginaFinal" => "4048"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17846141"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and epidemiologic characteristics as predictors of treatment failures in uncomplicated skin abscesses within seven days after incision and drainage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;K&#46; Olderog"
                            1 => "G&#46;R&#46; Schmitz"
                            2 => "D&#46;R&#46; Bruner"
                            3 => "R&#46; Pittoti"
                            4 => "J&#46; Williams"
                            5 => "K&#46; Ouyang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jemermed.2011.09.037"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Emerg Med"
                        "fecha" => "2012"
                        "volumen" => "43"
                        "paginaInicial" => "605"
                        "paginaFinal" => "611"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22698825"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673611615365"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Emergence of multidrug- resistant&#44; community-associated&#44; methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> clone USA300 in men who have sex with men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;A&#46; Diep"
                            1 => "H&#46;F&#46; Chambers"
                            2 => "C&#46;J&#46; Graber"
                            3 => "J&#46;D&#46; Szumowski"
                            4 => "L&#46;G&#46; Miller"
                            5 => "L&#46;L&#46; Han"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2008"
                        "volumen" => "148"
                        "paginaInicial" => "249"
                        "paginaFinal" => "257"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18283202"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Community-associated methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> in acute musculoskeletal infection in children&#58; A game changer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;L&#46; Vander Have"
                            1 => "B&#46; Karmazyn"
                            2 => "M&#46; Verma"
                            3 => "M&#46;S&#46; Caird"
                            4 => "R&#46;N&#46; Hensinger"
                            5 => "F&#46;A&#46; Farley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/BPO.0b013e3181bd1e0c"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Orthop"
                        "fecha" => "2009"
                        "volumen" => "29"
                        "paginaInicial" => "927"
                        "paginaFinal" => "931"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19934711"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Community-acquired methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> pneumonia&#58; A clinical audit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Thomas"
                            1 => "J&#46; Ferguson"
                            2 => "G&#46; Coombs"
                            3 => "P&#46;G&#46; Gibson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1440-1843.2011.01965.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respirology"
                        "fecha" => "2011"
                        "volumen" => "16"
                        "paginaInicial" => "926"
                        "paginaFinal" => "931"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21382130"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary infections and community associated methicillin resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#58; A dangerous mix"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46; Shilo"
                            1 => "C&#46; Quach"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.prrv.2010.10.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Paediatr Respir Rev"
                        "fecha" => "2011"
                        "volumen" => "12"
                        "paginaInicial" => "182"
                        "paginaFinal" => "189"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21722847"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Heterosexual transmission of community-associated methicillin- resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Skov"
                            1 => "K&#46; Christiansen"
                            2 => "S&#46;J&#46; Dancer"
                            3 => "R&#46;S&#46; Daum"
                            4 => "M&#46; Dryden"
                            5 => "Y&#46;C&#46; Huang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/510681"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2007"
                        "volumen" => "44"
                        "paginaInicial" => "410"
                        "paginaFinal" => "413"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17205449"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Update on the prevention and control of community-acquired meticillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;CA-MRSA&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Skov"
                            1 => "K&#46; Christiansen"
                            2 => "S&#46;J&#46; Dancer"
                            3 => "R&#46;S&#46; Daum"
                            4 => "M&#46; Dryden"
                            5 => "Y&#46;C&#46; Huang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijantimicag.2011.09.029"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Antimicrob Agents"
                        "fecha" => "2012"
                        "volumen" => "39"
                        "paginaInicial" => "193"
                        "paginaFinal" => "200"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22226649"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Allergic contact dermatitis from povidone-iodine&#58; A re-evaluation study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;M&#46; Lachapelle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.0105-1873.2005.00479.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Contact Dermatitis"
                        "fecha" => "2005"
                        "volumen" => "52"
                        "paginaInicial" => "9"
                        "paginaFinal" => "10"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15701122"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Household versus individual approaches to eradication of community-associated <span class="elsevierStyleItalic">Staphylococcus aureus</span> in children&#58; A randomized trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Fritz"
                            1 => "P&#46;G&#46; Hogan"
                            2 => "G&#46; Hayek"
                            3 => "K&#46;A&#46; Eisenstein"
                            4 => "M&#46; Rodriguez"
                            5 => "E&#46;K&#46; Epplin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cid/cir919"
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2012"
                        "volumen" => "54"
                        "paginaInicial" => "743"
                        "paginaFinal" => "751"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22198793"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673612621679"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Highly effective regimen for decolonization of methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> carriers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Buehlmann"
                            1 => "R&#46; Frei"
                            2 => "L&#46; Fenner"
                            3 => "M&#46; Dangel"
                            4 => "U&#46; Fluckiger"
                            5 => "A&#46;F&#46; Widmer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/588201"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infect Control Hosp Epidemiol"
                        "fecha" => "2008"
                        "volumen" => "29"
                        "paginaInicial" => "510"
                        "paginaFinal" => "516"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18510460"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010500000002/v1_201403090058/S1578219014000304/v1_201403090058/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6155"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010500000002/v1_201403090058/S1578219014000304/v1_201403090058/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014000304?idApp=UINPBA000044"
]

