Scientific Letter
Bronchial Infection due to Pseudomonas Aeruginosa in Patients with Cystic Fibrosis Diagnosed in Neonatal Screening
Infección bronquial por Pseudomonas aeruginosa en los pacientes con fibrosis quística diagnosticados por cribado neonatal
Roser Ayats Vidal
, Montserrat Bosque García, Miguel García González, Óscar Asensio de la Cruz
Corresponding author
Unidad de Fibrosis Quística y Unidad de Neumología, Alergia e Inmunología Pediátrica, Servicio de Medicina Pediátrica, Parc Taulí, Hospital Universitario de Sabadell, Sabadell (Barcelona), Spain
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If intensive and persistent treatment is established as soon as this pathogen is isolated, eradication can be achieved in most cases and chronic colonization can be delayed, improving survival.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9–11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The main objective of this study was to describe the prevalence of primary infection, intermittent infection, and chronic infection with <span class="elsevierStyleItalic">P. aeruginosa</span> (according to Leeds criteria<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a>) in patients with cystic fibrosis diagnosed by newborn screening (D-NBS) compared with patients not diagnosed by neonatal screening (ND-NBS) who are being or who have been followed up in our Pediatric Cystic Fibrosis Unit. The secondary objective was to describe the prevalence in both groups in terms of mutations.</p><p id="par0025" class="elsevierStylePara elsevierViewall">This was a retrospective descriptive study that included all patients diagnosed with cystic fibrosis before the age of 18 years from 1985 to 2018. We compared D-NBS with ND-NBS patients (including false negatives on NBS). Patients were sub-classified as no function (NF): patients with 2 mutations with no or minimal CFTR function (group I, II or III mutations), and residual function (RF): patients with a mutation with no or minimal CFTR function and a mutation with residual CFTR function (group IV, V, VI, or VII mutation) or 2 mutations with residual CFTR function. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the characteristics of both patient groups.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Patients’ medical records and all cultures of respiratory secretions (from birth to age 18 or January 2018 if they were younger) were reviewed. Cultures were performed monthly and, when positive, weekly until negativization. The treatment used for <span class="elsevierStyleItalic">P. aeruginosa</span> primary bronchial infection was inhaled colistin, tobramycin, or aztreonam (3–6 months) along with oral ciprofloxacin (3 weeks). In chronic infections, continuous inhaled treatment with colistin or 28-day on-off cycles with tobramycin or aztreonam were prescribed. During mild-moderate exacerbations, treatment was oral ciprofloxacin (2–3 weeks) and in severe exacerbations, intravenous (β-lactam combined with an aminoglycoside according to sensitivity testing) therapy was administered.</p><p id="par0035" class="elsevierStylePara elsevierViewall">From a statistical perspective, quantitative variables were described by mean and range, and qualitative variables by relative and absolute frequencies. The <span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span> test was used to compare prevalences between groups.</p><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the prevalences of <span class="elsevierStyleItalic">P. aeruginosa</span> infection in both D-NBS and ND-NBS patients, and in the NF and RF patient subgroups.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">A comparison of the prevalences of <span class="elsevierStyleItalic">P. aeruginosa</span> infection between D-NBS and ND-NBS patients revealed statistically significant differences in primary infection (<span class="elsevierStyleItalic">P</span>=.0014), intermittent infection (<span class="elsevierStyleItalic">P</span><.001), and chronic infection (<span class="elsevierStyleItalic">P</span><.001). This may be due in part to age differences between the 2 groups, since the mean age of the D-NBS patients was 10.38 years and the ND-NBS patients were followed up to the age of 18 years.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Patients with more severe mutations (NF group) diagnosed by neonatal screening had a higher prevalence of primary <span class="elsevierStyleItalic">P. aeruginosa</span> infection than the RF group (<span class="elsevierStyleItalic">P</span>=.018). It should be noted that none of the patients in the RF group (neither D-NBS nor ND-NBS) had chronic <span class="elsevierStyleItalic">P. aeruginosa</span> infection.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Of the D-NBS patients, 53.57% (30/56) had <span class="elsevierStyleItalic">P. aeruginosa</span> infection at some time. Mean age at the time of primary infection was 6 years and the eradication rate was 100%. The median time between first and second infection was 29 months (range: 1.4–96.8). Only 1.78% (1/56) of this group had chronic infection.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Of the ND-NBS patients, 92.30% (24/26) had <span class="elsevierStyleItalic">P. aeruginosa</span> infection at some time. Overall, 19.23% (5/26) already had chronic infection at diagnosis, without eradication. The mean age at diagnosis of these 5 patients was 5.66 years, whereas the mean age at diagnosis for the whole group was 4.38 years. Another 19.23% (5/26) had intermittent infection at diagnosis, but this eventually became chronic. In total, 38.46% (10/26) of this group had chronic infection.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Our results are consistent with other publications, which also show a decrease in the prevalence of chronic <span class="elsevierStyleItalic">P. aeruginosa</span> infection after the introduction of neonatal screening.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">13–15</span></a> In Canada,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> the prevalence of chronic <span class="elsevierStyleItalic">P. aeruginosa</span> infection was 28.4% in D-NBS and 61.8% in ND-NBS patients (<span class="elsevierStyleItalic">P</span><.001). In the United Kingdom,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> prevalence in children under 15 was 16% in the D-NBS and 20% in the ND-NBS group. The 2018 American Cystic Fibrosis Foundation registry shows that 46.2% of cystic fibrosis patients under the age of 18 had <span class="elsevierStyleItalic">P. aeruginosa</span> infection (17% intermittent and 28.3% chronic) with a median age at primary infection of 5.2 years.