1. Epidemiology and molecular bases of antimicrobial resistance in Gram-negative and Gram-positive bacteria of clinical interest.
Much of the research activity of our group focuses on the study of genetic and biochemical aspects of antimicrobial resistance mechanisms of greatest clinical interest (mainly beta-lactams, quinolones and aminoglycosides) in a range of resistant bacteria, particularly Gram-negative organisms such as enterobacteria (Escherichia coli, Klebsiella pneumoniae, Enterobacter spp.) and non-fermenting organisms such as Pseudomonas aeruginosa, Actinetobacter baumannii and the Burkholderia cepacia complex, among others. In the case of the Gram-positive bacteria, the group focuses mainly on the study of characterization of the genetic elements involved in antibiotic resistance and its dissemination in multiresistant enterococci, mainly Enterococcus faecalis and Enterococcus faecium. Specifically, we are interested in the mechanism of conjugation of various mobile genetic elements including pheromone response plasmids, which are found in almost 95% of the clinical strains of E. faecalis associated with hospital outbreaks and that can be transferred with a frequency of 100%. Similarly, we are studying the resistance to antimicrobials in different species of corynebacteria, such as Corynebacterium diphtheriae, C. amycolatum, C. xerosis, and C. jeikeium, since many of the clinical isolates of these species are resistant to several antibiotics.
2. New diagnostic-epidemiological methodologies and in vitro activity of new antimicrobials.
The molecular diagnosis of infectious diseases has become an indispensable tool in our group. The Microbiology Service has included the sequencing and direct detection of genes related to the microbial taxonomy and antibiotic resistance mechanisms, and has initiated the first steps for the implementation of massive sequencing techniques with promising applications in multiple fields such as analysis phylogenetic of epidemiological outbreaks or studies of human microbiomes and their possible relationship with different pathologies. Our group also participates in multi-center projects and clinical trials for the evaluation of new antimicrobials. We also participate in the evaluation with reference methods of automated antibiogram systems, especially when these systems incorporate new antimicrobials.
3. Mechanisms of pathogenicity and pathogen / host interactions in gram-negative bacteria of clinical interest.
Responding to the need for studies on the mechanisms of interaction with host cells and resistance to antimicrobials, our group develops a multidisciplinary research on host-pathogen interactions, mainly in Acinetobacter, Pseudomonas aeruginosa and Burkholderia cepacia species. For this, our group is involved in the identification of the main regulators involved in the perception of environmental signals through "quorum sensing", which induce the formation of biofilms and their dispersion and also in the characterization of the molecular determinants that contribute to the virulence, as are the bacterial secretion systems
4. Infections by multiresistant microorganisms in patients transplanted from solid organs and hematopoietic progenitors.
This line of research started in 2012 is being consolidated in our group mainly through the acquisition of competitive financing research projects (FIS - PI13 / 01191 - PI16 / 01415 and Mutua Madrileña FMM 14/01) as well as with participation in projects of Pathology Network of Investigation in Infectious Pathology (REIPI) and European Projects (Increment-SOT).
5. Epidemiology, microbiological and clinical diagnosis of Cardiovascular and Osteoarticular Infections
Among the cardiovascular infections, the creation of the Multidisciplinary Endocarditis Group in 2008, in which the Infectious Diseases, Microbiology, Cardiology, Cardiovascular Surgery, Domiciliary Hospitalization and Internal Medicine of the H.U. Marques of Valdecilla, H. Sierrallana and H. de Laredo are participating. Our group has managed since the creation of the Support Group for the Management of Endocarditis in Spain (GAMES) in 2007, one of the 7 nodes in which the 44 participating hospitals have been divided. In these 11 years of collaboration has contributed to a better knowledge of endocarditis in Spain that is impacting on a better approach both diagnostic and therapeutic.
In the case of osteoarticular infections, we have focused mainly on the study of joint prosthesis infections, which began in 2009 with the execution of the Research Project: PI 08/0609 where the study of the role of the sonicate in the diagnosis was introduced of joint prosthetic infections (in conjunction with the Traumatology and Orthopedics and Microbiology Services). The results have had as a positive consequence the incorporation into the routine of the Microbiology laboratory of said technique. Next, and thanks to API 11/09, the study of Systemic Markers is being carried out in the diagnosis and evolutionary control of Knee or Hip Prosthesis Infection (IPRC) prior to the removal of the implant.
6. Optimization of antimicrobial treatment and its impact of antibiotic consumption on cost savings and bacterial resistance.
The excessive and inadequate use of antimicrobials is currently an important public health problem, due to the emergence of microorganisms increasingly resistant to available antibiotics, as stated in the National Plans against Resistance to Antibiotics 2014 -2018 and 2019-2021, prepared by the Ministry of Health, Consumption and Social Welfare (MSCBS) in collaboration with the Ministry of Agriculture, Fisheries and Food (MAPA) and under the coordination of the Spanish Agency for Medicines and Health Products (AEMPS) ). This line of research started in 2006 with the award of two research projects (FIS: PI06 / 90094 and API: 06/01), and that has received the award for teaching excellence Valdecilla Caja Cantabria in 2013 aims to achieve through recommendations and training on the use of antimicrobials in a standardized way, by a person with experience in this area and the result of a multidisciplinary collaboration, an appropriate use of antibiotics. The experience accumulated in the Marqués de Valdecilla Hospital has been transferred to other hospitals for 6 years by teaching specialist physicians from National hospitals who come to the Infectious Diseases Service to be trained.