Linguistic Problems in E-S Translation: With Special Reference to Principles and Procedures Involved in Medical Translation TRABAJO RECEPCIONAL EN LA MODALIDAD DE: Trabajo Práctico Educativo COMO REQUISITO PARCIAL PARA OBTENER EL TÍTULO DE

Licenciado en Lengua Inglesa PRESENTAN:

Briza Paola Pérez Córdoba Miguel Guillermo Tejeda Jon DIRECTOR: José Luis Pérez Chávez LECTORAS: Mtra. Lorena Amelia Mercado Lara Mtra. Lilia Rosario Patiño López XALAPA, VER.

MARZO 2015

Contenido 1.

Introduction...............................................................................................................................3

2.

Theoretical Framework..............................................................................................................6 2.1 Medical Translation..................................................................................................................6 2.2 Type of Text..............................................................................................................................7 2.3 Informative texts......................................................................................................................9 2.4 Importance of the TT..............................................................................................................10 2.5 Linguistic Aspects..................................................................................................................10 2.5.1 Passive Voice...................................................................................................................11 2.5.2 Structures with ~Ing Suffix.............................................................................................15 2.6 Translation Methods...............................................................................................................23 2.6.1 Direct Translation Procedures..........................................................................................25 2.6.2 Oblique Translation.........................................................................................................27

3. METHODOLOGY.......................................................................................................................35 3. a. - Translation..........................................................................................................................36 3. a. a. Steps in the Translation Process....................................................................................36 3. b. Analysis of the TT................................................................................................................41 3. c. -Design of Data Collection Instruments................................................................................42 3. d. -Data Management...............................................................................................................45 3. d. a. Data Collection.............................................................................................................45 3. d. b. Analysis of the data......................................................................................................47 3. d. c. Classification and Organization of Translation Cards...................................................47 3.

d. d. Report.......................................................................................................................49

4.

ANALYSIS..............................................................................................................................51

5.

CONCLUSIONS......................................................................................................................66

6.

REFERENCES.........................................................................................................................68

7.

APPENDIX..............................................................................................................................72

1. Introduction Translation has become an important tool in modern societies around the world, not only because of the great value that translation has in the communicative role of the human progress (Sánchez, 1996), but also for its function as a necessary bridge that has helped civilizations share and gain knowledge in science, agriculture, religion, biology, medicine, music and so forth. In order to reach prosperity as a nation, there is always the necessity to be able to change and to evolve. Science and technology have constantly had an important part in this evolution; medicine can be mentioned as one of the great number of areas with a notably growing development. As it is knowndiverse studies, outcomes, medical procedures, reports, and even the most reputed medicine journals are published in English; the great dimension of this language as lingua franca inside international scientific community is evident. Such publications help scientists and medicine practitioners to be well informed and updated, unfortunately, these publications have not reached many parts of the world due to the existence of language barriers. Therefore, many scholars and researchers of translation have directed their attention to the translation of scientific and medical texts. Some aspects that are interesting in scientific translation research are: terminology, differences in registers between cultures, metaphors used in medical texts, and the numerous competences that a translator trainee should acquire in the practice of the medical translation field (Montalt, 2010). Furthermore, medicine is one of the oldest sciences in the world. It focuses on treating matters about health like diagnosis, treatment and prevention of diseases. Montalt (2010, p. 76) asserts that knowledge of this science is “constructed, communicated and used in a

great variety of contexts and situations, ranging from … researchers involved in groundbreaking projects, to health professionals … in clinical settings, to patients and the general public in their everyday lives.”Thus, knowledge must be properly disseminated between cultures according to each context. Differences in this knowledge would become a critical situation. As we already mentioned, English is the habituated language in the dissemination of knowledge inside the international scientific community; translation is necessary to achieve such dissemination. Although a specialist of the area would be the most suitable option to translate documents with such knowledge, he would not be able to identify all the phenomena and linguistic varieties in a ST (Source Text) and adapt them to a TT (Target Text). For that reason, a professional translator would be the best option in medical translation practice,in spite of implying a lot of work and research. In order to be categorized as a well-prepared translator and achieve a proper translation, he/she must be aware of knowledge about all the linguistic and translational theories as well as a specific methodological action. This paper deals with a medical translation and allows reflecting on all the phenomena presented in medical translation through a deep analysis. Therefore, this paper is aimed at a product-oriented descriptive study which analyzes, describes, and observes a single existing translation (Munday, J., 2012). In translation analysis, the main aspects to be examined are the diverse linguistic and non-linguistic features of the Target Text (TT).These features can be terminological, syntactical, pragmatic, and discourse problems encountered during the translation. With the purpose of carrying out a proper translation analysis, the translator must support his work with theoretical-practical elements provided by the experts on

translation discourse. To summarize, there are many aspects to be analyzed in a translation, but this paper is only focused on describing the different uses of passives and ~ing forms, and trying to implement some solutions to the main problems during their translation. Literal methods are discarded as they would not provide the necessary elements to develop a full description for the simplicity of the procedure. There is an extensive use of the mentioned structures in scientific texts. The final version of the work was analyzed and commented with help and design of analysis translation cards.We also discuss theoretical-practical issues presented in our translation proposal and propose a guide for students interested in translation of scientific texts. Furthermore, wetranslated from English into Spanish a medical scientific article that deals with the recent changes made by the institution calledClinical Laboratory Standards Institute(CLSI) related to susceptibility testing of fluoroquinolones in Salmonella,and analyzed such translation with the purpose of demonstrating our command in the translation of technical scientific texts and showing our knowledge about translation theories obtained during our university years. This paper is constructed with a theoretical background that mentions and discusses the main concepts involved in the activity of translation. An extensive methodology is also included describing the steps that were necessary to take in order to achieve a satisfactory translation and the different phases involved in the analysis of such translation. On the next part of the work, there is the analysis section with the description of the encountered variables. The last part consists in conclusions, references and an appendix including the tools that were used throughout the analysis, the source text, and the final translation.

2. Theoretical Framework 2.1 Medical Translation Delisle and Woodsworth (2005) stated that soon after writing was invented by men, translation emerged and apart from communication, one of the principal purposes of translation was to acquire and use the new technical and scientific knowledge from other groups. Nowadays, globalization has allowed and encouraged civilizations to develop this kind of knowledge more than ever. Medical translation is one of the activities inside scientific knowledge that spread important breakthroughs all around the globe. Therefore, medical translation has great demand and production in the professional market of translation (Muñoz, 2011). Medical translation refers to the translation of documents like articles, scientific papers, results of studies, text books, teaching material, and so on; associated with medicine and other fields like nursery, public health, pharmacology, molecular biology, psychology, genetics, and veterinary sciences (Montalt, 2010). Moreover, medical translation must emphasize accuracy, precision and clarity (Navarro, 2008). As in any kind of translation, there are linguistic, stylistic, and semantic differences from one text culture to another. Every kind of text has particular features that translators have to be aware of while translating and medical texts are not the exception. For this reason, translators must be qualified enough to translate them. A translator must learn to distinguish from a specialized or medical text to another kind of text. There are two main classifications of writings: literary and non-literary texts. In literary texts like stories, poems and novels, authors use language to evoke feelings and imagination from the reader in an esthetical manner using diverse figures of speech, a

common type of language, and cultural knowledge. In contrast, the goal of non-literary texts is to communicate a fact or idea with no emotions, either with an informative or technical approach. Moreover, inside the non-literary texts category, there are specialized texts with specialized knowledge, and medical texts belong to this subdivision. Unlike the esthetical features of literary texts, specialized and medical texts manage and introduce information with a clear and logic presentation, impersonality, objectivity, concision, and absence of common language (Álvarez and Muñoz, 2008). Besides having different features, one of the major distinctions of each kind of text is the managed discourse connected to the setting of the writing. What’s more, this managed discourse serves as an instrument to enable access to specialized knowledge, just as Lerat (1995) stated: “La notion de langue spécialiseé est plus pragmatique: c’est una langue naturelle consideré en tant que vecteur de connaissances spécialisées” (p. 32). Furthermore, Cabré (2000)state that specialized writing can only be set up by specialists with thematic knowledge, to avoid comprehension difficulties, and management of medical speech. Nevertheless, the translator should make a full research about the topic that is being dealt with and overcome such comprehension difficulties. We must bear in mind that a specialist of a field in science cannot always identify and represent linguistic aspects.

2.2 Type of Text It is well-known that we use language in order to produce a text and all texts are the product of a linguistic activity with a social nature. In its social nature there is always a speaker that intends to state something but the message must be well-structured to reach proper communication (Clérici, 2013). The interest is not only in the speaker but in the receiver as well. Therefore, to consider a text as a communicative action we have to

highlight the situation and the participants involved in the text (Nord, 2005). Once we understand and know the specific kind of text and its peculiarities, we can easily differentiate if we are reading an article, a biography, an essay, an advertisement, or a report. Within all the peculiarities and features of a text, we can find different functions that can be described as narrative, expressive, descriptive, informative, or vocative. All the functions mentioned before are related to a social practice in which the language is of great importance with specific circumstances. Secondly, each specific function presents a combination of characteristics formed by pragmatic, semantic, syntactic, and stylistic aspects (Nord, 2005). Such combination can yield to a systematic classification of text types, genres, classes, etc. The author of a text must choose what specific function or genre and style to use in order to accomplish his/her objectives. A bad decision can lead to confusion or to an error in the message or intention of the text. In translation, each function with its specific circumstances, style, norms, and structured features play an important role both in the source text (ST) and the target text (TT) (Nord, 2005). We must always consider all linguistic and extra linguistic features that are presented in texts. A better understanding will be the result of such consideration. Moreover, both ST and TT are created in an isolated situation that takes part of a communicative interaction. Therefore, each situation in each text, all along with the factors and elements involved, should be compared. Furthermore, a comparison like this will help the translator to create a text in the culture of the TT that carries the intention and features of a ST. In order to do this correctly, the translator should collect as much information as possible about the situational elements in the TT and the ST as well; such as receivers, time, place, topic, and so forth. If the information is not known, the translator can always infer by

context (Nord, 2005). It is considered that knowing all the possible functions of a text is of great deal of importance in translation for it can be known the real intention and that should be transferred into the TL as well. The message of the ST must be maintained to fulfill a correct translation.

2.3 Informative texts Just as important as situation and function, the translator must be familiarized with the genre of the ST for this can be useful to avoid translation problems (Montalt, 2011). Therefore, by familiarizing with the ST, the TT will carry the intention and features of the ST and the translation will be more reliable. This is why we provide a brief description of the ST´s genre characteristics. The characteristics of scientific text genres are dominated by informative and descriptive functions and sometimes can appear the explicative or argumentative function (Newmark, 1988). Informative texts often omit expressiveness and metaphors. They describe and explain situations, ideas, arguments, topics of knowledge, and facts of an external reality in order to explore and present such information. Likewise, the format of an informative text can be the one of a textbook, a paper, a thesis, an article, and so on. One of the linguistic peculiarities of informative texts is a formal, non-emotive, technical style, characterized in English by passives, present and perfect tenses, literal language, Latinized vocabulary, jargon, and multi-noun compounds with ‘empty' verbs (Newmark,1988). Medical and scientific genres are classified in research, professional, educational, and commercial (Montalt, 2011). Secondly, research genres can have different formats such as

original articles, case reports, theses, and so on (Montalt, 2011). An original article is a basic remake of an extensive research work (Swales, 1990 in Clerici, 2013). It is very common that these kinds of articles have an extension of seven pages. Moreover, an original article generally includes abstract, introduction, methods and materials, results, conclusion, and references (Clerici, 2013).

