Regulation of lymphocyte response in vitro and in vivo

CD4+ T helper (Th) cells have an important role in the defence against diverse pathogens. Th cells can differentiate into several functionally distinct subtypes including Th1 and Th2 cells. Th1 cells are important for eradicating intracellular pathogens, whereas Th2 cells pro¬tect our body against extracellular parasites. However if uncontrolled, Th cells can mediate immunopathology such as asthma or allergies, but inappropriate Th response can also lead to autoimmune diseases such as multiple sclerosis or type 1 diabetes. Deeper knowledge of the regulation of the lymphocyte response both in vitro and in vivo is important for un¬derstanding the pathogenesis of immune-mediated diseases and microbe-host interactions. In the work presented in this thesis, the first goal was to elucidate the role of novel factors, PIM kinases and c-FLIP in the regulation of human Th cell differentiation. The oncogenic serine-threonine kinases of the PIM family were shown to be preferentially expressed in Th1 cells and in addition, by using RNA interference, they were also shown to be positive regulators of Th1 differentiation. The PIM depletion experiments suggest that PIM kinases promote the expression of the hallmark cytokine of Th1 cells, IFNγ, and influence the IL12/STAT4 pathway during the early Th1 cell differentiation. In addition to cytokine and T cell receptor (TCR) induced pathways, caspase activity has been shown to regulate Th cell proliferation. In the work presented in this thesis, the two isoforms of the caspase regulator protein, c-FLIP, were shown to be differentially ex¬pressed in Th1 and Th2 cells. Both of the isoforms were up-regulated in response to TCR activation, but the expression of the short isoform was selectively induced by IL4, the Th2 inducing cytokine. Furthermore, the c-FLIP isoforms had distinct and opposite roles during the early differentiation of Th1 and Th2 cells. The knockdown of the long isoform of c-FLIP led to the induction of Th1 marker genes, such as IFNγ and TBET, whereas the depletion of c-FLIP short down-regulated Th2 marker genes IL-4 and GATA3. The third goal was to elucidate the gene expression profiles characterizing the T- and B-lymphocyte responses in vivo during experimental infection by intracellular bacte¬rium Chlamydia pneumoniae. Previously, it has been shown that CD8+ and CD4+ T cells are important for the protection against Chlamydia pneumoniae. In this study, the analysis revealed up-regulation of interferon induced genes during recurrent infection underlining the importance of IFNγ secreted by Th1 and CD8+ T cells in the protection against this pathogen. Taken together, in this study novel regulators of Th cell differ¬entiation were discovered and in addition the gene expression profiles of lymphocytes induced by Chlamydia pneumoniae infection were characterized.

Bastonetes Gram-negativos aeróbios e anaeróbios facultativos no fluido ruminal de bovinos de corte alimentados em pastagem lignificada e em novilhos com acidose ruminal

Resumo: Objetivou-se analisar a população de bastonetes Gram negativos aeróbios e anaeróbios facultativas no suco ruminal bovinos zebuínos de diferentes categorias, alimentados em pastagem tropical, e de novilhos alimentados com alto teor de grão e sem volumosos. Foram coletados fluido ruminal de 32 vacas, 50 novilhos e 50 bezerros alimentadas em pastagem de Brachiaria spp. e de 20 novilhos com acidose ruminal. Após diluições decimais, amostras foram inoculadas em placas contendo ágar MacConkey a 39°C. Para a identificação dos gêneros mais frequentes foram utilizadas provas bioquímicas. A concentração dessas bactérias não diferiu no ambiente ruminal de vacas, novilhos e bezerros de corte alimentados com pastagem tropical lignificada. Os gêneros mais frequentemente identificados para esses animais foram Escherichia, Enterobacter e Klebsiella. Novilhos alimentados sem volumoso e com acidose apresentaram maior taxa de detecção e maior população dessas bactérias no ambiente ruminal (>6 log/ml) quando comparados aos novilhos alimentados somente em pastagem. A espécie Escherichia coli foi predominante entre as bactérias isoladas do fluido ruminal de novilhos alimentados com dieta com alta concentração de grãos e com acidose (p<0,01). Constatou-se que em bovinos de corte, criados em pastagem tropical lignificada, a população desses microrganismos é baixa no ambiente ruminal e com maior diversidade de gêneros bacterianos. Entretanto em novilhos confinados e alimentos sem volumoso, apresentando acidose ruminal subaguda, ocorre desequilíbrio populacional com aumento da população de E. coli.

