array:23 [
  "pii" => "S1579212908600130"
  "issn" => "15792129"
  "doi" => "10.1016/S1579-2129(08)60013-0"
  "estado" => "S300"
  "fechaPublicacion" => "2008-01-01"
  "aid" => "60013"
  "copyright" => "Sociedad Española de Neumología y Cirugía Torácica (SEPAR)"
  "copyrightAnyo" => "2008"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Arch Bronconeumol. 2008;44:100-8"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 3829
    "formatos" => array:3 [
      "EPUB" => 97
      "HTML" => 2824
      "PDF" => 908
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S157921290860021X"
    "issn" => "15792129"
    "doi" => "10.1016/S1579-2129(08)60021-X"
    "estado" => "S300"
    "fechaPublicacion" => "2008-01-01"
    "aid" => "60021"
    "copyright" => "Sociedad Española de Neumología y Cirugía Torácica (SEPAR)"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "sco"
    "cita" => "Arch Bronconeumol. 2008;44:109-12"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 3496
      "formatos" => array:3 [
        "EPUB" => 87
        "HTML" => 2639
        "PDF" => 770
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Reports</span>"
      "titulo" => "Isolation of <span class="elsevierStyleItalic">Nocardia</span> Species in Patients With Cystic Fibrosis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "109"
          "paginaFinal" => "112"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Isabel Barrio, M&#46; Carmen Mart&#237;nez, Concepci&#243;n Prados, Rosa M&#46; Gir&#243;n, Luis Maiz, M&#46; Teresa Mart&#237;nez"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "M&#46; Isabel"
              "apellidos" => "Barrio"
            ]
            1 => array:2 [
              "nombre" => "M&#46; Carmen"
              "apellidos" => "Mart&#237;nez"
            ]
            2 => array:2 [
              "nombre" => "Concepci&#243;n"
              "apellidos" => "Prados"
            ]
            3 => array:2 [
              "nombre" => "Rosa M&#46;"
              "apellidos" => "Gir&#243;n"
            ]
            4 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "Maiz"
            ]
            5 => array:2 [
              "nombre" => "M&#46; Teresa"
              "apellidos" => "Mart&#237;nez"
            ]
            6 => array:1 [
              "colaborador" => "the Cystic Fibrosis Group of the Society of Pulmonology and Thoracic Surgery of Madrid &#40;Neumomadrid&#41;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921290860021X?idApp=UINPBA00003Z"
    "url" => "/15792129/0000004400000002/v1_201305150342/S157921290860021X/v1_201305150342/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1579212908600208"
    "issn" => "15792129"
    "doi" => "10.1016/S1579-2129(08)60020-8"
    "estado" => "S300"
    "fechaPublicacion" => "2008-01-01"
    "aid" => "60020"
    "copyright" => "Sociedad Espa&#241;ola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica &#40;SEPAR&#41;"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Arch Bronconeumol. 2008;44:87-99"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 3029
      "formatos" => array:3 [
        "EPUB" => 83
        "HTML" => 2278
        "PDF" => 668
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Consensus Statement</span>"
      "titulo" => "Standards of Care in Pulmonary Hypertension<a class="elsevierStyleCrossRef" href="#fn1"><span class="elsevierStyleSup">&#42;</span></a>"
      "subtitulo" => "Consensus Statement of the Spanish Society of Pulmonology and Thoracic Surgery &#40;SEPAR&#41; and the Spanish Society of Cardiology &#40;SEC&#41;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "87"
          "paginaFinal" => "99"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Joan Albert Barber&#224;, Pilar Escribano, Pilar Morales, Miguel &#193;ngel G&#243;mez, Mikel Oribe, &#193;ngel Mart&#237;nez, Antonio Rom&#225;n, Javier Segovia, Francisco Santos, Mar&#237;a Teresa Subirana"
          "autores" => array:10 [
            0 => array:2 [
              "nombre" => "Joan Albert"
              "apellidos" => "Barber&#224;"
            ]
            1 => array:2 [
              "nombre" => "Pilar"
              "apellidos" => "Escribano"
            ]
            2 => array:2 [
              "nombre" => "Pilar"
              "apellidos" => "Morales"
            ]
            3 => array:2 [
              "nombre" => "Miguel &#193;ngel"
              "apellidos" => "G&#243;mez"
            ]
            4 => array:2 [
              "nombre" => "Mikel"
              "apellidos" => "Oribe"
            ]
            5 => array:2 [
              "nombre" => "&#193;ngel"
              "apellidos" => "Mart&#237;nez"
            ]
            6 => array:2 [
              "nombre" => "Antonio"
              "apellidos" => "Rom&#225;n"
            ]
            7 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Segovia"
            ]
            8 => array:2 [
              "nombre" => "Francisco"
              "apellidos" => "Santos"
            ]
            9 => array:2 [
              "nombre" => "Mar&#237;a Teresa"
              "apellidos" => "Subirana"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212908600208?idApp=UINPBA00003Z"
    "url" => "/15792129/0000004400000002/v1_201305150342/S1579212908600208/v1_201305150342/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Updated Consensus Statement</span>"
    "titulo" => "Antimicrobial Treatment of Exacerbation in Chronic Obstructive Pulmonary Disease&#58; 2007 Consensus Statement<a class="elsevierStyleCrossRef" href="#fn1"><span class="elsevierStyleSup">&#42;</span></a>"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "100"
        "paginaFinal" => "108"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Marc Miravitlles, Eduard Mons&#243;, Jos&#233; Mensa, Jes&#250;s Aguar&#243;n P&#233;rez, Jos&#233; Barber&#225;n, Mario B&#225;rcena Caama&#241;o, Jos&#233; Luis Ca&#241;ada Merino, Mikel Mart&#237;nez Ortiz de Z&#225;rate, Manuel S&#46; Moya Mir, Juan J&#46; Picazo, Jos&#233; Antonio Quintano Jim&#233;nez, Jos&#233; &#193;ngel Garc&#237;a-Rodr&#237;guez"
        "autores" => array:12 [
          0 => array:4 [
            "nombre" => "Marc"
            "apellidos" => "Miravitlles"
            "email" => array:1 [
              0 => "marcm&#64;separ&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff1"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor1"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Eduard"
            "apellidos" => "Mons&#243;"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff1"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Jos&#233;"
            "apellidos" => "Mensa"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff2"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Jes&#250;s Aguar&#243;n"
            "apellidos" => "P&#233;rez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff3"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Jos&#233;"
            "apellidos" => "Barber&#225;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff4"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Mario B&#225;rcena"
            "apellidos" => "Caama&#241;o"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff3"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Jos&#233; Luis"
            "apellidos" => "Ca&#241;ada Merino"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff5"
              ]
            ]
          ]
          7 => array:2 [
            "nombre" => "Mikel Mart&#237;nez"
            "apellidos" => "Ortiz de Z&#225;rate"
          ]
          8 => array:2 [
            "nombre" => "Manuel S&#46;"
            "apellidos" => "Moya Mir"
          ]
          9 => array:3 [
            "nombre" => "Juan J&#46;"
            "apellidos" => "Picazo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff2"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "Jos&#233; Antonio"
            "apellidos" => "Quintano Jim&#233;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff5"
              ]
            ]
          ]
          11 => array:3 [
            "nombre" => "Jos&#233; &#193;ngel"
            "apellidos" => "Garc&#237;a-Rodr&#237;guez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff2"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Spanish Society of Pulmonology and Thoracic Surgery &#40;SEPAR&#41;"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff1"
          ]
          1 => array:3 [
            "entidad" => "Spanish Society of Chemotherapy &#40;SEQ&#41;"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff2"
          ]
          2 => array:3 [
            "entidad" => "Spanish Society of General Medicine &#40;SEMG&#41;"
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "aff3"
          ]
          3 => array:3 [
            "entidad" => "Spanish Society of Internal Medicine &#40;SEMI&#41;"
            "etiqueta" => "<span class="elsevierStyleSup">d</span>"
            "identificador" => "aff4"
          ]
          4 => array:3 [
            "entidad" => "Spanish Society of Rural and General Medicine &#40;SEMERGEN&#41;"
            "etiqueta" => "<span class="elsevierStyleSup">e</span>"
            "identificador" => "aff5"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor1"
            "etiqueta" => "&#42;"
            "correspondencia" => "Correspondence&#58; Dr M Miravitlles Institut Cl&#237;nic del T&#242;rax&#44; Hospital Cl&#237;nic Villarroel 170&#44; 08036 Barcelona&#44; Spain"
          ]
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2007-04-20"
    "fechaAceptado" => "2007-07-03"
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#42;"
        "nota" => "<p class="elsevierStyleNotepara">The affiliations of the authors of this consensus statement are provided at the end of the article&#46;</p>"
      ]
      1 => array:1 [
        "nota" => "<p class="elsevierStyleNotepara">The original Spanish article was published simultaneously in Semergen&#46; 2008&#59;34&#40;2&#41;&#58; 66&#8211;74&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:68 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Segundo documento de consenso sobre uso de antimicrobianos en la exacerbaci&#243;n de la enfermedad pulmonar obstructiva cr&#243;nica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F &#193;lvarez"
                            1 => "E Bouza"
                            2 => "JA Grac&#237;a-Rodr&#237;guez"
                            3 => "J Mensa"
                            4 => "E Mons&#243;"