2.4 Importance of the TT The article’s importance in the target culture lies in the fact that some medicine practitioners keep providing traditional antimicrobial agents and fluoroquinolones to treat Salmonellosis. The incidence of this disease has been growing in the industrialized world with epidemic proportions (Gutiérrez, Montiel, Aguilera, & González, 2000). This causes changes that affect the hygiene in food treatment. The cases of Salmonellosis in México increased from 1994 to 1998 with a number of 100 342 cases, and to 215 155 cases in 1994 (Gutiérrez et. al., 2000). Therefore, Salmonellosis is widely spread in the country as in any other. This is of great concern for the organisms that deal with the health of the population. Although medicine practitioners trust blindly in fluoroquinolones or others antimicrobial agents, they must be careful in the treatment with these substances. Some medics are not aware of the new changes in the breakpoints and resistance mechanisms of the microorganism causing this disease. They must be kept informed by reading journals or articles from other countries specialized in studies and testing of this phenomenon in order to provide a better treatment to their patients.

2.5 Linguistic Aspects In this section we will describe the linguistic aspects we dealt with while translating a specialized text. We focus only in two syntactic features such as gerund and passive

voice. These two elements are highly used in scientific and medical writing and generate problematic situations in the translation. Therefore, we will present each element to know their form and function and describe the importance of their use. We will also mention how a translator can cope with the problematic of dealing with these syntactic elements and what translation techniques use when translating scientific texts.

2.5.1 Passive Voice The voice as a grammatical element is the feature that relates the verb and the morpheme as grammatical subject stating what is the paper of the subject inside the sentence, that is to say, if it is the actor or the patient (Alarcos, 1995). Both active and passive voice constructions exist in both Spanish and English languages and is one of the main characteristics in the body of English specialized texts is the use ofpassive voice structures.. Through these voices the same situation can be presented from different perspectives. In Spanish there is a clear inclination to use the active voice which highlights who is the agent of an activity: Tommy bought a candy to Sussy. In this active sentence Tommy is the agent doing the action (bought). In active sentences, the agent of the action always needs to be identified. However, we can use the passive voice when the agent of the verb is not important enough to mention or when it is unknown, and is more imperative to highlight the action (Thomson and Martinet, 1986): A candy has been bought to Sussy (by Tommy). In this example Sussy is the person receiving the action (has been bought) and the agent can or cannot be mentioned and the meaning of the sentence is clear either way.

According to Huddleston and Pullum (2010), the direct object is the lexical unit receiving the action of the verb and it is easily identified by questioning what? or whom? + the verb: What was been bought? Answer: a candy The indirect object can be identified by questioning for what? for whom? to whom? + the verb: To whom was bought? answer: Sussy The indirect object is the person whom receives the action of the verb. In order to form a passive voice sentence, it is necessary to turn the object of an active sentence into the subject of a passive. In this way, the agent in an active sentence disappears or is placed at the end: A candy has been bought to Sussy. The verbs can be categorized in transitive or intransitive, according to whether the verbs can have a direct object as complement or not: Lola wrote a poem A poem was written (by Lola) The verb write is a transitive verb because it has a D.O. receiving the action: a poem. One of the main characteristics of transitive verbs is that they are action verbs and this means that they usually need a direct object to have a complete sense, examples: Sophie eats vegetables (Sophie eats what?) Courtney wants the world peace (Courtney wants what?) To transform an active sentence into a passive sentence it is necessary for the active verb to be transitive. A passive sentence with an intransitive verb has no coherent sense, and the

semantic value is affected: Mary went to the zoo --- To the zoo has been gone. Moreover, every transitive verb can be conjugated in all tenses. These verbs as well as the verb forms such as infinitives and participles can be produced in passive voice with different forms according to their respective tense. The different forms are constructed as follows: •

The passive of continuous tenses present the subject of the phrase, conjugated form

of the continuous with the verb to be and the main verb in participle (Thomson and Martinet, 1986): Active - They are repairing the bridge. Passive - The bridge is being repaired. •

The passive of structures which present an auxiliary verb is constructed with the

pattern: subject + auxiliary + passive infinitive (be) + participle (Thomson and Martinet, 1986). Active - You must/should shut these doors. Passive - These doors must/should be shut. •

The passive of structures which present perfect tenses is constructed with the pattern

subject + passive infinitive in participle form (been) + participle of main verb. Active – He has bought a candy to Sussy. Passive - A candy has been bought to Sussy Furthermore, Spanish passive structure is formed using the verb ser + participle and also

have the function of presenting the same information of active sentences but from different perspectives. In Spanish, the use of a passive verbal structure in sentences is not as common as in English. Although the passive sentences express the same thing as the active sentences, the use of this formation is not appropriate in every context (Bosque, 2011). The passive voice of Spanish has two variations: the periphrastic passive voice and the pronominal passive voice or passive reflexive. The periphrastic voice, like in English, is formed with the pattern estar/ser (in a personal or non-personal form) + pasado participio: Pedrito lava el piso. El piso es lavado (por Pedrito) Pronominal passive voice (also known as pasiva refleja in Spanish) has not an equivalent form in English. It is used to make statements without a precise agent. The pronominal pronoun se, a variation of a personal pronoun with a function of third person, is always next to the verb (Bosque, 2011). To use pronominal passive voice, as the periphrastic voice, it is required to have a transitive verb: No se habla chino en México. This type of voice is employed when the author is unknown or when the information presented is from a general understanding. In spoken Spanish the use of the passive voice is unusual; however, it is frequent to find it in some kinds of documents such as specialized texts (Bosque, 2011) and it is a clear feature in medical discourse. One of the frequent mistakes while translating medicine texts from English into Spanish is the overuse of periphrastic passive voice which is not natural in Spanish. In spite of the similarities between the passive voices in both languages, Spanish prefers the use of the pronominal passive voice. Vivaldi (2000) states that the

overuse of passive expressions is not part of Spanish genius and these mistakes are influenced by mistranslations from English and French. When the overuse of passives is maintained, the nature of the TT is lost leading to an Anglicism of frequency in its syntax (Vázquez, 1977). In translation, it is essential to carry out an adjustment in the style of the TT. Moreover, the incorrect use of pronominal passive voice can also lead to semantic errors (Navarro, Hernández and Rodriguez, 1994). For instance, when the agent is a person: The pregnant women were vaccinated --- Se vacunaron las embarazadas This is a case of ambiguity because the women were vaccinated not by themselves but for a practitioner. Therefore, the pronominal passive voice must be used correctly avoiding a person to be the subject of the structure. It is preferable that the subject of the structure be a non-living element when using a passive reflexive structure in Spanish (Vivaldi, 2000).

2.5.2 Structures with ~Ing Suffix English grammar can present a ~ing suffix in many verbs. This ~ing suffix can be called gerund or present participle structure. These structures might be also called ~ing clauses and they are mainly used in legal documents and academic writings as an impersonal form of a verb aiming to objectivity (Agnese, 2000). A ~ing clause can function as: •

A noun

•

Subject of a sentence

•

Object

•

Predicative

•

Adjective

•

Modifier Complement

•

Relative clause

Sometimes, a gerund can be differentiated from a participle structure by comparing the gerund to a noun and the participle to an adjective (Huddleston and Pullum, 2010). On the other hand, Spanish possesses a structure with the suffixes ~ando, ~iendo that is only called gerund. A gerund in Spanish language can also be compound or periphrastic with the verb haber accompanied by the suffixes ~ando and ~iendo plus a verb with a participle form (Agnese, 2000). The function of a Spanish gerund can be the one of an adverb, a predicative and can also appears as a modifier clause. English gerund can function as a noun and can also be defined as a verbal noun or gerundial noun (Huddleston and Pullum, 2010). Therefore, when the gerund has the function of a noun it can be the subject, complement (or subject predicative) and object of a sentence and of a preposition as well. For example: Having a fever is pleasant. (Subject of the sentence) I enjoy reading. (Object of the sentence) The real problem is getting something done about the cheap imports. (Complement of the sentence as a noun) No one could rely on his going to bed early.(Preposition object) Jordan said he would get tough with the homeless by running identification checks on

them. (Complement of preposition) In contrast, a Spanish gerund does not possess the function of a noun and, therefore, cannot be the subject or the object of a sentence. It would be also incorrect to use the Spanish gerund in complements as a noun by influence of English (Bosque, 2010), as in: Lo que se pretende es consiguiendo. X Spanish can only use a noun or an infinitive as a subject or object of a sentence. Spanish infinitives can be considered as a form with verbal and nominal properties (Bosque, 2010). For that reason, an infinitive can construct a nominal group functioning as a noun. When the infinitive is preceded in a complement by a preposition or followed by a modifier, it is identified as a noun, just as the gerund of English language: El ladrar continuo de los perros. We must also take into account that Spanish infinitive has a fundamental noun function and because of that it can be preceded by a preposition (Alarcos, 1995). We can also mention that the complement or object of a preposition in English gerundform can be transferred into an infinitive preceded by a preposition in Spanish or simply use the preposition without transferring the gerund (Agnese, 2000). In conclusion, when transferring the gerundial noun into Spanish we can simply use a noun or a nominal infinitive of Spanish language: …the purpose of setting forth the understanding of the parties. … el objeto de formalizar el presente contrato … in providing the services … para prestar los servicios The real problem is getting something done about the cheap imports.

