Hospital De La Princesa Research Articles

Estudio comparativo de los factores de riesgo y pronósticos de mortalidad en las bacteriemias-fungemias polimicrobianas de un hospital universitario: evolución en 10 años

Eighty-two episodes of polymicrobial bacteremia in two time periods, 1986-87 and 1996-97, were compared to assess differences in risk factors and outcome to mortality. A prospective, concurrent, anterograde study with univariate analysis of all episodes of polymicrobial bacteremia was performed in Hospital de la Princesa. Logistic regression analysis was applied to all significant variables (p < 0.05) in the univariate analysis in either of the two time periods. Variables showing statistically significant differences in incidence between the two time periods included the following: hospital acquired bacteremia; previous use of antibiotics; genitourinary, respiratory and cardiovascular manipulations; septic metastases; and absence of leukocytosis. These factors were more frequently present during 1986-87 than during 1996-97. The overall RR of outcome to mortality was five-fold greater during the first period than the second: RR 5.6 (CI 1.76-17.56) p < 0.001. The clinical characteristics at the onset of bacteremia associated with mortality in the first period were: underlying disease - < RR 2.20 (CI 1.18-4.08), steroid treatment - < RR 4.24 (CI 0.68-26.59), hypotension - < RR 2.05 (CI 1.0-4.17), and disseminated intravascular coagulation - < RR 2.31 (CI 1.69-3.35). Clinical characteristics at the onset of bacteremia associated with mortality in the second period were: hypotension - < RR 1.44 (CI 1.01-2.08), underlying disease - < RR 1.16 (CI 1.02-1.34), and disseminated intravascular coagulation - < RR 6.40 (CI 1.15-35.69). The variables independently associated with mortality in polymicrobial bacteremia were: period - < RR 2.05 (CI 1.50-2.10), underlying disease - < RR 7.05 (CI 2.68-7.50), hypotension - < RR 7.06 (CI 3.80-7.29), and (probably) vascular manipulations - < RR 3.41 (CI 0.85-4.53). Polymicrobial bacteremia-associated mortality was five-fold greater in 1986-87 than in 1996-97. The variables independently associated with mortality risk were underlying disease, hypotension, the period studied (which would include a number of variables not analyzed in this work) and, probably, vascular manipulations.

Biochemical characterization of chromosomal cephalosporinases from isolates belonging to the Acinetobactet baumannii complex

Members of the Acinetobacter baumannii complex have emerged as some of the most important opportunistic pathogens within the hospital environment, being able to colonize and produce infections in most immunocompromised patients, especially in intensive care units (ICUs). Such infections are difficult to treat due to their multiple resistance to the antibiotics currently available for the treatment of nosocomial infections [1]. Various mechanisms of resistance to b-lactams have been identified in this genus, including b-lactamase production, alteration of penicillin-binding proteins, and reduced levels of penetration across the outer membrane. b-Lactamase production is one of the main mechanisms of resistance to b-lactams in Acinetobacter spp. [2,3]. Such enzymes can be either plasmid-encoded penicillinases (TEM and CARB type) or chromosomal cephalosporinases. The exact nature and character of these latter enzymes are not fully clarified for Acinetobacter spp. They belong to the group 1 b-lactamases of the classification of Bush et al [4], but several authors have found heterogeneity among the Acinetobacter cephalosporinases [5,6]. In the present work, the cephalosporinases produced by 125 strains belonging to the A. baumannii complex were characterized by determination of their pI values, b-lactamase inhibition profiles and substrate profiles. Clinical isolates (N1⁄4 125) belonging to the A. baumannii complex, obtained in the Hospital de la Princesa (Madrid, Spain) from January 1995 to December 1997, were studied. The isolates were identified by the API 20NE system (BioMerieux, Lyon, France) and growth at 44 8C [7]. Minimal inhibitory concentrations (MICs) and susceptibility percentages of 15 b-lactam agents were determined by an agar dilution method, as recommended by the National Committee for Clinical Laboratory Standards [8]. A. baumannii ATCC 19606, Escherichia coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853 were used as reference strains. b-Lactamase activity was detected in crude enzymatic extracts by the hydrolysis of nitrocefin (0.5 mg/mL). The pI values were determined by isoelectric focusing (IEF) (Multhiphor II Electrophoresis System; Amersham Pharmacia Biotech, Uppsala, Sweden), on wide-range ampholine (pH range 3.5–9.5) polyacrylamide gels; in some cases a narrow-range ampholine (pH 5.5–8.5) was used. The percentage of inhibition of the following inhibitors was studied at fixed concentrations for 43 enzymatic extracts: clavulanic acid (10 mM), sulbactam (20 mM), cloxacillin (4 mg/mL), aztreonam (1.148 mM), NaCl (140 mM) and EDTA (0.1 mM). This assay was performed as described by Papanicolaou et al [9] with several modifications. After incubating the extracts with nitrocefin solution, the changes in optical density at a wavelength of 492 nm were measured at 2, 5 and 10 min, and subsequently at 10-min intervals for 40 min. Duplicate determinations were performed for each extract. Sixteen crude enzymatic extracts were selected to study the substrate profile of the b-lactamases. Two methods were used. First, hydrolysis of the following b-lactams by the crude extracts was studied with a microbiological assay as described by Paton et al [10]: ampicillin, cefazolin, oxacillin, carbenicillin, cefuroxime, cefotaxime, ceftazidime, imipenem and meropenem. OXA-2 and TEM-1 were used as control enzymatic extracts. Staphylococcus aureus ATCC 25923 and E. coli ATCC 25922 were used as hydrolysis control strains depending on the antibiotic tested. Second, assay UV spectrophotometry was used to study the hydrolysis rate of cephaloridine, benzylpenicillin, cefotaxime, ceftazidime, imipenem, meropenem, carbenicillin and oxacillin. Duplicate determinations were performed for each enzymatic extract, with concentrations of either 100 mM or 1 mM. Hydrolysis rates were expressed as a percentage of hydrolysis with respect to cephaloridine. A high percentage of susceptibility was found to imipenem, meropenem and ampicillin–sulbactam (100%, 100% and 84%, respectively); however, low susceptibility was shown to most penicillins (piperacillin, 8%; ticarcillin, 18.4%), and cephalosporins (cefotaxime, 4.8%; ceftazidime, 11.2%; cefepime, 12.8%). Isoelectric focusing showed a unique band of pI> 8

