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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Healthcare-associated infections &#40;HAI&#41; are a main cause of morbidity and mortality in newborns&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;6</span></a> As an empirical guide to treat these types of infections&#44; they are grouped into two categories&#44; early and late onset-infections&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;7&#8211;12</span></a> For the treatment of early sepsis&#44; the bacteria in the maternal genital-urinary tract are considered&#59; for late sepsis&#44; the microbiological profile of the neonatal unit must be taken into account&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;7&#8211;12</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Usually&#44; the symptoms of HAI are nonspecific and similar to other common conditions of neonates&#44; such as respiratory&#44; metabolic&#44; hydro electrolytic&#44; and thermoregulatory disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;6&#8211;11</span></a> Timely treatment&#44; however&#44; is essential for improving the prognosis of infants&#46; Antimicrobial therapy is usually initiated without laboratory confirmation&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;11</span></a> In addition&#44; it is difficult to obtain two blood samples in volumes needed for culture&#44; so sepsis treatment is often initiated based on clinical symptoms&#44; leading to eight-fold increases in the levels of antimicrobial consumption&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Recently&#44; there has been an increase in HAI associated with resistant bacteria in neonatal units with high morbidity and mortality rates and raises hospital costs&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4&#44;9&#44;13&#8211;15</span></a> with the progressive increase of resistance&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8&#44;10&#44;16</span></a> It has been recognized that excessive use of antibiotics&#44; especially broad-spectrum types&#44; is a fundamental factor facilitating the onset of new bacterial resistance mechanisms&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7&#44;8&#44;10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;17</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Well-designed studies on this topic are scarce&#44; but some have shown the importance of stewardship programs in neonatal units&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;14&#44;15&#44;18</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> These studies have indicated that treatment should be precisely installed and should utilize antimicrobials with reduced spectrums&#46; Therefore&#44; the use of broad-spectrum antimicrobials&#44; such as third- and fourth-generation cephalosporins&#44; vancomycin&#44; and carbapenems&#44; should be indicated only for select cases to prevent the emergence of multidrug-resistant microorganisms&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3&#44;7&#44;8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;12&#44;13</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This study aimed to investigate the association between the use of broad-spectrum antimicrobials on bacterial sensitivity profiles in a referral unit of neonatal progressive care&#46; In addition&#44; the authors proposed an investigation of the association between the density of multidrug-resistant bacteria and the use of broad-spectrum antimicrobials &#40;ATM&#41; evaluated as ATM-day&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This cohort study was conducted at the Neonatal Unit of the Hospital das Cl&#237;nicas of Universidade Federal de Minas Gerais from January 2008 to December 2016&#44; a tertiary referral university medical center&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Qualified and trained professionals of the hospital infection control commission &#40;HICC&#41; routinely and systemically collect&#44; through active surveillance of medical records and discussion of cases with the care team&#44; data regarding newborns considered to be under-risk for HAI&#44; according to legislation recommendation&#46; The infection criteria used here are the same as those standardized by the Brazilian Health Surveillance Agency &#40;Ag&#234;ncia Nacional de Vigil&#226;ncia Sanit&#225;ria &#40;ANVISA&#93;&#41; and are based on criteria formulated by the Centers for Disease and Control &#40;CDC&#41; and the National Healthcare Safety Network &#40;NHSN&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Microbiological identification was performed using an automated method &#40;VITEK2&#41; and with a diffusion sensitivity test in agar &#40;Kirby Bauer&#41; to confirm the resistance profile&#46; The sensitivity profile of microorganisms was established by the CCIH and is based on the Clinical &#38; Laboratory Standards Institute &#40;CLSI&#41; guidelines&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This study included the following variables for analysis&#58; notified HAI frequency&#44; number of patients at risk&#44; patient-days&#44; patients with HAI&#44; HAI cumulative incidence &#40;number of HAI for 100 patients at risk&#41;&#44; and HAI incidence density &#40;number of HAI per 1&#46;000 patient-days&#41;&#46; HAI incidence density was also stratified in a control chart according to the birth weight and topography of the infection&#46; In addition&#44; a chart control was created using the mean incidence density&#44; the alert threshold &#40;two standard deviations&#41;&#44; and the control limit &#40;three standard deviations&#41; for follow-up reporting over time&#46; Mean and endemic limits were calculated from monthly HAI rates per 1&#46;000 patient-days&#46; The model selected for the representation of the graphic rate was a U-type and was based on a Poisson probability distribution&#46; The periods defined for comparison considered the control chart&#44; which indicated an increase in the number of infections by multidrug-resistant microorganisms isolated after 2012&#46; Thus&#44; the two periods for comparison were&#44; from 2008 to 2012 and from 2013 to 2016&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">As antimicrobial consumption is not standardized for neonatology&#44; in this study&#44; the use of antimicrobials was evaluated by ATM-day&#44; which is the sum of the total days of exposure to each antimicrobial&#46; The same calculation was also performed for each broad-spectrum antimicrobial analyzed&#46; The incidence density of multidrug-resistant microorganisms per 1000 ATM-days of broad-spectrum antimicrobials was calculated&#44; along with the resistance density per group of bacteria &#40;Gram-positive or Gram-negative&#41; 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2751 neonates were hospitalized&#44; corresponding to 60&#44;656 patient-days&#46; A total of 1398 infections were diagnosed&#44; 1106 of which were systemic bacterial infections&#44; requiring venous antimicrobial treatment&#46; HAI incidence density throughout the study period was 23 per 1000 patient-day and the ATM-day&#47;patient-day ratio was 0&#46;367&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A total of 92&#37; of patients admitted to the unit weighed above 1000<span class="elsevierStyleHsp" style=""></span>g&#59; however&#44; the incidence density of HAI per weight range was higher in the group under 750<span class="elsevierStyleHsp" style=""></span>g &#40;34&#44;6 per 1000 patients-day&#41;&#46; When analyzing HAI by topography&#44; a higher incidence density of laboratory-confirmed late-onset sepsis was observed &#40;6&#46;2 per 1000 patients-day&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">During the nine-year period&#44; 36 multidrug-resistant bacterial infections were identified&#46; In 2009&#44; no HAI from these bacteria was identified&#46; The types of microorganisms identified and their distributions over the years investigated in this study are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">When analyzing antimicrobial-day&#47;patient-day and broad-spectrum antimicrobials-day&#47;patient-day&#44; it was possible to observe a decreasing tendency for antimicrobial-day&#47;patient-day use after 2012&#46; Nevertheless&#44; when this curve is superimposed on the multidrug-resistant microorganism density curve&#44; progressive increases in the density of microorganisms can be observed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The increased incidence density of multi-resistant microorganisms&#47;patient-day can also be observed in the control chart &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; which was associated with increases in the reporting of ESBL-producing <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> and it reached alert level in 2015&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">It was also observed an increase in the density of multidrug-resistance to broad-spectrum antimicrobials after 2012&#46; This increase was observed when the analysis was performed including all antimicrobials and also for broad-spectrum antimicrobials for Gram-negative bacteria&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">When evaluating the use of all broad-spectrum antimicrobial groups&#44; the use of carbapenems and third- and fourth-generation cephalosporins provided a significant increase in multidrug-resistant microorganism density for antimicrobial-day in the second period of study&#46; However&#44; for aminopenicillin associated with the &#946;-lactamase inhibitors&#44; the opposite trend was observed&#44; with significant reductions in multi-resistant microorganism density by antimicrobial-day&#46; Regarding Gram-positive bacteria&#44; no statistically significant differences were observed in relation to antimicrobials administered&#44; even when vancomycin was analyzed separately&#44; despite the increase in incidence density use &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">In the referral neonatal unit where the present study was conducted&#44; a higher HAI incidence density was observed in newborns with birth weights below 1000<span class="elsevierStyleHsp" style=""></span>g&#44; especially late onset sepsis&#46; Preterm infants generally undergo more invasive procedures and are hospitalized for a greater length of time than higher birth weight infants&#59; the literature indicates that these are risk factors for late sepsis and high mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;20</span></a> These factors justify the greater use of ATM in this age group&#44; especially in newborns weighing less than 750<span class="elsevierStyleHsp" style=""></span>g&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A review showed that global consumption of antibiotics has risen 36&#37; from 2000 to 2010&#46; BRICS countries &#40;Brazil&#44; Russia&#44; India&#44; China&#44; and South Africa&#41; contributed to 75&#37; of this increase while accounting for only 40 &#37; of the world&#8217;s population&#46; The same review cited one study including 226 hospitals in Europe&#44; Africa&#44; and South East Asia that reported a 40&#37; of pathogens resistant to the first-line antibiotics as recommended by World Health Organization &#40;WHO&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> In Senegal&#44; Landre-Peigne et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> observed a positive association of increased consumption of