A multidrug-resistant microorganism infection risk prediction model: development and validation in an emergency medicine population
Por:
del Castillo, JG, Julian-Jimenez, A, Gamazo-Del Rio, JJ, Garcia-Lamberechts, EJ, Llopis-Roca, F, Tey, JMG, de Zarate, MMO, Bustos, CN, Salmeron, PP, Alvarez-Manzanares, J, Romero, MDO, Grinspan, MR, Gutierrez, SG, Martin-Sanchez, FJ, Gonzalez, FJC, Borrego, BV, Rodrigo, IC, Corrochano, EC, del Campo, KKM, Martinez, LP, Belloso, MEM, Soriano, SMQ, Ramos, AU, Xanco, CG, Martinez, CZ, Munoz, CM, Gonzalez, EF, Aguilar, NG, Rodriguez, VA, Rodriguez, AH, Diaz, JLM, Flores, MM, Cana, CC, Loranca, MM, Pareja, RR, Galan, JL, Beliz, OJS, Ramirez, JMP, Suberviola, AE, Moreno, BG, Rodriguez, JMM, Rodrigo, SA, del Blanco, CF, Ruano, OD, Pena, MP, Canovas, JFV, Gutierrez, CC, Garmendia, JLG, Prieto, ST, Garcia, VP, Moll, MA, Gallego, MA, Arranz, RC, Sanchez, MDC, Bonilla, FD, Luperena, JD, Gomez, AV, Garcia, AG, Martin, LM, Hermida, AM, Moreno, MM, Mocanu, CN, Calvo, CM, Diaz-Guerra, MLP, Leal, CMR, Yebes, NJT, Pizarro, A, Galan, CD, Teleki, AV, Guijorro, NV, Rua, MN, Murillo, EC, Mulet, MA, Ubago, AD, Poveda, CS, Garcia, RC, de Santos, FJV, del Val, SG, Hortoneda, MC, Isidro, IL, Fernandez, BR, Domingo, LC, Torresano, MDD, Torres, AMF, Otero, LL, Ricoy, LC, Molina, IG, Roca, MM, Mateo, SH, Roig, MS, Andion, MB, Sansone, LH, Reus, FS, Motto, EQ, Fajardo, LA, Valencia, MP, Romero, RG, Cerdan, MB, Belvis, JM, Morata, MP, Pineda, MCS, Asensio, CM, Rodriguez, EV, Toldos, CM, Perales, R, Sanchez, AB, Ordenana, IM, Borras, MRC, Bargallo, LN, Vazquez, EAM, Arenas, MF, Maimo, MM, Ruiz, FJR, Aznar, NF, Martinez, SL, Redondo, GB, Carballo, C, Quiros, AM, Paredes, MCL, Gallego-Acho, PIR, Barco, JMP, Alvira, RM, Garcia, FJP, Martin, ACA, Calvo, CM, Izquierdo, RL, Sanchez, MDR, Ramos, JRO, Martin, AP, Pardal, AA, Castrodeza, MNS, Aguirre, RR, Pelaez, JG, Fernandez-Bermejo, MSI, Serrano, CC, Gallar, PM, David, MM, Orantos, MJN, Putze, GEB, Gomez, MAM, Perez, CMG, Sanz, IH, Querejeta, AG, Anza, DV, Martin-Penaranda, T, Aguirre, AA, Betegon, MA, Martinez, CH, Ruiz, MVD, Moreno, AS, Santos, LS, de Sosa, SJ, Lafont, MDO, Montoya, MC, Noriega, ARL, Rodriguez, GF, Molina, IG, Rocamora, JLS, Vicente, LM, Escudero, IM, Morcillo, AC, Dominguez, AB, Ayala, MIA, Espinosa, PG, Mebuy, AM, Latorre, FM, de