El verdadero problema es hacer algo …. Moreover, we have mentioned before that the present participle structure can be compared to an adjective. This structure can give the function of an adjective to the verb with a ~ing suffix and can be called participial adjective (Riber, Johansson, Leech, Conrad, & Finegan, 2000), i.e. leaking pipes, running water. This is a unique characteristic of the present participle in English that is not shared with the equivalent ~ing suffix structures of Spanish language. Apart from being compared to an adjective, the English present participle structure can also be used as a post modifier clause. This structure can be referred to as participial post modifier clause and can be rephrased as a relative clause (Riber et al, 2000). Both the participial post modifier clause and the relative clause are post modifier clauses that give more information about their subject, i.e. Students handing in their essays late will lose ten marks. Students who hand in their essays late will lose ten marks. The relative clause can also be formed with the participle in progressive structure: -young families attending the local clinic. -young families who are attending the local clinic. However, if the relative clause presents a verb with a progressive structure stative in meaning, the clause will change its sense and the function of post modifier clause will be lost (Riber et al, 2000). In addition, most of the participial post modifier clauses accept a verb with stative meaning: -a matter concerning the public interest. (post modifying clause with ~ing suffix using a

stative verb) -a matter which is concerning the public interest. (change in meaning with ~ing progressive structure and stative verb) It can be also stated that the participial clause cannot be used with a verb talking about one finished action that is not repeated. Instead we can use a relative clause: She was the girl dropping the coffee. X She was the girl who dropped the coffee.√ Furthermore, the Spanish gerund can also be the post modifier of a noun giving more information about it. This function is similar to the one of adjectives and allows the gerund to be in an attributive function (Alarcos, 1995). i.e. Viene el coche rodando por la ladera. The Spanish gerund having the function of a post modifier clause can also replace to relative structures. Nevertheless, the Spanish gerund has a restriction of using verbs with static meaning as a substitute of relative structures (Alarcos, 1995). Therefore, if a verb with static meaning is presented in the gerund, it will lose its post modifying function and the use will be incorrect: Tiene un hijo siendo miope.X (static verb in meaning) Tiene un hijo que es miope.√ Thus, when the participial post modifier clause is presented in an English text, we can state that the best solution is changing that structure for a relative clause in a Spanish text. In other cases, we can just use just change the participle for an adjective (Agnese, 2000). Moreover, a participial clause has a function close to the one of an adverb as well. Although

an adverb just qualifies another adverb or a verb, a participial clause adds some circumstantial information to its main clause (Thornbury, 2011). In these cases, we can identify the participial clause restructuring it as a full finite clause: She walked out of the room smoking--------She walked out of the room and she was smoking This structure implies two simultaneous actions made by the same subject. The participial can be placed before or after the main clause (Thomson and Martinet, 1986). Sometimes, the participle can have its own subject different from the one in the main clause. She walked out of the room smoking. (She walked out and she was smoking at the same time) Smoking, she walked out of the room. (Participial clause before the main clause) The plane crashed, its bombs exploding as it hit the ground. (Participial clause with its own subject). Moreover, besides having a sense of simultaneity, the participial structure can also have a sense of anteriority. In this case, the participial clause is placed first and expresses that one action is immediately followed by another action by the same subject (Thomson and Martinet, 1986). Opening the drawer, he took out a revolver. (The participial clause expresses a previous action and is placed at the beginning) Sometimes, the participle clause can be replaced by a perfect participle when the meaning is ambiguous giving the same sense of anteriority (Thomson and Martinet, 1986). Eating his dinner, he rushed out of the house. (This structure is ambiguous and can be

understood as if the person rushed out of the house and eating at the same time) Having eaten his dinner, he rushed out of the house. (The person ate first and then he rushed out) In addition, the participial clause also states that the second action forms part of the first, or that it is a result of it (Thomson and Martinet, 1986). This structure has the sense of posterity in relation with the main clause. She went out, slamming the door. (She went out and after that she slammed the door) He fired, wounding one of the bandits. (He fired and then the bandit was wounded) Conversely, the equivalent of the English structures previously mentioned in Spanish language is the gerund structure. The Spanish gerund structure also complies with the function of giving some circumstantial information about the verb in the main clause with a sense of simultaneity. The Spanish gerund have an aspect of anteriority related to the verb in the main clause as well (Alarcos, 1995). The aspect of anteriority can be expressed with only the gerund structure or with the compound form of the gerund. Mi mama llegó llorando. (Simultaneity, the mom arrived and she was crying at the same time) Paseando, me encontré con Gloria. (The two actions are simultaneous) La herida se curó aplicándole antibióticos.(The action in the gerund clause is previous to action in the main clause) Habiendo llegado a la casa, me encontré con Gloria. (The compound form of the gerund with sense of anteriority)

In the last example, the gerund structure can refer to the same subject of the main clause or it can refer to its own subject. When the gerund has its own subject and only adds some independent information it can be called absolute or independent gerund. In addition, the gerund clause with a sense of simultaneity can refer to the subject and verb in the main clause or to a direct object (Bosque, 2010), i.e. Vi a Pedro cenando. (“Pedro” is the direct object and the gerund structure refers to “Pedro”) The Spanish gerund cannot comply with the sense of posterity (Alarcos, 1995), as the English participle does. Therefore, transferring the same sense of English participle clause would be incorrect. Instead, the English participle can be transferred into a verb in personal tense in Spanish. He fired, wounding one of the bandits. Disparó e hirió a uno de los bandidos. However, the sense of posterity is accepted when is completely instantaneous (Alarcos, 1995). Last of all, a participle clause can replace a subordinate clause with a point of view of concession, cause and reason, condition, and time (Thomson and Martinet, 1986). In these clauses, the participial structure can replace the conjunctions as/since/because. Knowing that he wouldn't be able to buy food on his journey he took large supplies with him As he knew that he wouldn't be able to… Being a student he was naturally interested in museums Because he was a student he was naturally…

When the participial structure has its own subject, the participle must be placed after its subject. The day being fine, we decided to go swimming. On the other hand, the Spanish gerund structures do not have this function. The same structure cannot be transferred from English into Spanish because Spanish gerund structures do not establish the meaning of concession, cause and reason, condition, and time (Agnese, 2000). In conclusion, there are some functions of English gerund and participles that are equivalent to the gerund of Spanish. Nevertheless, this equivalence is not permitted in many cases. The transference of these English structures can be done with the equivalent structure in Spanish,but if we always transfer the same equivalent structure into Spanish, the resultant structure and its function will be incorrect. We must bear in mind that Spanish has other grammatical elements that comply with the functions of the participial and gerund clauses of English.

2.6 Translation Methods More than a hundred years ago, great part of translated texts were of religious, literary, scientific and philosophical nature, only the educated élite had access to them (Newmark, 1991). These translations were made from the part of people with some foreign language knowledge that consequently were considered capable enough to translate. For that reason, the main characteristic of the translated texts was a lack of precision and logic, causing confusions, poor understanding or even a complete misleading of the central topic or information. In this point, the purpose of the translation practice was only focused in

transfer the exact words from one text to another, giving as result different kinds of interpretations of the writing. Long afterwards, and parallel with the numerous develops in writing, translation also had transformations and improvements. Firstly, there were identified some linguistic and semantic variances between the languages which retained the exact exchange of lexical units from one text to another. Then, there was the understanding about the different characteristics of styles among the writings depending of diverse conditions as: content, lectors, writing style of the author, and so forth. Promptly, the literal translation was no longer accepted in every case because of its lack of fidelity to the mentioned conditions. Some pioneers about the translation studies emerged, as Jean P. Vinay and Darbelnet (1977), who stated that “En fait la traduction est une discipline exacte, possédant ses techniques et ses problèmes particuliers, et c’est ainsi que nous voulons l’envisager dans les pages qui vont suivre“(p. 43). They claimedtranslation as a formal discipline; therefore, they considered that just an expert could be prepared to manage the resolution of the particular problems while translating. Bell R. (1991) mentions: What is it that translators need to know and be able to do in order to translate? The translator must, as a communicator, possess the knowledge and skills that are common to all communicators (this much by definition) but, and this is the issue in this section, in two languages (at least) (p. 36).

Translators need to have a proper academic formation to possess the necessary knowledge and practice in the translation area and, therefore, be able to manage any kind of complications while translating (semantic, syntactic, linguistic, and pragmatic problems). Jean-Paul Vinay and Jean Darbelnetpresented their book named: Stilistique comparée du francais et de l’anglish, published in 1959. In this book, they compared the stylistics of the French and English languages, and based on this comparison they suggested procedures of translation that could allow the sufficient transference of information of diverse kinds of texts written in different languages. Although the revisions of these two authors were focused in the linguistic comparison between French and English, their book and theories became the rational base for many professional translators around the world. Besides, some more writers also developed methods of translation, in consideration of the features of their own languages. The procedures proposed by Vinay and Darbelnet (1977) were: DIRECT TRANSLATION PROCEDURES : Literal/direct translation (la traduction littérale), transference/borrowing (l’emprunt) and calque (le calque). OBLIQUE TRANSLATION PROCEDURES : Modulation (la modulation), Transposition (la transposition), Equivalence (l’équivalence) and adaptation (la adaptation).

2.6.1 Direct Translation Procedures In this method word for word is transferred from the ST to the TT. Depending on the kind of sentence to translate, it can be a good option to use or not the direct translation. It is possible to use this kind of procedure when both languages have a complete correspondence in meaning and structure (Vázquez, 1977). However, if the conditions are

not appropriate, it is impractical to use this procedure because as Vinay and Darbelnet (1958) said, result in unacceptable translations: Par inacceptable, nous entendons que le message, tel qu’il se laisse rédiger littéralement, a) donne autre sens b) n’a pas de sens c) est impossible pour des raisons structurales d) ne correspond à rien dans la métalinguistique de TO e) correspond bien à quelque chose, mais non pas au même niveau de langue (p. . Sometimes, the use of literal translation is often a feature of non-professional translators because the resulting translation often causes confusion and misleading to the lector, and is not possible a natural understanding or a continuous reading. Example of a literal translation: 

Fluoroquinolone: An antibiotic used especially in the treatment of systemic infections. (Definition of fluoroquinolone in English, oxforddictionaries.com)



Fluoroquinolona: Un antibiótico usado especialmente en el tratamiento de sistemáticas infecciones.

Borrowing

Borrowing is the most simple translation technique. With this method some words from other language are transferred to another language in a literal manner (Vinay, and Darberlnet, 1958). Moreover, Grey and Kaufman (1988) state that “Borrowing is the incorporation of foreign features into a group's native language by speakers of that language: the native language is maintained but is changed by the addition of the incorporated features.” (p. 47).We can appreciate from these points of view that borrowing is just taking a word from a foreign language and inserting it into a different language. Some common examples about borrowing cases in Spanish are: Software, rock, spaghetti, chic, pop, pizza, etc. These kinds of words often do not have an exact equivalent word in the TL, so it is necessary to borrow the original term. Calque “Le calque

est le emprunt d’un genre particulier: on emprunte à la langue étrangère le

syntagme, mas on traduit littéralement les éléments qui le composent“ (Vinay andDarberlnet, 1958, p. 47).According to Vinay and Darberlnet, this is a type of borrowing where the structure from a ST term or expression is copied to the TT, and it also is a literal translation. Examples: football fútbol science fictionciencia ficción e-mail correo electrónico

mouse ratón (dispositivo de computadora)

2.6.2 Oblique Translation The use of oblique translation is necessary when the language units in the ST have not a literal conversion to the TL. Through this kind of translation can be able to understand broadly a reading of any kind of matter in a fluent way and without linguistic misperceptions. The main oblique technical procedures are: Transposition, modulation, equivalence and adaptation. There are also some complementary procedures: Amplification, explicitation, omission and compensation. Transposition Many academics consider this procedure as the soul of translation. It consists inreplacing one part of speech from the ST to another one in the TT, without changing the meaning and intention of the message.This is a necessary procedure due to the differences between grammatical structures among languages. There are numerous types of transposition: adverb by adverb, subject by adverb, adjective by subject, and so on. Examples: 

