Letter to the Editor
Effectiveness of the scheme reimpregnation maintenance schedule vs. ceftazidime/cephalothin in dialysis patients with peritonitis
Eficacia del esquema de impregnación vs. esquema de mantenimiento con ceftazidima/cefalotina en pacientes con peritonitis por diálisis
Julia Monzerrath Carranza-Torresa,b, Emma Rosa Vargas-Dazaa, Enrique Villarreal-Ríosa,c,
, Liliana Galicia-Rodrígueza, Lidia Martínez-Gonzáleza
Corresponding author
a Unidad de Investigación Epidemiológica y en Servicios de Salud Querétaro, Instituto Mexicano del Seguro Social, Querétaro, Querétaro de Arteaga, Mexico
b Residencia de Geriatría, Hospital General Regional N.° 1 Querétaro, Instituto Mexicano del Seguro Social, Querétaro, Querétaro de Arteaga, Mexico
c Escuela de Medicina, División de Ciencias de la Salud, Campus Querétaro, Universidad del Valle de México, Querétaro, Querétaro de Arteaga, Mexico
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=> array:2 [ "paginaInicial" => "448" "paginaFinal" => "450" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Julia Monzerrath Carranza-Torres, Emma Rosa Vargas-Daza, Enrique Villarreal-Ríos, Liliana Galicia-Rodríguez, Lidia Martínez-González" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Julia Monzerrath" "apellidos" => "Carranza-Torres" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "Emma Rosa" "apellidos" => "Vargas-Daza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:4 [ "nombre" => "Enrique" "apellidos" => "Villarreal-Ríos" "email" => array:2 [ 0 => "enrique.villarreal@imss.gob.mx" 1 => "evr57@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "Liliana" "apellidos" => "Galicia-Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Lidia" "apellidos" => "Martínez-González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Investigación Epidemiológica y en Servicios de Salud Querétaro, Instituto Mexicano del Seguro Social, Querétaro, Querétaro de Arteaga, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Residencia de Geriatría, Hospital General Regional N.° 1 Querétaro, Instituto Mexicano del Seguro Social, Querétaro, Querétaro de Arteaga, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Escuela de Medicina, División de Ciencias de la Salud, Campus Querétaro, Universidad del Valle de México, Querétaro, Querétaro de Arteaga, Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eficacia del esquema de impregnación vs. esquema de mantenimiento con ceftazidima/cefalotina en pacientes con peritonitis por diálisis" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Peritoneal dialysis is a type of renal replacement therapy that uses the physical and chemical properties of the peritoneal membrane to perform ultrafiltration and clearance processes.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1–3</span></a> One complication of this procedure is peritonitis,<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4,5</span></a> which is diagnosed with the presence of at least two out of the three following criteria: a leukocyte count higher than 100<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">−3</span>, a corresponding clinical picture and microorganisms on a Gram stain.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The International Society for Peritoneal Dialysis recommends management with first-generation cephalosporins for Gram-positive microorganisms and third-generation cephalosporins for Gram-negative microorganisms.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It also recommends starting treatment with third-generation cephalosporins (ceftazidime) and first-generation cephalosporins (cefalotin) by the intraperitoneal route, with permeation doses of one gram and maintenance doses of 250<span class="elsevierStyleHsp" style=""></span>mg every 6<span class="elsevierStyleHsp" style=""></span>h; however, the response is uncertain.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Against this background, the aim of this study was to compare the efficacy of the permeation regime and the maintenance regime in patients with peritonitis due to dialysis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A cohort study was conducted in patients with end-stage renal disease and peritonitis. The exposure group included patients treated with a permeation regimen (one gram of ceftazidime/cefalotin q 24<span class="elsevierStyleHsp" style=""></span>h); the unexposed group included patients with a maintenance regimen (one gram initially and 250<span class="elsevierStyleHsp" style=""></span>mg of ceftazidime/cefalotin q 6<span class="elsevierStyleHsp" style=""></span>h thereafter).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients with a diagnosis made by cell count were included; patients with refractory peritonitis, recurrent peritonitis or cephalosporin allergy were excluded.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The sample (31 per group) was calculated using a percentage formula for 2 populations, assuming that the efficacy of ceftazidime/cefalotin was 60% in the permeation group and 35% in the maintenance group.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Their sociodemographic characteristics, concomitant diseases, modality of dialysis, time on peritoneal dialysis and time of progression of chronic kidney disease were studied.