Lymphocyte traffic and homing in autoimmune thyroid disorders.

Journal Article Lymphocyte traffic and homing in autoimmune thyroid disorders Get access M Marazuela M Marazuela Endocrinology Service, Hospital de la Princesa, Universidad Autónoma, Madrid, Spain Correspondence should be addressed to M Marazuela, Servicio de Endocrinologia, Hospital de la Princesa, Diego de León 62, Madrid 28006, Spain Search for other works by this author on: Oxford Academic Google Scholar European Journal of Endocrinology, Volume 140, Issue 4, Apr 1999, Pages 287–290, https://doi.org/10.1530/eje.0.1400287 Published: 01 April 1999 Article history Received: 02 December 1998 Accepted: 14 December 1998 Published: 01 April 1999

Tumor DNA content as a prognostic indicator in squamous cell carcinoma of the oral cavity and tongue base.

Nuclear deoxyribonucleic acid (DNA) content is a prognostic factor in several tumors, and decisions regarding treatment have been made using this parameter. Nevertheless, there is no agreement in head and neck cancer. The purpose of the present study was to ascertain whether tumor DNA content correlated with prognosis in cases of primary squamous cell carcinoma (SCC) of the oral cavity and tongue base. A retrospective study of formalin-fixed, paraffin-embedded tissue from patients with histologically confirmed SCC of the oral cavity and tongue base was performed using flow cytometry. Tumor DNA content was studied in 109 sets of specimens from previously untreated patients. All of them underwent surgical resection at the University "Hospital de La Princesa" between 1982 and 1992. Clinical parameters (age, sex, site of primary tumor, clinical stage, adjuvant therapy received, and disease-free and overall survival) and histologic parameters (histopathologic stage, tumor differentiation, type of inflammatory infiltration, presence of perineural invasion) were recorded in all cases. An exhaustive statistical analysis was applied. Only the histograms of 93 patients were adequate for consideration. In flow cytometric analysis, DNA aneuploidy was observed in 51 tumors (55%). The proportion of aneuploid tumors was significantly higher in advanced-stage carcinomas (p < .05), tumors with perineural invasion (p < .05) and in men (p < .05). In the 24 patients with lymph node metastasis, the incidence of aneuploidy was 82% (19 of 24) (p < .05). The rate of metastasis and aneuploidy increased as the degree of differentiation decreased (p < .05 for both). Patients with aneuploid carcinomas in both early and advanced stages had shorter relapse-free and overall survival periods than did the patients with diploid tumors (p < .001 for both). A Cox regression analysis demonstrated that ploidy was the single most important prognostic factor in determining relapse and death (p < .001 for both). The results indicate that tumor DNA analysis by flow cytometry appears to be useful as a supplement to clinical and histologic evaluation in predicting the tendency of SCC of the oral cavity and tongue base to metastasize to regional lymph nodes and to predict the outcome of the disease.

The development of autoantibodies can interfere the therapeutic response to interferon (IFN) in chronic hepatitis C (CHC): [formula omitted] Liver and Molecular Biology Units, Hospital de la Princesa, Universidad Autónoma de Madrid, Spain

The development of autoantibodies can interfere the therapeutic response to interferon (IFN) in chronic hepatitis C (CHC): [formula omitted] Liver and Molecular Biology Units, Hospital de la Princesa, Universidad Autónoma de Madrid, Spain

Subtypes of autoimmune hepatobiliary — overlap syndrome (AH-OS): [formula omitted]. Liver Unit and Pathology Service, Hospital de la Princesa, Universidad Autónoma de Madríd, Spain

Subtypes of autoimmune hepatobiliary — overlap syndrome (AH-OS): [formula omitted]. Liver Unit and Pathology Service, Hospital de la Princesa, Universidad Autónoma de Madríd, Spain

Expression of transferrine receptors in inflamed gastric mucosa and its relation to Helicobacter pylory infection : A. M. Terrés, M. García Buey, J.M. Pajares. Gastroenterology Department, Hospital de La Princesa. U.A.M. Madrid, Spain

Expression of transferrine receptors in inflamed gastric mucosa and its relation to Helicobacter pylory infection : A. M. Terrés, M. García Buey, J.M. Pajares. Gastroenterology Department, Hospital de La Princesa. U.A.M. Madrid, Spain

Impaired natural killer cytotoxicity in peripheral blood mononuclear cells in Graves' disease.

We studied the natural killer (NK) activity of peripheral blood mononuclear cells (PBMC) in patients with Graves' disease (GD). Peripheral blood mononuclear cells from 20 untreated hyperthyroid patients with GD showed a significantly reduced NK activity against 51 Cr-labeled K562 cells (33.9 +/- 15.9%), while in 32 euthyroid patients under antithyroid drug therapy. NK activity was similar to that of controls (46.9 +/- 17.3 and 49.9 +/- 20.2%, respectively). Furthermore, normalization of thyroid function with antithyroid drugs was associated with a significant increase and normalization of NK activity during the follow-up of nine GD patients (from 29.2 +/- 17.9 to 48.1 +/- 16.5%). This phenomenon could not be ascribed to a defective number of NK cells because the amounts of CD56+ and CD16+ cells in PBMC from both hyperthyroid and euthyroid GD patients were within normal ranges. Natural killer activity of PBMC from patients with toxic multinodular goiter was similar to that of normal controls (45 +/- 12.8 to 49.9 +/- 20%). No correlation was found between natural killer activity and serum levels of free thyroxine, TSH-inhibitory immunoglobulins, thyroidal antibodies to thryoglobulin and thyroidal microsomal antigen, dose or duration of antithyroid drug therapy. Natural killer activity from both controls and GD patients was enhanced in vitro by addition of recombinant interleukin 2 (IL-2), reaching control levels in hyperthyroid patients. These abnormalities were not associated with a defective IL-2 production by T cells, nor with a decreased IL-2R expression. We conclude that in untreated Graves' disease there is a decrease in NK cell activity in PBMC, probably dependent on the autoimmune process.(ABSTRACT TRUNCATED AT 250 WORDS)

High-level quinolone resistance amongst clinical isolates of Escherichia coli and Klebsiella pneumoniae from Spain.

A recombinant plasmid containing gyr A encoding wild-type Escherichia coli quinolone susceptible DNA gyrase A subunits has been used as a broad host range gene probe. Strains expressing gyr A-mediated quinolone resistance become susceptible to quinolones upon insertion of the plasmid, whereas the plasmid without gyrA (pLA2917, vector) has no effect. Fifteen highly ciprofloxacin-resistant E. coli and three Klebsiella pneumoniae (MICs 2-64 mg/L) were isolated from clinical specimens in the Hospital de la Princesa, Madrid, Spain. Plasmid pNJR3-2 and pLA2917 were introduced into the clinical isolates by conjugation, and transconjugants selected with tetracycline or kanamycin (for which the plasmids encode resistance). Ten transconjugants from each mating, the original isolates, the gene probe and vector control were screened for susceptibility to nalidixic acid, ciprofloxacin, ofloxacin, norfloxacin, tetracycline, chloramphenicol, cefoxitin and trimethoprim. Lower MICs of quinolones were seen for the transconjugants of two K. pneumoniae isolates in the presence of the gene probe, suggesting that these isolates harboured mutations in gyr A. Plasmid profiles confirmed the presence of the probe. The susceptibility of the third K. pneumoniae strain and all E. coli isolates were unaffected by insertion of the plasmid, suggesting another mechanism was responsible for quinolone resistance.