Antimicrobial Resistance and Spread of Multi Drug Resistant Escherichia coli Isolates Collected from Nine Urology Services in the Euregion Meuse-Rhine
Publication Date
October 17, 2012
Journal
PLOS ONE
Authors
Christina F. M. Van Der Donk, Jeroen H. B. Van De Bovenkamp, Els I. G. B. De Brauwer, Patrick De Mol, et al
Volume
7
Issue
10
Pages
e47707
DOI
https://dx.plos.org/10.1371/journal.pone.0047707
Publisher URL
http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0047707
PubMed
http://www.ncbi.nlm.nih.gov/pubmed/23082197
PubMed Central
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474752
Europe PMC
http://europepmc.org/abstract/MED/23082197
Web of Science
000311146900094
Scopus
84867630001
Mendeley
http://www.mendeley.com/research/antimicrobial-resistance-spread-multi-drug-resistant-escherichia-coli-isolates-collected-nine-urolog
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Mendeley | Further Information

{"title"=>"Antimicrobial Resistance and Spread of Multi Drug Resistant Escherichia coli Isolates Collected from Nine Urology Services in the Euregion Meuse-Rhine", "type"=>"journal", "authors"=>[{"first_name"=>"Christina F.M.", "last_name"=>"van der Donk", "scopus_author_id"=>"37078253700"}, {"first_name"=>"Jeroen H.B.", "last_name"=>"van de Bovenkamp", "scopus_author_id"=>"57193789472"}, {"first_name"=>"Els I.G.B.", "last_name"=>"de Brauwer", "scopus_author_id"=>"6602889511"}, {"first_name"=>"Patrick", "last_name"=>"de Mol", "scopus_author_id"=>"7003529133"}, {"first_name"=>"Karl Heinz", "last_name"=>"Feldhoff", "scopus_author_id"=>"6603360907"}, {"first_name"=>"Wiltrud M.", "last_name"=>"Kalka-Moll", "scopus_author_id"=>"6602362669"}, {"first_name"=>"Sita", "last_name"=>"Nys", "scopus_author_id"=>"12244849000"}, {"first_name"=>"Inge", "last_name"=>"Thoelen", "scopus_author_id"=>"57193862501"}, {"first_name"=>"Thera A.M.", "last_name"=>"Trienekens", "scopus_author_id"=>"6507441205"}, {"first_name"=>"Ellen E.", "last_name"=>"Stobberingh", "scopus_author_id"=>"7005278203"}], "year"=>2012, "source"=>"PLoS ONE", "identifiers"=>{"pmid"=>"23082197", "sgr"=>"84867630001", "doi"=>"10.1371/journal.pone.0047707", "scopus"=>"2-s2.0-84867630001", "pui"=>"365880147", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)", "issn"=>"19326203"}, "id"=>"ee39c87f-b3ea-3089-91ee-dba556c7ed0f", "abstract"=>"We determined the prevalence and spread of antibiotic resistance and the characteristics of ESBL producing and/or multi drug resistant (MDR) Escherichia coli isolates collected from urine samples from urology services in the Euregio Meuse-Rhine, the border region of the Netherlands (n=176), Belgium (n=126) and Germany (n=119). Significant differences in resistance between the three regions were observed. Amoxicillin-clavulanic acid resistance ranged from 24% in the Netherlands to 39% in Belgium (p=0.018), from 20% to 40% (p<0.004) for the fluoroquinolones and from 20% to 40% (p=0.018) for the folate antagonists. Resistance to nitrofurantoin was less than 5%. The prevalence of ESBL producing isolates varied from 2% among the Dutch isolates to 8% among the German ones (p=0.012) and were mainly CTX-M 15. The prevalence of MDR isolates among the Dutch, German and Belgian isolates was 11%, 17% and 27%, respectively (p< =0.001 for the Belgian compared with the Dutch isolates). The majority of the MDR and ESBL producing isolates belonged to ST131. This study indicates that most antibiotics used as first choice oral empiric treatment for UTIs (amoxicillin-clavulanic acid, fluoroquinolones and folate antagonists) are not appropriate for this purpose and that MDR strains such as CTX-M producing ST131 have spread in the entire Euregion. Our data stress the importance of ward specific surveillance to optimize empiric treatment. Also, prudent use of antibiotics and further research to alternative agents are warranted.", "link"=>"http://www.mendeley.com/research/antimicrobial-resistance-spread-multi-drug-resistant-escherichia-coli-isolates-collected-nine-urolog", "reader_count"=>26, "reader_count_by_academic_status"=>{"Professor > Associate Professor"=>2, "Researcher"=>4, "Student > Ph. D. Student"=>4, "Student > Postgraduate"=>3, "Other"=>3, "Student > Master"=>3, "Student > Bachelor"=>6, "Professor"=>1}, "reader_count_by_user_role"=>{"Professor > Associate Professor"=>2, "Researcher"=>4, "Student > Ph. D. Student"=>4, "Student > Postgraduate"=>3, "Other"=>3, "Student > Master"=>3, "Student > Bachelor"=>6, "Professor"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>1, "Biochemistry, Genetics and Molecular Biology"=>4, "Agricultural and Biological Sciences"=>7, "Medicine and Dentistry"=>11, "Veterinary Science and Veterinary Medicine"=>2, "Computer Science"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>11}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>7}, "Computer Science"=>{"Computer Science"=>1}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>4}, "Unspecified"=>{"Unspecified"=>1}, "Veterinary Science and Veterinary Medicine"=>{"Veterinary Science and Veterinary Medicine"=>2}}, "reader_count_by_country"=>{"France"=>1}, "group_count"=>1}

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/557491"], "description"=>"<p>NL  =  the Netherlands, B  =  Belgium and G  =  Germany, -  =  not significant.</p>", "links"=>[], "tags"=>["public health and epidemiology", "Infectious diseases", "microbiology"], "article_id"=>227975, "categories"=>["Microbiology", "Infectious Diseases", "Biotechnology"], "users"=>["Christina F. M. van der Donk", "Jeroen H. B. van de Bovenkamp", "Els I. G. B. De Brauwer", "Patrick De Mol", "Karl-Heinz Feldhoff", "Wiltrud M. Kalka-Moll", "Sita Nys", "Inge Thoelen", "Thera A. M. Trienekens", "Ellen E. Stobberingh"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0047707.t001", "stats"=>{"downloads"=>3, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Antimicrobial_resistance_among_E_coli_isolates_/227975", "title"=>"Antimicrobial resistance among (%) <i>E. coli</i> isolates.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-19 21:36:56"}
  • {"files"=>["https://ndownloader.figshare.com/files/557263"], "description"=>"<p>Antibiotic resistance for the different antibiotics among the three groups of isolates compared with a 10% resistance cutoff to decide whether an antibiotic agent is suitable for empiric treatment. AMC  =  amoxicillin-clavulanic acid, TZP  =  piperacillin-tazobactam, CXM  =  cefuroxime, CAZ  =  ceftazidime, FIX  =  cefixime, TIB  =  ceftibuten, CIP  =  ciprofloxacin, NIT  =  nitrofurantoin, SXT  =  trimethoprim-sulfamethoxazole and GEN  =  gentamicin.</p>", "links"=>[], "tags"=>["suitability", "antibiotics", "empiric"], "article_id"=>227750, "categories"=>["Microbiology", "Infectious Diseases", "Biotechnology"], "users"=>["Christina F. M. van der Donk", "Jeroen H. B. van de Bovenkamp", "Els I. G. B. De Brauwer", "Patrick De Mol", "Karl-Heinz Feldhoff", "Wiltrud M. Kalka-Moll", "Sita Nys", "Inge Thoelen", "Thera A. M. Trienekens", "Ellen E. Stobberingh"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0047707.g002", "stats"=>{"downloads"=>3, "page_views"=>14, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Antibiotic_resistance_and_suitability_of_antibiotics_for_empiric_treatment_/227750", "title"=>"Antibiotic resistance and suitability of antibiotics for empiric treatment.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-19 21:35:46"}
  • {"files"=>["https://ndownloader.figshare.com/files/557141"], "description"=>"<p>*  =  p<0.05, **  =  p< = 0.001.</p>", "links"=>[], "tags"=>["multi"], "article_id"=>227619, "categories"=>["Microbiology", "Infectious Diseases", "Biotechnology"], "users"=>["Christina F. M. van der Donk", "Jeroen H. B. van de Bovenkamp", "Els I. G. B. De Brauwer", "Patrick De Mol", "Karl-Heinz Feldhoff", "Wiltrud M. Kalka-Moll", "Sita Nys", "Inge Thoelen", "Thera A. M. Trienekens", "Ellen E. Stobberingh"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0047707.g001", "stats"=>{"downloads"=>1, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Prevalence_of_multi_drug_resistance_of_E_Coli_/227619", "title"=>"Prevalence of multi drug resistance of <i>E. Coli.</i>", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-19 21:35:01"}
