CLINICAL MICROBIOLOGY

Author: JAVALOYAS DE MORLIUS MANUEL.
Year: 2003.
University: BARCELONA [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA UNIVERSIDAD DE BARCELONA.

Summary: From a standpoint epidemiolÃÂ ³ gico and pronÃÂ ³ stico bacteremia is a fenÃÂ ³ meno subjected to constant variaciones.La Most of the studies conducted since those aspects come from hospitals universitarios.Por contrast, barely exists informaciÃÂ charges of hospitals pequeÃÂ ± or tamaÃÂ ± o. This thesis abordaa the subject of bacteremia in a district hospital with the following objectives: 1.Demostrar differences epidemiolÃÂ ³ gicas regard to hospitals in higher technology. 2. Identifying factors pronÃÂ ³ sticos that can be modified. 3. Analyze epidemiologÃÂa of bacteremia in a ÃÂ ¡rea hospital (emergency service). 4. Analyze epidemiologÃÂa and evoluciÃÂ ³ n of the sensitivity of a microorganism (E. Coli). The varibles collected during 10 aÃÂ ± os in a hospital of 116 beds were: microorganisms, sex age, lugaar of adquisiciÃÂ ³ n, origin, variables spsis severe risk factors intrÃÂnseco and extÃÂnseco, treatment antibiÃÂ ³ tico in related (under 7 dÃÂas) and overall (less 30 dÃÂas). adecuaciÃÂ ³ n treatment antibiÃÂ ³ tico is fundamentÃÂ ³ on the data from antibiogram. It performs anÃÂ ¡lisis descriptive, chi-square for comparaciÃÂ ³ nde proportions, with significaciÃÂ charges if p-menor 0.05. For anÃÂ ¡lysis of the factors pronÃÂ ³ sticos is estimÃÂ ³ RR with CI 95% For anÃÂ ¡lisis multivariate was utilizÃÂ ³ regresiÃÂ ³ n logÃÂstica. We evaluated 798 episodes xonsecutivos of bacteremia clÃÂnicamente significativa.El 24% (185 episidios) was adquisiciÃÂ ³ n nosocomial.El hotbed of origin mÃÂ ¡s frequent urinary tract (41%) followed by lung (14%) and bacteremia primaria.La overall mortality rate was 14.4% and the related from 8%. etiologÃÂa mÃÂ ¡s common was Escherichia coli, followed by S.pfneumoniae and S.aureus. The anÃÂ ¡lisis multivariente asociÃÂ ³ the following variables to a evoluciÃÂ ³ n adversely: Age greater than 70 aÃÂ ± os, adquisiciÃÂ ³ n nosocomial, or unknown origin lung, shock sÃÂ © ptico, pronÃÂ ³ stico living less than 5 aÃÂ ± os, leukopenia, treatment antibiÃÂ ³ tico wrong and etiologÃÂa by S. Auresspp, Pseudomonas aeruginosa and bacteroides spp. In the emergency department 85 patients with bacteremia were discharged to domicilio.El hotbed of origin mÃÂ It was touch s frequent urinary (69%) followed by hotbed unknown (12%). In the 62% aislÃÂ ³ E.coli . in 21% of cases of antibiotic treatment was wrong. Mortality was low (3.5%). We analyzed 330 episodes of bacteremia by E.coli. Mortalidas overall was 6.6% and connected on 4%. In 46 cases was nosocomial.Se observÃÂ ³ a significant decrease in sensitivity to ciprofloxacin over time (10 aÃÂ ± os). Conclusions: 1.Member studies epidemiolÃÂ ³ ments on bacteremia to detect differences epidemiolÃÂ ³ gicas regarding university hospitals, variables related to adquisiciÃÂ ³ n nosocomial antibiotics and inappropriate treatments. 2. Rate of nosocomial bacteremia in our environment reflects the importance of fenÃÂ ³ meno at any ÃÂ ¡field hospital, but they must be updated concepts related adquisiciÃÂ charges of bacteremia. 3. Should define quÃÂ © patients at risk of bacteremia are candidates to be discharged from the emergency services and improve them in the adecuaciÃÂ charges of antibiotic treatment. 4. Was detected factors pronÃÂ ³ sticos likely to modificaciÃÂ ³ n: adquisiciÃÂ ³ n nosocomial, antibiotic treatment appropriate especially in the face S.aureus, Proteus spp, Pseudomonas aeruginosa, bacteroides spp, and correcciÃÂ ³ n early alterations hemodinÃÂ ¡micas. 5. Increased resistance to ciprofloxacin by E.coli reflects the need for a polÃÂtica of antibiÃÂ ³ ticos appropriate in any ÃÂ ¡health field.