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> If we compare the results of these publications with ours, we can see that, although all of them show a decrease in the prevalence of chronic <span class="elsevierStyleItalic">P. aeruginosa</span> infection in D-NBS patients, prevalence in our series is lower. This may be due to very close follow-up, with monthly visits and respiratory secretion cultures, and early and intensive treatment of primary <span class="elsevierStyleItalic">P. aeruginosa</span> infection, and also because there are more patients in the RF group.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion, we observed a change in the natural history of <span class="elsevierStyleItalic">P. aeruginosa</span> bronchial infection in cystic fibrosis following the implementation of NBS, with a significant decrease (<span class="elsevierStyleItalic">P</span><.001) in the prevalence of chronic infection with this pathogen in these patients.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors have not received any funding or grants.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Ayats Vidal R, Bosque García M, García González M, Asensio de la Cruz Ó. Infección bronquial por <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> en los pacientes con fibrosis quística diagnosticados por cribado neonatal. Arch Bronconeumol. 2020;56:532–534.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">D-NBS: diagnosed by newborn screening; NBS: newborn screening; ND-NBS: not diagnosed by newborn screening; NF: no function, patients with 2 mutations with no or minimal CFTR function (group I, II or III mutations); RF: residual function, patients with a mutation with no or minimal CFTR function and a mutation with residual CFTR function (group IV, V, VI or VII mutation) or patients with 2 mutations with residual CFTR function.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">D-NBS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ND-NBS \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (2 false negatives per NBS) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean age at diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.38 (0.13–15) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Current mean age in years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.38 (0.8–18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.5 (5–36)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male: 33 (58.9)Female: 23 (41.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male: 13 (50)Female: 13 (50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lung transplantation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Deceased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NF group <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 (64.28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (73) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RF group <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (35.71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (26.92) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2356443.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Although the current age is 21.5 years, respiratory secretion cultures were only reviewed up to the age of 18.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Characteristics of Patients Diagnosed With Cystic Fibrosis by Newborn Screening and Those Not Diagnosed by Newborn Screening.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">They are also analyzed by patient subgroups: NF group: 2 mutations with no or minimal CFTR function (group I, II or III mutations), RF group: a mutation with no or minimal CFTR function and a mutation with residual CFTR function (group IV, V, VI, or VII mutation) or 2 mutations with residual CFTR function.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">D-NBS: diagnosed by newborn screening; NBS: newborn screening; ND-NBS: not diagnosed by newborn screening; NF: no function; RF: residual function.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Definition According to Leeds<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">D-NBS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ND-NBS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Primary infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First positive culture of <span class="elsevierStyleItalic">P. aeruginosa</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.57% (30/56)By group:NF: 66.6% (24/36)RF: 30% (6/20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.30% (24/26)By group:NF: 89.4% (17/19)RF: 100% (7/7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.0014 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intermittent infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Consecutive cultures intermittently positive and negative after initial infection. Microbiological criteria: ≤50% of cultures positive for <span class="elsevierStyleItalic">P. aeruginosa</span> in the previous 12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.92% (19/56)By group:NF: 44.4% (16/36)RF: 15% (3/20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.92% (20/26)By group:NF: 84.2% (16/19)RF: 57.1% (4/7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chronic infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cultures persistently positive for <span class="elsevierStyleItalic">P. aeruginosa</span> with no new clinical signs of infection and with inflammatory response. Microbiological criteria: >50% of cultures positive for <span class="elsevierStyleItalic">P. aeruginosa</span> in the previous 12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.78% (1/56)By group:NF: 1.4% (1/36)RF: 0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.46% (10/26)By group:NF: 52.6% (10/19)RF: 0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2356442.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Prevalence of <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> infection in patients diagnosed with cystic fibrosis by newborn screening and those not diagnosed by newborn screening.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatments for preventing recurrence of infection with <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> in people with cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 2 | 8 |
| 2024 October | 47 | 21 | 68 |
| 2024 September | 37 | 13 | 50 |
| 2024 August | 62 | 35 | 97 |
| 2024 July | 35 | 21 | 56 |
| 2024 June | 57 | 22 | 79 |
| 2024 May | 80 | 27 | 107 |
| 2024 April | 33 | 25 | 58 |
| 2024 March | 43 | 24 | 67 |
| 2024 February | 29 | 21 | 50 |
| 2023 March | 7 | 3 | 10 |
| 2023 February | 27 | 20 | 47 |
| 2023 January | 23 | 25 | 48 |
| 2022 December | 35 | 31 | 66 |
| 2022 November | 42 | 25 | 67 |
| 2022 October | 43 | 29 | 72 |
| 2022 September | 29 | 17 | 46 |
| 2022 August | 28 | 56 | 84 |
| 2022 July | 29 | 48 | 77 |
| 2022 June | 25 | 44 | 69 |
| 2022 May | 29 | 36 | 65 |
| 2022 April | 38 | 27 | 65 |
| 2022 March | 35 | 39 | 74 |
| 2022 February | 14 | 21 | 35 |
| 2020 November | 1 | 0 | 1 |
| 2020 October | 1 | 0 | 1 |
| 2020 August | 1 | 2 | 3 |
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