Adverb by adjective

She gracefully walked to her car Ella caminó de forma elegante hacia su auto



Adverb by noun

There isusuallybelieved that brides should wear a white dress La gente cree que las novias deben usar vestido blanco 

Adjective by noun

An english teacher Un maestro de inglés 

Verb by adjective

They know how to dance pretty well Ellos son muy buenos bailadores In addition, it also exist the crossed transposition whichfocuses in the adjustment between the verb and its complements in the sentence. In Spanish, the verb is the lexical unit which presents the action and the complement shows the characteristics of how the action is done (Bosque, 2011): Ellaesmuy bonita (Atributive complement) Veoa las modelos (D.O.) Le di un libro a Carlos (I.O.) Caperucitaviveen el bosque(Circumstantial complement) La casa ha sido construida por el arquitecto (Agent complement) Mi hermano y su novia escucharon asustados la leyenda(Predicative complement)

Contrasting, in English the action is presented by the complement of the verb and not the verb itself. Example: This sentence combines a gerund (complement) and a transition verb. She broke up with her boyfriendsending him a rude text message Ella leenvió un mensaje grosero a su noviopara terminar con el Modulation This procedure allows the reader to understand the text as the author intended in the ST without the interference of cultural linguistic variances between the different languages.Ayora (1977) has stated that the translator who not modulates is not a real translator because without modulating readers often cannot understand the message of a text. In this procedure the conceptual base of the original sentence is changed and sopresenting a different point of view to the reader (Vinay and Darberlnet, 1958). Different changes in the kind of units are necessary to indicate the same meaning and thus rich an appropriate naturalness in the final product. Example: It is not easy for me to talk in public Es dificil para mí hablar en público Modulation consists in a great number of procedures (Ayora, 1977): 

The abstract for the complete

      

Explicative modulation The part for the whole One part for another The negated contrary Space for time And general for particular Passive for active

This type of modulation has a great importance in the development of this work. As we mentioned before, the use of periphrastic passive voice has a noticeable frequency in English, on the contrary of Spanish which has a clear preference in the use of active voice. Modulation is often used in order to avoid the continuous translation of passive voice sentences, therefore, avoiding this kind of Anglicism of frequency (Ayora, 1977). Example: The kitchen was cleaned by Henry Henry limpió la cocina Thepronominal passive voice is also used to translate passive voice sentences from English to Spanish, but only whenthe agent of the action is unknown. Example: The house was painted yesterday La casa se pintó ayer Equivalence This method replicates the precise message of the ST but using different language units. “Nous

avons souligné à plusieurs que reprises qu’il est possible que deux textes rendent

compte d’une même situation en mettant en œuvre des moyens stylistiques et structuraux entièrement différents“(Vinay and Darberlnet, 1958, p. 48). For this reason Ayora (1977) has referred to this method as an extreme case of modulation, but in this case not only some words are changed to express the original idea, but sometimes the whole structure is altered. The equivalence method is used when is necessary to translate a colloquialism, idiom or a saying and there is not an exact equivalence in the TL. Newmark (1988) refers to this procedure as idiomatic translation. Example: Hijo de león, pintitoAs father as son A leopard never changes its spots Genio y figura, hasta la sepultura Adaptation With this procedure an idea from the SL to the TL can be expressed but in a different way than the one presented in the original. This is a required change when a literal translation results strange and difficult to understand to the TL culture, therefore, it is necessary to use an equivalent reference (Vinay and Darberlnet, 1958). Common examples: titles of books, movies and books. 

City of angels Un ángel enamorado

It is a love story developed in a city called Los Angeles and the main male character is an angel. Amplification

In this method the translator explains the meaning of a segment in the text; therefore the statement becomes more extended. This procedure is about indicating the same object but using more words or even a description to make the meaning of the segment more clearly to the reader, and also to set some naturalness to the writing. It is well known that in an English-Spanish translation the Spanish version is longer than the English version; since the English discourse is less descriptive than Spanish (Ayora, 1977). Newmark (1988) agrees with the fact that it is necessary to add words in the TT in order to overcome any gap in the message from one language to another stating that: Naturally, translation does not remain at this simple level; all languages have many ‘untranslatable’ words whose meaning, if important, has to be spread and manipulated across two or more words or a phrase of the target language. Translation can be described as filling up the gaps between languages. Many words are affected by the context, linguistic, cultural and situational aspects and cannot be translated in isolation (p. 43). In some cases, the meaning of words needs to be explained in the TT otherwise, the reader would not understand some necessary information to follow the reading. Examples:   

ADVERB: To answer smartly (contestar de una manera inteligente) VERB: To borrowed an earring (Tomar prestado un arête) PREPOSITIONS: I went over there against my will (Fuí allá en contra de mi voluntad)

Explicitation

Ayora (1977) claimed that this procedure was a type of amplification because of the addition of elements to the TT but without changing the idea of the text. Explicitation is a great implement for the reader to overpass the cultural and social differences between languages. This procedure helps the foreign readers/audiences to comprehend some implicit information for the SL society. There are four kinds of explicitation: Example:



Kelly, do you know the story of Anabelle? Kelly, sabes la historia de la muñeca diabólica Anabelle?

The syntactic normalization is a form of explicitation characterized by minor alterations in the TT. The structure of the ST is not altered. Example Mary smiled to John Mary le sonrió a John Omission On the contrary of amplification or explicitation, in this method are eliminated some elements while translating. This procedure aids the TT to be free of not necessary strange elements. (Ayora, 1997) Example: She is taking a bath at the moment Ella se está bañando

That Sunday was a cold and rainy day Aquél domingo fue frío y lluvioso Compensation After finding a right equivalence of translation, and if this one causes the loss of some information, then it should be compensating another fragment of the text. (Ayora, 1977)

3. METHODOLOGY Descriptive Translation Studies deal with the description of phenomena which are produced by the components, processes, theories involved in bilingual communication (Holmes, 1970 in Munday, 2001). Descriptive studies help us to understand in a deeper and better way the activity of translation so that we can clear out our doubts and improve our performance while translating. But communication is not the same all the time; different contexts involve different elements and different relations. Systematic observation of scientific discursive situations may throw some light in this area, although medicine is not really a new field. Similarly, what we do to solve a translational difficulty in a text may not be suitable for all other texts but it might be useful. Understanding the inner mechanisms of the problem-solution relation, from discursive perspective, may help us to increase our theoretical sub-competence so that we can adapt it to new situations resulting from global development. Although translation is an activity as old as man, the last hundred years have produced new technologies, scientific fields, social relations and many other things which require translation. Collecting, describing, and analyzing data is the best way to generate solid basis for decision making. So, we followed a systematic procedure to produce a

reliable analysis based on different techniques and concepts relevant to the phenomena presented in the object of study of this paper which is a translation. We also made a documentary research to gain some knowledge about the field and context of the TLT as well as textual elements that we should keep while we transferred the text. Apart from this, we made a thorough review in different kinds of documentary sources such as books, specialized journals, dictionaries, web pages, and so on.

This work was carried out in different phases namely: a). Translation, b).Analysis of the TLT, c). Design of data collection instruments, d). Data management: Data collection, analysis of the data,organization & classification and finally e). Report.

3. a. - Translation The translation of a document was the first phase of this paper. A first draft of the translation of the ST was to be created. The translation process was divided in different practical steps proposed by Jack Child and other authors. Child (2010) claims that before the translator starts to translate, he will carry out a series of practical and systematic steps so as to create an acceptable translation. The translator should not just start to translate working in a disorganized way and without a specific method. The steps that we followed are briefly described and mentioned afterwards.

3. a. a. Steps in the Translation Process Child (2010)sustains that the first step in translation is to fully understand the text by a careful reading. In this way, we can determine what the subject is as well as recognize

its semantic source, the written style, the grammatical matters, its intention, and the used terminology in order to maintain and express the sense in the target language (TL). For this reason, the first step we needed to take was to make an extensive reading and analyze the text in a general form; its composition, organization, formality, terminology, and even in what kind of magazine it was published so as to realize to what kind of readers it was directed to. Afterwards, the translator should define what type of material is involved: literary, technical, descriptive, informational, or communicative (Child, 2010). Therefore, we identified, described, and defined the type of the text. Importance and Description of the Source Text The ST was published in the journal named Clinical Infectious Diseases (CID) by Oxford University Press in July of 2012 .The title of the text is “In Vitro Susceptibility Testing of Fluoroquinolone Activity against Salmonella: Recent Changes to CLSI Standards”. The authors are Romney M. Humphries, Ferric C. Fang, Frank M. Aarestrup, and Janet A. Hindler. The journal in which the text was published is very important in the area of medicine and it is directed towards practitioners of medicine and researchers of the area all over the world. There are a wide range of subjects that are dealt with in this journal. The web page of oxfordjournals(2014) gives a more precise description of the journal: Clinical Infectious Diseases (CID) is a leading journal in the field of infectious disease with a broad international readership. The Journal publishes articles on a variety of subjects of interest to practitioners and researchers. Topics range from clinical descriptions of infections, public health, microbiology, and immunology to the prevention of infection, the evaluation of current and novel treatments, and the promotion of optimal practices for diagnosis and treatment. The Journal publishes

original research, editorial commentaries, review articles, and practice guidelines and is among the most highly cited journals in the field of infectious diseases. Clinical Infectious Diseases is an official publication of the Infectious Diseases Society of America. The ST is inside the research genre which intends to share and communicate information and takes part of the clinical microbiology area. The text is descriptive with an informative function and presents the format of an original article that is mainly used in specialized journals and includes an abstract, an introduction, a conclusion, and references. The extension of the text is of seven pages and includes one graphic and three tables to present data that is relevant to the understanding of the topic. The linguistic features of the text are: 

Participles as adjectives and nouns



Simple and compound sentences



Subordinate clauses with gerund and present participles



Structures with passive voice



Multi-noun compounds with empty verbs



Use of specialized terms.