Author: NAVAS ELORZA ENRIQUE.
Year: 2003.
University: AUTÓNOMA DE MADRID [www.uam.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The study was conducted during the years 1998 to 2001, and was carried out in collaboration between the services of Infectious Diseases and Microbiology at the University Hospital Ramón y Cajal the Department of Animal Health, School of Veterinary Medicine at the Universidad Complutense de Madrid. We evaluated two techniques: detencción antibody igG front antigen A60 by enzimoinmunoensayo (Anda TB) test and release interferón-? After stimulation with tuberculin QUANTIFERON-TB (QIFN), which compared with intrademorreación tuberculinca (RTD) for the diagnosis of TB infection in patients with suspected tuberculosis in close contacts of index cases with diagnoses recent Tuberculosis bacilifera, and in healthy controls. The study population comprised 221 patients finally being evaluable 210, which are distributed in the following groups:-Group II 91 patients, close contacts of patients with tuberculosis (103 studies contacts). -30 RTD negative (less 5 mm) without second-determination. -12 RTD negative (less 5 mm) with the second-determination (a conversion tuberculinica) -49 RTD positive (less 5 mm) in the first determination. - Group III: 59 healthy patients (population control). The match between QIFN and RTD was generally weak among QIFN was generally weak (Kappa, 0.28) especially by the large number of results differing controls estudiados.La match between QIFN and RTD was moderate in constadtos studied (kappa 0, 41). Detection of antibodies igG versus antegeno A60 of M.tuberculosis (Anda Tb) is a sensibility slightly less than the RTD (sensitivity 59%) for the diagnosis of the disease tuberculosa.Discrimina infected patients, but specificity limitada.La serology Anda Tba was negative in most cases of suspected latent TB infection (without disease). In light of the results of our study, neither of the two tests alternaativas studied in our experience brings advantages over intrademorreacción tuberculína for the diagnosis of tuberculous infection and disease.

Author: LÓPEZ ONRUBIA PEDRO MANUEL.
Year: 2003.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: FACULTAD MEDICINA.
Place of preparation: UNIVERSIDAD AUTÓNOMA DE BARCELONA.

Summary: The experimental model of endocarditis in rabbits reproduced quite approximate the pathophysiology of the disease in humans. The therapeutic efficacy studies using this model raise the issue of the differences in pharmacokinetic profiles in the serum of humans and rabbits of antibiotics that are studied. To circumvent this problem in this paper is a compilation of the results of studies on the therapeutic efficacy that has been used a mathematical model to compensate faster aliminación drugs in animals and simulate the pharmacokinetic profiles of antibiotics that are obtained in the serum of humans and play with endocarditis in rabbits through the infusion pump infusion controlled by computer. It has used the model of endocarditis in rabbits and administering antibiotics simulating pharmacokinetic profiles in humans to evaluate alternative treatments or different patterns of administration in experimental endocarditis caused by Gram-positive cocci and presents four studies .- In the first evaluation the effectiveness of the combination of ampicillin with ceftriaxone, which is administered by simulating the pharmacokinetics of antibiotics in both humans in experimental endocarditis Enterococcus faecalis with high-level resistance to aminoglycosides showed that this combination is effective and significantly reduces the burden this bacterial the vegetation compared to the animals that received ampicillin alone. The second study showed that the combination of gentamicin and teicoplanin administered in a single daily dose and pharmacokinetic profiles humans had similar efficacy to conventional therapy ampicillin more gentamicin, endocarditis experimental E.faecalis. In the third study showed that for the treatment of endocarditis pilot by Staphylococcus auereus the combination of ceftriaxone with gentamicin administered once daily was as effective than the conventional treatment of cloxacillin and gentamicin. The latest study showed the efficacy of the combination d eampicilina and ceftriaxone in the treatment of endocarditis experimental E.faecalis without resistance to aminoglycosides.

Author: CRUZADO LÓPEZ M. MAR.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE VETERINARIA.
Place of preparation: FACULTAD DE VETERINARIA DE LA UNIVERSIDAD COMPLUTENSE.

Summary: INTRODUCTION A.fumigatus is a fungus haploid and eucariota which is reproduced so asexual. Holds a wide range of temperatures and climates may isolated from the air, soil and water. Part of the flora saprofita of man and animals. The elastase activity is an important virulence factor of A.fumigatus and may be related to the pathogenicity of the same through the Activity Index Elastasa (IAE). Therefore, A.fumigatus can behave as a pathogen causing aspergillosis in men and animals. The aspergillosis in human medicine affects mainly in immunosuppressed individuals and is a very important disease, increasingly frequent and with high mortality rates. In veterinary medicine there is a large number of animal species that can be affected in aspergillosis but in our study we focused on mastitis aspergilar and aspergillosis canine. There are different types of aspergillosis diagnosis: clinical, image, microbiology, histopathology, immunological and molecular level. OBJECTIVES To develop a technique for amplificiar genomic DNA PCR A. Fumigatus and detection sensitivity and specificity of the same. Apply this téncia PCR to serums to sheep dog suspected of suffering from aspergillosis and compare the results with those obtained previously immunological methods. Characterization genotypic strains A.fumigatus with different origin and IAE, attempting to connect genotypes obtained with the IAE, attempting to connect genotypes obtained with the IAE and its origin. Calculation of Minimum Inhibitoria Concentration (MIC) of various antigúngicos against these strains to compare the different activities of the same and see if there is a relationship relationship between the WCC obtained and IAE, as well as between the WCC and the origin of the isolates. MATERIALS AND METHODS were used several methods for obtaining genomic DNA of A.fumigatus and DNA serum suspected of being infected with A. Fumigatus. Making two neste PCR techniques, according Yamakami et al.y as Williamson et al. Diagnosing aspergillosis sheep and dogs using the nested PCR technique of Yamakami et al. Indirect ELISA and PLATELIA. Criminalizing strains A.fumigatus isolated from different origins by RAPD, RED and microsatellites. Making antifungal susceptibility testing using the method M38-A of NCCLS. Results The sensitivity of técnias nested PCR was very acceptable, but not so much specificity. The diagnosis of aspergillosis animals must do so with clinical isolation duplicate mushroom ELISA positive. The first C5 employee in the RAPD seem capable of linking the origin of environmental isolates with genotype obtained. The REA is not a valid characterization technique, while microsatellites have a degree of optimal characterization. The voriconazole and popsaconazol are more effective than itraconazole, and amphotericin B to inhibit the growth of A.fumigatus. The method M38-A the NCCLS is not suitable for measuring the WCC of equinocandinas caspofungin and micafungina. There may be some relationship between increased pathogenicity of some isolated A.fumigatus and their resistance to amphotericin B. DISCUSSION nested PCR techniques employed was described as being specific to amplify DNA genónmico Gender Aspergillus, but our results do not corroborated. Other authors as Mondon et al.sí were able to relate genotype obtained A.fumigatus and pathogenicity of these strains. The technique has been used REA co 8 No successful 523 for the criminalization of A.fumigatus, but have diregido DNA fragments larger than 50 Kb and have used other restriction enzymes different samples. There are two pairs of isolated submitted the same pattern including microsatellites, which undoubtedly is a aúnica strain, as this method has a high power of discrimination. The CMIs generated by these antifungals coincide with those which describe other authors face A.fumigatus, but the result always depends on many variables. There is no apparent relationship between the CMIs obtained and the origin of the strains, but between the WCC obtained with amphotericin B strains of the IAE, these could be because the gene coding for resistance increase virulence, or the interaction host with specific substances secreted by A.fumigatus to possess this gene.