antibiotics and number of multidrug-resistant bacteria&#46; Conversely&#44; in the present unit an increase of multidrug-resistant bacteria was observed over the time&#44; despite the reduction in the use of broad-spectrum antimicrobials when ATM-day was considered&#46; This reduction is likely associated with the modification of the vancomycin to oxacillin empirical scheme for late sepsis treatment in the second period of study in this neonatal unit&#46; International studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;20&#44;22&#44;23</span></a> as well another research in the same neonatal unit&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> have demonstrated that replacing vancomycin with oxacillin can be done safely and without increasing mortality when considering coagulase-negative <span class="elsevierStyleItalic">Staphylococcus</span>&#46; Moreover&#44; the overall incidence of multidrug-resistant Gram-positive bacteria remained relatively constant throughout the present study&#44; with no statistical difference observed&#46; This was probably due to the low incidence of HAI caused by <span class="elsevierStyleItalic">Staphylococcus aureus</span> and <span class="elsevierStyleItalic">Enterococcus</span> sp&#46; in the neonatal unit of this study and the modification of empirical therapy as described&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In 2002&#44; the Center for Diseases Control<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> published the twelve-step recommendation for bacterial resistance prevention&#44; which reinforces the need for a careful choice of antimicrobial&#44; which should be used for the shortest time required&#44; as well as restriction and adequacy according to microbiological results&#46; Stewardship programs also recommend not only reducing the use of antimicrobials&#44; but also using them for the shortest time possible and with spectrum restrictions aiming to produce the best possible outcomes&#46; Although studies designed to evaluate the impact of antimicrobial use in the neonatal population are scarce&#44; a previous systematic review has demonstrated the association between inadequate use of antimicrobial agents and increase of multidrug-resistant bacterial HAI in neonatal units&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Thus&#44; it is recommended to reduce the practice of empirical antimicrobial treatments and to include treatment of clinical sepsis for five days&#44; the use of oxacillin in an initial regimen for late sepsis rather than vancomycin&#44; and adequacy of treatment based on culture and not clinical severity&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8&#44;12&#44;15</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In this study&#44; a significant increase in the density of broad-spectrum antimicrobial multidrug-resistance was observed when all antimicrobials within the third and fourth generation of cephalosporin and carbapenems group were considered&#46; The relationship between the increase in multidrug-resistant Gram-negative bacteria and these two groups of antimicrobials was already recognized in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5&#44;8&#44;11&#8211;13&#44;16&#8211;18&#44;25&#8211;29</span></a> It is mainly reported with respect to the increase of bacteria-producing ESBL and the use of cephalosporins of the third and fourth generations&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5&#44;11&#44;16&#8211;18&#44;26&#8211;29</span></a> In 2015&#44; the studied neonatal unit presented an alert as a result of increases in ESBL-producing <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>&#44; reinforcing the hypothesis that inadequate empirical treatment occurred after 2012&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A reduction in the incidence density of resistant microorganisms when using aminopenicillins&#44; associated with an increase in the use of &#946;-lactamase inhibitors was observed in the second period&#46; There was a shortage of ampicillin&#44; which is indicated as the treatment of choice for early sepsis&#44; and the institution allowed the use of ampicillin and sulbactam&#46; In a study conducted in the Netherlands&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> different empiric antimicrobial regimes for sepsis were used in neonatal units &#40;penicillin-tobramycin or flucloxacillin versus tobramicyn regimen and amoxicillin-cefotaxime regimen&#41;&#46; Gram-negative bacillus resistance to empiric therapy was 1798 greater &#40;CI 95&#37; 5&#44;57&#8211;58&#44;01&#41; when a large-spectrum regimen was used&#46; However&#44; the increased number of ESBL microorganisms in the present study was observed in the second period of follow-up&#46; As a result&#44; the study may not have carried out long enough to observe associations between the occurrence of these ATM use and prevalence of ESBL strains&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The present study has limitations&#44; due to its prospective observational design with multifactorial predictors&#44; in which there was no control of other care factors that could influence the incidence of late neonatal infections by multidrug-resistant bacteria&#46; Such factors include hand hygiene&#44; cleaning and sterilization of instruments&#44; distance between hospital beds&#44; and professional&#47;patient relationship recommended by the level of care provided&#44; affecting quality of assistance&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Although there is no standardization of antimicrobial consumption in neonatal units&#44; it was observed that use of broad-spectrum antimicrobials&#44; especially those with coverage for Gram-negative bacteria&#44; was associated with increases in multidrug-resistance&#46; It should be noted that this association was identified in the second period of the study&#44; considering antimicrobial-day density when broad-spectrum antibiotics were used as an empirical treatment&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Stewardship programs are essential in neonatal units&#44; especially when considering treatment for clinical neonatal sepsis&#44; to reduce the empirical use of antimicrobials and to indicate a rational use of antimicrobial agents&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">This work was supported by an Institutional Scholarship from <span class="elsevierStyleGrantSponsor" id="gs0005">Universidade Federal de Minas Gerais</span> and <span class="elsevierStyleGrantSponsor" id="gs0010">Pr&#243;-Reitoria de Pesquisa &#40;PRPq&#41; da Universidade Federal de Minas Gerais</span>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The use of broad-spectrum antimicrobials&#44; such as third and fourth-generation&#44; are responsible for emergence of multidrug-resistant microorganisms in neonatal units&#46; Furthermore&#44; antimicrobial daily doses are not standardized in neonatology&#46; This study aimed to investigate the association between the use of antimicrobial broad spectrum to bacterial sensitivity profile in a referral unit of neonatal progressive care&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">This is a cohort study conducted in a referral neonatal progressive care unit from January 2008 to December 2016&#46; The data of all hospitalized neonates was collected daily&#46; The infection criteria used were the standardized national criteria&#44; based on definitions of Center for Diseases Control and Prevention&#46; In this study&#44; the use of antimicrobials was evaluated as antimicrobial-day &#40;ATM-day&#41; and the ratio of multidrug-resistant microorganisms per 1000 ATM-day of broad spectrum was also calculated&#46; The study was approved by the Institutional Review Board of the Universidade Federal de Minas Gerais &#40;ETIC 312&#47;08 e CAAE 58973616&#46;2&#46;0000&#46;5149&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">From 2008 to 2016&#44; 2751 neonates were hospitalized&#44; corresponding to 60&#44;656 patient-days&#46; The ratio of multidrug-resistant microorganisms per 1000 ATM-day of broad spectrum was 1&#44;3 in the first period and 4&#44;3 in the second period &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">It was observed that use of broad-spectrum antimicrobials&#44; especially those with coverage for Gram-negative bacteria&#44; was associated with an increase of multidrug-resistant bacteria&#46;</p></span>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Multidrug-resistant bacteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Acinetobacter baumannii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">5</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Antibiotic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2013&#8722;2016&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;0364&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">3rd and 4th generation cephalosporin&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ampicillin and sulbactam OR Amoxicillin with clavulanate&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">All broad-spectrum antibiotics &#40;Gram positive&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">All broad-spectrum antibiotics &#40;Gram negative&#41;&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "Challenges in the diagnosis and management of neonatal sepsis"
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                        0 => array:2 [
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                          "autores" => array:2 [
                            0 => "A&#46; Zea-Vera"
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                    0 => array:2 [
                      "doi" => "10.1093/tropej/fmu079"
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                        "tituloSerie" => "J Trop Pediatr"
                        "fecha" => "2015"
                        "volumen" => "61"
                        "paginaInicial" => "1"
                        "paginaFinal" => "13"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25604489"
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                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reduction in colonization and nosocomial infection by multiresistant bacteria in a neonatal unit after institution of educational measures and restriction in the use of cephalosporins"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Calil"
                            1 => "S&#46;T&#46; Marba"
                            2 => "A&#46; von Nowakonski"
                            3 => "A&#46;T&#46; Tresoldi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1067/mic.2001.114223"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Infect Control"
                        "fecha" => "2001"
                        "volumen" => "29"
                        "paginaInicial" => "133"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11391273"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical characteristics and epidemiology of sepsis in the neonatal intensive care unit in the era of multi-drug resistant organisms&#58; a retrospective review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            2 => "S&#46; Awad"
                            3 => "H&#46; Algharaibeh"
                            4 => "W&#46; Khasawneh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pedneo.2017.06.001"
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                        "tituloSerie" => "Pediatr Neonatol"