                            5 => "JJ Picazo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2003"
                        "volumen" => "39"
                        "paginaInicial" => "274"
                        "paginaFinal" => "282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12797944"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patrones de frecuentaci&#243;n y factores asociados al ingreso en el hospital de las urgencias hospitalarias por asma y enfermedad pulmonar obstructiva cr&#243;nica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F Ballester"
                            1 => "S P&#233;rez-Hoyos"
                            2 => "ML Rivera"
                            3 => "T Merelles"
                            4 => "JM Ten&#237;as"
                            5 => "JB Soriano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "1999"
                        "volumen" => "35"
                        "paginaInicial" => "20"
                        "paginaFinal" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10047916"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio epidemiol&#243;gico de las infecciones en el &#193;rea de Urgencias"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Grupo para el Estudio de la Infecci&#243;n en Urgencias"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Emergencias"
                        "fecha" => "2000"
                        "volumen" => "12"
                        "paginaInicial" => "80"
                        "paginaFinal" => "89"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prospective study of aetiology and outcome of adult lower respiratory tract infections in the community"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "JT MacFarlane"
                            1 => "A Colville"
                            2 => "A Guion"
                            3 => "RM MacFarlane"
                            4 => "DH Rose"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1993"
                        "volumen" => "341"
                        "paginaInicial" => "511"
                        "paginaFinal" => "514"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8094769"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of chronic obstructive pulmonary disease and its exacerbations in general practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M Miravitlles"
                            1 => "C Mayordomo"
                            2 => "M Art&#233;s"
                            3 => "L S&#225;nchez-Agudo"
                            4 => "F Nicolau"
                            5 => "Group Seg&#250; JL on behalf of the EOLO"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "1999"
                        "volumen" => "93"
                        "paginaInicial" => "173"
                        "paginaFinal" => "179"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10464874"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of investigations in lower respiratory tract infection in the community&#58; a European survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M Woodhead"
                            1 => "G Gialdroni Grassi"
                            2 => "GJ Huchon"
                            3 => "P L&#233;ophonte"
                            4 => "F Manresa"
                            5 => "T Schaberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "1996"
                        "volumen" => "9"
                        "paginaInicial" => "1596"
                        "paginaFinal" => "1600"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8866578"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio de las infecciones respiratorias extrahospitalarias"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J Romero Vivas"
                            1 => "M Rubio Alonso"
                            2 => "O Corral"
                            3 => "S Pacheco"
                            4 => "E Agudo"
                            5 => "JJ Picazo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Enferm Infecc Microbiol Clin"
                        "fecha" => "1997"
                        "volumen" => "15"
                        "paginaInicial" => "289"
                        "paginaFinal" => "298"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9376399"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Variabilidad de la prescripci&#243;n antibi&#243;tica en las infecciones respiratorias en dos pa&#237;ses de Europa"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C Llor"
                            1 => "JM Cots"
                            2 => "A Boada"
                            3 => "L Bjerrum"
                            4 => "B Gahrn-Jansen"
                            5 => "A Munck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Enf Infecc Microbiol Clin"
                        "fecha" => "2005"
                        "volumen" => "23"
                        "paginaInicial" => "598"
                        "paginaFinal" => "604"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A Papi"
                            1 => "CM Bellettato"
                            2 => "F Braccioni"
                            3 => "M Romagnoli"
                            4 => "P Casolari"
                            5 => "G Caramori"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200506-859OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2006"
                        "volumen" => "173"
                        "paginaInicial" => "1114"
                        "paginaFinal" => "1121"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16484677"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of chronic obstructive pulmonary disease exacerbations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M Miravitlles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Pulm Med"
                        "fecha" => "2002"
                        "volumen" => "9"
                        "paginaInicial" => "191"
                        "paginaFinal" => "197"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease &#40;COPD&#41; requiring mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N Soler"
                            1 => "A Torres"
                            2 => "S Ewig"
                            3 => "J Gonz&#225;lez"
                            4 => "R Celis"
                            5 => "M el-Ebiary"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.157.5.9711044"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1998"
                        "volumen" => "157"
                        "paginaInicial" => "1498"
                        "paginaFinal" => "1505"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9603129"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory viruses in exacerbations of chronic obstructive pulmonary disease requiring hospitalisation&#58; a case-control study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G Rhode"
                            1 => "A Wiethege"
                            2 => "I Borg"
                            3 => "M Kauth"
                            4 => "TT Bauer"
                            5 => "A Gillissen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2003"
                        "volumen" => "58"
                        "paginaInicial" => "37"
                        "paginaFinal" => "42"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12511718"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute purulent exacerbation of chronic obstructive pulmonary diisease and <span class="elsevierStyleItalic">Chlamydia pneumoniae</span> infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N Mogulkoc"
                            1 => "S Karakurt"
                            2 => "B Isalska"
                            3 => "U Bayindir"
                            4 => "T Celikel"
                            5 => "V Korten"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.160.1.9809041"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1999"
                        "volumen" => "160"
                        "paginaInicial" => "349"
                        "paginaFinal" => "353"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10390424"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of temperature on lung function and symptoms in chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "GC Donaldson"
                            1 => "T Seemungal"
                            2 => "DJ Jeffries"
                            3 => "JA Wedzicha"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "1999"
                        "volumen" => "13"
                        "paginaInicial" => "844"
                        "paginaFinal" => "849"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10362051"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Air pollution and mortality in a cohort of patients with chronic obstructive pulmonary disease&#58; a time series analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J Garc&#237;a-Aymerich"
                            1 => "A Tob&#237;as"
                            2 => "JM Ant&#243;"
                            3 => "J Sunyer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Epidemiol Community Health"
                        "fecha" => "2000"
                        "volumen" => "54"
                        "paginaInicial" => "73"
                        "paginaFinal" => "74"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10692968"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global strategy for the diagnosis&#44; management&#44; and prevention of chronic obstructive pulmonary disease&#46; NHLBI&#47;WHO Global Initiative for Chronic Obstructive Lung Disease &#40;GOLD&#41; workshop summary"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "RA Pauwels"
                            1 => "AS Buist"
                            2 => "PMA Calverley"
                            3 => "CR Jenkins"
                            4 => "SS Hurd"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.163.5.2101039"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2001"
                        "volumen" => "163"
                        "paginaInicial" => "1256"
                        "paginaFinal" => "1276"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11316667"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "When can an exacerbation of COPD be treated at home&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "DS Postma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1998"