Author: SEGOVIA ARIAS JUAN MATIAS.
Year: 2004.
University: BARCELONA [www.ub.es].
Place of defense: FACULTAD DE FARMÁCIA.

Author: MARTO CATALA ELISA.
Year: 2004.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: ESCUELA DE POSTGRADO.

Summary: The herpesvirus human 8 (HVH-8) is the etiologic agent of Kaposi's Sarcoma (KS). This endothelial multifocal malignancy is the leading cause of malignancy in patients with AIDS. In countries where the HVH-8 is not endemic (northern Europe, USA), SK affects mainly homo or bisexual men (MSM) HIV positive, among whom the virus is transmitted sexually, whereas in endemic countries (Central Africa ) represents the first malignancy in both adults and children, and the virus is transmitted by saliva. The HVH-8 was detected by PCR in peripheral blood mononuclear cells (PBMC), but only in 50% of cases of SK. With regard to the detection of infection with HVH-8, the thesis raises two objectives: 1-To determine, through serological methods, what was the extent of infection with HVH-8 in non-endemic areas during the first two decades Life, to determine whether the primary infection occurs during this stage compared with the virus Espstein-Barr (EBV). 2-Study by the detection of the virus itself, what is the scope of viremia in HIV-positive individuals for HVH-8 and HIV, and the role of eesta in the pathogenesis of KS. The results indicate that in non-endemic areas (Germany and Georgia, USA), the rate of seroprevalence of HVH-8 to 17 years is significantly less than that seen in endemic zones (Nigeria). Compared with the VEB, the closest phylogenetically and horizontal transmission, the HVH-8 is not transmitted as efficiently. Still, the primary infection can occur during childhood also in non-endemic areas in a small percentage, and the antibodies may not persist over the long term. The IFA technique used allows to better detect infection HVH-8 that the ELISA based on peptides. For the second part of this dissertation was necessary to develop a test limiting dilution and a duplex real-time PCR (co-cuantificación the viral genome and analyzed the number of PBMC), which helped to show that the proportion of cells infected with HVH-8 blood is relatively low, even in patients with active SK (up less than 1 to 6 million), although it may change during the course of SK. The diseases associated with EBV proportion tends to be higher. The HVH-8 is more easily detectable in PBMC in the plasma. Although detection HVH-8 was more common among patients with KS, the presence of lesions not always accompanied by the detection of the virus in the blood, where the virus could be below the detection limit. The virus can infect latentemente B lymphocytes but also carrying out the lytic cycle as a percentage of the PBMC (with high numbers of copies of HVH-8 per infected cell and the presence of the virus in plasma), PBMC líticamente infected can help the spread of the virus towards targets in the pathogenesis of endothelial SK. The latency in the B lymphocytes in vivo and in lymphoma cells transformed by the HVH-8 (BCBL-1) could be regulated in different ways, such as different types of EBV latency. Some published studies have underestimated the presence of HVH-8 in blood. This thesis has been set conditions more suitable for the sampling and analysis of blood samples in order to obtain reliable results, and proposes a new methodology that will allow more in-depth detailed study of viremia by HVH-8 and its relevance the pathogenesis of KS and other illnesses associated with this virus.