Biodegradação do diclosulam por bactérias isoladas de solos cultivados com soja

Este trabalho teve como objetivo avaliar a capacidade de degradação do herbicida diclosulam por bactérias. Essas bactérias foram isoladas de solos procedentes de três importantes regiões de cultivo de soja do Brasil, as quais receberam a aplicação do herbicida diclosulam. Os testes foram conduzidos em shaker, sendo utilizado um meio de cultivo sintético. As características avaliadas foram: massa de glicose e diclosulam consumidos, velocidade de degradação do diclosulam e massa celular produzida. Embora todas elas tenham sido capazes de utilizar o diclosulam, os resultados indicaram que Klebsiella sp. foi mais eficiente e promissora para ser utilizada na biorremediação de áreas contaminadas com esse composto.

Purification and binding analysis of the nitrogen fixation regulatory NifA protein from Azospirillum brasilense

NifA protein activates transcription of nitrogen fixation operons by the alternative sigma54 holoenzyme form of RNA polymerase. This protein binds to a well-defined upstream activator sequence (UAS) located at the -200/-100 position of nif promoters with the consensus motif TGT-N10-ACA. NifA of Azospirillum brasilense was purified in the form of a glutathione-S-transferase (GST)-NifA fusion protein and proteolytic release of GST yielded inactive and partially soluble NifA. However, the purified NifA was able to induce the production of specific anti-A. brasilense NifA-antiserum that recognized NifA from A. brasilense but not from K. pneumoniae. Both GST-NifA and NifA expressed from the E. coli tac promoter are able to activate transcription from the nifHDK promoter but only in an A. brasilense background. In order to investigate the mechanism that regulates NifA binding capacity we have used E. coli total protein extracts expressing A. brasilense nifA in mobility shift assays. DNA fragments carrying the two overlapping, wild-type or mutated UAS motifs present in the nifH promoter region revealed a retarded band of related size. These data show that the binding activity present in the C-terminal domain of A. brasilense NifA protein is still functional even in the presence of oxygen.

Factors associated with penicillin-nonsusceptible pneumococcal infections in Brazil

Resistance of Streptococcus pneumoniae is a worldwide, growing problem. Studies of factors associated with resistance to penicillin have not been conducted in Brazil. The objective of the present study was to evaluate factors associated with infection by S. pneumoniae not susceptible to penicillin. A prevalence study was conducted including all patients with a positive culture for S. pneumoniae in a hospital from July 1991 to December 1992 and the year 1994. Of 165 patients identified, 139 were considered to have clinically relevant infections and 88% of them had invasive infections. All infections were community acquired and consisted of pneumonia (44%) and of central nervous system (19%), pelvic or abdominal (12%), upper airway or ocular (12%), primary bloodstream (9%) and skin and soft tissue (5%) infections. Mortality was 25%. Susceptibility to penicillin was present in 77.6% of the isolates; 21.8% were relatively resistant, and one isolate was resistant (minimal inhibitory concentration = 4 µg/ml). Multivariate analysis showed that age below 4 years (odds ratio (OR): 3.53, 95% confidence interval (95%CI): 1.39-8.96) and renal failure (OR: 5.50, 95%CI: 1.07-28.36) were associated with lack of susceptibility to penicillin. Bacteremia occurred significantly less frequently in penicillin-nonsusceptible infections (OR: 0.34, 95%CI: 0.14-0.84), possibly suggesting that lack of penicillin susceptibility is associated with lower virulence in S. pneumoniae.

Nasopharyngeal colonization by pathogenic bacteria: effect of polymorphisms in innate immune genes of young children