Valderrama, MHF, Crepo, CG, Francia, BU, Perez-Reverte, FR, Diaz, MRL, Saldumbide, SM, Martinez, LS, Quevedo, JC, Vela, MI, Gilmartin, LMM, Fernandez, RC, Natal, IF, Huerga, SG, Orus, MS, Martinez, FG, Olmeda, DM, Varea, PD, Criado, JG, Garcia, MIG, Galindo, AM, Avellaneda, C, Hernandez, F, Penalver, C, Onate, J, Grima, MLL, Garcia, DC, Edo, IAS, Rodriguez, MF, Entrala, BA, Amez, JMF, Clemens, RP, Olivares, MF, Fernandez, BG, Esteban, MAL, Ortega, AB, Slaoui, HB, Palmerin, JDI, Mota, MS, Inchauspe, FJE, Gorrotxategi, AMI, Gamito, GM, Quesada, SF, Ungerer, OT, Urraca, A, Brezmez, MF, Mendia, IG, Pinto, DD, Ordonez, BM, Garcia, AMC, Navarro, RD, Navarro, S, Fernandez, EC, Macias, A, Jimenez, MTH, Martin, SG, Garcia, AE, Canovas, EM, Marin, SP, Cayuela, GB, Sanchez, AH, Nicolas, JAS, Fernandez, MD, Barroso, IM, Bautista, JG, Hostalet, FO
Publicada:
1 feb 2020
Ahead of Print:
1 nov 2019
Resumen:
The aim was to develop a predictive model of infection by multidrug-resistant microorganisms (MDRO). A national, retrospective cohort study was carried out including all patients attended for an infectious disease in 54 Spanish Emergency Departments (ED), in whom a microbiological isolation was available from a culture obtained during their attention in the ED. A MDRO infection prediction model was created in a derivation cohort using backward logistic regression. Those variables significant at p < 0.05 assigned an integer score proportional to the regression coefficient. The model was then internally validated by k-fold cross-validation and in the validation cohort. A total of 5460 patients were included; 1345 (24.6%) were considered to have a MDRO infection. Twelve independent risk factors were identified in the derivation cohort and were combined into an overall score, the ATM (assessment of threat for MDRO) score. The model achieved an area under the curve-receiver operating curve of 0.76 (CI 95% 0.74-0.78) in the derivation cohort and 0.72 (CI 95% 0.70-0.75) in the validation cohort (p = 0.0584). Patients were then split into 6 risk categories and had the following rates of risk: 7% (0-2 points), 16% (3-5 points), 24% (6-9 points), 33% (10-14 points), 47% (15-21 points), and 71% (> 21 points). Findings were similar in the validation cohort. Several patient-specific factors were independently associated with MDRO infection risk. When integrated into a clinical prediction rule, higher risk scores and risk classes were related to an increased risk for MDRO infection. This clinical prediction rule could be used by providers to identify patients at high risk and help to guide antibiotic strategy decisions, while accounting for clinical judgment.