Author: PAZOS PACHECO M. CARMEN.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: In the period April 2001 to June 2002, we studied 1053 sera from a total of 154 patients admitted to hematological neutropenic Hematology Service at the University Hospital on October 12, developed 11 cases of AI which were classified into five episodes AI tested, three episodes of AI and probably three episodes of AI possible, the estimated prevalence of HIV infection in 2.5% and 6 cases of CI, which were classified into three episodes IQ tested and teas episodes IC likely, with an estimated prevalence of this infection at 1.4%. We have validated the usefulness of different diagnosed serological markers, identifying which are herramientoas useful separately, but combining them, but does not improve the sensitivity of each test separately obtained is very useful to confirm the results verdadereos and false positives, and that presents a very similar kinetics. Something hopeful in the prognosis of the IFIs is that these markers were positivizan at an early stage before they have clinical evidence of infection. This precocity something more obvious with BG and the fact that it can detect other IFIs different from those caused by Candida spp. And Aspergillusspp allows its use as a tool for screning to begin the diagnostic work IFIs, so that when a positive result is detected in serum enable the establishment of an early therapy with antifungal drugs widely espectro.Esta positivity should be confirmed with the determination of GM and antibodies antimicelio, and where possible with PCR, in order to exclude a false positive and make a more accurate diagnostic approach.

Author: VALERO FERNÁNDEZ EVA M..
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: DPTO. MICROBIOLOGÍA I. FACULTAD DE MEDICINA.

Summary: Working in which determines the diversity and the persistence clonal isolation A.baumannii from the same hospital and obtained during three time periods, observandose of diversity was high and persistent low among clones sporadic, while diversity There was a low, the persistent high among clones endemic. We analyze the sensitivity to 21 antimicrobials. In comparing the activity of a number of antimicrobial against two isolates resistant carbapenemas, it is noted that the clinical isolates resistant carbapenemas are generally resistant to the main groups of antimicrobial CONSIDERED multidrug and that is the only antimicrobial colistin with very good in vitro activity against strains multiresistant, major groups antimicrobial CONSIDERED multidrug and that the only antimicrobial colistin is very good in vitro activity against strains multiresistant. By studying the relationship between the resistance phenotype and the genetic profile on the basis of susceptibility testing, we can conclude that the study of the patterns of phenotypic sensitivity / resistance has limited value in differentiating clones. It analyzes the presence of the gene blaIMP in resisting carbapemas, detection of this gene in most isolates selected for this, indicates that perhaps is underestimating the presence of these genes in Acinetobacter spp. Its ease of transmission to others strains and / or spices requires early detection of these genes to prevent the spread of potentially clones resistant carbapenemas. It is analyzed by sequencing, mutations in the genes gyrA and parC, strains with different sensitivity to new and old fluorquinolonas, indicating that these mutations alone do not explain the different sensitivities which have isolated the front wings quinolones, they there are other mechanisms of resistance. The study of combinations of antimicrobials, as a potential treatment strategies effective against A.baumannii multidrug indicates that the combinations sgatifloxacino-cefapima and clinafloxacino-cefepima may be a reference in the therapy of patients with serious infections caused by A.baumanni multidrug requiring these results corroborate through in vivo studies.

Author: VERA ALMENAR FÉLIX DE.
Year: 2004.
University: MIGUEL HERNÁNDEZ DE ELCHE [www.umh.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: 1 - The epidemiology of the infection Community observed is similar to the one described is literature. 2 - The use of dis per se does not alter the epidemiology of infections to hospital. 3, dis-exposure, the presence of resistant strains of E.coli which occur simultaneously, but that only seemed to relate cause when exposure to dis is very long existed.

Author: PEDREÑO LÓPEZ YOLANDA.
Year: 2004.
University: MURCIA [www.um.es].
Place of defense: FACULTAD DE BIOLOGÍA.
Place of preparation: UNIVERSIDAD DE MURCIA.

Summary: Candida albicans is a yeast opportunistic pathogen, whose clinical incidence has increased dramatically in recent years, mainly associated with the experienced huge increases in the population of immunocompromised individuals. The disaccharide trehalose is a very studied in yeast and filamentous fungi which plays a dual role: (i) carbohydrate reserves and (ii) compound protector of the integrity in a variety of situations of stress. The genes responsible for the biosynthesis and degradation of trehalose in C. Albicans (TPS1 and NTC1, respectively) have been cloned and sequenced. However, this pathogen contains a third gene activity trehalasa of unknown function, whose product is located on the cell surface. Previous work suggested that it could be one trehalasa acid. Identification and disruption of the gene ATC1. After tracking a database of the genome of C. Albicans (http://genolist.pasteur.fr/CandidaDB) proceeds from an ORF (PEI 19760/CA2574), which has a 41% homology with the trehalasa acid (Ath1p) Saccharomyces cerevisiae, according to the deduced amino acid sequence ( BLAST), was identified and named Atc1p (acid trehalase of Candida). To investigate the role of Atc1p, null mutants were constructed using the technique of "ura-blaster", which uses the tapes from disruption hisG: URA3: HisG replacing a portion of the ORF of ATC1. The selected transformants were analyzed by Southern blot to confirm that they had inserted the desired fragment in the locus of ATC1. Localization of the protein were analyzed by Western blot protéicas species of the various subcellular fractions using a polyclonal antibody obtained against a oligopéptido synthetic Atc1p. One species was detected molecular 170 KDa in SDS extract from the cell wall of the parental strain, but not in the mutant. The deduced amino acid sequence shows that Atc1p has a hydrophobic signal peptide and 19 potential sites of N-glicosilación. No differences were observed in the pattern of protein extracts from other. We conclude that ATC1 codifies, in C. Albicans, a protein associated with the cell wall of non-covalent binding. Phenotype: atc1/atc1 lacks activity trehalasa Acid: The measure of activity trehalasa acid in the sample cell extracts Wall absence, in the levels of detection of the assay, in the mutant of this void, and the decrease in the mutant heterocigótico respect the parental strain, indicating dependence on the dose of the gene ATC1. Atc1/atc1 does not grow on trehalose as a sole source of carbon: When parental strains, hetero and homocigóticas for mutation ATC1, were grown in medium containing glucose and performed a replica plate on a minimal medium with trehalose, the null mutant showed no growth, while in heterocigótico there was a noticeable decline in the parental strain. Amid liquid was repeated the same phenotype. Atc1/atc1 experiencing a lesser degree of filamentation: We used different inducers of filamentation; amid strong "Spider", and liquid "form of Lee" and "medium rich with human serum," 37Â ° C. In every way we see a marked decrease in levels of filamentation of mutant heterocigótico and sharper still in the void for the mutant gene ATC1. Patterns of expression of ATC1 The expression of ATC1 was examined by RT-PCR. The results indicate that the gene ATC1 shows a pattern of expression different depending on the source of carbon used, showing a higher level of expression when cells are grown with trehalose rather than with glucose. The 8 s data 6e7 match Test enzymatic activity, which measures activity trehalasa acid in the parental strain was an order 20 times in walls from growing crops trehalose with respect to glucose. Note that ATC1 is a gene regulated by catabolite repression by glucose, and that when making a RT-PCR from cells growing in minimal medium with trehalose as a source of carbon, which is suplementaron with glucose 4%, we note that the abundance of mRNA ATC1 suffered a significant decline after adding glucose. This decrease occurs in parallel with the rapid loss of activity trehalasa acid. Implication gene ATC1 in response to stress mutation homocigótica in gene ATC1 gives the C. Albicans greater capacity for resistance to oxidative stress, thermal and saline. The intracellular accumulation trehalose is a component of the mechanism of cellular response compared to various types of stress (oxidative, thermal and saline). However, there seems to be the determining factor.