                        "volumen" => "351"
                        "paginaInicial" => "1827"
                        "paginaFinal" => "1828"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9652660"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "DE Niewoehner"
                            1 => "ML Erbland"
                            2 => "RH Deupree"
                            3 => "D Collins"
                            4 => "NJ Gross"
                            5 => "RW Light"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199906243402502"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1999"
                        "volumen" => "340"
                        "paginaInicial" => "1941"
                        "paginaFinal" => "1947"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10379017"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of clinical dyspnea ratings and psychophysical measurements of respiratory sensation in obstructive airways disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "DA Mahler"
                            1 => "RA Rosiello"
                            2 => "A Harver"
                            3 => "T Lentine"
                            4 => "JF McGovern"
                            5 => "JA Daubenspeck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1987"
                        "volumen" => "165"
                        "paginaInicial" => "1229"
                        "paginaFinal" => "1233"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intravenous aminophylline in patients admitted to hospital with nonacidotic exacerbations of chronic obstructive pulmonary disease&#58; a prospective randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N Duffy"
                            1 => "P Walker"
                            2 => "F Diamantea"
                            3 => "PM Calverley"
                            4 => "L Davies"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2004.036046"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2005"
                        "volumen" => "60"
                        "paginaInicial" => "713"
                        "paginaFinal" => "717"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15939732"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes following acute exacerbations of severe chronic obstructive lung disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "AFJ Connors"
                            1 => "NV Dawson"
                            2 => "C Thomas"
                            3 => "FE Harrell Jr"
                            4 => "N Desbiens"
                            5 => "WJ Fulkerson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.154.4.8887592"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1996"
                        "volumen" => "154"
                        "paginaInicial" => "959"
                        "paginaFinal" => "996"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8887592"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infecci&#243;n respiratoria en observaci&#243;n de urgencias"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "MS Moya Mir"
                            1 => "P Laguna del Estal"
                            2 => "R Salgado Marqu&#233;s"
                            3 => "S Calabrese S&#225;nchez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Emergencias"
                        "fecha" => "1997"
                        "volumen" => "9"
                        "paginaInicial" => "98"
                        "paginaFinal" => "102"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of emergency medical services by patients with decompensated obstructive lung disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "GH Murata"
                            1 => "MS Gorby"
                            2 => "TW Chick"
                            3 => "AK Halperin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Emerg Med"
                        "fecha" => "1989"
                        "volumen" => "18"
                        "paginaInicial" => "501"
                        "paginaFinal" => "506"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2719362"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R Kessler"
                            1 => "M Faller"
                            2 => "G Fourgaut"
                            3 => "B Mennecier"
                            4 => "E Weitzenblum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.159.1.9803117"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1999"
                        "volumen" => "159"
                        "paginaInicial" => "158"
                        "paginaFinal" => "164"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9872834"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M Miravitlles"
                            1 => "C Espinosa"
                            2 => "E Fern&#225;ndez-Laso"
                            3 => "JA Martos"
                            4 => "JA Maldonado"
                            5 => "M Gallego"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1999"
                        "volumen" => "116"
                        "paginaInicial" => "40"
                        "paginaFinal" => "46"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10424501"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infective exacerbations of chronic bronchitis&#46; Relation between bacteriologic etiology and lung function"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J Eller"
                            1 => "A Ede"
                            2 => "T Schaberg"
                            3 => "MS Niederman"
                            4 => "H Mauch"
                            5 => "H Lode"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1998"
                        "volumen" => "113"
                        "paginaInicial" => "1542"
                        "paginaFinal" => "1548"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9631791"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bacterial infection in exacerbated COPD with changes in sputum characteristics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E Mons&#243;"
                            1 => "J Garc&#237;a-Aymerich"
                            2 => "N Soler"
                            3 => "E Farrero"
                            4 => "MA F&#233;lez"
                            5 => "JM Ant&#243;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Epidemiol Infect"
                        "fecha" => "2003"
                        "volumen" => "131"
                        "paginaInicial" => "799"
                        "paginaFinal" => "804"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12948381"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bacterial infection in chronic obstructive pulmonary disease&#46; A study of stable and exacerbated out-patients using the protected specimen brush"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E Mons&#243;"
                            1 => "J Ruiz"
                            2 => "A Rosell"
                            3 => "J Manterola"
                            4 => "J Fiz"
                            5 => "J Morera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.152.4.7551388"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1995"
                        "volumen" => "152"
                        "paginaInicial" => "1316"
                        "paginaFinal" => "1320"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7551388"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characterization of distal bronchial microflora during acute exacerbations of chronic bronchitis&#58; use of the protected specimen brush technique in 54 mechanically ventilated patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "JY Fagon"
                            1 => "J Chastre"
                            2 => "JL Trouillet"
                            3 => "Y Domart"
                            4 => "MC Dombret"
                            5 => "M Bornet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm/142.5.1004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1990"
                        "volumen" => "142"
                        "paginaInicial" => "1004"
                        "paginaFinal" => "1008"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2240819"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antimicrobial resistance in respiratory tract pathogens&#58; results of an international surveillance study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C Thornsberry"
                            1 => "DF Sahm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "48488"
                      "Revista" => array:7 [
                        "tituloSerie" => "Chemotherapy"
                        "fecha" => "2000"
                        "volumen" => "46"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "15"
                        "paginaFinal" => "23"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10810209"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Spanish Surveillance group&#58; antimicrobial resistance of 1113 <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> isolates from patients with respiratory tract infections in Spain&#58; results of a 1 year &#40;1996&#8211;1997&#41; multicenter surveillance study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F Baquero"
                            1 => "JA Garc&#237;a-Rodr&#237;guez"
                            2 => "J Garc&#237;a de Lomas"
                            3 => "L Aguilar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Antimicrob Agents Chemother"
                        "fecha" => "1999"
                        "volumen" => "43"
                        "paginaInicial" => "357"
                        "paginaFinal" => "359"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9925532"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of community acquired pneumonia in the era of pneumococcal resistance&#58; a report from drug-resistant <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>&#46; Therapeutic Working Group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "JD Heffelfinger"
                            1 => "SF Dowell"
                            2 => "JH Jorgensen"