Nasopharyngeal bacteria can asymptomatically colonize the nasopharynx of infants and young children but are also associated with the development of respiratory infections and diseases. Such nasopharyngeal bacteria include Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae and Staphylococcus aureus. The host defense against invading pathogens is largely relies germline-encoded pattern recognition receptors (PRR), which are expressed on the cells of innate immunity, and different cytokines. These include toll-like receptors (TLR), mannose-binding lectin (MBL) and different cytokines such as IL-17A. Single nucleotide polymorphisms (SNP) in these receptors and cytokines have been reported. The aim of this study was to investigate genetic polymorphisms in the genes for TLR2, 3 and 4, MBL as well as for IL-17A and their associations with nasopharyngeal pathogenic bacterial colonization during a two-year follow-up. The study revealed that polymorphisms in TLRs, MBL2 and IL17A are associated with the nasopharyngeal bacterial colonization in young children. Healthy young (2.6 months of age) children with variant types of MBL2, TLR2 R753Q or TLR4 D299G had an increased risk to be colonized by S. pneumonia, S. aureus or M. catarrhalis, respectively. Moreover, variant types of MBL2 in healthy children with might facilitate human rhinovirus (HRV)-induced S. pneumoniae colonization at 2.6 months of age. The polymorphism of TLR4 D299G was shown to be associated with M. catarrhalis colonization throughout the whole two-year follow-up (2.6, 13 and 24 months of age) and also with the bacterial load of this pathogen. Also, the polymorphism of IL17A G152A was shown to be associated with increased risk to be colonized by S. pneumoniae at 13 and 24 months of age. Furthermore, the results suggest that IL17A G152A has an effect on production of serum IL-17A already at young age. In conclusion, the results of this study indicate that polymorphisms in the key PRRs and IL17A seem to play an important role to colonization of S. pneumoniae, M. catarrhalis, and S. aureus in healthy young Finnish children. The nasopharyngeal colonization by these pathogenic bacteria may further promote the development of respiratory infections and may be related to development of asthma and allergy in the later life of children. These findings offer a possible explanation why some children have more respiratory infections than other children and provide a rational basis for future studies in this field.

Immunogenicity of a 23-valent pneumococcal polysaccharide vaccine in Brazilian elderly

Serum antibodies specific for the capsular polysaccharides of Streptococcus pneumoniae provide protection against invasive pneumococcal infection. In Brazil, this vaccine has been used for people over 65 years with clinical risk to develop pneumococcal infection since 1999. We evaluated the immune response of 102 elderly subjects (75.5% females and 24.5% males) with a mean age of 71 years, and 19 young healthy adults (63.2% females and 36.8% males) with a mean age of 27 years. The elderly study group consisted of outpatients who received follow-up care in the Geriatric Department of General Hospital, Faculty of Medicine, University of São Paulo. None had acute illness at the time of vaccination. Both groups were immunized with one intra-deltoid injection with 0.5 ml of a 23-valent pneumococcal polysaccharide vaccine. The total IgG specific antibody concentrations to capsular polysaccharides 1, 3, 5, 6B, 8, and 14 were determined against pre- and 1-month post-vaccination sera. All samples were analyzed according to the second-generation pneumococcal polysaccharide ELISA protocol. We observed that the pneumococcal polysaccharide vaccine evoked consistent antibody increase for serotypes 1, 5, 6B, 8, and 14 (geometric mean concentration increase of 2.46 in the elderly and 2.84 in the young adults). Otherwise, we observed no increase in antibody concentration for serotype 3 in both groups.

Antibody response to pneumococcal capsular polysaccharide vaccine in Down syndrome patients

The majority of children with Down syndrome (DS) tend to have frequent bacterial infections including recurrent respiratory infections. Our objective was to evaluate the production of antibodies to pneumococcal polysaccharide antigens after active immunization in DS subjects. IgG antibodies to pneumococcal serotypes (1, 3, 6B, 9V, and 14) were measured before and 6 weeks after immunization with a 23-valent pneumococcal vaccine (Pneumo23®, Pasteur-Merrieux) in 6- to 13-year-old DS children (N = 17) and in aged-matched normal controls (N = 30). An adequate response was defined as a 4-fold increase over baseline or a post-immunization level of specific pneumococcal serotype antibody > or = 1.3 µg/mL. After immunization, all DS children had an increase in post-immunization levels against all serotypes analyzed. A 4-fold or more increase was observed in all DS children concerning serotypes 1 and 14, in 90% of subjects for serotypes 3 and 9V, and in 65% for serotype 6B. Regarding this increase, 8 of the 17 DS children had an adequate response to all serotypes analyzed, 8/17 patients to 4 serotypes and 1/17 to 3 serotypes. However, when we compared post-immunization levels between DS children and controls, we observed lower levels in the former group (P < 0.05) for all serotypes except serotype 3. We conclude that pneumococcal polysaccharide immunization could be beneficial for these DS children.