                        "fecha" => "2018"
                        "volumen" => "59"
                        "paginaInicial" => "35"
                        "paginaFinal" => "41"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28642139"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bloodstream infections&#58; epidemiology and resistance"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;B&#46; Cantey"
                            1 => "A&#46;M&#46; Milstone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clp.2014.10.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Perinatol"
                        "fecha" => "2015"
                        "volumen" => "42"
                        "paginaInicial" => "1"
                        "paginaFinal" => "16"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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                ]
              ]
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            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extended-spectrum beta-lactamase producing <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> in neonatal intensive care unit"
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                        0 => array:2 [
                          "etal" => false
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                            3 => "R&#46; El-Kady"
                          ]
                        ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "J Perinatol"
                        "fecha" => "2008"
                        "volumen" => "28"
                        "paginaInicial" => "685"
                        "paginaFinal" => "690"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18580881"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of a guideline to reduce vancomycin use in the neonatal intensive care unit"
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                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;H&#46; Chiu"
                            1 => "I&#46;C&#46; Michelow"
                            2 => "J&#46; Cronin"
                            3 => "S&#46;A&#46; Ringer"
                            4 => "T&#46;G&#46; Ferris"
                            5 => "K&#46;M&#46; Puopolo"
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                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "2011"
                        "volumen" => "30"
                        "paginaInicial" => "273"
                        "paginaFinal" => "278"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21085051"
                            "web" => "Medline"
                          ]
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                  ]
                ]
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              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Principles and strategies of antimicrobial stewardship in the neonatal intensive care unit"
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                          "autores" => array:2 [
                            0 => "S&#46;J&#46; Patel"
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                          ]
                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.semperi.2012.06.005"
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                        "tituloSerie" => "Semin Perinatol"
                        "fecha" => "2012"
                        "volumen" => "36"
                        "paginaInicial" => "431"
                        "paginaFinal" => "436"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23177802"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antimicrobial stewardship in the NICU"
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                          "autores" => array:2 [
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.idc.2014.01.005"
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                        "tituloSerie" => "Infect Dis Clin North Am"
                        "fecha" => "2014"
                        "volumen" => "28"
                        "paginaInicial" => "247"
                        "paginaFinal" => "261"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24857391"
                            "web" => "Medline"
                          ]
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              ]
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            8 => array:3 [
              "identificador" => "bib0045"
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                      "titulo" => "Antibiotic stewardship in perinatal and neonatal care"
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                          "autores" => array:2 [
                            0 => "J&#46; Ramasethu"
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                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Fetal Neonatal Med"
                        "fecha" => "2017"
                        "volumen" => "22"
                        "paginaInicial" => "278"
                        "paginaFinal" => "283"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28735809"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The current and future roles of neonatal infection surveillance programmes in combating antimicrobial resistance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46; Cailes"
                            1 => "S&#46; Vergnano"
                            2 => "C&#46; Kortsalioudaki"
                            3 => "P&#46; Heath"
                            4 => "M&#46; Sharland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.earlhumdev.2015.08.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Early Hum Dev"
                        "fecha" => "2015"
                        "volumen" => "91"
                        "paginaInicial" => "613"
                        "paginaFinal" => "618"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26386612"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antimicrobial therapy in neonatal intensive care unit"
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                            0 => "C&#46; Tzialla"
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                            2 => "G&#46; Serra"
                            3 => "M&#46; Stronati"
                            4 => "G&#46; Corsello"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13052-015-0117-7"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ital J Pediatr"
                        "fecha" => "2015"
                        "volumen" => "41"
                        "paginaInicial" => "27"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25887621"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antibiotic use in neonatal intensive care units and adherence with Centers for Disease Control and Prevention 12 Step Campaign to Prevent Antimicrobial Resistance"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "P&#46; Prasad"
                            3 => "P&#46; Delamora"
                            4 => "E&#46; Larson"
                            5 => "T&#46; Zaoutis"
                          ]
                        ]
                      ]
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/INF.0b013e3181b12484"
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                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "2009"
                        "volumen" => "28"
                        "paginaInicial" => "1047"
                        "paginaFinal" => "1051"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19858773"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0065"
              "etiqueta" => "13"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Antibiotic resistance in neonatal intensive care unit pathogens&#58; mechanisms&#44; clinical impact&#44; and prevention including antibiotic stewardship"
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                          "etal" => false
                          "autores" => array:2 [
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                    0 => array:2 [
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                        "paginaInicial" => "547"
                        "paginaFinal" => "563"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20813270"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0070"
              "etiqueta" => "14"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Neonatal sepsis&#58; mortality and morbidity in neonatal sepsis due to multidrug-resistant &#40;MDR&#41; organisms&#58; part 1"
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                        0 => array:2 [
                          "etal" => false
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                            3 => "A&#46; Fursule"
                            4 => "A&#46; Kumar"
                            5 => "A&#46; Thakur"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                        "tituloSerie" => "Indian J Pediatr"
                        "fecha" => "2020"
                        "volumen" => "87"
                        "paginaInicial" => "117"
                        "paginaFinal" => "121"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31828600"
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                          ]
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                      ]
                    ]
                  ]
                ]
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              "etiqueta" => "15"
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                    0 => array:2 [
                      "titulo" => "Secular trends in antibiotic use among neonates&#58; 2001&#8211;2008"
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                            3 => "B&#46; Huttner"
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                            5 => "D&#46; Pittet"
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                        "paginaFinal" => "370"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21099446"
                            "web" => "Medline"
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0080"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Restriction of cephalosporins and control of extended spectrum beta-lactamase producing Gram negative bacteria in a neonatal intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Murki"
                            1 => "S&#46; Jonnala"
                            2 => "F&#46; Mohammed"
                            3 => "A&#46; Reddy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s13312-010-0118-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian Pediatr"
                        "fecha" => "2010"
                        "volumen" => "47"
                        "paginaInicial" => "785"
                        "paginaFinal" => "788"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21048261"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extended-spectrum beta-lactamase-producing <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> in a neonatal intensive care unit&#58; risk factors for infection and colonization"
                      "autores" => array:1 [
                        0 => array:2 [
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                          "autores" => array:6 [