Author: GARCIA SAENZ NATALIA.
Year: 2004.
University: SALAMANCA [www.usal.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: This is an epidemiological study, descriptive, cross-sectional observational multistage, national level. By applying a questionnaire with questions semi-closed and open implemented through a personal interview by appointment. The sample included: Doctors: Physicians General / Family and Geriatras in exercise total 262, of whom 60 were geriatricians and the rest of General Practice / Family. Simultaneously studied 583Prescripciones antimicrobial, conducted by doctors to geriatric patients infected community on the day of the interview, (2 prescriptions by MG / MF and 3 prescriptions per geriatra). OBJECTIVES  § Knowing the major infections in the elderly community and explore the antimicrobial prescriptions of doctors in these infections  § Evaluate the knowledge and attitudes of doctors in the main community for the elderly infections diagnosed on the day of the interview  § Establish differences between knowledge and behavior in clinical practice  § compare the fit between antibiotic prescriptions with the guidance provided in therapeutic guidelines for such infections CONCLUSIONS  respiratory infections, followed by urinary infections, the skin and soft tissue Gastrointestinal and the causes are more frequent doctor and requiring greater antibiotic prescription.  Doctors believe that the elderly have a pneumonia similar to the etiology of adult  As to the requirements antimicrobial there is a widespread use of fluoroquinolones for the treatment of urinary tract infections and also to the tract infections respiratory  Doctors PHC infraestiman the etiology of viral respiratory infections  The more active ingredients used, were amoxicillin / clavulanic acid, ciprofloxacin, amoxicillin, cefuroxime axetilo azithromycin, clarithromycin, and norfloxacino  This is the first time that relates the use of antimicrobials with the opinion and action of doctors in everyday clinical practice

Author: Ubeda Morant Carles.
Year: 2004.
University: CARDENAL HERRERA CEU [www.uch.ceu.es].
Place of defense: Universidad Cardenal Herrera-CEU, Valencia..
Place of preparation: Universidad Cardenal Herrera-CEU, Valencia..

Summary: Staphylococcus aureus is a pathogen responsible for a large number of infections. The ability of S. Aureus to produce disease is due to its ability to produce a wide range of virulence factors. Many of these virulence factors are encoded by mobile genetic elements as fagos, plasmids, and transposons pathogenicity islands (PIs). The PIs are characterized by large genomic regions (10-200 kb) with a G + C content in different genome in which they find themselves, are integrated into a specific site on chromosome of the bacteria, encode virulence factors, are flanked by direct repetitions and contain genes similar to those integrasas of fagos. To date there have described numerous islands of pathogenicity in S. Aureus (SaPIs). All of them presented in common 10-12 ORFs of unknown function in their region 3 'and genes encoding toxins in their region 5'. In this dissertation we describe SaPIbov2 a new pathogenicity island of St. Aureus, identified in clinical isolates of bovine origin. SaPIbov2 is flanked by direct repetitions of 18 nt, is located adjacent to the gene gmps on chromosome S. Aureus, contains a integrasa (SIP) and a transposón in their region 5 ', which contains the gene bap involved in the formation of biofilm. Our studies indicate that the presence of SaPIbov2 favors the persistence of the bacterium in a pattern of infection in the mammary gland. On the other hand we show that SaPIbov2, is mobile because it is capable of splitting, circularizar and integrated into your site-specific integration into the chromosome of the bacteria through the activity of his own integrasa (SIP), these mechanisms remain independent system RecA the bacterium. Furthermore we find different clinical isolates containing PIs with integrasas similar to Sip but different pathogenic factors, suggesting the existence of a family of related mobile pathogenicity islands. On the other hand we show that the induction cycle lytic phage artificial f80a and at least two fagos natural f11 and f147 following the activation of the SOS response in bacteria, induces replication SaPIbov1. Subsequently, the island is encapsidada in cápsides special smaller and very efficiently transferred to other bacteria. In the same way SaPIbov2 is also replicated and transferred very efficiently by the phage f80a. The mutacional analysis of the genes of SaPIbov1 present in the common area between SaPIs indicated that the vast majority of the genes were involved in the replication process and transfer of the island. On the other hand each of the mutants of the island could be supplemented with SaPI1, an island that has many genes in common with SaPIbov1, suggesting that SaPIs present a common mechanism of horizontal transfer. Finally, the induction of profagos activation of the SOS response through commonly used antibiotics, such as fluoroquinolones and specifically ciprofloxacin, also induced replication and high transfer both SaPIbov1 as SaPI1, suggesting that the use of such antibiotics would promote the spread of bacteria between virulence factors encoded by SaPIs. Although strains containing these profagos do not normally contain SaPIs, we have encountered in strain RF122-1, the original clinical isolate containing SaPIbov1, a second island of pathogenicity to be replicated after the induction of profagos residents after activation the SOS response by treatment with antibiotics. Although SaPIbov1 not replied after induction in this strain of the SOS response, it could be transferred through fagos activated by the antibiotic. Therefore, we concluded that the induction of the SOS response by therapeutic agents can promote the spread of virulent factors staphylococci.