Avaliação do padrão coliformes a 45ºC e comparação da eficiência das técnicas dos tubos múltiplos e Petrifilm EC na detecção de coliformes totais e Escherichia coli em alimentos

Coliformes fecais são definidos como coliformes capazes de fermentar a lactose com produção de gás em 48 h a 45ºC. Escherichia coli, juntamente com algumas cepas de Enterobacter e Klebsiella, podem apresentar essas características. Entretanto, apenas a presença de Escherichia coli em alimentos indica contaminação fecal por ser encontrada em grande quantidade no trato gastrointestinal do homem e animais de sangue quente, não sendo isolada normalmente em outros nichos. A denominação clássica de coliformes fecais foi alterada para coliformes a 45ºC, na Resolução nº 12 da Agência Nacional de Vigilância Sanitária. O objetivo deste trabalho foi avaliar a presença de E. coli entre os coliformes a 45ºC e comparar a eficiência das técnicas dos tubos múltiplos e Petrifilm EC na detecção de coliformes totais e E. coli em queijo Minas, lingüiça frescal, hortaliças e fubá. Petrifilm EC mostrou-se mais sensível na detecção de E. coli em relação ao método de tubos múltiplos, o qual apresentou resultados falso-negativos ou contagens subestimadas de E. coli, principalmente para amostras de alimentos de origem animal. Petrifilm EC foi o mais eficiente e prático, sendo um método alternativo adequado para a enumeração de coliformes totais e E. coli em alimentos.

Isolation and characterization of bacterial strains with a hydrolytic profile with potential use in bioconversion of agroindustial by-products and waste

There is a trend towards the use of novel technologies nowadays, mainly focused on biological processes, for recycling and the efficient utilization of organic residues that can be metabolized by different microorganisms as a source of energy. In the present study the isolation of bacterial strains from six different agro-industrial by-products and waste was performed with the objective of evaluating their hydrolytic capacities and suitability for use in bioconversion of specific substrates. The 34 isolated strains were screened in specific culture media for the production of various hydrolytic enzymes (lipase, protease, cellulase, and amylase). It was found that 28 strains exhibited proteolytic activity, 18 had lipolytic activity, 13 had caseinolytic activity, 15 had amylolytic activity, and 11 strains exhibited cellulolytic activity. The strains that showed the highest hydrolytic capacities with biotechnological potential were selected, characterized genotipically, and identified as Bacillus, Serratia, Enterococcus, Klebsiella, Stenotrophomonas, Lactococcus, and Escherichia genera. It was concluded that the strain isolates have a high potential for use in the bioconversion of agro-industrial waste, both as a pure culture and as a microbial consortium.

Enhancing pnemonia surveillance in acute care facilities in post SARS era : a Canadian hospital surveillance study, 2003-2004 influenza season

A retrospective study of patients hospitalized with influenza and/or pneumonia in a Niagara area community hospital for the influenza season 2003-04 was designed with the main goal of enhancing pneumonia surveillance in acute care facilities and the following specific objectives: 1) identify etiologies, factors, and clinical presentation associated with pneumonia; 2) assess the ODIN score on ICU patients to predict outcomes of severe pneumonia; 3) identify the frequency of pneumonia and influenza in a hospital setting; and 4) develop a hospital pneumonia electronic surveillance tool. A total of 172 patients' charts (50% females) were reviewed and classified into two groups: those with diagnosis of pneumonia (n=132) and those without pneumonia (n=40). The latter group consisted mainly of patients with influenza (85%). Most patients were young (<10yrs) or elderly (>71yrs). Presenting body temperature <38°C, cough symptoms, respiratory and cardiac precomorbidities were common in both groups. Pneumonia was more frequent in males (p= .032) and more likely community-acquired (98%) than nosocomial (2%). No evidence of ventilator-associated pneumonia was found. Microbiology testing in 72% of cases detected 19 different pathogens. In pneumonia patients the most common organisms were Streptococcus pneumoniae (3%), Respiratory syncytial virus (4%), and Influenza A virus (2%). Conversely, Influenza A virus was identified in 73% of non-pneumonia patients. Community-acquired influenza was more common (80%) than nosocomial influenza (20%). The ODIN score was a good predictor of mortality and the new electronic surveillance tool was an effective prototype to monitor patients in acute care, especially during influenza season. The results of this study provided baseline data on respiratory illness surveillance and demonstrated that future research, including prospective studies, is warranted in acute care facilities.