                            3 => "KP Klugman"
                            4 => "LR Mabry"
                            5 => "DM Musher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "2000"
                        "volumen" => "160"
                        "paginaInicial" => "1399"
                        "paginaFinal" => "1408"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10826451"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antibiotics are associated with lower relapse rates in outpatients with acute exacerbations of COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "SG Adams"
                            1 => "J Melo"
                            2 => "M Luther"
                            3 => "A Anzueto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2000"
                        "volumen" => "117"
                        "paginaInicial" => "1345"
                        "paginaFinal" => "1352"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10807821"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors associated with relapse after ambulatory treatment of acute exacerbations of chronic bronchitis&#46; A prospective multicenter study in the community"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M Miravitlles"
                            1 => "C Murio"
                            2 => "Group Guerrero T on behalf of the DAFNE Study"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2001"
                        "volumen" => "17"
                        "paginaInicial" => "928"
                        "paginaFinal" => "933"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11488328"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microscopic and bacteriologic analysis of expectorated sputum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "TJ Murray"
                            1 => "JA Washington"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Mayo Clinic Proc"
                        "fecha" => "1975"
                        "volumen" => "50"
                        "paginaInicial" => "339"
                        "paginaFinal" => "344"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exacerbations of chronic obstructive pulmonary disease&#58; when are bacteria important&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M Miravitlles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2002"
                        "volumen" => "20"
                        "numero" => "Suppl 36"
                        "paginaInicial" => "9"
                        "paginaFinal" => "19"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship of sputum color to nature and outpatient management of acute exacerbations of COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "RA Stockley"
                            1 => "C O&#39;Brien"
                            2 => "A Pye"
                            3 => "SL Hill"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2000"
                        "volumen" => "117"
                        "paginaInicial" => "1638"
                        "paginaFinal" => "1645"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10858396"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bronchoscopic validation of the significance of sputum purulence in severe exacerbations of chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N Soler"
                            1 => "C Agust&#237;"
                            2 => "J Angrill"
                            3 => "J Puig de la Bellacasa"
                            4 => "A Torres"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2005.056374"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2007"
                        "volumen" => "62"
                        "paginaInicial" => "29"
                        "paginaFinal" => "35"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16928715"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib39"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pharmacodynamic studies of amoxicillin against <span class="elsevierStyleItalic">Streptococcus pneumoniae&#58;</span> comparison of a new pharmacokinetically enhanced formulation &#40;2000 mg twice daily&#41; with standard dosage regimens"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I Odenholt"
                            1 => "O Cars"
                            2 => "E Lowdin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jac/dkh484"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Antimicrob Chemother"
                        "fecha" => "2004"
                        "volumen" => "54"
                        "paginaInicial" => "1062"
                        "paginaFinal" => "1066"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15563517"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib40"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antimicrobial resistance among clinical isolates of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> isolated in four southern European countries &#40;ARISE project&#41; from adult patients&#58; results from the cefditoren surveillance program"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F Soriano"
                            1 => "JJ Granizo"
                            2 => "A Fenoll"
                            3 => "M Gracia"
                            4 => "R Fern&#225;ndez-Roblas"
                            5 => "J Esteban"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1179/joc.2003.15.2.107"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Chemother"
                        "fecha" => "2003"
                        "volumen" => "15"
                        "paginaInicial" => "107"
                        "paginaFinal" => "112"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12797384"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib41"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antimicrobial susceptibility of <span class="elsevierStyleItalic">Haemophilus influenzae</span>&#44; <span class="elsevierStyleItalic">Haemophilus parainfluenzae</span> and <span class="elsevierStyleItalic">Moraxella catarrhalis</span> isolated from adult patients with respiratory tract infections in four southern European countries&#46; The ARISE project"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F Soriano"
                            1 => "JJ Granizo"
                            2 => "P Coronel"
                            3 => "M Gimeno"
                            4 => "E R&#243;denas"
                            5 => "M Gracia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Antimicrob Agents"
                        "fecha" => "2004"
                        "volumen" => "23"
                        "paginaInicial" => "296"
                        "paginaFinal" => "299"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15164972"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib42"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contribuci&#243;n de la farmacodinamia en la elecci&#243;n del antimicrobiano para las exacerbaciones de la EPOC"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "JM Eiros Bouza"
                            1 => "L Vald&#233;s"
                            2 => "MR Bachiller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Quimioter"
                        "fecha" => "2006"
                        "volumen" => "19"
                        "paginaInicial" => "220"
                        "paginaFinal" => "230"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17099790"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib43"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Moxifloxacin in respiratory tract infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M Miravitlles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1517/14656566.6.2.283"
                      "Revista" => array:6 [
                        "tituloSerie" => "Expert Opin Pharmacother"
                        "fecha" => "2005"
                        "volumen" => "6"
                        "paginaInicial" => "283"
                        "paginaFinal" => "293"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15757424"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib44"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Should patients with acute exacerbation of chronic bronchitis be treated with antibiotics&#63; Advantages of the use of fluoroquinolones"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J Mensa"
                            1 => "A Trilla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1469-0691.2006.01396.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Microbiol Infect"
                        "fecha" => "2006"
                        "volumen" => "12"
                        "numero" => "Suppl 3"
                        "paginaInicial" => "42"
                        "paginaFinal" => "54"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16669928"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib45"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tratamiento del paciente con EPOC agudizada"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M Miravitlles"
                            1 => "A Mart&#237;n Graczyk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Gu&#237;a de buena pr&#225;ctica cl&#237;nica en Geriatr&#237;a&#46; Enfermedad pulmonar obstructiva cr&#243;nica&#46; Normativa conjunta SEPAR-SEGG"
                        "paginaInicial" => "75"
                        "paginaFinal" => "88"
                        "serieFecha" => "2006"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib46"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Steady-state plasma and intrapulmonary concentrations of levofloxacin and ciprofloxacin in healthy adult subjects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "MH Gotfried"
                            1 => "LH Danzinger"
                            2 => "KA Rodvold"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2001"
                        "volumen" => "119"
                        "paginaInicial" => "1114"
                        "paginaFinal" => "1122"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11296178"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib47"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Short-term and long-term outcomes of moxifloxacin compared to standard antibiotic treatment in acute exacerbations of chronic bronchitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R Wilson"