Author: FERNÁNDEZ TORRES BELCKYS.
Year: 2004.
University: ROVIRA I VIRGILI [www.urv.cat].
Place of defense: FACULTAT DE MEDICINA I CIÈNCIES SALUT.
Place of preparation: UNIVERSIDAD DE SANTIAGO DE COMPOSTELA.

Summary: The dermatophytosis likely to affect the quality of life in a significant manner, the infection can persist for years due to available therapy is not very effective. This problem is really important in the case of onychomycosis or dermatophytosis chronic often accompanied by therapeutic failure. Some dermatophytosis tend to chronicity, which leads to increased consumption of antifungals, and po both an important health spending in both the public and staff. To try to alleviate this problem, new antifungal agents have been developed in recent years which has generated interest in the need to be able to assess how reproducible sensitivity to antifungal dermatophytes. However, at present there are no standard methods for assessing the in vitro activity of antifungal these fungi. Taking into account all these considerations, we are committed to develop and standardize various methods to prove to be practical and useful in determining the sensitivity of the antifungal dermatophytes. In this thesis, we studied a large number of strains of dermatophytes including almost all species that make up this group of fungi, as well as we have tested a large number of antifungal either already marketed or synthetic pilot. Among the methods tested include methods microdilution, agar dilution and distribution disks. We have also adapted some business methods for yeast and the Etest ®, and Sensititre YeastOne. We have also studied different variables that affect the minimum inhibitory concentrations of antifungal well as the culture medium, the concentration of inoculum, the incubation temperature, incubation time, or the point of reading ..

Author: PALANCA GIMENEZ MATILDE MARÍA.
Year: 2004.
University: GRANADA [www.ugr.es].
Place of defense: FACULTAD DE MEDICINA DE LA UNIVERSIDAD DE GRANADA.
Place of preparation: FACULTAD DE MEDICINA DE LA UNIVERSIDAD DE GRANADA.

Summary: We have managed to develop a Western Blot test to detect anticuerps face chlamydophila pneumoniae, which has been implemented in serum samples from subjects with peripheral arterial disease (PAD). The subjects studied belonging to the cases and controls were comparable, as they are controlled in the design, variablilidad of factors age, sex, smoking and obesity. The most important contribution of this study stems from the simultaneous analysis of different tests that evaluate the relationship between infection c. Paneumoniae and the CAS. Using a nested PCR test the DNA of C. Peneurmoniae was detected by leaps and bounds in the case. Through MiFID and Elisa, the IGG anti-ce was most prevalent in cases that DNA was detected. Using a Western Blot was found in commercial cases IGG a significant presence of anti-39 and Anti-54 KD, which is related to the results meidante MiFID and DNA, as well as IGA anti-LPS, anti-92 KD and anti - hsp60, the latter was not related to the presence of DNA of the bacterium. When used Western blot test "in house" noted the presence of gangs and IGG IGA versus antigens different molecular weights, highlighting bands IGG compared with antigens 128.8 and 9.2 KD, because coexisted in a meaningful way with the DNA of the bacteria and the presence of the CAS. It could be that the antibodies in cases reflect an early stage of infection with the presence of DNA and IGG specific anti-128, 8,54,39 and 9.2 KD. Subsequently, even in the absence dela bacterium can develop the disease so inmunomediada. Based on this we can conclude that the infection is significantly related to the disease are justified further investigation.

Author: POLO TORCAL CAROLINA.
Year: 2004.
University: BARCELONA [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Study of the urinary excretion of human poliomavirus BIC and JC in immunocompetent adults and children and the interstitial nephritis in renal transplant patients and hemorrhagic cystitis in patients undergoing a transplant of recursores haematopoietic.