                            0 => "C&#46;L&#46; Pessoa-Silva"
                            1 => "B&#46; Meurer Moreira"
                            2 => "V&#46; C&#226;mara Almeida"
                            3 => "B&#46; Flannery"
                            4 => "M&#46;C&#46; Almeida Lins"
                            5 => "J&#46;L&#46; Mello Sampaio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/jhin.2002.1373"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hosp Infect"
                        "fecha" => "2003"
                        "volumen" => "53"
                        "paginaInicial" => "198"
                        "paginaFinal" => "206"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12623321"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors of nosocomial infection with extended-spectrum beta-lactamase-producing bacteria in a neonatal intensive care unit in China"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Y&#46; Huang"
                            1 => "S&#46; Zhuang"
                            2 => "M&#46; Du"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s15010-007-6356-9"
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                        "tituloSerie" => "Infection"
                        "fecha" => "2007"
                        "volumen" => "35"
                        "paginaInicial" => "339"
                        "paginaFinal" => "345"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17721736"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inadequate use of antibiotics and increase in neonatal sepsis caused by resistant bacteria related to health care assistance&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;C&#46; Silva"
                            1 => "L&#46;M&#46; Anchieta"
                            2 => "M&#46;F&#46; Lopes"
                            3 => "R&#46;M&#46; Romanelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bjid.2018.07.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Braz J Infect Dis"
                        "fecha" => "2018"
                        "volumen" => "22"
                        "paginaInicial" => "328"
                        "paginaFinal" => "337"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30125532"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fulminant late-onset sepsis in a neonatal intensive care unit&#44; 1988-1997&#44; and the impact of avoiding empiric vancomycin therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;G&#46; Karlowicz"
                            1 => "E&#46;S&#46; Buescher"
                            2 => "A&#46;E&#46; Surka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.106.6.1387"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2000"
                        "volumen" => "106"
                        "paginaInicial" => "1387"
                        "paginaFinal" => "1390"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11099593"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of an infection control programme in reducing nosocomial bloodstream infections in a Senegalese neonatal unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Landre-Peigne"
                            1 => "A&#46;S&#46; Ka"
                            2 => "V&#46; Peigne"
                            3 => "J&#46; Bougere"
                            4 => "M&#46;N&#46; Seye"
                            5 => "P&#46; Imbert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jhin.2011.04.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hosp Infect"
                        "fecha" => "2011"
                        "volumen" => "79"
                        "paginaInicial" => "161"
                        "paginaFinal" => "165"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21820760"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "No survival benefit with empirical vancomycin therapy for coagulase-negative staphylococcal bloodstream infections in infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;E&#46; Ericson"
                            1 => "J&#46; Thaden"
                            2 => "H&#46;R&#46; Cross"
                            3 => "R&#46;H&#46; Clark"
                            4 => "V&#46;G&#46; Fowler Jr"
                            5 => "D&#46;K&#46; Benjamin Jr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/INF.0000000000000573"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "2015"
                        "volumen" => "34"
                        "paginaInicial" => "371"
                        "paginaFinal" => "375"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25760564"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "A seven-year survey of management of coagulase-negative staphylococcal sepsis in the neonatal intensive care unit&#58; vancomycin may not be necessary as empiric therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "M&#46;A&#46; Hemels"
                            1 => "A&#46; van den Hoogen"
                            2 => "M&#46;A&#46; Verboon-Maciolek"
                            3 => "A&#46; Fleer"
                            4 => "T&#46;G&#46; Krediet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000324852"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neonatology"
                        "fecha" => "2011"
                        "volumen" => "100"
                        "paginaInicial" => "180"
                        "paginaFinal" => "185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21455008"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Empirical antimicrobial therapy for late-onset sepsis in a neonatal unit with high prevalence of coagulase-negative Staph<span class="elsevierStyleItalic">ylococcus</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;M&#46; Romanelli"
                            1 => "L&#46;M&#46; Anchieta"
                            2 => "A&#46;C&#46; Bueno E Silva"
                            3 => "L&#46;A&#46; de Jesus"
                            4 => "V&#46; Rosado"
                            5 => "W&#46;T&#46; Clemente"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr &#40;Rio J&#41;"
                        "fecha" => "2016"
                        "volumen" => "92"
                        "paginaInicial" => "472"
                        "paginaFinal" => "478"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for extended-spectrum beta-lactamase-producing <span class="elsevierStyleItalic">Enterobacteriaceae</span> in a neonatal intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;R&#46; Linkin"
                            1 => "N&#46;O&#46; Fishman"
                            2 => "J&#46;B&#46; Patel"
                            3 => "J&#46;D&#46; Merrill"
                            4 => "E&#46; Lautenbach"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/502477"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infect Control Hosp Epidemiol"
                        "fecha" => "2004"
                        "volumen" => "25"
                        "paginaInicial" => "781"
                        "paginaFinal" => "783"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15484805"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of resistant infections with <span class="elsevierStyleItalic">Enterobacteriaceae</span> in hospitalized neonates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Singh"
                            1 => "K&#46;M&#46; Patel"
                            2 => "M&#46;M&#46; L&#233;ger"
                            3 => "B&#46; Short"
                            4 => "B&#46;M&#46; Sprague"
                            5 => "N&#46; Kalu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00006454-200211000-00010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "2002"
                        "volumen" => "21"
                        "paginaInicial" => "1029"
                        "paginaFinal" => "1033"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12442024"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reduction in multiresistant nosocomial infections in neonates following substitution of ceftazidime with piperacillin&#47;tazobactam in empiric antibiotic therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "O&#46; Flidel-Rimon"
                            1 => "S&#46; Friedman"
                            2 => "S&#46; Gradstein"
                            3 => "R&#46; Bardenstein"
                            4 => "E&#46;S&#46; Shinwell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta P&#230;diatrica"
                        "fecha" => "2003"
                        "volumen" => "92"
                        "paginaInicial" => "1205"
                        "paginaFinal" => "1207"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14632339"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors and outcomes for multidrug-resistant Gram-negative bacteremia in the NICU"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;H&#46; Tsai"
                            1 => "S&#46;M&#46; Chu"
                            2 => "J&#46;F&#46; Hsu"
                            3 => "R&#46; Lien"
                            4 => "H&#46;R&#46; Huang"
                            5 => "M&#46;C&#46; Chiang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2013-1248"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2014"
                        "volumen" => "133"
                        "paginaInicial" => "e322"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24420803"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of empiric antibiotic use on development of infections caused by extended-spectrum beta-lactamase bacteria in a neonatal intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Le"
                            1 => "T&#46; Nguyen"
                            2 => "M&#46; Okamoto"
                            3 => "S&#46; McKamy"
                            4 => "J&#46;M&#46; Lieberman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/INF.0b013e3181606850"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "2008"
                        "volumen" => "27"
                        "paginaInicial" => "314"
                        "paginaFinal" => "318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18316990"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An antibiotic policy to prevent emergence of resistant bacilli"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; de Man"
                            1 => "B&#46;A&#46; Verhoeven"
                            2 => "H&#46;A&#46; Verbrugh"
                            3 => "M&#46;C&#46; Vos"
                            4 => "J&#46;N&#46; van den Anker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "doi" => "10.1016/s0140-6736(00)90015-1"
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                        "tituloSerie" => "Lancet"
                        "fecha" => "2000"
                        "volumen" => "355"
                        "paginaInicial" => "973"
                        "paginaFinal" => "978"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10768436"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
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Original article
Antimicrobial use for treatment of healthcare-associated infections and bacterial resistance in a reference neonatal unit
Ana Carolina Bueno e Silvaa,b,
Corresponding author
acbuenos@yahoo.com.br

Corresponding author.