                            1 => "L Allegra"
                            2 => "G Huchon"
                            3 => "JL Izquierdo"
                            4 => "P Jones"
                            5 => "T Schaberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2004"
                        "volumen" => "125"
                        "paginaInicial" => "953"
                        "paginaFinal" => "964"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15006954"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib48"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eradication of <span class="elsevierStyleItalic">H&#46; influenzae</span> in AECB&#58; a pooled analysis of moxifloxacin phase III trials compared with macrolide agents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "MS Niederman"
                            1 => "A Anzueto"
                            2 => "S Sethi"
                            3 => "S Choudhri"
                            4 => "A Kureishi"
                            5 => "D Haverstock"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2006.01.025"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2006"
                        "volumen" => "100"
                        "paginaInicial" => "1781"
                        "paginaFinal" => "1790"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16531032"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib49"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Geographical and ecological analysis of resistance&#44; coresistance&#44; and coupled resistance to antimicrobials in respiratory pathogenic bacteria in Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E P&#233;rez-Trallero"
                            1 => "C Garc&#237;a-de-la-Fuente"
                            2 => "C Garc&#237;a-Rey"
                            3 => "F Baquero"
                            4 => "L Aguilar"
                            5 => "R Dal-R&#233;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/AAC.49.5.1965-1972.2005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Antimicrob Agents Chemother"
                        "fecha" => "2005"
                        "volumen" => "49"
                        "paginaInicial" => "1965"
                        "paginaFinal" => "1972"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15855520"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib50"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antibiotic activity of telithromycin and comparators against bacterial pathogens isolated from 3&#44;043 patients with acute exacerbation of chronic bronchitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S Sethi"
                            1 => "A Anzueto"
                            2 => "DJ Farrell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1476-0711-4-5"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Clin Microbiol Antimicrob"
                        "fecha" => "2005"
                        "volumen" => "4"
                        "paginaInicial" => "5"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15755326"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib51"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Brief communication&#58; severe hepatotoxicity of telithromycin&#58; three case reports and literature review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "KD Clay"
                            1 => "JS Hanson"
                            2 => "SD Pope"
                            3 => "RW Rissmiller"
                            4 => "III Purdum PP"
                            5 => "PM Banks"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2006"
                        "volumen" => "144"
                        "paginaInicial" => "415"
                        "paginaFinal" => "420"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16481451"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib52"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of pharmacokinetically enhanced amoxicillin-clavulanate at 2&#44;000&#47;125 milligrams twice daily for 5 days versus amoxicillin-clavulanate at 875&#47;125 milligrams twice daily for 7 days in the treatment of acute exacerbations of chronic bronchitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S Sethi"
                            1 => "J Breton"
                            2 => "B Wynne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/AAC.49.1.153-160.2005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Antimicrob Agents Chemother"
                        "fecha" => "2005"
                        "volumen" => "49"
                        "paginaInicial" => "153"
                        "paginaFinal" => "160"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15616290"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib53"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and bacteriological efficacy in treatment of acute exacerbations of chronic bronchitis with cefditoren-pivoxil versus cefuroxime-axetil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "JL &#193;lvarez-Sala"
                            1 => "P Kardos"
                            2 => "J Mart&#237;nez-Beltr&#225;n"
                            3 => "P Coronel"
                            4 => "L Aguilar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/AAC.50.5.1762-1767.2006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Antimicrob Agents Chemother"
                        "fecha" => "2006"
                        "volumen" => "50"
                        "paginaInicial" => "1762"
                        "paginaFinal" => "1767"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16641447"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib54"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of azithromycin vs levofloxacin in the outpatient treatment of acute bacterial exacerbations of chronic bronchitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "GW Amsden"
                            1 => "IM Baird"
                            2 => "S Simon"
                            3 => "G Treadway"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2003"
                        "volumen" => "123"
                        "paginaInicial" => "772"
                        "paginaFinal" => "777"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12628877"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib55"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Shortcourse moxifloxacin therapy for treatment of acute bacterial exacerbations of chronic bronchitis&#46; The Bronchitis Study Group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S Chodosh"
                            1 => "CA DeAbate"
                            2 => "D Haverstock"
                            3 => "L Aneiro"
                            4 => "D Church"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2000"
                        "volumen" => "94"
                        "paginaInicial" => "18"
                        "paginaFinal" => "27"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10714475"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib56"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Five-day telithromycin once daily is as effective as 10-day clarithromycin twice daily for the treatment of acute exacerbations of chronic bronchitis and is associated with reduced health-care resource utilization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C Fogarty"
                            1 => "R De Wet"
                            2 => "L Mandell"
                            3 => "J Chang"
                            4 => "M Rangaraju"
                            5 => "R Nusrat"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.128.4.1980"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2005"
                        "volumen" => "128"
                        "paginaInicial" => "1980"
                        "paginaFinal" => "1988"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16236845"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib57"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Pseudomonas aeruginosa&#58;</span> a survey of resistance in 136 hospitals in Spain&#46; The Spanish <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> Study Group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E Bouza"
                            1 => "F Garc&#237;a-Garrote"
                            2 => "E Cercenado"
                            3 => "M Mar&#237;n"
                            4 => "MS D&#237;az"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Antimicrob Agents Chemother"
                        "fecha" => "1999"
                        "volumen" => "43"
                        "paginaInicial" => "981"
                        "paginaFinal" => "982"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10103217"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib58"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The antibacterial efficacy of levofloxacin and ciprofloxacin against <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> assessed by combining antibiotic exposure and bacterial susceptibility"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "AP MacGowan"
                            1 => "M Wootton"
                            2 => "HA Holt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Antimicrob Chemother"
                        "fecha" => "1999"
                        "volumen" => "43"
                        "paginaInicial" => "345"
                        "paginaFinal" => "349"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10223589"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib59"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient&#39;s perception of exacerbations of COPD &#8211; the PERCEIVE study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M Miravitlles"
                            1 => "A Anzueto"
                            2 => "D Legnani"
                            3 => "L Forstmeier"
                            4 => "M Fargel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2006.07.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2007"
                        "volumen" => "101"
                        "paginaInicial" => "453"
                        "paginaFinal" => "460"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16938447"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib60"