  • {"files"=>["https://ndownloader.figshare.com/files/557400"], "description"=>"<p>ESBL singletons: ESBL strains with a pulsotype of which no similar type has been demonstrated among the other typed isolates.</p><p>ST  =  sequence type, CC  =  clonal complex, n  =  amount.</p>", "links"=>[], "tags"=>["sts", "multi", "resistant", "esbl", "producing"], "article_id"=>227882, "categories"=>["Microbiology", "Infectious Diseases", "Biotechnology"], "users"=>["Christina F. M. van der Donk", "Jeroen H. B. van de Bovenkamp", "Els I. G. B. De Brauwer", "Patrick De Mol", "Karl-Heinz Feldhoff", "Wiltrud M. Kalka-Moll", "Sita Nys", "Inge Thoelen", "Thera A. M. Trienekens", "Ellen E. Stobberingh"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0047707.t003", "stats"=>{"downloads"=>1, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Pulsotypes_and_STs_of_multi_drug_resistant_and_or_ESBL_producing_isolates_/227882", "title"=>"Pulsotypes and STs of multi drug resistant and/or ESBL producing isolates.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-19 21:36:28"}
  • {"files"=>["https://ndownloader.figshare.com/files/557444"], "description"=>"*<p>Significantly higher than among isolates from the Netherlands (p<0.05).</p>", "links"=>[], "tags"=>["esbl", "producing"], "article_id"=>227935, "categories"=>["Microbiology", "Infectious Diseases", "Biotechnology"], "users"=>["Christina F. M. van der Donk", "Jeroen H. B. van de Bovenkamp", "Els I. G. B. De Brauwer", "Patrick De Mol", "Karl-Heinz Feldhoff", "Wiltrud M. Kalka-Moll", "Sita Nys", "Inge Thoelen", "Thera A. M. Trienekens", "Ellen E. Stobberingh"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0047707.t002", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Number_and_identification_of_ESBL_producing_isolates_/227935", "title"=>"Number and identification of ESBL producing isolates.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-19 21:36:43"}

PMC Usage Stats | Further Information

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  • {"unique-ip"=>"20", "full-text"=>"19", "pdf"=>"9", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"4", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2013", "month"=>"3"}
  • {"unique-ip"=>"23", "full-text"=>"28", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2013", "month"=>"2"}
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  • {"unique-ip"=>"72", "full-text"=>"75", "pdf"=>"45", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"8", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2012", "month"=>"11"}
  • {"unique-ip"=>"20", "full-text"=>"25", "pdf"=>"10", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2013", "month"=>"5"}
  • {"unique-ip"=>"19", "full-text"=>"16", "pdf"=>"13", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2013", "month"=>"6"}
  • {"unique-ip"=>"11", "full-text"=>"9", "pdf"=>"8", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2013", "month"=>"7"}
  • {"unique-ip"=>"10", "full-text"=>"10", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2013", "month"=>"8"}
  • {"unique-ip"=>"15", "full-text"=>"14", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2013", "month"=>"9"}
  • {"unique-ip"=>"7", "full-text"=>"4", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2013", "month"=>"10"}
  • {"unique-ip"=>"10", "full-text"=>"11", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2013", "month"=>"11"}
  • {"unique-ip"=>"8", "full-text"=>"7", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2013", "month"=>"12"}
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  • {"unique-ip"=>"3", "full-text"=>"5", "pdf"=>"0", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"5"}
  • {"unique-ip"=>"5", "full-text"=>"4", "pdf"=>"5", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"6"}
  • {"unique-ip"=>"13", "full-text"=>"9", "pdf"=>"7", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"4"}
  • {"unique-ip"=>"6", "full-text"=>"6", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"4"}
  • {"unique-ip"=>"7", "full-text"=>"8", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"5"}