Author: GARDUÑO ESEVERRI EUGENIO.
Year: 2004.
University: EXTREMADURA [www.unex.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: This paper is a study of the factors of pathogenic Candida parapsilosis, a yeast that becomes increasingly more prominent role in human clinic. It was the second most frequently isolated species in samples of domestic origin (blood, catheter tip, etcâ |) showing a good sensitivity to antifungal studied (amphotericin B. fluconazole, itraconazole, ketoconazole, flucytosine and voriconzal). It analyzed the hidrogobicidad surface cell (HSC) 31 strains noting that unlike C.albicans shown hidrogóbica or hidrogilica depending on the temperature growth, C.parapsilosis maintains high levels of HSC both temperatures. It also study the adhesion of C.parapsilosis to poliesterineo, noting that the incubation temperature is a key factor, because when the microorganism in contact with the surface 24 has 22Â ° C, the bond was significantly higher than 37Â ° C. It was demonstrated that the HSC is linked to adherence, and that strains very hydrophobic, the burden of yeast surface participates in the process. Some materials used in biomedicine (latex, PVC and silicone) strains hydrophobic stick with more avidity to the polymer, silicone being the most responsive to the membership. C.parapsilosis also is capable of producing biocapas when it grows amid nutritious, putting in evidence that strains with low values HSC showed always biocapas zero or very weak, while the strains were able to form biocapas dense were always hydrophobic. Finally, we demonstrate that C.parapsilosis produces aspartyl proteases to 37Â ° C, and that ritonavir produced inhibition of enzyme activity.

Author: JOVER BOTELLA ALEJANDRO.
Year: 2005.
University: MIGUEL HERNÁNDEZ DE ELCHE [www.umh.es].
Place of defense: FAC.DE MEDICINA.CAMPUS S.JUAN. U.M.H..
Place of preparation: DEPARTAMENTO PRODUCCION VEGETAL Y MICROBIOLOGIA. FACULTAD DE MEDICINAD.

Summary: The incidence of invasive fungal infections (IFIs) have been increasing significantly in recent decades. The main reason is that a growing number of patients with some form of immunosuppression or with different levels of immunocompromise. At present, many efforts are focused on developing new diagnostic tools based on the detection of nucleic acids more sensitive, specific and rapid techniques conventional microscopy, cultivation methods and molecular immunology mainly based on the detection of nucleic acids, field in that great advances have been achieved. In this study we evaluated and optimized a rapid and sensitive method for the detection of fungi in clinical samples based on the amplification by PCR semi-anidada with subsequent DNA sequencing. For this we use three different regions of the ribosomal complex that enabled us to make molecular diagnosis of IFIs based on two different strategies for the detection of fungi: identification oriented, using primers specific for Aspergillus spp (AFU7/AFU5) and Candida albicans (CTSR / CADET / CTSF), and identification is not targeted by primers panfúngicos (ITS1/ITS4/ITS86). First is optimized for all these amplification primers their reactions in order to obtain the greatest possible sensitivity testing different concentrations of primers and number of cycles. Then cuantificamos sensitivity of our diagnostic method through a trial in water and various human tissues, allowing us to test their usefulness in the detection of fungi in different types of clinical specimen (blood, cerebrospinal fluid, ascitic fluid, pleural fluid and bronchoalveolar lavage) . The sensitivity of the technique to C. Albicans was 1 célula/500 Â µ l with primers ITS1/ITS86/ITS4 in all tissues tested. For Aspergillus niger sensitivity was 1 conidia/500 Â µ l in water and LBA, 10 conidias/500 Â µ l in pleural fluid and 100 conidias/500 Â µ l in the blood. Subsequently evaluated the diagnostic method oriented model experimental infection in mice which enabled it to assess the evolution of infectious process characterized by a decrease in the fungal load in the tissues of mice due to its high sensitivity and specificity. Finally, we applied the method diagnosis is not oriented in a study that included a total of 228 clinical samples with suspected fungal infection. The diagnosis was applied oriented in some specific cases, to confirm the diagnosis and follow-up of some patients. The percentage of positive samples for PCR semi-anidada was higher than for farming (31.6% vs. 19.3%), hence the sensitivity of the PCR semi-anidada with universal primers was higher than that shown by the cultivation. The species most commonly identified by sequencing, as happened for cultivation, were Candida albicans and Cryptococcus neoformans, 27 and 8 cases, respectively. In addition to these common pathogens, identification not geared allowed the detection and identification of emerging pathogens such as Fusarium proliferatum and other less frequent as Cryptococcus gattii, among others. The similarity in terms of detecting fungal infection among crop and CRP was higher than 83% and matching sequences analyzed using molecular biology to the identification by crop was 97.5%, which allowed us to validate the accuracy of our technique in front of the crop. Moreover, the speed in obtaining diagnosis was superior to the art molecular can reach an identification of the causative agent in 24 hours. In this paper, we have proposed a method rápi 8 do, sens 354 ible and specific for the diagnosis of IFIs. The future of diagnosing the IFIs passes through the standardization of these and other molecular techniques and their use in combination with the immune.

Author: Hernández Rodríguez Águeda.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: Universitaro Germans Trias i Pujol.
Place of preparation: H.Unv.Germans Trias i Pujol.