              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "COPD exacerbations&#46; 4&#58; Prevention"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S Scott"
                            1 => "P Walker"
                            2 => "PMA Calverley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2006"
                        "volumen" => "61"
                        "paginaInicial" => "440"
                        "paginaFinal" => "447"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16648352"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib61"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of pneumococcal polysaccharide vaccine in older adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "LA Jackson"
                            1 => "KM Neuzil"
                            2 => "O Yu"
                            3 => "P Benson"
                            4 => "WE Barlow"
                            5 => "AL Adams"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa022678"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2003"
                        "volumen" => "348"
                        "paginaInicial" => "1747"
                        "paginaFinal" => "1755"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12724480"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib62"
              "etiqueta" => "62"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Prevention of pneumococcal disease&#58; recommendations of the Advisory Committee on Immunization Practices &#40;ACIP&#41;"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "MMWR Morb Mortal Wkly Rep"
                        "fecha" => "1997"
                        "volumen" => "46"
                        "paginaInicial" => "1"
                        "paginaFinal" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9011775"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib63"
              "etiqueta" => "63"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Protective effect of pneumococcal vaccine against death by pneumonia in elderly subjects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A Vila-C&#243;rcoles"
                            1 => "O Ochoa-Gondar"
                            2 => "C Llor"
                            3 => "I Hospital"
                            4 => "E Rodr&#237;guez"
                            5 => "A G&#243;mez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.05.00030205"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "1086"
                        "paginaFinal" => "1091"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16319340"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            63 => array:3 [
              "identificador" => "bib64"
              "etiqueta" => "64"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical efficacy of anti-pneumococcal vaccination in patients with COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I Alfageme"
                            1 => "R V&#225;zquez"
                            2 => "N Reyes"
                            3 => "J Mu&#241;oz"
                            4 => "A Fern&#225;ndez"
                            5 => "M Hern&#225;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2005.043323"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2006"
                        "volumen" => "61"
                        "paginaInicial" => "189"
                        "paginaFinal" => "195"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16227328"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            64 => array:3 [
              "identificador" => "bib65"
              "etiqueta" => "65"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How viral infection cause exacerbation of airway diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P Mallia"
                            1 => "SL Johnston"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.130.4.1203"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2006"
                        "volumen" => "130"
                        "paginaInicial" => "1203"
                        "paginaFinal" => "1210"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17035457"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            65 => array:3 [
              "identificador" => "bib66"
              "etiqueta" => "66"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influenza vaccine for patients with chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "PJ Poole"
                            1 => "E Chacko"
                            2 => "RWB Wood-Baker"
                            3 => "CJ Cates"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Cochrane Database of Systematic Reviews"
                        "fecha" => "2006"
                        "numero" => "1"
                        "paginaInicial" => "CD002733"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            66 => array:3 [
              "identificador" => "bib67"
              "etiqueta" => "67"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral purified bacterial extracts in chronic bronchitis and COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C Steurer-Stey"
                            1 => "LM Bachmann"
                            2 => "J Steurer"
                            3 => "MR Tram&#232;r"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.126.5.1645"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2004"
                        "volumen" => "126"
                        "paginaInicial" => "1645"
                        "paginaFinal" => "1655"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15539739"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            67 => array:3 [
              "identificador" => "bib68"
              "etiqueta" => "68"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment with the immunomodulator AM3 improves the health-related quality of life of patients with chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M &#193;lvarez-Mon"
                            1 => "M Miravitlles"
                            2 => "J Morera"
                            3 => "L Callol"
                            4 => "JL &#193;lvarez-Sala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.127.4.1212"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2005"
                        "volumen" => "127"
                        "paginaInicial" => "1212"
                        "paginaFinal" => "1218"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15821197"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000004400000002/v1_201305150342/S1579212908600130/v1_201305150342/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000004400000002/v1_201305150342/S1579212908600130/v1_201305150342/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212908600130?idApp=UINPBA00003Z"
]
Share
Journal Information
Vol. 44. Issue 2.
Pages 100-108 (January 2008)
Share
Share
Download PDF
More article options
Vol. 44. Issue 2.
Pages 100-108 (January 2008)
Updated Consensus Statement
Full text access
Antimicrobial Treatment of Exacerbation in Chronic Obstructive Pulmonary Disease: 2007 Consensus Statement*
Visits
5818
Marc Miravitllesa,
Corresponding author
marcm@separ.es

Correspondence: Dr M Miravitlles Institut Clínic del Tòrax, Hospital Clínic Villarroel 170, 08036 Barcelona, Spain
, Eduard Monsóa, José Mensab, Jesús Aguarón Pérezc, José Barberánd, Mario Bárcena Caamañoc, José Luis Cañada Merinoe, Mikel Martínez Ortiz de Zárate, Manuel S. Moya Mir, Juan J. Picazob, José Antonio Quintano Jiméneze, José Ángel García-Rodríguezb
a Spanish Society of Pulmonology and Thoracic Surgery (SEPAR)
b Spanish Society of Chemotherapy (SEQ)
c Spanish Society of General Medicine (SEMG)
d Spanish Society of Internal Medicine (SEMI)
e Spanish Society of Rural and General Medicine (SEMERGEN)
This item has received
Article information
Full text is only aviable in PDF
References
[1]
F Álvarez, E Bouza, JA Gracía-Rodríguez, J Mensa, E Monsó, JJ Picazo, et al.
Segundo documento de consenso sobre uso de antimicrobianos en la exacerbación de la enfermedad pulmonar obstructiva crónica.
Arch Bronconeumol, 39 (2003), pp. 274-282
[2]
F Ballester, S Pérez-Hoyos, ML Rivera, T Merelles, JM Tenías, JB Soriano, et al.
Patrones de frecuentación y factores asociados al ingreso en el hospital de las urgencias hospitalarias por asma y enfermedad pulmonar obstructiva crónica.
Arch Bronconeumol, 35 (1999), pp. 20-26
[3]
Grupo para el Estudio de la Infección en Urgencias.
Estudio epidemiológico de las infecciones en el Área de Urgencias.
Emergencias, 12 (2000), pp. 80-89
[4]
JT MacFarlane, A Colville, A Guion, RM MacFarlane, DH Rose.
Prospective study of aetiology and outcome of adult lower respiratory tract infections in the community.
Lancet, 341 (1993), pp. 511-514
[5]
M Miravitlles, C Mayordomo, M Artés, L Sánchez-Agudo, F Nicolau, Group Segú JL on behalf of the EOLO.
Treatment of chronic obstructive pulmonary disease and its exacerbations in general practice.
Respir Med, 93 (1999), pp. 173-179
[6]
M Woodhead, G Gialdroni Grassi, GJ Huchon, P Léophonte, F Manresa, T Schaberg.
Use of investigations in lower respiratory tract infection in the community: a European survey.
Eur Respir J, 9 (1996), pp. 1596-1600
[7]
J Romero Vivas, M Rubio Alonso, O Corral, S Pacheco, E Agudo, JJ Picazo.
Estudio de las infecciones respiratorias extrahospitalarias.
Enferm Infecc Microbiol Clin, 15 (1997), pp. 289-298
[8]
C Llor, JM Cots, A Boada, L Bjerrum, B Gahrn-Jansen, A Munck, et al.
Variabilidad de la prescripción antibiótica en las infecciones respiratorias en dos países de Europa.
Enf Infecc Microbiol Clin, 23 (2005), pp. 598-604
[9]
A Papi, CM Bellettato, F Braccioni, M Romagnoli, P Casolari, G Caramori, et al.
Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations.
Am J Respir Crit Care Med, 173 (2006), pp. 1114-1121
[10]
M Miravitlles.
Epidemiology of chronic obstructive pulmonary disease exacerbations.
Clin Pulm Med, 9 (2002), pp. 191-197
[11]
N Soler, A Torres, S Ewig, J González, R Celis, M el-Ebiary, et al.
Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation.
Am J Respir Crit Care Med, 157 (1998), pp. 1498-1505
[12]
G Rhode, A Wiethege, I Borg, M Kauth, TT Bauer, A Gillissen, et al.
Respiratory viruses in exacerbations of chronic obstructive pulmonary disease requiring hospitalisation: a case-control study.
Thorax, 58 (2003), pp. 37-42
[13]
N Mogulkoc, S Karakurt, B Isalska, U Bayindir, T Celikel, V Korten, et al.