  • {"unique-ip"=>"9", "full-text"=>"8", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"6"}
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  • {"unique-ip"=>"5", "full-text"=>"4", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"3"}
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  • {"unique-ip"=>"8", "full-text"=>"32", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"8", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"8"}
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  • {"unique-ip"=>"15", "full-text"=>"15", "pdf"=>"8", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"10"}
  • {"unique-ip"=>"16", "full-text"=>"18", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"7"}
  • {"unique-ip"=>"18", "full-text"=>"20", "pdf"=>"2", "abstract"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"8"}
  • {"unique-ip"=>"16", "full-text"=>"15", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"3", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"9"}
  • {"unique-ip"=>"11", "full-text"=>"11", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"6", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"10"}
  • {"unique-ip"=>"3", "full-text"=>"3", "pdf"=>"0", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"2"}
  • {"unique-ip"=>"18", "full-text"=>"20", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"11"}
  • {"unique-ip"=>"9", "full-text"=>"16", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"3", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"12"}
  • {"unique-ip"=>"5", "full-text"=>"9", "pdf"=>"0", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"1"}
  • {"unique-ip"=>"8", "full-text"=>"6", "pdf"=>"5", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"2", "year"=>"2015", "month"=>"11"}
  • {"unique-ip"=>"11", "full-text"=>"11", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"12"}
  • {"unique-ip"=>"3", "full-text"=>"2", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"1"}
  • {"unique-ip"=>"11", "full-text"=>"11", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"3"}
  • {"unique-ip"=>"1", "full-text"=>"2", "pdf"=>"0", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"4"}
  • {"unique-ip"=>"8", "full-text"=>"6", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"5"}
  • {"unique-ip"=>"5", "full-text"=>"5", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"6"}
  • {"unique-ip"=>"5", "full-text"=>"6", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"7"}
  • {"unique-ip"=>"6", "full-text"=>"8", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"8"}
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Relative Metric

{"start_date"=>"2012-01-01T00:00:00Z", "end_date"=>"2012-12-31T00:00:00Z", "subject_areas"=>[{"subject_area"=>"/Biology and life sciences", "average_usage"=>[322, 550, 671, 773, 864, 955, 1048, 1135, 1223, 1308, 1387, 1465, 1534, 1602, 1673, 1744, 1813, 1885, 1955, 2026, 2093, 2160, 2228, 2290, 2349]}, {"subject_area"=>"/Medicine and health sciences", "average_usage"=>[312, 547, 668, 769, 861, 953, 1046, 1135, 1224, 1307, 1388, 1464, 1536, 1606, 1676, 1744, 1812, 1882, 1954, 2020, 2089, 2155, 2218, 2282, 2344]}, {"subject_area"=>"/Medicine and health sciences/Infectious diseases", "average_usage"=>[328, 580, 713, 821, 914, 1012, 1107, 1202, 1293, 1381, 1477, 1551, 1633, 1694, 1769, 1847, 1917, 1986, 2056, 2121, 2194, 2267, 2329, 2410, 2461]}, {"subject_area"=>"/Medicine and health sciences/Pharmaceutics", "average_usage"=>[305, 566, 705, 814, 911, 1028, 1121, 1228, 1325, 1435, 1532, 1608, 1690, 1769, 1843, 1921, 1997, 2089, 2155, 2225, 2285, 2361, 2433, 2496, 2560]}, {"subject_area"=>"/Medicine and health sciences/Pharmacology", "average_usage"=>[314, 554, 687, 796, 891, 983, 1075, 1170, 1261, 1340, 1422, 1504, 1574, 1647, 1715, 1786, 1848, 1919, 1990, 2053, 2115, 2197, 2258, 2333, 2395]}, {"subject_area"=>"/Medicine and health sciences/Urology", "average_usage"=>[354, 588, 721, 835, 935, 1015, 1103, 1217, 1309, 1400, 1505, 1594, 1662, 1738, 1799, 1873, 1937, 2016, 2085, 2151, 2234, 2302, 2401, 2443, 2500]}]}
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