The clinical course of Burkholderia cepacia complex bacteria respiratory infection in cystic fibrosis patients
Infecção respiratória por bactérias do complexo Burkholderia cepacia: Evolução clínica em doentes com fibrose quística
Susana Correia1,
, Catarina Nascimento1, Luísa Pereira2, Mónica V. Cunha3, Isabel Sá-Correia4, Celeste Barreto5
Corresponding author
susanaamcorreia@hotmail.com
Correspondence to/Correspondência: Susana Correia Departamento da Criança e da Família, Hospital de Santa Maria Av. Prof. Egas Moniz, 1699 Lisboa, Portugal.
Correspondence to/Correspondência: Susana Correia Departamento da Criança e da Família, Hospital de Santa Maria Av. Prof. Egas Moniz, 1699 Lisboa, Portugal.
1 Interna do Internato Complementar de Pediatria / Resident, Specialist Training, Paediatrics
2 Assistente Hospitalar / Consultant
3 Investigadora Doutorada / PhD Researcher
4 Professora Catedrática / Cathedratic Professor IBB – Institute for Biotechnology and Bioengineering, Centro de Engenharia Biológica e Química, Instituto Superior Técnico. Av. Rovisco Pais, 1049-001 Lisboa, Portugal
5 Chefe de Serviço / Unit Head Centro Especializado em fibrose quística (Coordenadora: Dr.ª Celeste Barreto) / Cystic Fibrosis Centre (Coordinator: Dr Celeste Barreto) Unidade de Pneumologia (Coordenadora: Dr.ª Celeste Barreto) / Pulmonology Unit (Coordinator: Dr Celeste Barreto) Departamento da Criança e da Família (Director: Prof. J. Gomes Pedro) / Child and Family Department (Director: Prof. J. Gomes Pedro) Hospital de Santa Maria, Av. Prof. Egas Moniz, 1699 Lisboa
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Prof. Egas Moniz, 1699 Lisboa, Portugal." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Infecção respiratória por bactérias do complexo <span class="elsevierStyleItalic">Burkholderia cepacia</span>: Evolução clínica em doentes com fibrose quística" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2007-07-18" "fechaAceptado" => "2007-10-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec159370" "palabras" => array:6 [ 0 => "<span class="elsevierStyleItalic">Burkholderia cepacia</span> (Bcc) <span class="elsevierStyleItalic">complex</span>" 1 => "<span class="elsevierStyleItalic">cystic fibrosis</span> (CF)" 2 => "<span class="elsevierStyleItalic">B. cepacia</span>" 3 => "<span class="elsevierStyleItalic">B. cenocepacia</span>" 4 => "<span class="elsevierStyleItalic">B. multivorans</span>" 5 => "<span class="elsevierStyleItalic">B. stabilis</span>" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec159371" "palabras" => array:6 [ 0 => "<span class="elsevierStyleItalic">Complexo Burkholderia cepacia</span> (Bcc)" 1 => "<span class="elsevierStyleItalic">fibrose quística</span> (FQ)" 2 => "<span class="elsevierStyleItalic">B. cepacia</span>" 3 => "<span class="elsevierStyleItalic">B. cenocepacia</span>" 4 => "<span class="elsevierStyleItalic">B. multivorans</span>" 5 => "<span class="elsevierStyleItalic">B. stabilis</span>" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Bacteria of the <span class="elsevierStyleItalic">Burkholderia cepacia</span> complex (Bcc), a group of nine related species, are opportunistic pathogens in cystic fibrosis (CF) patients, associated with a poor prognosis and patient-to-patient transmissibility. The pulmonary deterioration in Bcc-colonised/ infected patients has a heterogeneous pattern leading, sometimes, to a fulminant development – the <span class="elsevierStyleItalic">cepacia</span> syndrome.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To evaluate the relationship between colonisation/ infection by the different Bcc species and the clinical course, the authors carried out a retrospective study of 31 CF patients with Bcc bacteria isolations followed at Hospital de Santa Maria from January 1995 to March 2006. Patients were categorised into two groups: Group I, with intermittent isolations and Group II with chronic isolations. The prevalence of Bcc species was as follows: <span class="elsevierStyleItalic">B. cepacia</span> 57%, <span class="elsevierStyleItalic">B. cenocepacia</span> 43%, <span class="elsevierStyleItalic">B. multivorans</span> 7%, <span class="elsevierStyleItalic">B. stabilis</span> 13%. Three of the patients died of cepacia syndrome. The species B. cepacia and B. stabilis, usually less frequent in CF populations of Europe and America, were isolated in a considerable percentage of the patients examined. No correlation could be established between the species and the clinical outcome.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Deteriorated but not stable patients from group II, whose lung function and pulmonary exacerbationcaused hospitalisation could be retrospectively analysed, exhibited significant differences in the number of hospitalisations and pulmonary function (FEV1) in the year prior to and the years following Bcc isolation.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Based on the available data, it is not currently possible to outline preventive measures through the molecular characterisation of Bcc isolates, reinforcing the notion that the recommended control measures must be followed.