, Leni Márcia Anchietac, Viviane Rosadod, Janita Ferreirad, Wanessa Trindade Clementee, Julia Sampaio Coelhoc, Paulo Henrique Orlandi Mourãod, Roberta Maia de Castro Romanellic
a Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Centro de Pós graduação, Belo Horizonte, MG, Brazil
b Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, MG, Brazil
c Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil
d Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Serviço de Controle de Infecção Hospitalar, Belo Horizonte, MG, Brazil
e Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento Propedêutico, Belo Horizonte, MG, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Healthcare-associated infections &#40;HAI&#41; are a main cause of morbidity and mortality in newborns&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;6</span></a> As an empirical guide to treat these types of infections&#44; they are grouped into two categories&#44; early and late onset-infections&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;7&#8211;12</span></a> For the treatment of early sepsis&#44; the bacteria in the maternal genital-urinary tract are considered&#59; for late sepsis&#44; the microbiological profile of the neonatal unit must be taken into account&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;7&#8211;12</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Usually&#44; the symptoms of HAI are nonspecific and similar to other common conditions of neonates&#44; such as respiratory&#44; metabolic&#44; hydro electrolytic&#44; and thermoregulatory disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;6&#8211;11</span></a> Timely treatment&#44; however&#44; is essential for improving the prognosis of infants&#46; Antimicrobial therapy is usually initiated without laboratory confirmation&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;11</span></a> In addition&#44; it is difficult to obtain two blood samples in volumes needed for culture&#44; so sepsis treatment is often initiated based on clinical symptoms&#44; leading to eight-fold increases in the levels of antimicrobial consumption&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Recently&#44; there has been an increase in HAI associated with resistant bacteria in neonatal units with high morbidity and mortality rates and raises hospital costs&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4&#44;9&#44;13&#8211;15</span></a> with the progressive increase of resistance&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8&#44;10&#44;16</span></a> It has been recognized that excessive use of antibiotics&#44; especially broad-spectrum types&#44; is a fundamental factor facilitating the onset of new bacterial resistance mechanisms&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7&#44;8&#44;10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;17</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Well-designed studies on this topic are scarce&#44; but some have shown the importance of stewardship programs in neonatal units&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;14&#44;15&#44;18</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> These studies have indicated that treatment should be precisely installed and should utilize antimicrobials with reduced spectrums&#46; Therefore&#44; the use of broad-spectrum antimicrobials&#44; such as third- and fourth-generation cephalosporins&#44; vancomycin&#44; and carbapenems&#44; should be indicated only for select cases to prevent the emergence of multidrug-resistant microorganisms&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3&#44;7&#44;8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;12&#44;13</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This study aimed to investigate the association between the use of broad-spectrum antimicrobials on bacterial sensitivity profiles in a referral unit of neonatal progressive care&#46; In addition&#44; the authors proposed an investigation of the association between the density of multidrug-resistant bacteria and the use of broad-spectrum antimicrobials &#40;ATM&#41; evaluated as ATM-day&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This cohort study was conducted at the Neonatal Unit of the Hospital das Cl&#237;nicas of Universidade Federal de Minas Gerais from January 2008 to December 2016&#44; a tertiary referral university medical center&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Qualified and trained professionals of the hospital infection control commission &#40;HICC&#41; routinely and systemically collect&#44; through active surveillance of medical records and discussion of cases with the care team&#44; data regarding newborns considered to be under-risk for HAI&#44; according to legislation recommendation&#46; The infection criteria used here are the same as those standardized by the Brazilian Health Surveillance Agency &#40;Ag&#234;ncia Nacional de Vigil&#226;ncia Sanit&#225;ria &#40;ANVISA&#93;&#41; and are based on criteria formulated by the Centers for Disease and Control &#40;CDC&#41; and the National Healthcare Safety Network &#40;NHSN&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Microbiological identification was performed using an automated method &#40;VITEK2&#41; and with a diffusion sensitivity test in agar &#40;Kirby Bauer&#41; to confirm the resistance profile&#46; The sensitivity profile of microorganisms was established by the CCIH and is based on the Clinical &#38; Laboratory Standards Institute &#40;CLSI&#41; guidelines&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This study included the following variables for analysis&#58; notified HAI frequency&#44; number of patients at risk&#44; patient-days&#44; patients with HAI&#44; HAI cumulative incidence &#40;number of HAI for 100 patients at risk&#41;&#44; and HAI incidence density &#40;number of HAI per 1&#46;000 patient-days&#41;&#46; HAI incidence density was also stratified in a control chart according to the birth weight and topography of the infection&#46; In addition&#44; a chart control was created using the mean incidence density&#44; the alert threshold &#40;two standard deviations&#41;&#44; and the control limit &#40;three standard deviations&#41; for follow-up reporting over time&#46; Mean and endemic limits were calculated from monthly HAI rates per 1&#46;000 patient-days&#46; The model selected for the representation of the graphic rate was a U-type and was based on a Poisson probability distribution&#46; The periods defined for comparison considered the control chart&#44; which indicated an increase in the number of infections by multidrug-resistant microorganisms isolated after 2012&#46; Thus&#44; the two periods for comparison were&#44; from 2008 to 2012 and from 2013 to 2016&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">As antimicrobial consumption is not standardized for neonatology&#44; in this study&#44; the use of antimicrobials was evaluated by ATM-day&#44; which is the sum of the total days of exposure to each antimicrobial&#46; The same calculation was also performed for each broad-spectrum antimicrobial analyzed&#46; The incidence density of multidrug-resistant microorganisms per 1000 ATM-days of broad-spectrum antimicrobials was calculated&#44; along with the resistance density per group of bacteria &#40;Gram-positive or Gram-negative&#41; per ATM-specific day&#46; Broad-spectrum antimicrobials were considered as those that were not the first choice for the treatment of the etiological agent in the microorganism sensitivity profile&#46; The mid-test was used to compare incidence densities calculated between the periods&#46; Statistical significance was considered if p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The study was approved by the Institutional Review Board of the Federal University of Minas Gerais and the need for a signed informed consent was waived&#44; as the data included was institutional &#40;ETIC 312&#47;08 and CAAE 58973616&#46;2&#46;0000&#46;5149&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">From 2008 to 2016&#44; 2751 neonates were hospitalized&#44; corresponding to 60&#44;656 patient-days&#46; A total of 1398 infections were diagnosed&#44; 1106 of which were systemic bacterial infections&#44; requiring venous antimicrobial treatment&#46; HAI incidence density throughout the study period was 23 per 1000 patient-day and the ATM-day&#47;patient-day ratio was 0&#46;367&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A total of 92&#37; of patients admitted to the unit weighed above 1000<span class="elsevierStyleHsp" style=""></span>g&#59; however&#44; the incidence density of HAI per weight range was higher in the group under 750<span class="elsevierStyleHsp" style=""></span>g &#40;34&#44;6 per 1000 patients-day&#41;&#46; When analyzing HAI by topography&#44; a higher incidence density of laboratory-confirmed late-onset sepsis was observed &#40;6&#46;2 per 1000 patients-day&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">During the nine-year period&#44; 36 multidrug-resistant bacterial infections were identified&#46; In 2009&#44; no HAI from these bacteria was identified&#46; The types of microorganisms identified and their distributions over the years investigated in this study are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">When analyzing antimicrobial-day&#47;patient-day and broad-spectrum antimicrobials-day&#47;patient-day&#44; it was possible to observe a decreasing tendency for antimicrobial-day&#47;patient-day use after 2012&#46; Nevertheless&#44; when this curve is superimposed on the multidrug-resistant microorganism density curve&#44; progressive increases in the density of microorganisms can be observed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The increased incidence density of multi-resistant microorganisms&#47;patient-day can also be observed in the control chart &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; which was associated with increases in the reporting of ESBL-producing <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> and it reached alert level in 2015&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">It was also observed an increase in the density of multidrug-resistance to broad-spectrum antimicrobials after 2012&#46; This increase was observed when the analysis was performed including all antimicrobials and also for broad-spectrum antimicrobials for Gram-negative bacteria&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">When evaluating the use of all broad-spectrum antimicrobial groups&#44; the use of carbapenems and third- and fourth-generation cephalosporins provided a significant increase in multidrug-resistant microorganism density for antimicrobial-day in the second period of study&#46; However&#44; for aminopenicillin associated with the &#946;-lactamase inhibitors&#44; the opposite trend was observed&#44; with significant reductions in multi-resistant microorganism density by antimicrobial-day&#46; Regarding Gram-positive bacteria&#44; no statistically significant differences were observed in relation to antimicrobials administered&#44; even when vancomycin was analyzed separately&#44; despite the increase in incidence density use &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">In the referral neonatal unit where the present study was conducted&#44; a higher HAI incidence density was observed in newborns with birth weights below 1000<span class="elsevierStyleHsp" style=""></span>g&#44; especially late onset sepsis&#46; Preterm infants generally undergo more invasive procedures and are hospitalized for a greater length of time than higher birth weight infants&#59; the literature indicates that these are risk factors for late sepsis and high mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;20</span></a> These