Filiaciones:
del Castillo, JG:
Hosp Univ Clin San Carlos, Emergency Dept, Calle Prof Martin Lagos S-N, Madrid 28040, Spain
Hosp Univ San Carlos, Hlth Res Inst IdISSC, Madrid, Spain
Julian-Jimenez, A:
Univ Castilla La Mancha, Complejo Hosp Univ Toledo, Emergency Dept, Toledo, Spain
Gamazo-Del Rio, JJ:
Hosp Univ Galdakao Usansolo, Emergency Dept, Bizkaia, Spain
Garcia-Lamberechts, EJ:
Hosp Univ Clin San Carlos, Emergency Dept, Calle Prof Martin Lagos S-N, Madrid 28040, Spain
Hosp Univ San Carlos, Hlth Res Inst IdISSC, Madrid, Spain
Llopis-Roca, F:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Spain
Tey, JMG:
Univ Autonoma Barcelona, Emergency Dept, Hosp Univ St Pau, Univ Int Catalunya,Hosp Univ St Pau Univ, Barcelona, Spain
de Zarate, MMO:
Hosp Univ Basurto, Emergency Dept, Bilbao, Spain
Bustos, CN:
Hosp Univ Virgen de la Macarena, Emergency Dept, Seville, Spain
Salmeron, PP:
Hosp Univ Reina Sofia, Emergency Dept, Murcia, Spain
Alvarez-Manzanares, J:
Hosp Univ Rio Hortega, Emergency Dept, Valladolid, Spain
Romero, MDO:
Hosp Clin Barcelona, Emergency Dept, Barcelona, Spain
Grinspan, MR:
Hosp Univ Henares, Emergency Dept, Madrid, Spain
Gutierrez, SG:
Hosp Galdakao Usansolo, Res Unit REDISSEC, Bizkaia, Spain
Martin-Sanchez, FJ:
Hosp Univ Clin San Carlos, Emergency Dept, Calle Prof Martin Lagos S-N, Madrid 28040, Spain
Hosp Univ San Carlos, Hlth Res Inst IdISSC, Madrid, Spain
Gonzalez, FJC:
Hosp Univ San Carlos, Hlth Res Inst IdISSC, Madrid, Spain
Hosp Univ Clin San Carlos, Clin Microbiol Dept, Madrid, Spain
Borrego, BV:
Hosp Univ Severo Ochoa Leganes, Madrid, Spain
Rodrigo, IC:
Hosp Univ Severo Ochoa Leganes, Madrid, Spain
Corrochano, EC:
Hosp Univ Severo Ochoa Leganes, Madrid, Spain
del Campo, KKM:
Hosp Univ Severo Ochoa Leganes, Madrid, Spain
Martinez, LP:
Hosp Univ Severo Ochoa Leganes, Madrid, Spain
Belloso, MEM:
Hosp Univ Severo Ochoa Leganes, Madrid, Spain
Soriano, SMQ:
Hosp Univ Severo Ochoa Leganes, Madrid, Spain
Ramos, AU:
Hosp Clin Barcelona, Barcelona, Spain
Xanco, CG:
Hosp Clin Barcelona, Barcelona, Spain
Martinez, CZ:
Hosp Clin Barcelona, Barcelona, Spain
Munoz, CM:
Hosp Univ Bellvitge, Barcelona, Spain
Gonzalez, EF:
Hosp Univ Bellvitge, Barcelona, Spain
Aguilar, NG:
Hosp Univ Bellvitge, Barcelona, Spain
Rodriguez, VA:
Hosp Univ Getafe, Madrid, Spain
Rodriguez, AH:
Hosp Univ Getafe, Madrid, Spain
Diaz, JLM:
Hosp Univ Getafe, Madrid, Spain
Flores, MM:
Hosp Univ Getafe, Madrid, Spain
Cana, CC:
Hosp Univ Getafe, Madrid, Spain
Loranca, MM:
Hosp Univ Getafe, Madrid, Spain
Pareja, RR:
Hosp Univ Getafe, Madrid, Spain
Galan, JL:
Hosp Univ Getafe, Madrid, Spain
Beliz, OJS:
Hosp Univ Fdn Alcorcon, Madrid, Spain
Ramirez, JMP:
Hosp Univ Fdn Alcorcon, Madrid, Spain
Suberviola, AE:
Hosp Univ Fdn Alcorcon, Madrid, Spain
Moreno, BG:
Hosp Univ Fdn Alcorcon, Madrid, Spain
Rodriguez, JMM:
Hosp Univ Fdn Alcorcon, Madrid, Spain
Rodrigo, SA:
Hosp Univ Fdn Alcorcon, Madrid, Spain
del Blanco, CF:
Hosp Univ Fdn Alcorcon, Madrid, Spain
Ruano, OD:
Hosp Univ Fdn Alcorcon, Madrid, Spain
Pena, MP:
Hosp Univ Fdn Alcorcon, Madrid, Spain
Canovas, JFV:
Hosp Univ Fdn Alcorcon, Madrid, Spain
Gutierrez, CC:
Hosp Univ Fdn Alcorcon, Madrid, Spain
Garmendia, JLG:
Hosp San Juan de Dios Aljarafe Bormujos, Bormujos, Seville, Spain
Prieto, ST:
Hosp San Juan de Dios Aljarafe Bormujos, Bormujos, Seville, Spain
Garcia, VP:
Hosp San Juan de Dios Aljarafe Bormujos, Bormujos, Seville, Spain
Moll, MA:
Hosp Univ Henares, Coslada, Spain
Gallego, MA:
Hosp Univ Henares, Coslada, Spain
Arranz, RC:
Hosp Univ Henares, Coslada, Spain
Sanchez, MDC:
Hosp Univ Henares, Coslada, Spain
Bonilla, FD:
Hosp Univ Henares, Coslada, Spain
Luperena, JD:
Hosp Univ Henares, Coslada, Spain
Gomez, AV:
Hosp Univ Henares, Coslada, Spain
Garcia, AG:
Hosp Univ Henares, Coslada, Spain
Martin, LM:
Hosp Univ Henares, Coslada, Spain
Hermida, AM:
Hosp Univ Henares, Coslada, Spain
Moreno, MM:
Hosp Univ Henares, Coslada, Spain
Mocanu, CN:
Hosp Univ Henares, Coslada, Spain
Calvo, CM:
Hosp Univ Henares, Coslada, Spain
Diaz-Guerra, MLP:
Hosp Univ Henares, Coslada, Spain
Leal, CMR:
Hosp Univ Henares, Coslada, Spain
Yebes, NJT:
Hosp Univ Henares, Coslada, Spain
Pizarro, A:
Hosp Univ Princesa, Madrid, Spain
Galan, CD:
Hosp Univ Princesa, Madrid, Spain
Teleki, AV:
Hosp Univ Princesa, Madrid, Spain
Guijorro, NV:
Hosp Univ Princesa, Madrid, Spain
Rua, MN:
Hosp Univ Princesa, Madrid, Spain
Murillo, EC:
Hosp Univ Princesa, Madrid, Spain
Mulet, MA:
Hosp Univ Princesa, Madrid, Spain
Ubago, AD:
Hosp Univ Princesa, Madrid, Spain
Poveda, CS:
Hosp Univ Princesa, Madrid, Spain
Garcia, RC:
Hosp Univ Princesa, Madrid, Spain
de Santos, FJV:
Hosp Univ Princesa, Madrid, Spain
del Val, SG:
Hosp Univ Princesa, Madrid, Spain
Hortoneda, MC:
Hosp Univ Princesa, Madrid, Spain
Isidro, IL:
Hosp Univ Princesa, Madrid, Spain
Fernandez, BR:
Hosp Univ Princesa, Madrid, Spain
Domingo, LC:
Hosp Univ Princesa, Madrid, Spain
Torresano, MDD:
Hosp Univ Princesa, Madrid, Spain
Torres, AMF:
Hosp Univ Princesa, Madrid, Spain
Otero, LL:
Hosp Univ Princesa, Madrid, Spain
Ricoy, LC:
Hosp Univ Princesa, Madrid, Spain
Molina, IG:
Hosp Univ Princesa, Madrid, Spain
Roca, MM:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Mateo, SH:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Roig, MS:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Andion, MB:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Sansone, LH:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Reus, FS:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Motto, EQ:
Hosp Univ Arrixaca Murcia, Murcia, Spain
Fajardo, LA:
Hosp Univ Arrixaca Murcia, Murcia, Spain
Valencia, MP:
Hosp Univ Arrixaca Murcia, Murcia, Spain
Romero, RG:
Hosp Univ Arrixaca Murcia, Murcia, Spain
Cerdan, MB:
Hosp Univ Arrixaca Murcia, Murcia, Spain
Belvis, JM:
Hosp Univ Arrixaca Murcia, Murcia, Spain
Morata, MP:
Hosp Univ Arrixaca Murcia, Murcia, Spain
Pineda, MCS:
Hosp Univ Arrixaca Murcia, Murcia, Spain
Asensio, CM:
Hosp Univ Arrixaca Murcia, Murcia, Spain
Rodriguez, EV:
Hosp Univ Arrixaca Murcia, Murcia, Spain
Toldos, CM:
Hosp Univ Arrixaca Murcia, Murcia, Spain
Perales, R:
Complejo Hosp Univ Albacete, Albacete, Spain
Sanchez, AB:
Hosp Univ Basurto, Bilbao, Spain
Ordenana, IM:
Hosp Univ Basurto, Bilbao, Spain
Borras, MRC:
Hosp Verge Cinta de Tortosa, Tarragona, Spain
Bargallo, LN:
Hosp Verge Cinta de Tortosa, Tarragona, Spain
Vazquez, EAM:
Hosp Verge Cinta de Tortosa, Tarragona, Spain
Arenas, MF:
Hosp Verge Cinta de Tortosa, Tarragona, Spain
Maimo, MM:
Hosp Verge Cinta de Tortosa, Tarragona, Spain
Ruiz, FJR:
Hosp Clin Univ Zaragoza, Zaragoza, Spain
Aznar, NF:
Hosp Clin Univ Zaragoza, Zaragoza, Spain
Martinez, SL:
Hosp Clin Univ Zaragoza, Zaragoza, Spain
Redondo, GB:
Hosp Univ La Paz, Madrid, Spain
Carballo, C:
Hosp Univ La Paz, Madrid, Spain
Quiros, AM:
Hosp Univ La Paz, Madrid, Spain
Paredes, MCL:
Hosp Univ La Paz, Madrid, Spain
Gallego-Acho, PIR:
Hosp Univ La Paz, Madrid, Spain
Barco, JMP:
Hosp Univ La Paz, Madrid, Spain
Alvira, RM:
Hosp Univ La Paz, Madrid, Spain
Garcia, FJP:
Hosp Univ La Paz, Madrid, Spain
Martin, ACA:
Hosp Univ La Paz, Madrid, Spain
Calvo, CM:
Hosp Univ La Paz, Madrid, Spain
Izquierdo, RL:
Hosp Univ Rio Hortega, Valladolid, Spain
Sanchez, MDR:
Hosp Univ Rio Hortega, Valladolid, Spain
Ramos, JRO:
Hosp Univ Rio Hortega, Valladolid, Spain
Martin, AP:
Hosp Univ Rio Hortega, Valladolid, Spain
Pardal, AA:
Hosp Univ Rio Hortega, Valladolid, Spain
Castrodeza, MNS:
Hosp Univ Rio Hortega, Valladolid, Spain
Aguirre, RR:
Hosp Gen Univ Ciudad Real, Ciudad Real, Spain
Pelaez, JG:
Hosp Gen Univ Ciudad Real, Ciudad Real, Spain
Fernandez-Bermejo, MSI:
Hosp Gen Univ Ciudad Real, Ciudad Real, Spain
Serrano, CC:
Hosp Gen Univ Ciudad Real, Ciudad Real, Spain
Gallar, PM:
Hosp Univ Clin San Carlos, Madrid, Spain
David, MM:
Hosp Univ Clin San Carlos, Madrid, Spain
Orantos, MJN:
Hosp Univ Clin San Carlos, Madrid, Spain
Putze, GEB:
Hosp Univ Canarias Tenerife, San Cristobal La Laguna, Spain
Gomez, MAM:
Hosp Univ Canarias Tenerife, San Cristobal La Laguna, Spain
Perez, CMG:
Hosp Univ Canarias Tenerife, San Cristobal La Laguna, Spain
Sanz, IH:
Hosp Univ Donostia, Donostia San Sebastian, Gipuzkoa, Spain
Querejeta, AG:
Hosp Univ Donostia, Donostia San Sebastian, Gipuzkoa, Spain
Anza, DV:
Hosp Univ Donostia, Donostia San Sebastian, Gipuzkoa, Spain
Martin-Penaranda, T:
Hosp Univ Donostia, Donostia San Sebastian, Gipuzkoa, Spain
Aguirre, AA:
Hosp Mendaro, Mendaro, Gipuzkoa, Spain
Betegon, MA:
Hosp Viladecans, Barcelona, Spain
Martinez, CH:
Hosp Viladecans, Barcelona, Spain
Ruiz, MVD:
Hosp Viladecans, Barcelona, Spain
Moreno, AS:
Hosp Viladecans, Barcelona, Spain
Santos, LS:
Complejo Asistencial Univ Burgos, Burgos, Spain
de Sosa, SJ:
Complejo Asistencial Univ Burgos, Burgos, Spain
Lafont, MDO:
Complejo Asistencial Univ Burgos, Burgos, Spain
Montoya, MC:
Hosp Villarrobledo, Villarrobledo, Spain
Noriega, ARL:
Hosp Villarrobledo, Villarrobledo, Spain
Rodriguez, GF:
Hosp Villarrobledo, Villarrobledo, Spain
Molina, IG:
Hosp Villarrobledo, Villarrobledo, Spain
Rocamora, JLS:
Hosp Villarrobledo, Villarrobledo, Spain
Vicente, LM:
Hosp Villarrobledo, Villarrobledo, Spain
Escudero, IM:
Hosp Villarrobledo, Villarrobledo, Spain
Morcillo, AC:
Hosp Villarrobledo, Villarrobledo, Spain
Dominguez, AB:
Hosp Medina Campo, Valladolid, Spain
Ayala, MIA:
Hosp Medina Campo, Valladolid, Spain
Espinosa, PG:
Hosp Alto Deba, Arrasate Mondragon, Gipuzkoa, Spain
Mebuy, AM:
Hosp Alto Deba, Arrasate Mondragon, Gipuzkoa, Spain
Latorre, FM:
Hosp Alto Deba, Arrasate Mondragon, Gipuzkoa, Spain
de Valderrama, MHF:
Hosp Santiago Apostol Miranda de Ebro, Miranda De Ebro, Burgos, Spain
Crepo, CG:
Hosp Santiago Apostol Miranda de Ebro, Miranda De Ebro, Burgos, Spain
Francia, BU:
Hosp Santiago Apostol Miranda de Ebro, Miranda De Ebro, Burgos, Spain
Perez-Reverte, FR:
Hosp Gen Univ Santa Lucia, Murcia, Spain
Diaz, MRL:
Hosp Gen Univ Santa Lucia, Murcia, Spain
Saldumbide, SM:
Hosp Gen Univ Santa Lucia, Murcia, Spain
Martinez, LS:
Hosp Gen Univ Santa Lucia, Murcia, Spain
Quevedo, JC:
Hosp Gen Univ Santa Lucia, Murcia, Spain
Vela, MI:
Complejo Asistencial Univ Leon, Leon, Spain
Gilmartin, LMM:
Complejo Asistencial Univ Leon, Leon, Spain
Fernandez, RC:
Complejo Asistencial Univ Leon, Leon, Spain
Natal, IF:
Complejo Asistencial Univ Leon, Leon, Spain
Huerga, SG:
Complejo Asistencial Univ Leon, Leon, Spain
Orus, MS:
Complejo Asistencial Univ Leon, Leon, Spain
Martinez, FG:
Hosp Virgen de La Luz Cuenca, Cuenca, Spain
Olmeda, DM:
Hosp Virgen de La Luz Cuenca, Cuenca, Spain
Varea, PD:
Hosp Virgen de La Luz Cuenca, Cuenca, Spain
Criado, JG:
Hosp Univ Salamanca, Salamanca, Spain
Garcia, MIG:
Hosp Univ Salamanca, Salamanca, Spain
Galindo, AM:
Hosp Univ Salamanca, Salamanca, Spain
Avellaneda, C:
Complejo Asistencial Segovia, Segovia, Spain
Hernandez, F:
Complejo Asistencial Segovia, Segovia, Spain
Penalver, C:
Complejo Asistencial Segovia, Segovia, Spain
Onate, J:
Hosp Cruces Barakaldo, Baracaldo, Spain
Grima, MLL:
Hosp Univ Doctor Peset, Valencia, Spain
Garcia, DC:
Hosp Univ Doctor Peset, Valencia, Spain
Edo, IAS:
Hosp Univ Doctor Peset, Valencia, Spain
Rodriguez, MF:
Hosp San Eloy Barakaldo Sestao, Baracaldo, Spain
Entrala, BA:
Hosp Royo Villanova, Zaragoza, Spain
Amez, JMF:
Hosp Royo Villanova, Zaragoza, Spain
Clemens, RP:
Hosp Univ Badajoz, Badajoz, Spain
Olivares, MF:
Hosp Univ Badajoz, Badajoz, Spain
Fernandez, BG:
Hosp Univ Vinalopo, Alicante, Spain
Esteban, MAL:
Hosp Can Misses, Eivissa, Illes Balears, Spain
Ortega, AB:
Hosp Can Misses, Eivissa, Illes Balears, Spain
Slaoui, HB:
Hosp Can Misses, Eivissa, Illes Balears, Spain
Palmerin, JDI:
Hosp Can Misses, Eivissa, Illes Balears, Spain
Mota, MS:
Hosp Univ Reg Malaga, Malaga, Spain
Inchauspe, FJE:
Hosp Zumarraga, Zumarraga, Spain
Gorrotxategi, AMI:
Hosp Zumarraga, Zumarraga, Spain
Gamito, GM:
Hosp Univ Mutua Terrassa, Barcelona, Spain
Quesada, SF:
Hosp Santa Tecla Tarragona, Tarragona, Spain
Ungerer, OT:
Hosp Santa Tecla Tarragona, Tarragona, Spain
Urraca, A:
Complejo Asistencial Zamora, Zamora, Spain
Brezmez, MF:
Complejo Asistencial Zamora, Zamora, Spain
Mendia, IG:
Complejo Asistencial Zamora, Zamora, Spain
Pinto, DD:
Complejo Asistencial Zamora, Zamora, Spain
Ordonez, BM:
Hosp Virgen de la Victoria Malaga, Malaga, Spain
Garcia, AMC:
Hosp Virgen de la Victoria Malaga, Malaga, Spain
Navarro, RD:
Hosp Univ Torrevieja, Alicante, Spain
Navarro, S:
Hosp Univ La Ribera, Valencia, Spain
Fernandez, EC:
Hosp Altagracia Manzanares, Manzanares, Cdad Real, Spain
Macias, A:
Complejo Asistencial Avila, Avila, Spain
Jimenez, MTH:
Complejo Asistencial Avila, Avila, Spain
Martin, SG:
Hosp Escorial, Madrid, Spain
Garcia, AE:
Hosp Jerez, Cadiz, Spain
Canovas, EM:
Hosp Univ Reina Sofia Murcia, Murcia, Spain
Marin, SP:
Hosp Univ Reina Sofia Murcia, Murcia, Spain
Cayuela, GB:
Hosp Univ Reina Sofia Murcia, Murcia, Spain
Sanchez, AH:
Hosp Univ Reina Sofia Murcia, Murcia, Spain
Nicolas, JAS:
Hosp Univ Reina Sofia Murcia, Murcia, Spain
Fernandez, MD:
Hosp Univ Cent Asturias, Oviedo, Spain
Barroso, IM:
Hosp Univ Virgen Macarena, Seville, Spain
Bautista, JG:
Hosp Univ Virgen Macarena, Seville, Spain
Hostalet, FO:
Hosp Univ Virgen Macarena, Seville, Spain
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