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Therapeutic efficacy was established through cell counts, using 99 cells per field as a cut-off point, evaluated at 24, 48, 72 and 96<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Analysis included percentages, averages, standard deviations, Student's <span class="elsevierStyleItalic">t</span>-test for independent populations and the chi-squared test.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Age and gender were similar in the permeation group and the maintenance group: 48.06<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17.79 years and 55.07<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.64 years (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.84); male gender with 65.6% and 62.1%, respectively (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.77). In these groups the prevalence of hypertension (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.00), diabetes mellitus (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.62) and drug immunosuppression (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.35) were similar.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In both groups there was a predominance of continuous ambulatory peritoneal dialysis (59.4% and 69.0%, respectively; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.51). Time in dialysis (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.19) and time of progression of chronic kidney disease (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.18) were similar in the groups (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Seventy two hours after initiation of therapy, efficacy was 50.0% in the permeation group and 41.4% in the maintenance group; however, they were not statistically different (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.50). At 96<span class="elsevierStyleHsp" style=""></span>h, a statistical difference was found: in the permeation modality 65.6% showed efficacy and in the maintenance modality 41.4% showed efficacy (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.05) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">In the management of bacterial peritonitis associated with dialysis, the antimicrobial regimens and dosage regimens proposed in clinical practice guidelines have shown to produce ineffective results, hence the importance of this study analysing the prolonged stay of the antibiotic in the abdominal cavity and the decrease in the manipulation of the peritoneal cavity.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">It was ensured that the 2 groups were statistically similar with respect to disease history, type of dialysis, time of progression of chronic kidney disease and time in dialysis as these were significant benchmarks that made comparison between the different management regimens more reliable.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Similarly, the same antibiotic was used in the 2 groups as this made it possible to be certain that what was being compared was the number of drug administrations (one administration vs 4 administrations). The pathophysiological substrate was the drug's cumulative capacity in the peritoneum and its half-life, as well as the peritoneum's lower exposure to the introduction of microorganisms in each drug administration. To date, this matter has not received enough attention.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Cephalosporins are first-line antibiotics in the treatment of peritonitis in dialysis: as they are administered by the intraperitoneal route, they penetrate the tissue wall and achieve a half-life of 48–72<span class="elsevierStyleHsp" style=""></span>h. However, it will be necessary to clarify whether the efficacy achieved in the permeation regimen is due to the fact of exposing the peritoneum to a high dose of antibiotic, or to the fact of decreasing the events that penetrate the peritoneal cavity and therefore the potential for keeping from introducing germs into the cavity.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In conclusion, the permeation regimen has a greater efficacy than the maintenance regimen in the management of peritonitis secondary to peritoneal dialysis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</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 "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Carranza-Torres JM, Vargas-Daza ER, Villarreal-Ríos E, Galicia-Rodríguez L, Martínez-González L. Eficacia del esquema de impregnación vs. esquema de mantenimiento con ceftazidima/cefalotina en pacientes con peritonitis por diálisis. Nefrologia. 2016;36:448–450.</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: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="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Antibiotic therapy</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PERM \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">MAIN \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">t</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Years in PD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.1 (16.