factors justify the greater use of ATM in this age group&#44; especially in newborns weighing less than 750<span class="elsevierStyleHsp" style=""></span>g&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A review showed that global consumption of antibiotics has risen 36&#37; from 2000 to 2010&#46; BRICS countries &#40;Brazil&#44; Russia&#44; India&#44; China&#44; and South Africa&#41; contributed to 75&#37; of this increase while accounting for only 40 &#37; of the world&#8217;s population&#46; The same review cited one study including 226 hospitals in Europe&#44; Africa&#44; and South East Asia that reported a 40&#37; of pathogens resistant to the first-line antibiotics as recommended by World Health Organization &#40;WHO&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> In Senegal&#44; Landre-Peigne et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> observed a positive association of increased consumption of antibiotics and number of multidrug-resistant bacteria&#46; Conversely&#44; in the present unit an increase of multidrug-resistant bacteria was observed over the time&#44; despite the reduction in the use of broad-spectrum antimicrobials when ATM-day was considered&#46; This reduction is likely associated with the modification of the vancomycin to oxacillin empirical scheme for late sepsis treatment in the second period of study in this neonatal unit&#46; International studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;20&#44;22&#44;23</span></a> as well another research in the same neonatal unit&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> have demonstrated that replacing vancomycin with oxacillin can be done safely and without increasing mortality when considering coagulase-negative <span class="elsevierStyleItalic">Staphylococcus</span>&#46; Moreover&#44; the overall incidence of multidrug-resistant Gram-positive bacteria remained relatively constant throughout the present study&#44; with no statistical difference observed&#46; This was probably due to the low incidence of HAI caused by <span class="elsevierStyleItalic">Staphylococcus aureus</span> and <span class="elsevierStyleItalic">Enterococcus</span> sp&#46; in the neonatal unit of this study and the modification of empirical therapy as described&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In 2002&#44; the Center for Diseases Control<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> published the twelve-step recommendation for bacterial resistance prevention&#44; which reinforces the need for a careful choice of antimicrobial&#44; which should be used for the shortest time required&#44; as well as restriction and adequacy according to microbiological results&#46; Stewardship programs also recommend not only reducing the use of antimicrobials&#44; but also using them for the shortest time possible and with spectrum restrictions aiming to produce the best possible outcomes&#46; Although studies designed to evaluate the impact of antimicrobial use in the neonatal population are scarce&#44; a previous systematic review has demonstrated the association between inadequate use of antimicrobial agents and increase of multidrug-resistant bacterial HAI in neonatal units&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Thus&#44; it is recommended to reduce the practice of empirical antimicrobial treatments and to include treatment of clinical sepsis for five days&#44; the use of oxacillin in an initial regimen for late sepsis rather than vancomycin&#44; and adequacy of treatment based on culture and not clinical severity&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8&#44;12&#44;15</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In this study&#44; a significant increase in the density of broad-spectrum antimicrobial multidrug-resistance was observed when all antimicrobials within the third and fourth generation of cephalosporin and carbapenems group were considered&#46; The relationship between the increase in multidrug-resistant Gram-negative bacteria and these two groups of antimicrobials was already recognized in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5&#44;8&#44;11&#8211;13&#44;16&#8211;18&#44;25&#8211;29</span></a> It is mainly reported with respect to the increase of bacteria-producing ESBL and the use of cephalosporins of the third and fourth generations&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5&#44;11&#44;16&#8211;18&#44;26&#8211;29</span></a> In 2015&#44; the studied neonatal unit presented an alert as a result of increases in ESBL-producing <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>&#44; reinforcing the hypothesis that inadequate empirical treatment occurred after 2012&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A reduction in the incidence density of resistant microorganisms when using aminopenicillins&#44; associated with an increase in the use of &#946;-lactamase inhibitors was observed in the second period&#46; There was a shortage of ampicillin&#44; which is indicated as the treatment of choice for early sepsis&#44; and the institution allowed the use of ampicillin and sulbactam&#46; In a study conducted in the Netherlands&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> different empiric antimicrobial regimes for sepsis were used in neonatal units &#40;penicillin-tobramycin or flucloxacillin versus tobramicyn regimen and amoxicillin-cefotaxime regimen&#41;&#46; Gram-negative bacillus resistance to empiric therapy was 1798 greater &#40;CI 95&#37; 5&#44;57&#8211;58&#44;01&#41; when a large-spectrum regimen was used&#46; However&#44; the increased number of ESBL microorganisms in the present study was observed in the second period of follow-up&#46; As a result&#44; the study may not have carried out long enough to observe associations between the occurrence of these ATM use and prevalence of ESBL strains&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The present study has limitations&#44; due to its prospective observational design with multifactorial predictors&#44; in which there was no control of other care factors that could influence the incidence of late neonatal infections by multidrug-resistant bacteria&#46; Such factors include hand hygiene&#44; cleaning and sterilization of instruments&#44; distance between hospital beds&#44; and professional&#47;patient relationship recommended by the level of care provided&#44; affecting quality of assistance&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Although there is no standardization of antimicrobial consumption in neonatal units&#44; it was observed that use of broad-spectrum antimicrobials&#44; especially those with coverage for Gram-negative bacteria&#44; was associated with increases in multidrug-resistance&#46; It should be noted that this association was identified in the second period of the study&#44; considering antimicrobial-day density when broad-spectrum antibiotics were used as an empirical treatment&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Stewardship programs are essential in neonatal units&#44; especially when considering treatment for clinical neonatal sepsis&#44; to reduce the empirical use of antimicrobials and to indicate a rational use of antimicrobial agents&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">This work was supported by an Institutional Scholarship from <span class="elsevierStyleGrantSponsor" id="gs0005">Universidade Federal de Minas Gerais</span> and <span class="elsevierStyleGrantSponsor" id="gs0010">Pr&#243;-Reitoria de Pesquisa &#40;PRPq&#41; da Universidade Federal de Minas Gerais</span>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The use of broad-spectrum antimicrobials&#44; such as third and fourth-generation&#44; are responsible for emergence of multidrug-resistant microorganisms in neonatal units&#46; Furthermore&#44; antimicrobial daily doses are not standardized in neonatology&#46; This study aimed to investigate the association between the use of antimicrobial broad spectrum to bacterial sensitivity profile in a referral unit of neonatal progressive care&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">This is a cohort study conducted in a referral neonatal progressive care unit from January 2008 to December 2016&#46; The data of all hospitalized neonates was collected daily&#46; The infection criteria used were the standardized national criteria&#44; based on definitions of Center for Diseases Control and Prevention&#46; In this study&#44; the use of antimicrobials was evaluated as antimicrobial-day &#40;ATM-day&#41; and the ratio of multidrug-resistant microorganisms per 1000 ATM-day of broad spectrum was also calculated&#46; The study was approved by the Institutional Review Board of the Universidade Federal de Minas Gerais &#40;ETIC 312&#47;08 e CAAE 58973616&#46;2&#46;0000&#46;5149&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">From 2008 to 2016&#44; 2751 neonates were hospitalized&#44; corresponding to 60&#44;656 patient-days&#46; The ratio of multidrug-resistant microorganisms per 1000 ATM-day of broad spectrum was 1&#44;3 in the first period and 4&#44;3 in the second period &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">It was observed that use of broad-spectrum antimicrobials&#44; especially those with coverage for Gram-negative bacteria&#44; was associated with an increase of multidrug-resistant bacteria&#46;</p></span>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Multidrug-resistant bacteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Acinetobacter baumannii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">5</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Acinetobacter lwoffii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Antibiotic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MR bacteria</th><th class="td-with-role" title="\n
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                  \t\t\t\t" scope="col">P &#40;MID test&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2008&#8722;2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2013&#8722;2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2008&#8722;2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2013&#8722;2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2008&#8722;2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2013&#8722;2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Meropenem&#47;imipinem&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">761&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">6&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;0364&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3rd and 4th generation cephalosporin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;922&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">674&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">19&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ampicillin and sulbactam OR Amoxicillin with clavulanate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;500&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;0000</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Vancomycin&#47;teicoplamine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;5192&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">All broad-spectrum antibiotics &#40;Gram positive&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;5865&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">All broad-spectrum antibiotics &#40;Gram negative&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#46;241&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;486&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;0048</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">All broad-spectrum antibiotics &#40;All bacteria&#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">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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              "identificador" => "bib0005"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Challenges in the diagnosis and management of neonatal sepsis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Zea-Vera"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/tropej/fmu079"