Acute purulent exacerbation of chronic obstructive pulmonary diisease and Chlamydia pneumoniae infection.
Am J Respir Crit Care Med, 160 (1999), pp. 349-353
[14]
GC Donaldson, T Seemungal, DJ Jeffries, JA Wedzicha.
Effect of temperature on lung function and symptoms in chronic obstructive pulmonary disease.
Eur Respir J, 13 (1999), pp. 844-849
[15]
J García-Aymerich, A Tobías, JM Antó, J Sunyer.
Air pollution and mortality in a cohort of patients with chronic obstructive pulmonary disease: a time series analysis.
J Epidemiol Community Health, 54 (2000), pp. 73-74
[16]
RA Pauwels, AS Buist, PMA Calverley, CR Jenkins, SS Hurd.
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) workshop summary.
Am J Respir Crit Care Med, 163 (2001), pp. 1256-1276
[17]
DS Postma.
When can an exacerbation of COPD be treated at home?.
Lancet, 351 (1998), pp. 1827-1828
[18]
DE Niewoehner, ML Erbland, RH Deupree, D Collins, NJ Gross, RW Light, et al.
Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease.
N Engl J Med, 340 (1999), pp. 1941-1947
[19]
DA Mahler, RA Rosiello, A Harver, T Lentine, JF McGovern, JA Daubenspeck.
Comparison of clinical dyspnea ratings and psychophysical measurements of respiratory sensation in obstructive airways disease.
Am Rev Respir Dis, 165 (1987), pp. 1229-1233
[20]
N Duffy, P Walker, F Diamantea, PM Calverley, L Davies.
Intravenous aminophylline in patients admitted to hospital with nonacidotic exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial.
Thorax, 60 (2005), pp. 713-717
[21]
AFJ Connors, NV Dawson, C Thomas, FE Harrell Jr, N Desbiens, WJ Fulkerson, et al.
Outcomes following acute exacerbations of severe chronic obstructive lung disease.
Am J Respir Crit Care Med, 154 (1996), pp. 959-996
[22]
MS Moya Mir, P Laguna del Estal, R Salgado Marqués, S Calabrese Sánchez.
Infección respiratoria en observación de urgencias.
Emergencias, 9 (1997), pp. 98-102
[23]
GH Murata, MS Gorby, TW Chick, AK Halperin.
Use of emergency medical services by patients with decompensated obstructive lung disease.
Ann Emerg Med, 18 (1989), pp. 501-506
[24]
R Kessler, M Faller, G Fourgaut, B Mennecier, E Weitzenblum.
Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 159 (1999), pp. 158-164
[25]
M Miravitlles, C Espinosa, E Fernández-Laso, JA Martos, JA Maldonado, M Gallego, et al.
Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD.
Chest, 116 (1999), pp. 40-46
[26]
J Eller, A Ede, T Schaberg, MS Niederman, H Mauch, H Lode.
Infective exacerbations of chronic bronchitis. Relation between bacteriologic etiology and lung function.
Chest, 113 (1998), pp. 1542-1548
[27]
E Monsó, J García-Aymerich, N Soler, E Farrero, MA Félez, JM Antó, et al.
Bacterial infection in exacerbated COPD with changes in sputum characteristics.
Epidemiol Infect, 131 (2003), pp. 799-804
[28]
E Monsó, J Ruiz, A Rosell, J Manterola, J Fiz, J Morera, et al.
Bacterial infection in chronic obstructive pulmonary disease. A study of stable and exacerbated out-patients using the protected specimen brush.
Am J Respir Crit Care Med, 152 (1995), pp. 1316-1320
[29]
JY Fagon, J Chastre, JL Trouillet, Y Domart, MC Dombret, M Bornet, et al.
Characterization of distal bronchial microflora during acute exacerbations of chronic bronchitis: use of the protected specimen brush technique in 54 mechanically ventilated patients.
Am Rev Respir Dis, 142 (1990), pp. 1004-1008
[30]
C Thornsberry, DF Sahm.
Antimicrobial resistance in respiratory tract pathogens: results of an international surveillance study.
Chemotherapy, 46 (2000), pp. 15-23
[31]
F Baquero, JA García-Rodríguez, J García de Lomas, L Aguilar.
The Spanish Surveillance group: antimicrobial resistance of 1113 Streptococcus pneumoniae isolates from patients with respiratory tract infections in Spain: results of a 1 year (1996–1997) multicenter surveillance study.
Antimicrob Agents Chemother, 43 (1999), pp. 357-359
[32]
JD Heffelfinger, SF Dowell, JH Jorgensen, KP Klugman, LR Mabry, DM Musher, et al.
Management of community acquired pneumonia in the era of pneumococcal resistance: a report from drug-resistant Streptococcus pneumoniae. Therapeutic Working Group.
Arch Intern Med, 160 (2000), pp. 1399-1408
[33]
SG Adams, J Melo, M Luther, A Anzueto.
Antibiotics are associated with lower relapse rates in outpatients with acute exacerbations of COPD.
Chest, 117 (2000), pp. 1345-1352
[34]
M Miravitlles, C Murio, Group Guerrero T on behalf of the DAFNE Study.
Factors associated with relapse after ambulatory treatment of acute exacerbations of chronic bronchitis. A prospective multicenter study in the community.
Eur Respir J, 17 (2001), pp. 928-933
[35]
TJ Murray, JA Washington.
Microscopic and bacteriologic analysis of expectorated sputum.
Mayo Clinic Proc, 50 (1975), pp. 339-344
[36]
M Miravitlles.
Exacerbations of chronic obstructive pulmonary disease: when are bacteria important?.
Eur Respir J, 20 (2002), pp. 9-19
[37]
RA Stockley, C O'Brien, A Pye, SL Hill.
Relationship of sputum color to nature and outpatient management of acute exacerbations of COPD.
Chest, 117 (2000), pp. 1638-1645
[38]
N Soler, C Agustí, J Angrill, J Puig de la Bellacasa, A Torres.
Bronchoscopic validation of the significance of sputum purulence in severe exacerbations of chronic obstructive pulmonary disease.
Thorax, 62 (2007), pp. 29-35
[39]
I Odenholt, O Cars, E Lowdin.
Pharmacodynamic studies of amoxicillin against Streptococcus pneumoniae: comparison of a new pharmacokinetically enhanced formulation (2000 mg twice daily) with standard dosage regimens.
J Antimicrob Chemother, 54 (2004), pp. 1062-1066
[40]
F Soriano, JJ Granizo, A Fenoll, M Gracia, R Fernández-Roblas, J Esteban, et al.
Antimicrobial resistance among clinical isolates of Streptococcus pneumoniae isolated in four southern European countries (ARISE project) from adult patients: results from the cefditoren surveillance program.
J Chemother, 15 (2003), pp. 107-112
[41]
F Soriano, JJ Granizo, P Coronel, M Gimeno, E Ródenas, M Gracia, et al.
Antimicrobial susceptibility of Haemophilus influenzae, Haemophilus parainfluenzae and Moraxella catarrhalis isolated from adult patients with respiratory tract infections in four southern European countries. The ARISE project.
Int J Antimicrob Agents, 23 (2004), pp. 296-299
[42]
JM Eiros Bouza, L Valdés, MR Bachiller.