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.1 (12.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Years of CKD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.5 (17.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.2 (13.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.18 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1269794.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Time in dialysis and CKD by permeation (PERM) group and maintenance (MAIN) group in peritonitis. Mean (SD).</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 [ "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 " rowspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Start time of treatment</th><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Efficacy<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></th><th class="td" title="table-head " rowspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span></th><th class="td" title="table-head " rowspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RM</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Permeation \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">Maintenance \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentages</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">At 24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">At 48<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">At 72<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">At 96<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1269793.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Efficacy was considered to be a cell count lower than or equal to 99 cells per field.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Efficacy of permeation and maintenance by start time of treatment in peritonitis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estimating glomerular filtration rate from serum creatinine and cystatin C" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.A. 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| Year/Month | Html | Total | |
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| 2024 November | 4 | 5 | 9 |
| 2024 October | 44 | 49 | 93 |
| 2024 September | 37 | 30 | 67 |
| 2024 August | 51 | 64 | 115 |
| 2024 July | 40 | 31 | 71 |
| 2024 June | 58 | 25 | 83 |
| 2024 May | 54 | 45 | 99 |
| 2024 April | 40 | 34 | 74 |
| 2024 March | 35 | 23 | 58 |
| 2024 February | 32 | 33 | 65 |
| 2024 January | 24 | 26 | 50 |
| 2023 December | 19 | 21 | 40 |
| 2023 November | 34 | 26 | 60 |
| 2023 October | 39 | 35 | 74 |
| 2023 September | 22 | 26 | 48 |
| 2023 August | 28 | 20 | 48 |
| 2023 July | 38 | 27 | 65 |
| 2023 June | 31 | 18 | 49 |
| 2023 May | 38 | 30 | 68 |
| 2023 April | 18 | 9 | 27 |
| 2023 March | 26 | 27 | 53 |
| 2023 February | 32 | 20 | 52 |
| 2023 January | 34 | 28 | 62 |
| 2022 December | 55 | 43 | 98 |
| 2022 November | 49 | 32 | 81 |
| 2022 October | 40 | 62 | 102 |
| 2022 September | 74 | 58 | 132 |
| 2022 August | 37 | 89 | 126 |
| 2022 July | 27 | 55 | 82 |
| 2022 June | 33 | 45 | 78 |
| 2022 May | 34 | 38 | 72 |
| 2022 April | 26 | 55 | 81 |
| 2022 March | 56 | 45 | 101 |
| 2022 February | 41 | 60 | 101 |
| 2022 January | 28 | 47 | 75 |
| 2021 December | 46 | 49 | 95 |
| 2021 November | 55 | 45 | 100 |
| 2021 October | 51 | 39 | 90 |
| 2021 September | 57 | 38 | 95 |
| 2021 August | 38 | 36 | 74 |
| 2021 July | 55 | 38 | 93 |
| 2021 June | 25 | 30 | 55 |
| 2021 May | 44 | 32 | 76 |
| 2021 April | 72 | 53 | 125 |
| 2021 March | 57 | 39 | 96 |
| 2021 February | 26 | 27 | 53 |
| 2021 January | 44 | 25 | 69 |
| 2020 December | 37 | 22 | 59 |
| 2020 November | 35 | 28 | 63 |
| 2020 October | 19 | 12 | 31 |
| 2020 September | 25 | 19 | 44 |
| 2020 August | 46 | 19 | 65 |
| 2020 July | 33 | 14 | 47 |
| 2020 June | 30 | 13 | 43 |
| 2020 May | 48 | 20 | 68 |
| 2020 April | 36 | 21 | 57 |
| 2020 March | 42 | 23 | 65 |
| 2020 February | 40 | 20 | 60 |
| 2020 January | 52 | 22 | 74 |
| 2019 December | 42 | 28 | 70 |
| 2019 November | 35 | 26 | 61 |
| 2019 October | 37 | 24 | 61 |
| 2019 September | 29 | 24 | 53 |
| 2019 August | 27 | 19 | 46 |
| 2019 July | 28 | 28 | 56 |
| 2019 June | 36 | 29 | 65 |
| 2019 May | 29 | 20 | 49 |
| 2019 April | 31 | 47 | 78 |
| 2019 March | 30 | 28 | 58 |
| 2019 February | 32 | 23 | 55 |
| 2019 January | 24 | 16 | 40 |
| 2018 December | 124 | 46 | 170 |
| 2018 November | 242 | 21 | 263 |
| 2018 October | 199 | 23 | 222 |
| 2018 September | 84 | 18 | 102 |
| 2018 August | 55 | 20 | 75 |
| 2018 July | 50 | 15 | 65 |
| 2018 June | 47 | 14 | 61 |
| 2018 May | 66 | 21 | 87 |
| 2018 April | 90 | 16 | 106 |
| 2018 March | 101 | 13 | 114 |
| 2018 February | 37 | 9 | 46 |
| 2018 January | 50 | 7 | 57 |
| 2017 December | 46 | 13 | 59 |
| 2017 November | 50 | 15 | 65 |
| 2017 October | 26 | 10 | 36 |
| 2017 September | 40 | 20 | 60 |
| 2017 August | 24 | 11 | 35 |
| 2017 July | 38 | 8 | 46 |
| 2017 June | 46 | 19 | 65 |
| 2017 May | 52 | 13 | 65 |
| 2017 April | 58 | 15 | 73 |
| 2017 March | 36 | 7 | 43 |
| 2017 February | 26 | 9 | 35 |
| 2017 January | 22 | 5 | 27 |
| 2016 December | 36 | 6 | 42 |
| 2016 November | 27 | 9 | 36 |
| 2016 October | 13 | 4 | 17 |
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