The importance of the article and its general purpose lie in reporting and informing about the clinical concern that surrounds the substances called fluoroquinolones and the microorganism called Salmonella. Salmonellosis caused by nontyphoidal Salmonella is a very important public health problem in the United States and worldwide. Although there is an increased prevalence of antimicrobial resistance that limits the use of traditional

antimicrobial agents; such as ampicillin, chloramphenicol, and trimethoprim-sulfonamide, fluoroquinolones, such as ciprofloxacin, are the first to be used against an infection of Salmonella in adults. Nevertheless, there are studies indicating that Salmonella presents a high resistance to these substances due to the multiple mutations that this bacterium has been developing. The organism that deals with this issue is the Clinical Laboratory Standards Institute (CLSI). The CLSI is revising all the interpretive criteria and breakpoints for assigning new categories to the resistance to fluoroquinolones. The importance is in analyzing all the resistance mechanism of Salmonella in order to apply a better treatment. To continue with the translation process, we consulted and requested other sources in both languages as well as reference material such as dictionaries and glossaries with the aim of having better understanding of the subject. In this way, we familiarized with the vocabulary used. Child (2010) states that some research before starting the actual translation is always helpful. This research can be considered as a part of the second step in the translation process. Child also mentions that it is advisable to verify if there is another translation of the ST as relevant background material. If any translation of the ST is available, it can be useful in order to make a comparison, use it as a guide, and facilitate our job. Nevertheless, our goal is not to compare or criticize translations. We verified that there were no other translations of the ST by sending an e-mail to the responsible of the text´s publication. By confirming that there were no other translations, we could continue with our work. Once we read extensively and analyzed the text identifying all its features and unfamiliar terminology as well as making a full research, we created terminology files that include all the necessary information to delimit and identify a concept (Public Works and Government Services Canada, 2011). As terminology intends to communicate a concept of a specialized

field, the translator should identify with it and use it correctly in order to integrate a term in a TT with clarity. Cabré (1996) mentions that one of the most important tasks of a translator is to become familiar with the terminology of a text before starting to translate. Therefore, terminology files helped us to overcome complications with terminology and familiarize with it so as to have better understanding of the text and integrate the terms correctly in the TT. The design of terminology files will be described in the section of the design of the data collection tools. The third step was the creation of a first draft of the translation so as to produce a text in the TL. Child (2010) asserts that this step is the heart of the process because the translator finds the meaning and takes it to the TL. In this stage, we translated having the ST and the TT at hand. We constantly checked both texts as we were translating without putting much attention to small details and spelling mistakes. This gave continuity to the translation and allowed to think faster (Child, 2010). We underlined and left the most complicated segments isolated. The doubts and complications in these segments were to be solved later. This first draft was done with the help of certain kinds of auxiliaries, such as web pages, terminology files, and encyclopedias as well as bilingual, monolingual, general and specialized dictionaries. The fourth step was the revision of the first draft and corrections of the identified difficulties. Afterwards, the first draft was corrected and a second draft was prepared. In this second draft the translator must be sure that the sense was accurate and close to the original (Child, 2010). The style should also be attached to the TL features. After we verified that the accuracy and style of the TT were balanced, our supervisor took a look to the translation and to the ST. The supervisor underlined some errors and suggested some

changes. The fifth and final step in the translation process was the final correction of the last draft. When the correction was made, the final edition of the translation was performed. Child (2010) expresses that “Here you should be alert to format, margins, punctuation, spelling, grammar, and all those other factors which go into making a decent final text” (p. 151). The final product was read one more time just to verify if nothing has been left out. Once the translation was finished, we set out to make a general analysis of the TT as well as prepare and design instruments to facilitate the collection of data that were to be analyzed.

3. b. Analysis of the TT There are many linguistic phenomena in the ST and in the TT that can be possible important matters to observe and describe. We only focused on the fragments that presented a non-literal translation. Although literal translation is a legitimate method that can be correctly applied, its use in the translation of some linguistic features may lead to syntactical or stylistic problems. Therefore, oblique translation methods should be the best option. Being some of them the result of an oblique translation, the TT presents the next linguistic features: 

Specificity adjectives



Participles as adjectives



Compound, subordinate, and complex sentences



Specialized terms



Present and perfect tenses



Reflexive structures with reflexive pronouns particles



Adjectival nouns



Abstract nouns



Relative clauses

As it can be seen, there are a lot of important features that can be taken into account in the objects of study which are the ST and the TT. Nevertheless, we only emphasized on the analysis and description of all the phenomena presented in the translation of the passive voice structures and structures with ~ing suffixes.

3. c. -Design of Data Collection Instruments The creation and design of translation cards was the second phase in the methodology of this paper. These translation cards have as purpose to demonstrate more clearly what kinds of difficulties were presented in the translation and the solutions we suggested to cope with such difficulties. With this aim in view, we designed a proposal of translation cards as instruments to collect data and analyze it thoroughly. We enumerated the parts of these cards and each part was described so as to understand their structure and function. 1. - In this section of the cards it is mentioned if there is a problem that may be presented when translating a specific linguistic feature. 2. Here it will be mentioned what translation method was used in the translation of a specific fragment. 3. In this section we have to collect a sentence from the ST to be analyzed where a particular fragment with a specific linguistic aspect is included with no alterations.

4. The description of specific translation problemsand linguistic features are to be included in this section of the card. A specific linguistic aspect will be described with its translation difficulty. 5. The solution that can be given to the translation of a specific linguistic aspect of the ST will be included in this part. It will be described the aspects of the linguistic features used in the TT and it will be explained why these features are correct as well as validate the translation method that was used. 6. Here it will be included the final translation of the ST fragment. This final translation must comply with the syntax, style, and grammar of the TL. TYPE OF PROBLEM (1)

TRANSLATION METHOD (2)

SOURCE TEXT (3) PROBLEM (4) SOLUTION (5) FINAL TRANSLATION (6)

Furthermore, we also designed terminology files in order to overcome any complication with terminology. These files were used between the first and second step of the translation process. Terminology files include all the basic information to understand, delimit, and analyze a concept related to specific activities and themes of interest between different languages. This information can be synonyms, syntactic and orthographic variations, usage examples, definitions, contexts, notes about any pertinent observation, and sources of all

the collected information (Public Works and Government Services Canada, 2011). Consequently, we designed the terminology files based on the previous statement with an electronic form where all that information was to be added. In this way, we were able to understand and delimit specific concepts and terms in the ST and used them correctly in the TT.

The design of the terminology file was constructed as follows: Terminology Term: The concept to be identified Word Class: The grammatical variation of the term Gender: The gender of the term Type of T: In this part it will be Simple mentioned if the term is simple or Complex complex. If the term consists of only one morpheme, the term is simple. On the other hand, a complex term consists of more than one morpheme. A complex term can be derived from other word or can be a compound one. Equivalence: The equivalence of the Word class: The grammatical variation of the term in the TT. term in the TT Gender: The gender of the term in the TT Source: The source where was taken the equivalence of the term. Type of term:

Simple Complex

Antonyms: Any antonym of the term. Synonyms: Any synonym of the term. Area of study: The main area where the term is mainly used. This distinction of areas and fields will help to delimit the concept in order to avoid confusion because of polysemy. Field: The field inside the area where the term is used.

Subfield: The subfield where the term is used. Definition of term + ref: The definition of the term in the SL and its reference. Usage example+Ref: A usage example of the term in the SL, that is to say a context. Definition of equivalence + ref: The definition of the term in the TL and its reference. Usage example+Ref.: A usage example of the term in the TL, that is to say a context. Notes on term usage (Register, sociolect…). Any additional observation about the usage of the term or general comments.

3. d. -Data Management 3. d. a. Data Collection The third phase in the methodology of this paper was the collection and review of the data to be analyzed. First, we isolatedcomplete sentences that were taken from the ST along with its parallel translation and added them in the translation cards. The ST and TT arenow divided in many segments inside translation cards in order to observe more carefully the entire phenomenon presented in the translation as well as analyzing and commentinglinguistic translational difficulties and solutions. Such observation helped us to construct the theoretical framework with a full research as a basis for the analysis of the translation. For the collection of data and filling of terminology files, a full research was carried out. In the first step of the translation process, an extensive reading and analysis of the text were executed in order to identify its composition, organization, formality, and terminology. In this examination of the text all the relevant terms to be included in the terminology files

were collected. In the second step of the translation process other sources were consulted in both languages, Spanish and English, so as to familiarize with the vocabulary used and identify the use as well as the context of terms. The steps previously mentioned helped us to fill the terminology files with the pertinent data. Once we had all the necessary information obtained from many sources, the terminology files were filled segment by segment. We now present an example of the resultsin this process:

Terminology Term: MIC, minimum inhibitory Word Class: noun concentration Gender: male Type of T: Complex Simple Complex Equivalence: CMI, concentración minima Word class: noun inhibitoria Gender: male Fuente: http://www.proz.com/kudoz/english_to_spanish/medical/110018urgente_we_always_set_the_CMIs_up_x2.html Type of term: complex

Simple Complex

Antonyms: Synonyms: Area of study: medicine Field: clinical medicine Subfield: clinical microbiology Definition of term + ref: Examine tubes for visible signs of bacterial growth. The highest dilution without growth is the minimal inhibitory concentration (MIC). http://www.proz.com/kudoz/english_to_spanish/medical/110018urgente_we_always_set_the_mics_up_x2.html Usage example+Ref: “The sustance is bactericidal for susceptible strains near the minimum inhibitory concentracion (MIC)." http://www.proz.com/kudoz/english_to_spanish/medical_pharmaceuticals/3928739susceptible_strains_near_the_mic.html

Definition of equivalence + ref: La determinación de la Concentración Mínima Inhibidora (CMI) es la medida de la sensibilidad de una bacteria a un antibiótico. Es la mínima cantidad de antimicrobiano que es capaz de impedir el crecimiento de un microorganismo en unas condiciones normalizadas. http://campus.usal.es/~micromed/Practicas_odontologia/unidades/labv/LabMicro/Antibiograma.h tml Usage example+Ref.: Un total de 23.9% presentaron presentaron CMIs que permitían incluirlas dentro de la categoría de aislamientos con sensibilidad… http://www.redalyc.org/articulo.oa?id=17077609 Notes on term usage(Register, sociolect,…). Term used in formal situations by specialized people. Readership: doctors, institutes, chemists, students of medicine, laboratory workers. Of the resultant terminology files, we only included and classified only those which dealt with complex terms and terms in form of acronyms. These files are included in the appendix section.

3. d. b. Analysis of the data We reviewed, describedand commented each card with a linguistic and translational approach having as a guideline the theoretical framework previously constructed. We retained those cards which did not present a literal translation and presumed a deeper description and explanation. The rest of the cards were discarded because of their irrelevance in the purposes of this paper. The result of the analysis was the production of many translation cards that isolated sentences with the linguistic features of interest and the phenomena involved in them. When we analyzed the sentences and elements presented in the translation, we could be able to construct a theoretical background based on all the phenomena we observed in the analysis and use it as a guideline to complete the concepts we needed in order to construct the translation cards properly with pertinent commentaries and descriptions. Containing all the relevant information for making comments and filling the translation cards, the

theoretical framework was constructed with theory and concepts taken from Vazquez Ayora, Jack Child, Alarcos Llorch, Peter Newmark, Vinay and Dalbernet, Martin Vivaldi, the Grammar of Spoken and Written English, the Grammar of the English Language, and the Nueva Gramática de la Lengua Española: Manual.

