Legionella

This is the group's most established line of work, still active and robust today. It was initiated in 1990 following the award of its first project, aimed at studying the source of nosocomial Legionellosis at Germans Trias i Pujol University Hospital (HUGTiP). The progressive and growing involvement of clinical and basic professionals has enabled the expansion of the laboratory through the adoption of new techniques. These techniques range from the bacteriological isolation of the microorganism, determination of the intracellular activity of biocides targeting the colonisation of sanitary water systems, antibiotics aimed at Legionella infecting pulmonary macrophages, to molecular epidemiology techniques designed to identify the source of a case or outbreak of legionellosis. This line is led by Dr Noemí Párraga-Niño and Dr M. Luisa Pedro-Botet.

Currently, this laboratory holds prestigious responsibilities such as:

• An agreement with the Catalan Government (Directorate-General for Public Health) to establish the source of infection in cases and outbreaks of legionellosis.
• A contract with a private company for the modification of a molecule contained in an essential oil, which is highly effective against both intra- and extracellular Legionella and exhibits excellent stability in the presence of heat, making this molecule a promising solution against environmental colonisation of Legionella.
• The laboratory is working closely with the Respiratory Section of the Microbiology Laboratory at HUGTiP to improve the recovery of Legionella in clinical respiratory samples.
• The laboratory has an experimental water conduction model to evaluate the activity of biocides against Legionella in both planktonic and biofilm phases.

The group's scientific output has established it as a leading authority of national and international prestige in the field of legionellosis.

Nosocomial pneumonia outside the ICU

Pneumonia is one of the most prevalent nosocomial infections. Although nosocomial pneumonia reaches its highest prevalence in the ICU and among intubated patients, three-quarters of cases occur in conventional hospital wards, where it leads to high morbidity and mortality. Oropharyngeal dysphagia is the primary mechanism, and measures aimed at preventing micro- or macroaspiration in this context have proven crucial in reducing the incidence of this hospital complication.

The group, led by Dr Sopena, has conducted several studies in this area, which have been awarded three competitive public grants from the Instituto de Salud Carlos III (ISCIII) since 2000. The latest of these projects was granted in the 2022 call and aims to understand the pathogenesis of nosocomial pneumonia by considering risk factors for oropharyngeal colonisation by multidrug-resistant bacteria, identifying the aetiology through the use of molecular techniques for microbiological diagnosis on respiratory samples, and finally, evaluating ICT as a method for detecting nosocomial pneumonia (FISS PI22/01600).

Intestinal microbiota

This line of research was launched in November 2022 by Rosa Benítez in collaboration with Dr ML Pedro-Botet with the aim of finding out whether the intestinal microbiota of patients with invasive enterococcal disease (IE) is different from that of patients with other infections. For this reason, a case-control study was set up with the Microbiology Service of HUGTiP and three groups were created: the group of patients with IE matched by age, sex and Charlson with fever and blood cultures isolating Enterococcus spp. and with patients matched by age, sex and Charlson without fever or signs of infection. The group already has preliminary results in three patients with MEI and the controls showing clear differences in the diversity and dominance of Enterococcus spp. in the gut microbiota. This will be a proof of concept and the team is awaiting resolution of the 2023 FISS call where this project has been submitted. If their hypothesis is confirmed, intervention on the microbiota in patients at risk for MEI could be prevented or its impact minimised.

Immunocompromised Unit

For over 20 years, the Infectious Diseases Unit has been treating patients with primary antibody synthesis deficiencies, including common variable immunodeficiency, IgA deficiency, and unclassified IgG subclass deficiencies. These are complex diseases that evolve or are diagnosed following a lymphoproliferative disorder or systemic autoimmune disease, requiring a comprehensive and integrated understanding for early diagnosis and proper management. The unit has observed that increased knowledge of these diseases, thanks to training initiatives launched over a decade ago, allows for earlier diagnosis and intervention. As a result, the number of patients with primary immunodeficiency (PID) has grown significantly, and the unit currently manages between 200 and 300 patients, with or without immunoglobulin replacement therapy.

The experience gained over these years has also allowed the unit to understand another condition, secondary immunodeficiency due to antibody synthesis deficiency. Indeed, hypogammaglobulinemia is the most prevalent secondary immunodeficiency. Its management and treatment, in the absence of controlled studies, are currently the same as those used for primary immunodeficiency. This led the unit to establish the Immunocompromised Unit in 2022, with goals focused on infection prevention, early diagnosis, and appropriate treatment of infectious complications in the context of immunosuppression.

This unit has created a dedicated outpatient clinic for prevention and several multidisciplinary working groups to optimally address infections in patients with solid organ transplants, onco-hematologic patients, and patients with inflammatory diseases undergoing selective immunosuppressive treatments. This network has facilitated the inclusion of patients in trials aimed at preventing or treating infectious diseases, researching genetic mutations that may help identify the cause and provide genetic counseling when appropriate, ultimately improving the quality of life and disease control for patients.

The unit aims to consolidate the group, invest in specialised training for each type of immunosuppression, and become a prestigious group in this field.