Summary: Nosocomial Infections (IN) cause high morbidity and mortality and a heavy workload for staff and a high economic cost. Effective use of biocides, antiseptics and disinfectants, together with disinfection of medical devices and surfaces, hand washing and techniques barrier, are preventive measures such IN. The development of studies on the activity antimicrobina, enabling the selection of effective biocidal products can make a major improvement in the fight against IN. We studied in vitro antimicrobial activity of peracetic acid at 0.26% (Perasafe ®) compared with alkali to 2% glutaraldehyde (Cidex ®), compared with Mycobacterium avium- Mycobacterium intracelulare (MAI), Mycobacterium tuberculosis H37Rv, Mycobacterium fortuitum and Mycobacterium chelonae. Perasafe ® was micobactericida and tuberculocida (reduction factor? 5 log10) in 20 min. Contact; while Cidex ® was in 30 minutes. Exposure. MAI was micobacteria more resilient. They also demonstrate the effectiveness of Perasafe ® compared with Cidex ® for disinfecting broncoscopios contaminated experimentally with M.tuberculosis H37Rv and MAI. Both products get a reduction factor? 5 after 10 min. Contact front of M.tuberculosis, and after 20 min. Compared with MAI. Thus, as shown by in vitro studies and "use sham," Perasafe ® is a high-level disinfectant effective against mycobacteria and is a possible alternative to the 2% glutaraldehyde in alkaline disinfecting broncoscopios. We assessed the antimicrobial activity compared to M.tuberculosis H37Rv, MAI, M.kansasii and M.chelonae of Korsolex ® AF. The concentration of 1% was effective against all mycobacteria tested in 60 minutes. Contact. These data suggest that the products containing biocides amines could be useful in disinfecting intermediate and high level of medical devices. Acinetobacter baumannii is noted for its ability to develop and transmit antimicrobial resistance and for being an emerging nosocomial pathogen difficult to eradicate. We studied 9 strains multiresistant with progressive acquisition of resistance to beta lactam antibiotics isolated in the course of an outbreak. To do this, a study was carried out quantitative suspension according to the European Standard EN 1040. All strains A.baumannii were sensitive to all antiseptics (Sterillium ® 2 formulations alcoholic not sold Hibiscrub ® and Clorina ®) and disinfectants evaluated (Virkon ® and Instrunet superficies ®). It was found that resistance to beta lactam antibiotics in multiple strains of A.baumannii not associated with resistance or sensitivity to declining biocides. On the other hand, we have analyzed the spectrum of antimicrobial activity of Virkon following the AFNOR standards. The results show that Virkon ® 1% is a low-level disinfectant as a biocide with antimicrobial effect rapid (5 min.) Against vegetative bacteria (gram-positive and gram-negative bacteria), yeast, viruses and non-tuberculous mycobacteria in quantitative tests suspension, but only bactericidal in Tests portagérmenes. Finally, we evaluated the efficacy of a compound chlorine (Solprogel ®), compared to HIV-1 and HBV. The activity virucida of HIV-1 was established through a trial of infectivity in cells MT-2 and HBV by measuring the inhibition of the activity of DNA polymerase (DNA-P). In both cases, the antimicrobial activity of Solprogel ® was compared with that of the dicloroisocianurato sodium (NaDCC). Solprogel ® and NaDCC, at a concentration of 120 ppm and 100 ppm available chlorine, respectively, inhibit HIV-1 in 5 min. Contact. The DNA-P HBV was sensitive to inhibition by the two disinfectants, requiring 960 and 1 8 .000 ppm 2dc chlorine available to Solprogel ® (16%) and NaDCC respectively and a minimum exposure time of 2 min.

Author: Escorial Briso-Montiano María.
Year: 2005.
University: VALLADOLID [www.uva.es].
Place of defense: Faculatad de Medicina de Valladolis..
Place of preparation: Facultad de Medicina, Universidad de Valladolid.

Summary: The epidemiology of infections by Bartonella henselae is one of the health problems unresolved in many respects unknown what the real prevalence of infection in the general population and in different population groups theoretically have a higher risk of infection. There are few studies on the global front to Bartonella henselae infection in healthy people and this is highly variable (2-50%) according to geographic areas. In this study is a review of the current status of infections Bartonella henselae (taxonomy, pathogenesis and diagnostic) and discusses the seroprevalence compared with Bartonella henselae in a representative sample of the healthy population of Castilla y Leon (2.8 %) compared with the seroprevalence of groups with potential associated risk factors for acquiring infection with this microorganism (destitution, dorgadiccción, prostitution, provenance rural versus urban and partnership with other infections such as HIV, hepatitis B and C and syphilis). Among the findings include an increased prevalence in the grups carrying some risk factor compared to the healthy population of Castile and Leon.

Author: VIARCE TORRES DE MIER MARIA DE.
Year: 2005.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The pneumonia associated with mechanical ventilation (NAV) is a very common and very serious in intensive care units. His early and appropriate treatment is crucial and critical for the evolution of the patient. Anticipating information microbiological reliably and effectively must entail an anticipation on the adjustment of antibiotic therapy. Our work suggests microbiological forward with information in the form of an antibiogram done with E-test strips directly applied on the samples obtained from the lower respiratory tractor. This advance information on the microbiological favors the choice of appropriate antibiotic therapy coming and this has an impact clinical, therapeutic, and economic evolutionary favorable in patients with NAV measured; fewer days per episode of fever, fewer days and less defined daily doses antibiotic necessary for the resolution of the table, a better match of antibiotic treatment, less spending on economic antimicrobial therapy, fewer episodes of diarrhea associated with Clostridium difficile, and fewer days in mechanical ventilation from diagnosis of NAV.