3. d. c. Classification and Organization of Translation Cards The fourth phase was the classification of the translation cards. Once we had the translation cards properly filled, we decided to focus on analyzing cardsusing two specific linguistic features of the ST. These features are the use of the passive voice and ~ing suffix. Both structures are very important and prominent in the ST that may cause syntactic and stylistic issues and are mainly used in scientific medical texts. The translation methods used to overcome difficulties in the translation of these linguistic features are also very important. Passive voice and structures with a ~ing suffix are the main markers of impersonality in scientific texts and their use is part of the style and syntax of the ST. Our goal is to focus on the description of difficulties and solutions to the existing problematic in the transference of such structures into Spanish.Subsequently, each card was classified according to the different functions of each linguistic feature. Next, we present some of themost relevant categories in the classification of the two main linguistic features presented in the ST: Passive voice Passive in Present and Past Tense Passive voice with auxiliary verbs

Passive of perfect tenses Structures with ~ing suffix ~ing structure as a noun ~ing structure as an attributive or postmodifying clause ~ing structure as an adverbial clause

3. d. d. Report This paper deals with all the linguistic and translation theory that is necessary to be aware of in translation. Such theory was used to analyze carefully the linguistic features presented in scientific texts and the phenomena presented during their translation with the use of cards. The identified linguistic features in the ST are structures with passive voice and ~ing. Such structures can cause problems with syntactic or stylistic nature at the moment of translating. Therefore, it is necessary to have linguistic and translational knowledge to translate such features. A person who is only a specialist of a specific area may not succeed when translating these linguistic elements. The structures previously mentioned were analyzed and described. We must remember that some authors claim that the overuse of passive structures in Spanish would cause an inconsistent and unpleasant text. Therefore, the use of a different structure that implied the same impersonality and lack of agent of the SL was necessary to respect the style and discourse of the TL. The solutions were provided by the oblique translation methods that helped us to produce a more reliable TT changing the passive structure of English for

another structure in Spanish which is called passive reflexive with the same sense but different style. The structures with ~ing suffixes are also of great importance. These structures have many functions that may be confusing when translating into Spanish. There were plenty examples of ~ing structures with different functions in the ST. The solution to transfer those structures into the TT was provided by the identification of the function and the use of the oblique translation method. This method provides us with a wide range of solutions. We could observe that these structures had different equivalents with their own function in the TT. The linguistic feature of the ST had to be changed in order to respect the grammar and syntax of the TL. Moreover, a series of practical steps that can help a translator of scientific texts to improve his/her performance in the translation of such texts are proposed as follows: 1. - An extensive reading and analysis of the text in a general formdefining the type of material and the type of text. In this stage, we can also identify complicated terminology and vocabulary. 2. A research before starting the actual translation relating with the topic, area and 3. 4. 5. 6.

vocabulary. We can also verify if there is another translation. The third step is the creation of a first draft. Revision of the first draft and corrections of the identified difficulties. Final correction of the last draft. As an extra step the final product can be read one more time just to verify that nothing has been left out.

4. ANALYSIS In spite of the fact that there are many problems to be found in translation, we have only focused on two specific linguistic problems. Based on the research to construct the theoretical framework, we added some comments describing the problems and possible solutions in a scientific text with a linguistic and translational approach. Next, we present the most relevant comments dealing with the analysis of those linguistic problems already classified. PASSIVE VOICE Passive in Present and Past Tense 1. This change is supported by accumulating clinical, microbiological, and pharmacokinetic-pharmacodynamic (PK-PD) studies that indicate that such a revised break point is more appropriate for determining CIP susceptibility among contemporary Salmonella isolates causing systemic infection.

2. However, in June 2011, after appeals from individuals in countries where typhoid fever is endemic, the NAL screen recommendation was reinstated.

3. Azithromycin has been shown to yield higher cure rates and lower mean duration of fever than OFO for the treatment of Salmonella Typhi with DCS [72, 73] but is not approved for the treatment of salmonellosis in the United States. 4. In most cases, Salmonella enteritis is self-limiting, and antimicrobial therapyis not generally recommended because of potential prolongation of the carrier state. In these cases we have a passive voice structure. We must bear in mind that the passive structure is very common in this type of text as it reflects impersonality and creates the effect of putting important ideas at the beginning of a clause. English language tends to form structures with the passive voice that are not admitted in Spanish (García, 1982). Vivaldi (2000) agrees stating that the overuse of passive structures is not part of Spanish style.Therefore, the TL rejects the overuse of such structure and the literal the transference of the structure into the TT may be an error in the style creating an Anglicism of frequency. We can also appreciate that the agent is not known and, therefore, not mentioned in any of the examples. We must use a translation method that allows transferring correctly the SL structure into the TL.The passive structure is changed in all cases using modulation. The intention is not to completely eliminate all passive structures in the TL but to reduce its frequency or change the structure for a more common one. The reflexive pronoun “se” of Spanish is added with the verb in third person. Such structure is called passive reflexive which also expresses impersonality and eliminates an agent. In this way, the expression is more natural and, therefore, accepted. The exception is the first case where we avoided the structure modulating from a passive vision to an active vision (Vázquez, 1977). We must bear in mind that Spanish prefers

active constructions in contrast with English language. The strategy used was transforming the passive structure into an active voice and the agent acumulación took back its place as subject of the sentence. The verb of the passive is now in present active tense. 1. La acumulación de estudios clínicos, microbiológicos y farmacocinéticosfarmacodinámicos (PK-PD por sus siglas en inglés) que muestran que dicho valor límite actualizado es el más adecuado para determinar la susceptibilidad a la ciprofloxacina entre los aislados contemporáneos de la Salmonella que causan infecciones sistémicas respaldan el cambio a estos valores. 2. Sin embargo, después de varias peticiones por parte de individuos en países donde la fiebre tifoidea es endémica, en junio del 2011, se restableció la recomendación para utilizar el monitoreo con ácido nalidíxico. 3. Se ha comprobado que la azitromicina promueve mayores tasas de curación y fiebre de menor duración, más que la ofloxacina, para el tratamiento de Salmonella tifoidea con susceptibilidad disminuida a la ciprofloxacina [72, 73]; sin embargo, no se aprueba para el tratamiento de la salmonelosis en los Estados Unidos. 4. En la mayoría de los casos, la Salmonella entérica se auto limita y generalmente no se recomienda la terapia antimicrobial por la posible prolongación del estado de portador

Passive voice with auxiliary verbs 

The CLSI voted to remove this comment in M100-S23, because isolates that test in the intermediate range of the revised CIP break point include those that harbor PMQR determinants that may be associated with in vivo selection of high-level FQ



resistance, as detailed above. El CLSI optó por eliminar esta observación en el documento M100-S23, ya que los aislados que se probaron en el rango intermedio del valor límite actualizado al usar ciprofloxacina incluyen aquéllos que tienen determinantes de resistencia a quinolonas mediada por plásmidos que se relacionan posiblemente con la selección in vivo de la resistencia de alto nivel a las flouroquinolonas, tal como se ha señalado anteriormente.

Newmark (1988) asserts that present passives is one language variety characteristic of a formal and technical style. We can appreciate this characteristic inside this sentence. It is also presented an auxiliary and an infinitive. Thomson and Martinet (1986, p. 32) state that “… Auxiliary + infinitive combinations are made passive by using a passive infinitive.” Therefore, the passive infinitive be is included in this passive expression. We must remember that Spanish prefers the active structure rather than the passive. Therefore, we must change the structure of the passive vision to comply with the style of the TL. The solution in this example is replacing the passive structure for another structure of the TL called reflexive passive. Vivaldi (2000) states that is more common in Spanish to use the passive reflexive instead of the passive with the verb ser when the subject of the structure is a non-living object. Therefore, we have transferred successfully the structure

and the sense respecting the style of the TL. The ST has an auxiliary that denotes possibility. Therefore, the auxiliary may is changed into an adverb by transposition carrying the same meaning of possibility.



The extent of this verification study is at the discretion of the laboratory director, but reliability of Etest to detect CIP-susceptible, -intermediate, and -resistant results



with use of the new break points should be confirmed. El director del laboratorio determina la amplitud de este estudio de verificación. No obstante, debería comprobarse la fiabilidad de la Prueba Épsilon para detectar resultados mediante la ciprofloxacina; ya sean susceptibles, intermedios o resistentes, con el uso de los nuevos valores límite.

There is a structure of passive voice at the end of this sentence (should be confirmed). This structure also presents an auxiliary verb. English active structures that present the segment auxiliary + infinitive are made passive by using the auxiliary and a passive infinitive (Thomson and Martinet, 1986). If we maintain the same structure in the TT, the sentence might sound odd and the style will be incorrect. Therefore, we must adapt to the peculiarities and style of the TT. We have already mentioned that the abuse of passive voice is not part of Spanish features. In Spanish, exists something called “reflexive passive” that adds the particle “se” before the verb in active tense. It is possible to place the particle “se” next to the infinitive in Spanish if presented the English segment modal verb + infinitive. Therefore, the result is a natural Spanish structure with a verbal phrase: auxiliary (debe) + main verb in infinitive + reflexive pronoun se. This structure reflects the lack of an agent

and impersonality (Bosque, 2010). We have modulated from a passive structure in English to another kind of passive structure of Spanish language maintaining the sense and meaning. Passive of perfect tenses 

Azithromycin has been shown to yield higher cure rates and lower mean duration of fever than OFO for the treatment of Salmonella Typhi with DCS [72, 73] but is



not approved for the treatment of salmonellosis in the United States. Se ha comprobado que la azitromicina promueve mayores tasas de curación y fiebre de menor duración, más que la ofloxacina, para el tratamiento de Salmonella tifoidea con susceptibilidad disminuida a la ciprofloxacina [72, 73]; sin embargo, no se aprueba para el tratamiento de la salmonelosis en los Estados Unidos.

The grammatical issue in this segment is the passive voice presented in a perfect tense at the beginning of the sentence. We use the passive voice when the agent of the verb is not important enough or when it is unknown (A. Thomson, A. Martinet, 1986). Therefore, this structure reflects impersonality stating that the action was carried out or established by general consensus and when the agent is not really known. We must be careful of using a translation copying the same structure of English instead of using a more suitable form of Spanish. For this reason, we must use an appropriate translation method that comply with the style and grammar rules of the TL. The solution in the transference of this segment was a modulation of a passive vision to an impersonal form with the use of the pronoun se. We avoided the use of passive voice without altering the sense. The impersonal form with se of Spanish language does not refer to a person in particular and does not need an explicit subject (Alarcos, 1995). This form

refers to people in general stating the sense of impersonality. This structure is widely used in scientific texts. In this way, the meaning and sense of the ST is kept. 

Because of the clinical significance of DCS/NALR strains in systemic infections, clinical laboratories have been encouraged to identify these isolates during routine



susceptibility testing. A causa de la importancia clínica de los serotipos de sensibilidad disminuida a la ciprofloxacina y resistencia al ácido nalidíxico en infecciones generalizadas, se ha motivado a laboratorios clínicos a identificar estas mismas cepas aisladas durante antibiogramas rutinarios.