Community-acquired pneumonia

The group has led two multicentre retrospective studies as part of the CIBERes network on the influence of Influenza A (H1N1) on the incidence and characteristics of invasive pneumococcal disease. Additionally, it has participated in various trials evaluating different therapeutic strategies for Influenza A.

One Health

This line of research focuses on the study of colonisation by multidrug-resistant bacteria in farm animals and their potential transmission to humans. Subsequent molecular typing of MRSA strains has revealed that the most significant predisposing factor for colonisation by MRSA strains originating from farm animals is occupational contact with live animals, particularly live pigs before they enter the slaughterhouse. Since 2018, Dr Esteban A Reynaga has been a member of the research network "Genomics for One Health," which includes 29 research centres, and he represents HUGTiP in this network. Research and resulting publications have been made possible thanks to a grant from the Academy of Medical Sciences of Barcelona and a FISS grant from ISCIII awarded in 2018 (PI18/01258).

More recently, another project has been initiated to investigate multidrug-resistant Enterobacteriaceae in the waters of the Ter and Besòs rivers and their wastewater treatment plants, and their possible association with rectal colonisation in populations living in towns and cities supplied by these rivers. Finally, two doctoral theses have been registered in this line, and the candidates will explore the mechanisms of environmental contamination by multidrug-resistant Enterobacteriaceae and their potential connection with infections caused by these microorganisms in the community.

Utilidad de la vigilancia semiautomatizada y de las técnicas moleculares integrales en el diagnóstico precoz de la neumonía nosocomial en el enfermo no ventilado

PI: Nieves Sopena Galindo
Funding agency: Instituto de Salud Carlos III (ISCIII)
Agency code: PI22/01600
Duration: 2023 - 2025

Nuevos productos de bajo coste para la desinfección en sistemas de agua: estudio sobre la eficiencia sobre Legionella

PI: Noemí Párraga
Funding agency: Sustainco Invest
Duration: 2023 - 2025

Study of intracellular activity of delafloxacin compared with levofloxacin

PI: Luisa Pedro-Botet
Funding agency: Menarini
Duration: 2023 - 2024

Case-control study about risk factors of developing Pneumocystis jerovecii pneumonia in alloBMT patients

Start date: 2022

Dissecting Epigenomic and Transcriptomic Traits in Chronic Lymphocytic Leukemia with Secondary Immunodeficiencies: Identification of SID-specific features, relationship with Ig replacement therapy and Infections

PI: Esteban Ballestar
Funding agency: Grifols
Duration: 2023 - 2025

Estudio molecular de aislados clínicos y ambientales de Legionella implicados en brotes de legionelosis en nuestra área geográfica

PI: Noemí Párraga
Funding agency: Agència de Salut Pública de la Generalitat de Catalunya
Start date: 2015

Plantes Mediterrànies contra els Super Bacteris del tracte respiratori

PI: Sara Quero
Funding agency: 23a Convocatòria de les Beques Taulí de Recerca i Innovació, en la modalitat: Ajuts per a la recerca de grups acreditats de l'I3PT, grups consolidats i grups en fase de consolidació
Duration: 2022 - 2024

Bacterial gut microbiota and invasive enterococcal disease: prospective case-control study

PI: Luisa Pedro-Botet, Per-Joan Cardona
Funding agency: Microbiology Department, Laboratori Clínic Metropolitana Nord, HUGTiP, Germans Trias i Pujol Research Institute
Start date: 2022

CMV cell-mediated immunity in clinical practise

PI: Alba Romero, Ángela Casas, María Iglesias
Funding agency: Infectious Diseases, Nephrology and Immunology Department HUGTiP
Start date: 2023

Title: Neumonía nosocomial en el paciente no ventilado: impacto de una estrategia de intervención
Author: Valentina Isernia
Supervisors: Nieves Sopena, M. Luisa Pedro-Botet
University: Universitat Autònoma de Barcelona (UAB)
Date of defense: 15/12/2023
Evaluation: Excellent

Title: Endocarditis infecciosa a un hospital de referència: mortalitat i factors associats
Author: Raquel Núñez
Supervisors: M. Luisa Pedro-Botet, Sebastian Videla
University: Universitat Autònoma de Barcelona (UAB)
Date of defense: 05/2024

Title: Immunodeficiències primàries
Author: Carme Bracke Manzanares
Supervisors: M. Luisa Pedro-Botet, Jorge Carrillo Molina
University: Universitat Autònoma de Barcelona (UAB)
Date of defense: 2024

Title: Estudio de gérmenes multirresistentes de adquisicion comunitaria en la comarca de Osona
Author: Javier Díez de los ríos
Supervisors: Esteban Reynaga, Oscar Mascaró Cavaller
University: Universitat de Vic
Date of defense: 2024

Title: Fragilitat a la malaltia pulmonar obstructiva crònica
Author: Anna María Pedro Pijoan
Supervisors: M. Luisa Pedro-Botet, Antonio Sanjosé Laporte
University: Universitat Autònoma de Barcelona (UAB)
Date of defense: 2024