Interaktive Netzwerke zur Regulation des Wachstums-Differenzierungs-Übergangs bei Dictyostelium discoideum

Die Signaltransduktion in niederen und höheren Zellen gehört zu einem der intensivst beforschten, molekularen Mechanismen. Wie gelangt ein externer Stimulus in die Zelle, bzw. wie wird das entsprechende Signal von der Zelloberfläche in das Zellinnere übertragen? Welche Proteine, die in die Signaltransduktion involviert sind, benötigt die Zelle um auf diesen Stimulus zu reagieren – und wie reagiert die Zelle letztendlich auf dieses extrazelluläre Signal? In den letzten Jahren wurde deutlich, dass diese interaktiven Netzwerke hochkomplex sind und für die molekularbiologische Forschung nur dann einsehbar werden, wenn gezielt Mutanten hergestellt werden, die z.B. Rezeptoren oder interzelluläre Komponenten nicht mehr vorweisen können. Die Erforschung der Signaltransduktionsprozesse ist mittlerweile aus den Laboren der Grundlagenforschung auch in die molekularbiologischen Labors der pharmazeutischen Forschung übertragen worden. Aktuell wurden in den letzten Jahren mehrere Substanzen entwickelt, die z.B. für die Bekämpfung von bösartigen Tumoren geeignet sind, und diese Substanzen zeichnen sich dadurch aus, dass sie Komponenten der Signaltransduktion blockieren, bzw. Botenstoffe der Neoangiogenese aus dem Serum entfernen und so den Tumor „aushungern“. In Dictyostelium discoideum sind bereits zahlreiche Signaltransduktionskomponenten beschrieben worden und es finden sich die bekannten Systeme, wie z.B. Transmembranrezeptoren, G-Proteine oder ras-Proteine, die man aus anderen Organismen kennt wieder. Auch MAP-Kinase-Kaskaden sind vorhanden und verschiedene extrazelluläre Signalstoffe, wie z.B. cAMP, PSF oder CMF sind bekannt und teilweise charakterisiert. Dictyostelium discoideum eignet sich aus diesen Gründen und aus Gründen der biochemischen und zellbiologischen Verfügbarkeit dazu, Prozesse der Signalerkennung und deren Weiterleitung zu den Effektorproteinen zu erforschen. Das Primärziel dieser Arbeit war es, möglichst eine neue Komponente in einem der bereits bekannten Signalwege der Discoidin-Regulation durch Mutagenesen zu zerstören, um diese anschließend beschreiben und charakterisieren zu können.Dazu wurde die sog. REMI-Mutagenese am neu gegründeten Labor der Universität Kassel etabliert und ferner die Zellkulturtechnik von D. discoideum für den Routineeinsatz eingearbeitet. Eine weitere Aufgabe der vorliegenden Arbeit war das Screening bereits bekannter Zellinien, die durch einen auffälligen Phänotyp nach einer Mutagenese isoliert worden waren. Dieses Screening sollte mit Western-blot-Analysen des sog. Discoidin-Proteins durchgeführt werden. Zusätzlich sollten neue Methoden entwickelt werden, die es möglich machen die Interaktionen während des vegetativen Wachstums vom Dictyostelium in Klebsiella-Suspension zu beschreiben.

Análisis económico de las vacunas 10-valente y 13-valente contra neumococo: revisión sistemática

Introducción: Las vacunas clásicamente han representado un método económico y eficaz para el control y prevención de múltiples enfermedades infecciosas. En los últimos años se han introducido nuevas vacunas contra neumococo a precios elevados, y los diferentes análisis económicos a nivel mundial de estas vacunas no muestran tendencias. El objetivo de este trabajo era resumir la evidencia existente a través de los diferentes estudios económicos evaluando las dos vacunas de segunda generación contra neumococo en la población a riesgo. Metodología: En este trabajo se realizo una revisión sistemática de la literatura en 8 bases de datos localizadas en diferentes partes del mundo y también que tuvieran literatura gris. Los artículos fueron inicialmente evaluados acorde a su titulo y resumen, posteriormente los elegidos se analizaron en su totalidad. Resultados: Se encontraron 404 artículos, de los cuales 20 fueron incluidos en el análisis final. Se encontró que la mayoría de los estudios se realizaron en áreas donde la enfermedad tiene una carga baja, como es Norte América y Europa, mientras que en los lugares del mundo donde la carga es mas alta, se realizaron pocos estudios. De igual manera se observo que la mayoría de los estudios mostraron por los menos ser costo efectivos respecto a la no vacunación, y en su totalidad las dos vacunas de segunda generación mostraron costo efectividad respecto a la vacunación con PCV-7. Los resultados de los estudios son muy heterogéneos, hasta dentro del mismo país, señalando la necesidad de guías para la conducción de este tipo de estudios. De igual manera, la mayoría de los estudios fueron financiados por farmacéuticas, mientras en un numero muy reducido por entes gubernamentales. Conclusiones: La mayoría de los estudios económicos sobre las vacunas de segunda generación contra neumococo han sido realizados en países con un alto índice de desarrollo económico y patrocinados por farmacéuticas. Dado que la mayoría de la carga de la enfermedad se encuentran en regiones con un menor nivel de desarrollo económico se deberían realizar mas en estas zonas. De igual manera, al ser la vacunación un asunto de salud publica y con un importante impacto económico los gobiernos deberían estar mas involucrados en los mismos.