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                        "tituloSerie" => "J Trop Pediatr"
                        "fecha" => "2015"
                        "volumen" => "61"
                        "paginaInicial" => "1"
                        "paginaFinal" => "13"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25604489"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reduction in colonization and nosocomial infection by multiresistant bacteria in a neonatal unit after institution of educational measures and restriction in the use of cephalosporins"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Calil"
                            1 => "S&#46;T&#46; Marba"
                            2 => "A&#46; von Nowakonski"
                            3 => "A&#46;T&#46; Tresoldi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1067/mic.2001.114223"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Infect Control"
                        "fecha" => "2001"
                        "volumen" => "29"
                        "paginaInicial" => "133"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11391273"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical characteristics and epidemiology of sepsis in the neonatal intensive care unit in the era of multi-drug resistant organisms&#58; a retrospective review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46; Yusef"
                            1 => "T&#46; Shalakhti"
                            2 => "S&#46; Awad"
                            3 => "H&#46; Algharaibeh"
                            4 => "W&#46; Khasawneh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pedneo.2017.06.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Neonatol"
                        "fecha" => "2018"
                        "volumen" => "59"
                        "paginaInicial" => "35"
                        "paginaFinal" => "41"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28642139"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bloodstream infections&#58; epidemiology and resistance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;B&#46; Cantey"
                            1 => "A&#46;M&#46; Milstone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clp.2014.10.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Perinatol"
                        "fecha" => "2015"
                        "volumen" => "42"
                        "paginaInicial" => "1"
                        "paginaFinal" => "16"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25677993"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extended-spectrum beta-lactamase producing <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> in neonatal intensive care unit"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Abdel-Hady"
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                            2 => "M&#46; El-Daker"
                            3 => "R&#46; El-Kady"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/jp.2008.73"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Perinatol"
                        "fecha" => "2008"
                        "volumen" => "28"
                        "paginaInicial" => "685"
                        "paginaFinal" => "690"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18580881"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of a guideline to reduce vancomycin use in the neonatal intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;H&#46; Chiu"
                            1 => "I&#46;C&#46; Michelow"
                            2 => "J&#46; Cronin"
                            3 => "S&#46;A&#46; Ringer"
                            4 => "T&#46;G&#46; Ferris"
                            5 => "K&#46;M&#46; Puopolo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/INF.0b013e3182011d12"
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                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "2011"
                        "volumen" => "30"
                        "paginaInicial" => "273"
                        "paginaFinal" => "278"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21085051"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Principles and strategies of antimicrobial stewardship in the neonatal intensive care unit"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;J&#46; Patel"
                            1 => "L&#46; Saiman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.semperi.2012.06.005"
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                        "tituloSerie" => "Semin Perinatol"
                        "fecha" => "2012"
                        "volumen" => "36"
                        "paginaInicial" => "431"
                        "paginaFinal" => "436"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23177802"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antimicrobial stewardship in the NICU"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;B&#46; Cantey"
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                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.idc.2014.01.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infect Dis Clin North Am"
                        "fecha" => "2014"
                        "volumen" => "28"
                        "paginaInicial" => "247"
                        "paginaFinal" => "261"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24857391"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antibiotic stewardship in perinatal and neonatal care"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Ramasethu"
                            1 => "T&#46; Kawakita"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.siny.2017.07.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Fetal Neonatal Med"
                        "fecha" => "2017"
                        "volumen" => "22"
                        "paginaInicial" => "278"
                        "paginaFinal" => "283"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28735809"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The current and future roles of neonatal infection surveillance programmes in combating antimicrobial resistance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46; Cailes"
                            1 => "S&#46; Vergnano"
                            2 => "C&#46; Kortsalioudaki"
                            3 => "P&#46; Heath"
                            4 => "M&#46; Sharland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.earlhumdev.2015.08.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Early Hum Dev"
                        "fecha" => "2015"
                        "volumen" => "91"
                        "paginaInicial" => "613"
                        "paginaFinal" => "618"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26386612"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antimicrobial therapy in neonatal intensive care unit"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Tzialla"
                            1 => "A&#46; Borghesi"
                            2 => "G&#46; Serra"
                            3 => "M&#46; Stronati"
                            4 => "G&#46; Corsello"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13052-015-0117-7"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ital J Pediatr"
                        "fecha" => "2015"
                        "volumen" => "41"
                        "paginaInicial" => "27"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25887621"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antibiotic use in neonatal intensive care units and adherence with Centers for Disease Control and Prevention 12 Step Campaign to Prevent Antimicrobial Resistance"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "A&#46; Oshodi"
                            2 => "P&#46; Prasad"
                            3 => "P&#46; Delamora"
                            4 => "E&#46; Larson"
                            5 => "T&#46; Zaoutis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/INF.0b013e3181b12484"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "2009"
                        "volumen" => "28"
                        "paginaInicial" => "1047"
                        "paginaFinal" => "1051"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19858773"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antibiotic resistance in neonatal intensive care unit pathogens&#58; mechanisms&#44; clinical impact&#44; and prevention including antibiotic stewardship"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clp.2010.06.004"
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                        "tituloSerie" => "Clin Perinatol"
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                        "volumen" => "37"
                        "paginaInicial" => "547"
                        "paginaFinal" => "563"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20813270"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neonatal sepsis&#58; mortality and morbidity in neonatal sepsis due to multidrug-resistant &#40;MDR&#41; organisms&#58; part 1"
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                        0 => array:2 [
                          "etal" => false
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                            2 => "J&#46;K&#46; Oberoi"
                            3 => "A&#46; Fursule"
                            4 => "A&#46; Kumar"
                            5 => "A&#46; Thakur"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Indian J Pediatr"
                        "fecha" => "2020"
                        "volumen" => "87"
                        "paginaInicial" => "117"
                        "paginaFinal" => "121"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31828600"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0075"
              "etiqueta" => "15"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Secular trends in antibiotic use among neonates&#58; 2001&#8211;2008"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            2 => "K&#46;M&#46; Posfay-Barbe"
                            3 => "B&#46; Huttner"
                            4 => "S&#46; Touveneau"
                            5 => "D&#46; Pittet"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/INF.0b013e31820243d3"
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                        "tituloSerie" => "Pediatr Infect Dis J"
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                        "volumen" => "30"
                        "paginaInicial" => "365"
                        "paginaFinal" => "370"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21099446"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0080"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Restriction of cephalosporins and control of extended spectrum beta-lactamase producing Gram negative bacteria in a neonatal intensive care unit"
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                          "etal" => false
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                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Indian Pediatr"