The sentence in the ST presents a structure of passive voice in a perfect tense having as a subject and object at the same time to the noun clinical laboratories with no agent expressed in order to reflect impersonality. Passives are used when the subject of the active construction is not a person in particular or when is people in general making a statement (A. Thomson, A. Martinet, 1986). The same structure of the passive can lead to a stylistic problem in the TT. We used a translation method transferring a more suitable structure. We modulated the expression in passive voice and the TT has a more suitable structure now. The TT now presents the reflexive pronoun se stating impersonality to the structure. The tense is maintained in a compound form in Spanish. We can appreciate that the verb motivado is invariable with the object of the expression and suffer no changes keeping the singular form. This is an impersonal structure that eliminates the agent having no specific subject and refers to general statement as well (Alarcos, 1995). The sense of the ST is maintained. STRUCTURES WITH ~ING SUFFIX

~ing structure as a noun 1. RE-EVALUATING THE FQ BREAK POINTS REEVALUACIÓN DE LOS VALORES LÍMITE AL USAR FLOUROQUINOLONAS 2. Given the wild-type Salmonella CIP MIC distribution of 0.008–0.06 μg/mL, many have suggested lowering the susceptible break point for CIP to ≤0.06 ug/mL. Dada la distribución de la concentración inhibitoria mínima a la ciprofloxacina de 0,008 - 0,06 μg/ml de la Salmonella silvestre, se ha sugerido la disminución del valor límite susceptible de la ciprofloxacina a ≤ 0,06 μg/ml. 3. This change is supported by accumulating clinical, microbiological, and pharmacokinetic-pharmacodynamic (PK-PD) studies that indicate that such a revised break point is more appropriate for determining CIP susceptibility among contemporary Salmonella isolates causing systemic infection. La acumulación de estudios clínicos, microbiológicos y farmacocinéticosfarmacodinámicos (PK-PD por sus siglas en inglés) que muestran que dicho valor límite actualizado es el más adecuado para determinar la susceptibilidad a la ciprofloxacina entre los aislados contemporáneos de la Salmonella que causan infecciones sistémicas respaldan el cambio a estos valores. 4. CLSI rationale for maintaining the NAL screen arose from consideration of technical challenges faced by clinical laboratories in resource-limited countries. Los fundamentos del CLSI para mantener el monitoreo mediante el uso de ácido nalidíxico surgieron al tomar en consideración los desafíos técnicos que enfrentan los laboratorios clínicos en los países con recursos limitados.

The problem in the first example may arise at the moment of translating the gerund in the title. The gerund cannot be the translated literally for it possesses different functions that differ from Spanish. The Spanish gerund cannot be used as a noun. In the second example, the verb “suggest” is in the list of verbs that are followed by the gerund form (Thomson and Martinet, 1986). The TL may not have the same characteristic that after a certain verb comes a gerund form with the function of a D.O. In the third example we can appreciate a –ing form after the preposition “by”. After a preposition, it is sometimes added a gerund form in the ST (Thomson and Martinet, 1986). This behavior is not acceptable in the syntax of the TL. A gerund can also be the complement of a preposition in the ST and its function would be the one of a noun (Thomson and Martinet, 1986) as in the fourth case. In contrast, gerunds in Spanish cannot be used as nouns or as agents of the passive structure; literal translation of this structure would result in a syntactic problem. The –ing suffix in the segment for maintaining may be confusing to translate. The solution for all examples was changing the verbal form for a noun or another verbal form. The gerund in the first case is transposed to a noun which implies that the break points are involved in it and highlights the main theme of the next paragraphs. In all nonliterary texts, it is recommended that the title should describe and address the subject or the purpose of a process (Newmark, 1988). Therefore, the noun was a good option conveying the same sense that the title of the ST. In the second example, the verb “lowering” is changed for a noun with transposition. The Spanish gerund does not have this function and use, and if presented, the structure would be

incorrect. The ~ing structure of the ST is called gerundial noun (Huddleston and Pullum, 2010) and this characteristic is not shared with the Spanish gerund.We have added a noun in the TL that functions as a complement of the verb. In the third case we alsoapplied a verb-noun transposition to translate “accumulating;” the verb was changed into an abstract noun. The structure in the ST was constructed with the gerundas the agent and complement of the preposition and functioningas a noun. Therefore, the most suitable solution was inserting a natural noun in the TT that is the main subject and noun of the whole sentence. A previous modulation to reduce the use of passive voice was made putting the subject again at the beginning of the sentence. Thus, odd syntax is avoided as well as potential semantic problem. Spanish language tends to use an infinitive when a preposition is presented. According to Alarcos (1994) the infinitive tends to be preceded by prepositions because of its noun function. Therefore, we changed the vision of the gerund into an infinitive form in the TL (para mantener) in the fourth example. Although both are verbal forms, a transposition was the correct method to use because the gerund has different syntactic functions in both languages. Being a different verbal form, the Spanish infinitive complies with the function of the SL element. The structure now complies with the grammar rules of the TT. ~ing structure as an attributive or postmodifying clause 1. The CLSI is presently investigating alternative tests to replace the NAL screen, including OFO DD, which is associated with a sensitivity of 97.3% and specificity of 99.3% for the prediction of DCS [69]. El CLSI está en la actualidad investigando pruebas alternativas, que incluyen la difusión en disco de ofloxacina, para reemplazar el monitoreo con ácido

nalidíxico, el cual se asocia con una sensibilidad del 97,3 % y una especificidad de 99,3 % en el monitoreo de susceptibilidad disminuida a la ciprofloxacina [69].

2. Furthermore, because no data document favorable treatment outcomes using high dose CIP monotherapy for such isolates and high dose CIP may be associated with an increased risk of toxicity, it is the opinion of the authors that treatment with an alternative agent, such as ceftriaxone, may be preferable for such cases. Además, ya que no existe registro de resultados de tratamientos favorables que usen altas dosis en la monoterapia con ciprofloxacina para tales aislados; y que altas dosis de ciprofloxacina pueden relacionarse con un mayor riesgo de toxicidad, los autores consideran que el tratamiento utilizando un agente alternativo, por ejemplo la ceftriaxona, es preferible para casos de este tipo. The translation of the gerund in these cases may be complicated for a beginner translator for he/she must identify its actual function in the sentence. In English, a ~ing suffix or present participle clause can replace a relative pronoun (Thomson and Martinet, 1986). The relative clause as well as the participial clause can add some give some more information about its noun. Thomson and Martinet (1986) state that instead of a relative pronoun, present participles can be used when the verb in the clause expresses a habitual or continuous action. The same structure may be unusual in the TT. Therefore, we need to use a suitable element to express naturalness in syntax and style. The segment in the second case with using is describing and referring to the previous noun

favorable treatment outcomes. The English structure is being used as a post modifier clause and gives more information about its subject. In the first case we have the same subordinate structure with the same function. This structure can be rephrased as a relative clause (Riber, D., et al, 2000).The solution is provided by a transposition participial clause-relative clause. In the first case the participial clause in the ST is not immediately placed after its referent. Its position is changed and we decided to place the clause next to its referent in the TT in order to clear any confusion. Although Spanish gerund can also be the post modifier of a noun giving more information about it, the relative clause is more common when post modifying a noun. Therefore, the relative clause complains with the same function of the ST. In conclusion, the best option in both cases was a transposition from participial to a relative clause with the verb in personal form related to the previous subject. These structures give a full explanation about its referent in scientific texts. 

Typhoid fever is endemic in many developing countries, particularly on the Indian subcontinent



[10],

where

multidrug

resistance

(MDR)

to

ampicillin,

chloramphenicol, and trimethoprimsulfamethoxazole is common [10, 11]. La fiebre tifoidea es endémica en muchos países en vías de desarrollo, particularmente en el subcontinente indio [10,11], donde es común la resistencia a múltiples

drogas

(o

RMD):

a

la

ampicilina,

cloranfenicol

y

al

sulfametoxazol/trimetoprima. In this example developing is a verbal form with a ~ing suffix used as an adjective. In Spanish, the gerund structure is presented with the suffixes ~ando and ~iendo and a literal

translation would produce a sentence with a syntactic problem and no sense in the TT –La fiebre tifoidea es endémica en muchos desarrollando países The translation methods used here are expansion and transposition. We can just use the technique of changing the participial clause of English for an adjective in Spanish (Agnese, 2000). Nevertheless, Spanish has a specific adjectival phrase for representing the same sense and meaning of the adjective in the ST and that is mainly used instead of a single adjective. Descriptive terms (Collocations) are used when a term is not functional enough to express the exact meaning (Newmark, 1988).We needed to use a description adding two prepositions and two nouns. The verbal form has disappeared changing into one of the nouns in the adjectival phrase.

~ing structure as an adverbial clause 

At the very least, laboratories should interpret CIP MICs using the old break points, while providing a comment that Salmonella isolates with CIP MICs ≤1 μg/mL but >0.06 μg/mL are associated with delayed responses or clinical failure



after FQ therapy. Por lo menos, los laboratorios deberían interpretar las concentraciones inhibitorias mínimas de ciprofloxacina con los valores límite preliminares realizando la observación de que las cepas de Salmonella con concentraciones inhibitorias mínimas de ciprofloxacina con valor de ≤1 μg/mL pero >0.06 μg/mL se asocian con respuestas retardadas o fallas clínicas después de la terapia con flouroquinolonas.

The analyzed expression with –ing introduces a second clause stating simultaneity. This structure did not have a high frequency in the ST. Nevertheless, we consider important to describe this only case to reflect in the nature of this function. Both the main clause and participial clause with ~ing suffix have the same subject and happen at the same time (Thomson and Martinet, 1986). We must be sure if the equivalent structure of the TT can function in the same way or if transferring the same structure would lead to a syntactic error. The technique we used was a transposition from verb to preposition. In the ST the segment introduced by “using” is simultaneous with the previous clause. It implies that the action in the first clause should be done with the action of the second clause. Therefore, we added the preposition that joined both clauses implying the same meaning in the ST. Sometimes, we can just use the technique of changing the participial clause of English for a preposition in Spanish (Agnese, 2000). However, a literal translation transferring the same structure could also have been used without altering the sense and meaning but the intention is to avoid such artless technique. Moreover, prepositions has not specific functions by themselves and they introduce the complement in which is integrated (Alarcos, 1994). The meaning and sense of the ST has been successfully transferred.

5. CONCLUSIONS Translation requires a detailed methodology in practice and involves knowledge about linguistic and translation theories. A series of practical steps are necessary for a translator of scientific texts in order to improve his/her performance in the translation of such texts. The process of the methodology was extensively discussed and helped us to obtain an adequate translation. In English, one of the main characteristics in specialized writings, such as texts related with medicine, is the frequent presence of passive voice sentences. In Spanish, there is also this passive voice structure, but most of the time it is not

suitable using a literal translation. If these structures were transferred literally, it would cause a problem in the style and syntax of the TT. We are now convinced that the oblique translation methods proposed by Vazquéz Ayora and initially by Vinay and Darbelnet are very important if we want to keep the style and syntax of a TL, especially in scientific texts. We can reflect on the fact that there is a lot of theoretical background and practical knowledge behind translation that is very necessary to achieve a satisfactory translation.A person who is only a specialist of a specific area may not succeed when translating these kinds of texts if he/she is not aware of all that existing background and knowledge. Finally, we would like to mention that another complication presented was the terminology used in the ST. Terminology is one of the main issues when translating a scientific medical text. Although we did not focus on that issue, we created terminology files that helped us to overcome that problematic. The result was the creation of a great amount of files that guided us when trying to understand a concept and expressing it correctly into the TT. Therefore, terminology files can be a very important tool for translators and beginners translators of scientific texts. This issue can be a subject of research to future generations of translators. Inside the issue of terminology, we also dealt with high frequency of acronyms presented in the ST. We could appreciate that scientific texts in the SL had an overuse of a acronyms that may cause confusion to the reader and slow down the reading speed as well as understanding. Nevertheless, this is a very common characteristic in scientific texts and specialist can easily identify almost every acronym. On the other hand, Spanish scientific texts presented a smaller number of acronyms. The equivalence of some of the acronyms in

the ST was a complete descriptive term in the TT. A comparison through the use of corpora may be a suitable tool to analyze this phenomenon in further research.