Article information

ISSN: 15782190
Original language: English

DOI:10.1016/j.adengl.2013.09.005

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	14	15	29
2024 October	109	64	173
2024 September	115	38	153
2024 August	124	73	197
2024 July	102	66	168
2024 June	130	59	189
2024 May	92	42	134
2024 April	77	27	104
2024 March	110	28	138
2024 February	128	20	148
2024 January	123	41	164
2023 December	188	17	205
2023 November	196	29	225
2023 October	224	42	266
2023 September	217	37	254
2023 August	203	24	227
2023 July	173	25	198
2023 June	165	26	191
2023 May	134	17	151
2023 April	140	22	162
2023 March	123	33	156
2023 February	150	21	171
2023 January	117	24	141
2022 December	130	61	191
2022 November	104	31	135
2022 October	115	21	136
2022 September	123	40	163
2022 August	76	40	116
2022 July	65	38	103
2022 June	44	30	74
2022 May	133	43	176
2022 April	135	35	170
2022 March	126	51	177
2022 February	121	24	145
2022 January	101	30	131
2021 December	86	31	117
2021 November	100	57	157
2021 October	126	54	180
2021 September	89	43	132
2021 August	109	36	145
2021 July	102	40	142
2021 June	93	32	125
2021 May	103	41	144
2021 April	276	42	318
2021 March	129	22	151
2021 February	98	31	129
2021 January	73	15	88
2020 December	40	7	47
2020 November	41	15	56
2020 October	60	6	66
2020 September	52	14	66
2020 August	50	12	62
2020 July	32	16	48
2020 June	39	22	61
2020 May	27	13	40
2020 April	39	14	53
2020 March	22	15	37
2020 February	4	1	5
2020 January	4	3	7
2019 December	8	8	16
2019 November	6	9	15
2019 October	0	11	11
2019 September	7	9	16
2019 August	4	7	11
2019 July	4	7	11
2019 June	6	10	16
2019 May	4	17	21
2019 April	2	11	13
2019 March	2	11	13
2019 February	2	4	6
2019 January	2	0	2
2018 December	0	2	2
2018 November	2	4	6
2018 October	4	1	5
2018 June	0	2	2
2018 May	0	5	5
2018 March	5	2	7
2018 February	93	4	97
2018 January	90	6	96
2017 December	81	7	88
2017 November	93	11	104
2017 October	103	10	113
2017 September	92	12	104
2017 August	105	14	119
2017 July	89	16	105
2017 June	109	13	122
2017 May	104	14	118
2017 April	83	12	95
2017 March	66	30	96
2017 February	126	9	135
2017 January	76	6	82
2016 December	67	22	89
2016 November	112	17	129
2016 October	166	22	188
2016 September	192	17	209
2016 August	202	12	214
2016 July	73	4	77
2016 June	16	7	23
2016 May	4	0	4
2016 April	3	16	19
2016 March	2	2	4
2016 February	14	3	17
2016 January	6	2	8
2015 December	2	5	7
2015 November	7	2	9
2015 October	4	2	6
2015 September	5	0	5
2015 August	8	2	10
2015 July	205	9	214
2015 June	119	4	123
2015 May	106	9	115
2015 April	134	8	142
2015 March	159	5	164
2015 February	160	4	164
2015 January	97	3	100
2014 December	82	7	89
2014 November	102	6	108
2014 October	85	5	90
2014 September	80	2	82
2014 August	73	6	79
2014 July	72	2	74
2014 June	79	7	86
2014 May	101	10	111
2014 April	87	18	105
2014 March	48	16	64

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter