Letter to the Editor – Brief papers about basic research or clinical experiences
Mycobacterium fortuitum as a cause of peritoneal dialysis catheter port infection. A clinical case and a review of the literature
Mycobacterium fortuitum como causa de infección del orificio del catéter de diálisis peritoneal. Caso clínico y revisión de la literatura
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A clinical case and a review of the literature" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1872 "Ancho" => 894 "Tamanyo" => 164515 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Superior: orificio de catéter de diálisis peritoneal con aspecto eritematoso, aparición de un granuloma y supuración color chocolate. Centro: aspecto del orificio a las 2 semanas. 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A clinical case and a review of the literature" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "584" "paginaFinal" => "586" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ana Belén Martínez-López, Olalla Álvarez Blanco, María Jesús Ruíz Serrano, María Dolores Morales San-José, Augusto Luque de Pablos" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Ana Belén" "apellidos" => "Martínez-López" "email" => array:1 [ 0 => "anabelen.martinez@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Olalla" "apellidos" => "Álvarez Blanco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "María Jesús" "apellidos" => "Ruíz Serrano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "María Dolores" "apellidos" => "Morales San-José" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Augusto" "apellidos" => "Luque de Pablos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Sección de Nefrología Pediátrica, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Mycobacterium fortuitum</span> como causa de infección del orificio del catéter de diálisis peritoneal. Caso clínico y revisión de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1872 "Ancho" => 895 "Tamanyo" => 172362 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Top: erythema in the peritoneal dialysis catheter exit site, with granuloma and chocolate-like discharge. Centre: appearance of the exit site at Week 2. Bottom: appearance of the exit site at Week 6 from the start of targeted therapy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Catheter-related infections are a common and clinically relevant in peritoneal dialysis patients. Exit-site infections are characterized by the presence of purulent discharge, with or without local. The most common pathogens are <span class="elsevierStyleItalic">Staphylococcus</span> and Gram-negative bacteria; however, rapidly growing atypical mycobacteria (RGAM) are rare.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Here we describe a paediatric patient with a <span class="elsevierStyleItalic">Mycobacterium fortuitum</span> peritoneal catheter exit-site infection together with literature review.</p><p id="par0015" class="elsevierStylePara elsevierViewall">He is a 4-year-old boy with a 4-month history of continuous ambulatory peritoneal dialysis (CAPD). He complained of erythema in the peritoneal catheter exit site, with mild discharge and no improvement following 7 days of treatment with topical mupirocin. After sampling for exudate culture, topical therapy with ciprofloxacin was initiated. Six days later the erythema was still present and the patient developed a chocolate-coloured discharge and a granuloma was observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient was asympyomatic with no fever. Blood chemistry did not show an increase in acute-phase reactants, and cytochemistry of peritoneal fluid was normal. Previous culture was positive for RGAM. Intraperitoneal ciprofloxacin and amikacin were initiated, together local care of the exist site with Betadine<span class="elsevierStyleSup">®</span>. The Mycobacteria was subsequently classified as <span class="elsevierStyleItalic">Mycobacterium fortuitum</span> sensitive to both antibotics, ciprofloxacin and amikacin. Treatment was continued for 8 weeks and culture became negative, with low improvement of the exit site appearance (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Thus, it was decided to replace the Tenckhoff catheter, despite no evidence of peritonitis. The patient continued under CAPD with no acceptable ultrafiltration. The patient was <span class="elsevierStyleItalic">naïve</span> to systemic antibiotics and had no history of previous infections before this episode.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The incidence of RGAM infections has increased during the last years, this group of Mycobacteria is widespread, and without nutrients and over wide-ranging temperatures. The most prevalent RGAMs involved in human infections include: <span class="elsevierStyleItalic">M. fortuitum</span>, <span class="elsevierStyleItalic">Mycobacterium chelonae</span>, <span class="elsevierStyleItalic">Mycobacterium mucogenicum</span>, <span class="elsevierStyleItalic">Mycobacterium abscessus</span>, and <span class="elsevierStyleItalic">Mycobacterium marinum</span>,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> with the first two most commonly resulting in peritoneal dialysis catheter infections.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We have found twenty-three cases reported of RGAM infections of the peritoneal catheter exit site were identified in 10 English and Spanish articles published between 1990 and 2011,<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2–11</span></a> including a paediatric patient.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> The most common microorganism, as in our patient was <span class="elsevierStyleItalic">M. fortuitum</span>, followed by <span class="elsevierStyleItalic">M. chenolae</span>, and <span class="elsevierStyleItalic">M. abscessus</span>. Infection was associated with peritonitis in one patient and with the infection of subcutaneous tract in 4 patients (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Predisposing factors described are: immunesupression, peritonitis resistant to several cycles of antibiotic, surgery, accidental trauma, or injections.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Auramin or Ziehl-Neelsen staining techniques reveal the acid-alcohol resistance of mycobacteria. A culture should be made in 2 specific media: a solid egg-based medium (Lowenstein-Jensen) and a liquid medium allowing for automated reading (MGIT, MB/BacT, ESP). Colony growth usually occurs within 7 days and is identified by means of faster and more accurate phenotyping (biochemical tests) and genotyping systems, based on the detection of species-specific DNA sequences.</p><p id="par0040" class="elsevierStylePara elsevierViewall">RGAMs are relatively resistant to standard disinfectants and are able to generate biofilms to survive. Consequently in many cases, peritoneal catheters must often be removed or replaced. In our literature review the dialysis catheter was replaced in 65.2% of patients. The catheter was also removed in all cases showing peritonitis or tunnel infection, patients with <span class="elsevierStyleItalic">M. abcessus</span> infection, and 80% of <span class="elsevierStyleItalic">M. chenolae</span> infections. More than 50% of patients had to be on haemodialysis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In light of the extensive variability reported in terms of antibiotic resistance, species should be accurately screened <span class="elsevierStyleItalic">in vitro</span> for sensitivity to certain antibiotics so a right therapy can be established. Medium microdilution is recommended for determining sensitivity; a faster commercial technique, <span class="elsevierStyleItalic">E-test</span>, has been introduced in recent years, with an outstanding correlation with the reference method. An empirical therapy may include a combined therapy with aminoglycosides (amikacin), macrolides (clarithromycin and azithromycin), and fluoroquinolones (although <span class="elsevierStyleItalic">M. chenolae</span> and <span class="elsevierStyleItalic">M. abscessus</span> may be resistant to the latter). Optimal treatment duration has not been established yet, but ranged from one to six months in our literature review. One case was cured after withdrawal of topical gentamicin, which had been administered for 7 weeks, and required no further antibiotic treatment.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion RGAMs should be suspected in catheter infections or peritonitis with negative cultures so as to prevent a delay in diagnosis and decrease associated morbidity. A large number of patients require replacement or removal of the Tenckhoff catheter and should be switched to haemodialysis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-11-06" "fechaAceptado" => "2015-03-15" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez López ÁB, Álvarez Blanco O, Ruíz Serrano MJ, Morales San-José MD, Luque de Pablos A. <span class="elsevierStyleItalic">Mycobacterium fortuitum</span> como causa de infección del orificio del catéter de diálisis peritoneal. Caso clínico y revisión de la literatura. Nefrologia. 2015;35:584–586.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1872 "Ancho" => 895 "Tamanyo" => 172362 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Top: erythema in the peritoneal dialysis catheter exit site, with granuloma and chocolate-like discharge. Centre: appearance of the exit site at Week 2. Bottom: appearance of the exit site at Week 6 from the start of targeted therapy.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percent \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Organism</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">M. fortuitum</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">M. chenolae</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">M. abscessus</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Appearance of the exit site (N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">16)</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Purulent discharge \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16/16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Granulation tissue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9/16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Abscess \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Associated with peritonitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Associated with catheter tunnel infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Requiring catheter replacement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Switch to HD (N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">23 patients</span>)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes (temporal or permanent) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12/23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11/23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1375541.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Characteristics of patients on peritoneal dialysis with exit-site infection by rapidly growing non-tuberculous mycobacteria (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>24).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 6 | 12 |
| 2024 October | 81 | 47 | 128 |
| 2024 September | 83 | 43 | 126 |
| 2024 August | 97 | 70 | 167 |
| 2024 July | 60 | 25 | 85 |
| 2024 June | 72 | 52 | 124 |
| 2024 May | 99 | 36 | 135 |
| 2024 April | 63 | 30 | 93 |
| 2024 March | 81 | 29 | 110 |
| 2024 February | 85 | 43 | 128 |
| 2024 January | 67 | 37 | 104 |
| 2023 December | 59 | 27 | 86 |
| 2023 November | 89 | 24 | 113 |
| 2023 October | 65 | 30 | 95 |
| 2023 September | 74 | 23 | 97 |
| 2023 August | 82 | 34 | 116 |
| 2023 July | 131 | 32 | 163 |
| 2023 June | 84 | 28 | 112 |
| 2023 May | 113 | 35 | 148 |
| 2023 April | 75 | 20 | 95 |
| 2023 March | 87 | 25 | 112 |
| 2023 February | 70 | 18 | 88 |
| 2023 January | 88 | 34 | 122 |
| 2022 December | 124 | 34 | 158 |
| 2022 November | 97 | 21 | 118 |
| 2022 October | 111 | 41 | 152 |
| 2022 September | 93 | 30 | 123 |
| 2022 August | 70 | 41 | 111 |
| 2022 July | 101 | 44 | 145 |
| 2022 June | 110 | 29 | 139 |
| 2022 May | 81 | 37 | 118 |
| 2022 April | 100 | 60 | 160 |
| 2022 March | 70 | 47 | 117 |
| 2022 February | 109 | 47 | 156 |
| 2022 January | 123 | 43 | 166 |
| 2021 December | 70 | 46 | 116 |
| 2021 November | 71 | 41 | 112 |
| 2021 October | 132 | 51 | 183 |
| 2021 September | 61 | 34 | 95 |
| 2021 August | 90 | 41 | 131 |
| 2021 July | 84 | 35 | 119 |
| 2021 June | 97 | 33 | 130 |
| 2021 May | 156 | 51 | 207 |
| 2021 April | 258 | 75 | 333 |
| 2021 March | 148 | 36 | 184 |
| 2021 February | 111 | 24 | 135 |
| 2021 January | 70 | 20 | 90 |
| 2020 December | 81 | 21 | 102 |
| 2020 November | 74 | 20 | 94 |
| 2020 October | 73 | 25 | 98 |
| 2020 September | 66 | 14 | 80 |
| 2020 August | 58 | 15 | 73 |
| 2020 July | 57 | 15 | 72 |
| 2020 June | 56 | 13 | 69 |
| 2020 May | 100 | 6 | 106 |
| 2020 April | 103 | 22 | 125 |
| 2020 March | 123 | 10 | 133 |
| 2020 February | 89 | 30 | 119 |
| 2020 January | 99 | 22 | 121 |
| 2019 December | 73 | 24 | 97 |
| 2019 November | 47 | 22 | 69 |
| 2019 October | 388 | 19 | 407 |
| 2019 September | 73 | 14 | 87 |
| 2019 August | 67 | 24 | 91 |
| 2019 July | 69 | 30 | 99 |
| 2019 June | 62 | 22 | 84 |
| 2019 May | 51 | 16 | 67 |
| 2019 April | 102 | 26 | 128 |
| 2019 March | 55 | 26 | 81 |
| 2019 February | 52 | 34 | 86 |
| 2019 January | 41 | 19 | 60 |
| 2018 December | 145 | 39 | 184 |
| 2018 November | 206 | 11 | 217 |
| 2018 October | 234 | 18 | 252 |
| 2018 September | 150 | 12 | 162 |
| 2018 August | 70 | 14 | 84 |
| 2018 July | 52 | 11 | 63 |
| 2018 June | 52 | 9 | 61 |
| 2018 May | 52 | 7 | 59 |
| 2018 April | 61 | 8 | 69 |
| 2018 March | 60 | 9 | 69 |
| 2018 February | 67 | 7 | 74 |
| 2018 January | 58 | 11 | 69 |
| 2017 December | 59 | 7 | 66 |
| 2017 November | 73 | 9 | 82 |
| 2017 October | 43 | 10 | 53 |
| 2017 September | 48 | 6 | 54 |
| 2017 August | 47 | 14 | 61 |
| 2017 July | 50 | 10 | 60 |
| 2017 June | 66 | 25 | 91 |
| 2017 May | 101 | 8 | 109 |
| 2017 April | 62 | 17 | 79 |
| 2017 March | 106 | 6 | 112 |
| 2017 February | 141 | 10 | 151 |
| 2017 January | 64 | 10 | 74 |
| 2016 December | 57 | 19 | 76 |
| 2016 November | 125 | 21 | 146 |
| 2016 October | 189 | 23 | 212 |
| 2016 September | 298 | 11 | 309 |
| 2016 August | 400 | 6 | 406 |
| 2016 July | 225 | 11 | 236 |
| 2016 June | 108 | 0 | 108 |
| 2016 May | 131 | 0 | 131 |
| 2016 April | 105 | 0 | 105 |
| 2016 March | 81 | 0 | 81 |
| 2016 February | 86 | 0 | 86 |
| 2016 January | 5 | 0 | 5 |
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