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">O complexo <span class="elsevierStyleItalic">Burkholderia cepacia</span> (Bcc) é um grupo constituído por nove espécies de bactérias patogénicas oportunistas na fibrose quística (FQ), associadas a prognóstico mais reservado e a infecção cruzada entre os doentes. Existe grande heterogeneidade na deterioração pulmonar dos doentes colonizados/infectados com Bcc, evoluindo, por vezes, de forma fulminante – síndroma da <span class="elsevierStyleItalic">cepacia</span>.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Com o objectivo de avaliar a relação entre a colonização/ infecção com as diferentes espécies do Bcc e a evolução clínica, os autores analisaram, retrospectivamente, 31 doentes com FQ acompanhados no Hospital de Santa Maria com isolamentos entre Janeiro de 1995 e Março de 2006. Os doentes foram divididos nos grupos: Grupo I – isolamento intermitente (15 doentes) e Grupo II – isolamento crónico (16 doentes). A prevalência das espécies do Bcc foi: B. <span class="elsevierStyleItalic">cepacia</span> 57%, B. <span class="elsevierStyleItalic">cenocepacia</span> 43%, B. <span class="elsevierStyleItalic">multivorans</span> 7%, B. <span class="elsevierStyleItalic">stabilis</span> 13%. Três doentes faleceram com síndroma da cepacia. As espécies B. <span class="elsevierStyleItalic">cepacia</span> e B. <span class="elsevierStyleItalic">stabilis</span>, pouco frequentes nas populações de FQ caracterizadas na Europa e na América do Norte, foram isoladas de uma percentagem importante dos doentes estudados, não tendo sido possível estabelecer uma correlação entre a espécie e a evolução clínica.</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Nos doentes deteriorados, mas não nos estáveis, do grupo II, em quem foi possível analisar retrospectivamente a função respiratória (FEV1) e os períodos de internamento por exacerbação pulmonar, encontraramse algumas diferenças relevantes antes e após o isolamento de Bcc.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Perante a incapacidade actual de orientar as medidas de profilaxia através da caracterização molecular dos isolados de Bcc, há que manter as medidas de controlo recomendadas.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography/Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diversity of the <span class="elsevierStyleItalic">Burkholderia cepacia</span> complex and implications for risk assessment of biological control strains" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.L. Parke" 1 => "D. Gurian-Sherman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Rev Phytopathol" "fecha" => "2001" "volumen" => "39" "paginaInicial" => "225" "paginaFinal" => "258" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The multifarious, multireplicon <span class="elsevierStyleItalic">Burkholderia cepacia</span> complex" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Mahenthiralingam" 1 => "T.A. Urban" 2 => "J.B. Goldberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrmicro1085" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Microbiol" "fecha" => "2005" "volumen" => "3" "paginaInicial" => "144" "paginaFinal" => "156" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15643431" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advances in <span class="elsevierStyleItalic">Burkholderia cepacia</span> complex" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.P. Speert" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Paediatr Respir Rev" "fecha" => "2002" "volumen" => "3" "paginaInicial" => "230" "paginaFinal" => "235" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12376059" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cystic Fibrosis Foundation Consensus Conference on Infection Control Participants. Infection control recommendations for patients with cystic fibrosis: microbiology, important pathogens, and infection control practices to prevent patient-to-patient transmission" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Saiman" 1 => "J. Siegel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Infect Control" "fecha" => "2003" "volumen" => "31" "paginaInicial" => "S1" "paginaFinal" => "S62" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12762292" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diversity and significance of <span class="elsevierStyleItalic">Burkholderia cepacia</span> occupying diverse ecological niches" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Coenye" 1 => "P. Vandamme" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Environ. Microbiol" "fecha" => "2003" "volumen" => "5" "paginaInicial" => "719" "paginaFinal" => "729" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12919407" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The identification of <span class="elsevierStyleItalic">Pseudomonas cepacia</span> and its occurrence in clinical material" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B. Holmes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Appl Bacteriol" "fecha" => "1986" "volumen" => "61" "paginaInicial" => "299" "paginaFinal" => "314" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3781940" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Microbial contamination of antiseptics and disinfectants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Oie" 1 => "A. Kamiya" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Infect Control" "fecha" => "1996" "volumen" => "24" "paginaInicial" => "389" "paginaFinal" => "395" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8902114" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Person-to-person transmission of <span class="elsevierStyleItalic">Pseudomonas cepacia</span> between patients with cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.J. LiPuma" 1 => "S.E. Dase" 2 => "D.W. Nielson" 3 => "R.C. Stern" 4 => "T.L. Stull" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1990" "volumen" => "336" "paginaInicial" => "1094" "paginaFinal" => "1096" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1977981" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence for transmission of <span class="elsevierStyleItalic">Pseudomonas cepacia</span> by social contact in cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "J.R.W. Govan" 1 => "P.H. Brown" 2 => "J. Maddison" 3 => "C.J. Doherty" 4 => "J.W. Nelson" 5 => "M. Dodd" 6 => "A.P. Greening" 7 => "A.K. Webb" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1993" "volumen" => "342" "paginaInicial" => "15" "paginaFinal" => "19" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7686239" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemic of <span class="elsevierStyleItalic">Pseudomonas cepacia</span> in an adult cystic fibrosis unit: evidence of person-to-person transmission" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.L. Smith" 1 => "L.B. Gumery" 2 => "E.G. Smith" 3 => "D.E. Stableforth" 4 => "M.E. Kaufmann" 5 => "T.L. Pitt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "1993" "volumen" => "31" "paginaInicial" => "3017" "paginaFinal" => "3022" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7505294" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome of <span class="elsevierStyleItalic">Bur</span><span class="elsevierStyleItalic">kholderia (Pseudomonas) cepacia</span> colonisation in children with cystic fibrosis following a hospital outbreak" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "M.L. Whiteford" 1 => "J.D. Wilkinson" 2 => "J.H. McColl" 3 => "F.M. Conlon" 4 => "J.R. Michie" 5 => "T.J. Evans" 6 => "J.Y. Paton" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "1995" "volumen" => "50" "paginaInicial" => "1194" "paginaFinal" => "1198" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8553277" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Homeuse nebulizers: a potential source of <span class="elsevierStyleItalic">Burkholderia cepacia</span> and other colistin-resistant, gram-negative bacteria in patients with cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "G.R. Hutchinson" 1 => "S. Parker" 2 => "J.A. Pryor" 3 => "F. Ducan-Skingle" 4 => "P.N. Hoffman" 5 => "M.E. Hodson" 6 => "M.E. Kaufmann" 7 => "T.L. Pitt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "1996" "volumen" => "34" "paginaInicial" => "584" "paginaFinal" => "587" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8904419" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Microbial pathogenesis in cystic fibrosis: mucoid <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> and <span class="elsevierStyleItalic">Burkholderia cepacia</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.R.W. Govan" 1 => "V. Deretic" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Microbiol Rev" "fecha" => "1996" "volumen" => "60" "paginaInicial" => "539" "paginaFinal" => "574" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8840786" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An epidemic <span class="elsevierStyleItalic">Burkholderia cepacia</span> complex strain identified in soil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.J. LiPuma" 1 => "T. Spillker" 2 => "T. Coenye" 3 => "C.F. Gonzalez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(02)08836-0" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2002" "volumen" => "359" "paginaInicial" => "2002" "paginaFinal" => "2003" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12076559" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Taxonomy and identification of the <span class="elsevierStyleItalic">Burkholderia cepacia</span> complex" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Coenye" 1 => "P. Vandamme" 2 => "J.J. LiPuma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.39.10.3427-3436.2001" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2001" "volumen" => "39" "paginaInicial" => "3427" "paginaFinal" => "3436" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11574551" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disproportionate distribution of <span class="elsevierStyleItalic">Burkholderia cepacia</span> complex species and transmissibility markers in cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.J. LiPuma" 1 => "T. Spilker" 2 => "L.H. Gill" 3 => "P.W. Campbell" 4 => "L. Liu" 5 => "E. Mahenthiralingam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.164.1.2011153" "Revista" => array:6 [ "tituloSerie" => "Am J Resp Crit Care Med" "fecha" => "2001" "volumen" => "164" "paginaInicial" => "92" "paginaFinal" => "96" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11435245" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of <span class="elsevierStyleItalic">Burkholderia cepacia</span> complex in patients with cystic fibrosis in Canada: geographical distribution and clustering of strains" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.P. Speert" 1 => "D. Henry" 2 => "P. Vandamme" 3 => "M. Corey" 4 => "E. Mahenthiralingam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3201/eid0802.010163" "Revista" => array:6 [ "tituloSerie" => "Emerg Infect Dis" "fecha" => "2002" "volumen" => "8" "paginaInicial" => "181" "paginaFinal" => "187" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11897071" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Burkholderia cepacia</span> complex infection in Italian patients with cystic fibrosis: prevalence, epidemiology and genomovar status" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Agodi" 1 => "E. Mahenthiralingam" 2 => "M. Barchitta" 3 => "V. Giannino" 4 => "A. Sciacca" 5 => "S. Stefani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.39.8.2891-2896.2001" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2001" "volumen" => "39" "paginaInicial" => "2891" "paginaFinal" => "2896" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11474009" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Species distribution and ribotype diversity of <span class="elsevierStyleItalic">Burkholderia cepacia</span> complex isolates from French patients with cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "S. Brisse" 1 => "C. Cordevant" 2 => "P. Vandamme" 3 => "P. Bidet" 4 => "C. Loukil" 5 => "G. Chabanon" 6 => "M. Lange" 7 => "E. Bingen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.42.10.4824-4827.2004" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2004" "volumen" => "42" "paginaInicial" => "4824" "paginaFinal" => "4827" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15472352" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infection with <span class="elsevierStyleItalic">Burkholderia cepacia</span> complex genomovars in patients with cystic fibrosis: virulent transmissible strains of genomovar III can replace <span class="elsevierStyleItalic">Burkholderia multivorans</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Mahenthiralingam" 1 => "P. Vandamme" 2 => "M.E. Campbell" 3 => "D.A. Henry" 4 => "A.M. Geavelle" 5 => "L.T. Wong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/322684" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2001" "volumen" => "33" "paginaInicial" => "1469" "paginaFinal" => "1475" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11588691" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Mahenthiralingam E, Bischof J, Byrne SK, Radomski C, Davies JE, Av-Gay Y, Vandamme P. DNA-based diagnostic approaches for identification of Burkholderia cepacia complex, <span class="elsevierStyleItalic">Burkholderia vietnamiensis, Burkholderia</span><span class="elsevierStyleItalic">multivorans, Burkholderia stabilis, and Burkholderia cepacia genomovars</span> I and III. J Clin Microbiol 38; 3165–73." ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular typing and exopolysaccharide biosynthesis of <span class="elsevierStyleItalic">Burkholderia cepacia</span> isolates from a Portuguese Cystic Fibrosis Center" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "J.A. Richau" 1 => "J.H. Leitao" 2 => "M. Correia" 3 => "L. Lito" 4 => "M.J. Salgado" 5 => "C. Barreto" 6 => "P. Cescutti" 7 => "I. Sa-Correia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2000" "volumen" => "38" "paginaInicial" => "1651" "paginaFinal" => "1655" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10747161" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular analysis of <span class="elsevierStyleItalic">Burkholderia cepacia</span> complex isolates from a Portuguese Cystic Fibrosis Center: a 7-year study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "M.V. Cunha" 1 => "J.H. Leitao" 2 => "E. Mahenthiralingam" 3 => "P. Vandamme" 4 => "L. Lito" 5 => "C. Barreto" 6 => "M.J. Salgado" 7 => "I. Sa-Correia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2003" "volumen" => "41" "paginaInicial" => "4113" "paginaFinal" => "4120" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12958234" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exceptionally high representation of <span class="elsevierStyleItalic">Burkholderia cepacia</span> among the <span class="elsevierStyleItalic">B. cepacia</span> complex isolates recovered from the major Cystic Fibrosis Center" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "M.V. Cunha" 1 => "A. Pinto-de-Oliveira" 2 => "L. Meirinhos Soares" 3 => "M.J. Salgado" 4 => "J. Melo-Cristino" 5 => "C. Barreto" 6 => "I. Sa-Correia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.00234-07" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2007" "volumen" => "45" "paginaInicial" => "1628" "paginaFinal" => "1633" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17360834" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A National Guard outbreak of <span class="elsevierStyleItalic">Burkholderia cepacia</span> infection and colonization secondary to intrinsic contamination of albuterol nebulization solution" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:14 [ 0 => "H.H. Balkhy" 1 => "G. Cunningham" 2 => "C. Francis" 3 => "M.A. Almuneef" 4 => "G. Stevens" 5 => "N. Akkad" 6 => "A. Elgammal" 7 => "A. Alassiri" 8 => "E. Furukawa" 9 => "F.K. Chew" 10 => "M. Sobh" 11 => "D. Daniel" 12 => "G. Poff" 13 => "Z.A. Memish" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajic.2005.01.001" "Revista" => array:6 [ "tituloSerie" => "Am J Infect Control" "fecha" => "2005" "volumen" => "33" "paginaInicial" => "182" "paginaFinal" => "188" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15798674" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of isolation media for recovery of <span class="elsevierStyleItalic">Burkholderia cepacia</span> complex from respiratory secretions of patients with cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:4 [ 0 => "D. Henry" 1 => "M. Campbell" 2 => "C. McGimpsey" 3 => "A. Clarke" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "1999" "volumen" => "37" "paginaInicial" => "1004" "paginaFinal" => "1007" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10074517" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Burkholderia cepacia.</span> Management issues and new insights" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.J. LiPuma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Chest Med" "fecha" => "1998" "volumen" => "19" "paginaInicial" => "473" "paginaFinal" => "486" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9759550" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inaparent transmission of <span class="elsevierStyleItalic">Pseudomonas</span> (<span class="elsevierStyleItalic">Burkholderia</span>) <span class="elsevierStyleItalic">cepacia</span> among patients with cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.J. LiPuma" 1 => "K.A. Marks-Austin" 2 => "D.S. Holsclaw" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Pediatr Inf Dis J" "fecha" => "1994" "volumen" => "13" "paginaInicial" => "716" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An outbreak of <span class="elsevierStyleItalic">Burkholderia cepacia</span> associated with contamination of albuterol and nasal spray" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:4 [ 0 => "F. Concepcion" 1 => "M.D. Estivariz" 2 => "I. Lubna" 3 => "M.D. Bhatti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.130.5.1346" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2006" "volumen" => "130" "paginaInicial" => "1346" "paginaFinal" => "1350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17099009" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib30" "etiqueta" => "30." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Isolation measures for prevention of infection with respiratory pathogens in cystic fibrosis: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:4 [ 0 => "F. Festini" 1 => "R. Buzzetti" 2 => "C. Bassi" 3 => "C. Braggion" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhin.2006.02.021" "Revista" => array:6 [ "tituloSerie" => "J Hosp Infect" "fecha" => "2006" "volumen" => "64" "paginaInicial" => "1" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16835001" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "Duff, 2002." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phsychological consequences of segregation resulting from chronic <span class="elsevierStyleItalic">Burkholderia cepacia</span> infection in adults with CF" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.J. Duff" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2002" "volumen" => "57" "paginaInicial" => "756" "paginaFinal" => "758" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12200517" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735115/0000001400000001/v1_201305151449/S2173511509702416/v1_201305151449/en/main.assets" "Apartado" => array:4 [ "identificador" => "9552" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Article/Artigo Original" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735115/0000001400000001/v1_201305151449/S2173511509702416/v1_201305151449/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511509702416?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 3 | 8 |
| 2024 October | 33 | 26 | 59 |
| 2024 September | 43 | 25 | 68 |
| 2024 August | 41 | 29 | 70 |
| 2024 July | 33 | 32 | 65 |
| 2024 June | 26 | 24 | 50 |
| 2024 May | 34 | 32 | 66 |
| 2024 April | 33 | 27 | 60 |
| 2024 March | 23 | 22 | 45 |
| 2024 February | 19 | 32 | 51 |
| 2024 January | 18 | 21 | 39 |
| 2023 December | 18 | 31 | 49 |
| 2023 November | 16 | 31 | 47 |
| 2023 October | 21 | 29 | 50 |
| 2023 September | 21 | 23 | 44 |
| 2023 August | 19 | 13 | 32 |
| 2023 July | 22 | 27 | 49 |
| 2023 June | 17 | 18 | 35 |
| 2023 May | 27 | 24 | 51 |
| 2023 April | 12 | 7 | 19 |
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