Incidencia y factores asociados a infecciones bacterianas en el primer mes postrasplante hepático en la Fundación Cardioinfantil

Introducción: El trasplante hepático ortotópico es la colocación de un nuevo hígado en la misma ubicación del explantado. El objetivo es prolongar la duración y la calidad de vida en pacientes con enfermedades hepáticas terminales. Sin embargo, las infecciones bacterianas son una complicación en los pacientes receptores del trasplante, comprometiendo el éxito del procedimiento. El objetivo fue determinar los factores asociados a infecciones bacterianas en el primer mes tras realizada la intervención y describir las características demográficas de esa población. De 332 trasplantes realizados, que 262 cumplieron criterios para el análisis. Métodos: Se realizó un estudio observacional analítico de casos y controles anidado en una cohorte, en mayores de 18 años, receptores de trasplante hepático primario, de la FCI-IC de 2005 a 2014; excluyendo trasplante combinado hígado riñón, retrasplantes o fallecidos por causa diferente a la infecciosa durante el primer mes. Resultados: Se encontró que la ventilación mecánica por más de 1 día, el catéter venoso central mayor de 3 días son los principales factores de riesgo para infecciones bacterianas. La albúmina mayor de 2,6gr/dl se asoció a menor infección. Los agentes etiológicos predominantes fueron gérmenes gram negativos como E. coli, K. pneumonia y E. cloacae. Mientras que bacteremia, infección urinaria y peritonitis fueron las infecciones más frecuentes. La incidencia de infección bacteriana en esta población fue 24%. Discusión: Se recomienda por tanto extubación antes de 24 horas, uso de catéter central menor de 3 días y limitar el uso del catéter vesical.

Frequência de infecções urinárias em ambulatório : dados de um laboratório de Lisboa. Parte I

As infecções urinárias são uma das principais causas de doença em Portugal, variando conforme sejam infecções urinárias adquiridas na comunidade ou infecções urinárias nosocomiais. Neste estudo determinou-se a prevalência dos microrganismos, presentes nas amostras de urina obtidas pela técnica asséptica em doentes com infecções urinárias em ambulatório.Este estudo foi realizado no primeiro semestre do ano 2006, utilizando os dados recolhidos num laboratório de Lisboa. Foi um estudo observacional, descritivo e transversal. Foram incluídos todos os indivíduos que obtiveram um diagnóstico positivo na realização dos exames bacteriológicos (urinoculturas). Nos meses de Janeiro a Junho de 2006, primeiro semestre, foram realizadas 2820 urinoculturas, das quais 385 foram positivas. Destas, 334 (86,75%) pertenciam a indivíduos do sexo feminino e 53 a indivíduos sexo masculino (13,25%).A média de idades dos indivíduos foi de 55,25 anos (± 24,18 DP). As bactérias responsáveis pelas infecções do tracto urinário com maior frequência foram a Escherichia coli (63,6 %), Proteus spp.. (11,9 %), Enterococcus spp.. (7%) e Klebsiella spp.. (6%). Deste estudo concluiu-se que as percentagens verificadas de agentes infecciosos, responsáveis pelas infecções urinárias na comunidade, coincidem com padrões encontrados em estudos internacionais. Estas conclusões referem-se a um laboratório de Lisboa, carecendo de estudos semelhantes ao nível nacional, para caracterização do fenómeno em Portugal.