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                        "volumen" => "47"
                        "paginaInicial" => "785"
                        "paginaFinal" => "788"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21048261"
                            "web" => "Medline"
                          ]
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                ]
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                      "titulo" => "Extended-spectrum beta-lactamase-producing <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> in a neonatal intensive care unit&#58; risk factors for infection and colonization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;L&#46; Pessoa-Silva"
                            1 => "B&#46; Meurer Moreira"
                            2 => "V&#46; C&#226;mara Almeida"
                            3 => "B&#46; Flannery"
                            4 => "M&#46;C&#46; Almeida Lins"
                            5 => "J&#46;L&#46; Mello Sampaio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/jhin.2002.1373"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hosp Infect"
                        "fecha" => "2003"
                        "volumen" => "53"
                        "paginaInicial" => "198"
                        "paginaFinal" => "206"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12623321"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors of nosocomial infection with extended-spectrum beta-lactamase-producing bacteria in a neonatal intensive care unit in China"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Y&#46; Huang"
                            1 => "S&#46; Zhuang"
                            2 => "M&#46; Du"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s15010-007-6356-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infection"
                        "fecha" => "2007"
                        "volumen" => "35"
                        "paginaInicial" => "339"
                        "paginaFinal" => "345"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17721736"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inadequate use of antibiotics and increase in neonatal sepsis caused by resistant bacteria related to health care assistance&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;C&#46; Silva"
                            1 => "L&#46;M&#46; Anchieta"
                            2 => "M&#46;F&#46; Lopes"
                            3 => "R&#46;M&#46; Romanelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bjid.2018.07.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Braz J Infect Dis"
                        "fecha" => "2018"
                        "volumen" => "22"
                        "paginaInicial" => "328"
                        "paginaFinal" => "337"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30125532"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fulminant late-onset sepsis in a neonatal intensive care unit&#44; 1988-1997&#44; and the impact of avoiding empiric vancomycin therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;G&#46; Karlowicz"
                            1 => "E&#46;S&#46; Buescher"
                            2 => "A&#46;E&#46; Surka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.106.6.1387"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2000"
                        "volumen" => "106"
                        "paginaInicial" => "1387"
                        "paginaFinal" => "1390"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11099593"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of an infection control programme in reducing nosocomial bloodstream infections in a Senegalese neonatal unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Landre-Peigne"
                            1 => "A&#46;S&#46; Ka"
                            2 => "V&#46; Peigne"
                            3 => "J&#46; Bougere"
                            4 => "M&#46;N&#46; Seye"
                            5 => "P&#46; Imbert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jhin.2011.04.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hosp Infect"
                        "fecha" => "2011"
                        "volumen" => "79"
                        "paginaInicial" => "161"
                        "paginaFinal" => "165"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21820760"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "No survival benefit with empirical vancomycin therapy for coagulase-negative staphylococcal bloodstream infections in infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;E&#46; Ericson"
                            1 => "J&#46; Thaden"
                            2 => "H&#46;R&#46; Cross"
                            3 => "R&#46;H&#46; Clark"
                            4 => "V&#46;G&#46; Fowler Jr"
                            5 => "D&#46;K&#46; Benjamin Jr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/INF.0000000000000573"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "2015"
                        "volumen" => "34"
                        "paginaInicial" => "371"
                        "paginaFinal" => "375"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25760564"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A seven-year survey of management of coagulase-negative staphylococcal sepsis in the neonatal intensive care unit&#58; vancomycin may not be necessary as empiric therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;A&#46; Hemels"
                            1 => "A&#46; van den Hoogen"
                            2 => "M&#46;A&#46; Verboon-Maciolek"
                            3 => "A&#46; Fleer"
                            4 => "T&#46;G&#46; Krediet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000324852"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neonatology"
                        "fecha" => "2011"
                        "volumen" => "100"
                        "paginaInicial" => "180"
                        "paginaFinal" => "185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21455008"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Empirical antimicrobial therapy for late-onset sepsis in a neonatal unit with high prevalence of coagulase-negative Staph<span class="elsevierStyleItalic">ylococcus</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;M&#46; Romanelli"
                            1 => "L&#46;M&#46; Anchieta"
                            2 => "A&#46;C&#46; Bueno E Silva"
                            3 => "L&#46;A&#46; de Jesus"
                            4 => "V&#46; Rosado"
                            5 => "W&#46;T&#46; Clemente"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr &#40;Rio J&#41;"
                        "fecha" => "2016"
                        "volumen" => "92"
                        "paginaInicial" => "472"
                        "paginaFinal" => "478"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for extended-spectrum beta-lactamase-producing <span class="elsevierStyleItalic">Enterobacteriaceae</span> in a neonatal intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;R&#46; Linkin"
                            1 => "N&#46;O&#46; Fishman"
                            2 => "J&#46;B&#46; Patel"
                            3 => "J&#46;D&#46; Merrill"
                            4 => "E&#46; Lautenbach"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/502477"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infect Control Hosp Epidemiol"
                        "fecha" => "2004"
                        "volumen" => "25"
                        "paginaInicial" => "781"
                        "paginaFinal" => "783"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15484805"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of resistant infections with <span class="elsevierStyleItalic">Enterobacteriaceae</span> in hospitalized neonates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Singh"
                            1 => "K&#46;M&#46; Patel"
                            2 => "M&#46;M&#46; L&#233;ger"
                            3 => "B&#46; Short"
                            4 => "B&#46;M&#46; Sprague"
                            5 => "N&#46; Kalu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00006454-200211000-00010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "2002"
                        "volumen" => "21"
                        "paginaInicial" => "1029"
                        "paginaFinal" => "1033"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12442024"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reduction in multiresistant nosocomial infections in neonates following substitution of ceftazidime with piperacillin&#47;tazobactam in empiric antibiotic therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "O&#46; Flidel-Rimon"
                            1 => "S&#46; Friedman"
                            2 => "S&#46; Gradstein"
                            3 => "R&#46; Bardenstein"
                            4 => "E&#46;S&#46; Shinwell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta P&#230;diatrica"
                        "fecha" => "2003"
                        "volumen" => "92"
                        "paginaInicial" => "1205"
                        "paginaFinal" => "1207"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14632339"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors and outcomes for multidrug-resistant Gram-negative bacteremia in the NICU"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "S&#46;M&#46; Chu"
                            2 => "J&#46;F&#46; Hsu"
                            3 => "R&#46; Lien"
                            4 => "H&#46;R&#46; Huang"
                            5 => "M&#46;C&#46; Chiang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2013-1248"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2014"
                        "volumen" => "133"
                        "paginaInicial" => "e322"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24420803"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of empiric antibiotic use on development of infections caused by extended-spectrum beta-lactamase bacteria in a neonatal intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Le"
                            1 => "T&#46; Nguyen"
                            2 => "M&#46; Okamoto"
                            3 => "S&#46; McKamy"
                            4 => "J&#46;M&#46; Lieberman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/INF.0b013e3181606850"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "2008"
                        "volumen" => "27"
                        "paginaInicial" => "314"
                        "paginaFinal" => "318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18316990"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An antibiotic policy to prevent emergence of resistant bacilli"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; de Man"
                            1 => "B&#46;A&#46; Verhoeven"
                            2 => "H&#46;A&#46; Verbrugh"
                            3 => "M&#46;C&#46; Vos"
                            4 => "J&#46;N&#46; van den Anker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "doi" => "10.1016/s0140-6736(00)90015-1"
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                        "tituloSerie" => "Lancet"
                        "fecha" => "2000"
                        "volumen" => "355"
                        "paginaInicial" => "973"
                        "paginaFinal" => "978"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10768436"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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