Contribución de la farmacodinamia en la elección del antimicrobiano para las exacerbaciones de la EPOC.
Rev Esp Quimioter, 19 (2006), pp. 220-230
[43]
M Miravitlles.
Moxifloxacin in respiratory tract infections.
Expert Opin Pharmacother, 6 (2005), pp. 283-293
[44]
J Mensa, A Trilla.
Should patients with acute exacerbation of chronic bronchitis be treated with antibiotics? Advantages of the use of fluoroquinolones.
Clin Microbiol Infect, 12 (2006), pp. 42-54
[45]
M Miravitlles, A Martín Graczyk.
Tratamiento del paciente con EPOC agudizada.
Guía de buena práctica clínica en Geriatría. Enfermedad pulmonar obstructiva crónica. Normativa conjunta SEPAR-SEGG, pp. 75-88
[46]
MH Gotfried, LH Danzinger, KA Rodvold.
Steady-state plasma and intrapulmonary concentrations of levofloxacin and ciprofloxacin in healthy adult subjects.
Chest, 119 (2001), pp. 1114-1122
[47]
R Wilson, L Allegra, G Huchon, JL Izquierdo, P Jones, T Schaberg, et al.
Short-term and long-term outcomes of moxifloxacin compared to standard antibiotic treatment in acute exacerbations of chronic bronchitis.
Chest, 125 (2004), pp. 953-964
[48]
MS Niederman, A Anzueto, S Sethi, S Choudhri, A Kureishi, D Haverstock, et al.
Eradication of H. influenzae in AECB: a pooled analysis of moxifloxacin phase III trials compared with macrolide agents.
Respir Med, 100 (2006), pp. 1781-1790
[49]
E Pérez-Trallero, C García-de-la-Fuente, C García-Rey, F Baquero, L Aguilar, R Dal-Ré, et al.
Geographical and ecological analysis of resistance, coresistance, and coupled resistance to antimicrobials in respiratory pathogenic bacteria in Spain.
Antimicrob Agents Chemother, 49 (2005), pp. 1965-1972
[50]
S Sethi, A Anzueto, DJ Farrell.
Antibiotic activity of telithromycin and comparators against bacterial pathogens isolated from 3,043 patients with acute exacerbation of chronic bronchitis.
Ann Clin Microbiol Antimicrob, 4 (2005), pp. 5
[51]
KD Clay, JS Hanson, SD Pope, RW Rissmiller, III Purdum PP, PM Banks.
Brief communication: severe hepatotoxicity of telithromycin: three case reports and literature review.
Ann Intern Med, 144 (2006), pp. 415-420
[52]
S Sethi, J Breton, B Wynne.
Efficacy and safety of pharmacokinetically enhanced amoxicillin-clavulanate at 2,000/125 milligrams twice daily for 5 days versus amoxicillin-clavulanate at 875/125 milligrams twice daily for 7 days in the treatment of acute exacerbations of chronic bronchitis.
Antimicrob Agents Chemother, 49 (2005), pp. 153-160
[53]
JL Álvarez-Sala, P Kardos, J Martínez-Beltrán, P Coronel, L Aguilar.
Clinical and bacteriological efficacy in treatment of acute exacerbations of chronic bronchitis with cefditoren-pivoxil versus cefuroxime-axetil.
Antimicrob Agents Chemother, 50 (2006), pp. 1762-1767
[54]
GW Amsden, IM Baird, S Simon, G Treadway.
Efficacy and safety of azithromycin vs levofloxacin in the outpatient treatment of acute bacterial exacerbations of chronic bronchitis.
Chest, 123 (2003), pp. 772-777
[55]
S Chodosh, CA DeAbate, D Haverstock, L Aneiro, D Church.
Shortcourse moxifloxacin therapy for treatment of acute bacterial exacerbations of chronic bronchitis. The Bronchitis Study Group.
Respir Med, 94 (2000), pp. 18-27
[56]
C Fogarty, R De Wet, L Mandell, J Chang, M Rangaraju, R Nusrat.
Five-day telithromycin once daily is as effective as 10-day clarithromycin twice daily for the treatment of acute exacerbations of chronic bronchitis and is associated with reduced health-care resource utilization.
Chest, 128 (2005), pp. 1980-1988
[57]
E Bouza, F García-Garrote, E Cercenado, M Marín, MS Díaz.
Pseudomonas aeruginosa: a survey of resistance in 136 hospitals in Spain. The Spanish Pseudomonas aeruginosa Study Group.
Antimicrob Agents Chemother, 43 (1999), pp. 981-982
[58]
AP MacGowan, M Wootton, HA Holt.
The antibacterial efficacy of levofloxacin and ciprofloxacin against Pseudomonas aeruginosa assessed by combining antibiotic exposure and bacterial susceptibility.
J Antimicrob Chemother, 43 (1999), pp. 345-349
[59]
M Miravitlles, A Anzueto, D Legnani, L Forstmeier, M Fargel.
Patient's perception of exacerbations of COPD – the PERCEIVE study.
Respir Med, 101 (2007), pp. 453-460
[60]
S Scott, P Walker, PMA Calverley.
COPD exacerbations. 4: Prevention.
Thorax, 61 (2006), pp. 440-447
[61]
LA Jackson, KM Neuzil, O Yu, P Benson, WE Barlow, AL Adams, et al.
Effectiveness of pneumococcal polysaccharide vaccine in older adults.
N Engl J Med, 348 (2003), pp. 1747-1755
[62]
Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR Morb Mortal Wkly Rep, 46 (1997), pp. 1-24
[63]
A Vila-Córcoles, O Ochoa-Gondar, C Llor, I Hospital, E Rodríguez, A Gómez.
Protective effect of pneumococcal vaccine against death by pneumonia in elderly subjects.
Eur Respir J, 26 (2005), pp. 1086-1091
[64]
I Alfageme, R Vázquez, N Reyes, J Muñoz, A Fernández, M Hernández, et al.
Clinical efficacy of anti-pneumococcal vaccination in patients with COPD.
Thorax, 61 (2006), pp. 189-195
[65]
P Mallia, SL Johnston.
How viral infection cause exacerbation of airway diseases.
Chest, 130 (2006), pp. 1203-1210
[66]
PJ Poole, E Chacko, RWB Wood-Baker, CJ Cates.
Influenza vaccine for patients with chronic obstructive pulmonary disease.
Cochrane Database of Systematic Reviews, (2006), pp. CD002733
[67]
C Steurer-Stey, LM Bachmann, J Steurer, MR Tramèr.
Oral purified bacterial extracts in chronic bronchitis and COPD.
Chest, 126 (2004), pp. 1645-1655
[68]
M Álvarez-Mon, M Miravitlles, J Morera, L Callol, JL Álvarez-Sala.
Treatment with the immunomodulator AM3 improves the health-related quality of life of patients with chronic obstructive pulmonary disease.
Chest, 127 (2005), pp. 1212-1218

The affiliations of the authors of this consensus statement are provided at the end of the article.

The original Spanish article was published simultaneously in Semergen. 2008;34(2): 66–74.

Copyright © 2008. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?