6. REFERENCES Alarcos, E. 1995, Gramática de la Lengua Española. España: Editorial Espasa Calpe. Agnese, A. (2000). Hilando fino... con el gerundio. www.elcastellano.org/gerundio.html (consulted 20/12/2014) Argüelles, A., and Argüello, P. 2006, Traducción e interpretación técnica. In Dominguez, A. and Ibarra, D (eds) 1er congreso Multidisciplinario en Torno a la Traducción. Universidad intercontinental: 158-165 Arnts, R. 1993 TerinologicL Equivalence and Transaltion. In Sonneveld, H. and Loening, K. (eds) Terminology: Applications in Interdisciplinary Communication. John Benjamins Publishing, Co.: 5-19 Bell, R., (1991) Translation and Tranlating: Theory and Practice. Addison Wesley Publishing Company. Borja, A., García, I., Montalt, V., 2010, Research Methodology in Specialized Genres for Translation Purposes, Ian Mason (ed), The interpreter and Transaltor Trainer. St Jerome

Bosque, I. 2010, El verbo. Las formas no personales: el gerundio y el participio. In Bosque, I. (ed) Nueva Gramática de la Lengua Española: MANUEAL. Editorial Espasa: 511-527 Cabré, M.T., dic. 2000, El traductor y la terminología: necesidad y compromiso, Instituto universitario de Lingüística Aplicada, Universidad Pompeu Fabra, Barcelona. Cabré,M. 1996, Ingineering in honour of Juan C. Sager. John Benjamins Publishing Co.,: 15-33 Child, J. (2010). Introduction to Spanish Translation. Maryland: University Press of America Clerici, C. (2013) Lectura y Escritura de Textos académicos y científicos. Manual 2013. www.academia.edu/3218131/Lectura y escritura _de_textos_académicos_y_científicos. Consulted 20/10/2014. Delisle, J. and Woodworth, J., 2005, Los traductores de la historia, Editorial Universidad de Antioquia, Colombia García, Y., 1989, En torno a la traducción: teoría, crítica, historia, Madrid, España: Gredos García, Y., 1997, Teoría y Práctica de la Traducción, España: Editorial GREDOS Grey, S. & Kaufman, T., 1988, Language Contact, Creolization, and Genetic Linguistics, University of California Press Gutiérrez, L., Montiel, E., Aguilera, P.& González, M. C. (2000). Serotipos de Salmonella identificados en los servicios de salud de México. Salud Pública Méx 2000; Vol. 42(6): 490 – 493. Consulted 12/12/2014 from http://www.scielosp.org/scielo.php?pid=S003636342000000600004&script=sci_arttext Huddleston, R &Pullum, G. K. 2010, 3ra edción, The Cambridge Grammar of the English Language. New York: Cambridge University Press J.P Vinay& J. Darbelnet, 1958, Stylistique comparée du francais et de l’anglish, Editorial Didier Malone, J., L., 1988, The science of linguistics in the art of translation: Some Tools from Linguistics for the Analysis and Practice of Translation, Albany: University of New York Press. Montalt, V. 2011. Medical Translation and Interpreting. In Gambier, Y. and Van Doorslaer, L. (eds) Handbook of Translation Studies: Volume 2. John Benjamins Publishing Co.: 7983 Munday, J. 2001, Introducing Translation Studies: Theories and applications, USA; Canada: Toutledge Muñoz, C., Análisis contrastivo y traductológico de textos médicos (inglés-español) El caso género clínico. Tesis dictoral, Barcelona, España, Universidad Aut+onoma de Barcelona, 2011, 565 p. Navarro, F. (2008). Repertorio de siglas, acrónimos, abreviaturas y símbolos utilizados en los textos médicos en español. Panace@. Vol IX, n o 27. Primer semestre. Consulted 17/07/2014 from www.medtrad.org/panacea/IndiceGeneral/27_tradyterm-navarro.pdf Navarro, F., Hernández, F., & Rodríguez-Villanueva, L., 1994, Uso y abuso de la voz pasiva en el lenguaje médico escrito, Servicio de Traducción Médica. F Hoffmann-La Roche SA, Newmark, P., 1988, A text book of translation, Great Britain: Prentice Hall International.

Nord, C. 2005, Text Analysis in Translation: Theory, Methodology and Didactic Application of Model for Translation Oriented Text Analysis, Armsterdam-New York: Editions Rodopi B.V. Oxford Journals (2014). Clinical Infectious Diseases. About the journal. www.oxfordjournals.org/our_journals/cid/about.html (consulted 23/11/2014) Pérez, I.,2012, What is Good Translation from the Perspective of Culture and Linguistics Public Works and Government Services Canada (2011). The Pavel Terminology Tutorial. www.bt-tb.tpsgc-pwgsc.ca/btb-pavel.php?page=tdm-toc&lang=eng&contland=eng (consulted 8/01/2015) Riber, D., Johansson, S., Leech, G., Conrad, S. & Finegan, E. 2000, Grammar of Spoken and Written English. England: Longman Rodríguez, L., 1976, TRADUCCIÓN CIENTÍFICA O TRADUCCIÓN INTUITIVA?: introducción al análisis de los aspectos teóricos de la traducción del francés al español, , Editorial Pueblo y educacíon, La Habana, Cuba Rosendo, L., 2008, diciembre, English and Spanish Medical Languages: A Comparative Study from a Translation Point of View,Trans. Revista de Traductología, (Consulted on 2015) Ruíz, L., 2008, Universidad Pablo de Olavide, Sevilla, English and Spanish Medical Languages: A Comparative Study from a Translation Point of View, http://www.trans.uma.es/pdf/Trans_12/t12_231-246_LRuiz.pdf (consulted 2015) Segura, G. (1996). Traducción del texto: “Scale Insects” del capítulo Insects, mites and snails del libro Integrated Pest Management for Citrus.Trabajo Práctico Educativo de licenciatura. Universidad Veracruzana, Xalapa, Veracruz. Thomson A. &Martinet, A., 2006, A Practical English Grammar, United Kingdom, Oxford: University Press. Thornbury, S. (n.d.). Grammar: -ing forms and postmodification. www.onestopenglish.com/support/ask-the-experts/grammar-questions/grammar-ing-formsand-post-modification/146364.article (consulted 28/12/2014) Vázquez Ayora, G., 1977, Introducción a la traductología, D.C: Georgetown University Press Vivaldi, G. (2000). Curso de redacción: teoría y práctica de la composición y del estilo.Madrid: Thomson

7. APPENDIX Terminology Files

Term: MIC, minimum inhibitory concentration Type of T: Complex

Terminology Word Class: noun Gender: male Simple

Complex Equivalence: CMI, concentración minima Word class: noun inhibitoria Gender: male Fuente: http://www.proz.com/kudoz/english_to_spanish/medical/110018urgente_we_always_set_the_CMIs_up_x2.html Type of term: complex

Simple Complex

Antonyms: Synonyms: Area of study: medicine Field: clinical medicine Subfield: clinical microbiology Definition of term + ref: Examine tubes for visible signs of bacterial growth. The highest dilution without growth is the minimal inhibitory concentration (MIC). http://www.proz.com/kudoz/english_to_spanish/medical/110018urgente_we_always_set_the_mics_up_x2.html Usage example+Ref: “The sustanceis bactericidal for susceptible strains near the minimum inhibitory concentracion (MIC)." http://www.proz.com/kudoz/english_to_spanish/medical_pharmaceuticals/3928739susceptible_strains_near_the_mic.html Definition of equivalence + ref: La determinación de la Concentración Mínima Inhibidora (CMI) es la medida de la sensibilidad de una bacteria a un antibiótico. Es la mínima cantidad de antimicrobiano que es capaz de impedir el crecimiento de un microorganismo en unas condiciones normalizadas. http://campus.usal.es/~micromed/Practicas_odontologia/unidades/labv/LabMicro/Antibiogr ama.html Usage example+Ref.: Un total de 23.9% presentaron presentaron CMIs que permitían incluirlas dentro de la categoría de aislamientos con sensibilidad… http://www.redalyc.org/articulo.oa?id=17077609 Notes on term usage(Register, sociolect,…). Term used in formal situations by specialized people. Readership: doctors, institutes, chemists, students of medicine, laboratory workers.

Terminology Word Class: N Gender: Neutral Type of T: Complex Simple Complex Equivalence:fluoroquinolona Word class: N Gender: F Fuente: Carmen Ardanuy, et. Al., Detección fenotípica de mecanismos de resistencia en grampositivos, 2011, Term:Fluoroquinolone (FQ)

ed. Emilia Cercenado y Rafael Cantón, Procedimientos en Microbiología Clínica, Recomendaciones de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC). Type of term: Complex Simple Complex Antonyms: Synonyms: Area of study: medicine Field: clinical medicine Subfield: clinical microbiology Definition of term + ref:any of a group of fluorinated derivatives (as ciprofloxacin and levofloxacin) of quinolone that are used as antibacterial drugs, http://www.merriam-webster.com/medical/%20fluoroquinolone Usage example+Ref: Because of this widespread resistance, ceftriaxone or a fluoroquinolone (FQ) is recommended by the World Health Organization for the treatment of uncomplicated typhoid fever. Definition of equivalence + ref: Las quinolonas (quinolonas y fluoroquinolonas) son agentes antimicrobianos estructuralmente relacionados cuyo principal mecanismo de acción es inhibir la actividad de la ADNgirasa o de la topoisomerasa de muchas bacterias grampositivas y gramnegativas. Instituto de Estándares Clínicos y de Laboratorio. Normas para realizar las pruebas de sensibilidad a los antimicrobianos con discos. Norma aprobada, décima edición. Documento CLSI M02-A10. Wayne, PA: Clinical and Laboratory Standards Institute; 2009. Usage example+Ref: para algunos agentes (por ejemplo, fluoroquinolonas o cefalosporinas) que producen halos extremadamente grandes, solo habrá que poner dos o tres discos por placa. Instituto de Estándares Clínicos y de Laboratorio. Normas para realizar las pruebas de sensibilidad a los antimicrobianos con discos. Norma aprobada, décima edición. Documento CLSI M02-A10. Wayne, PA: Clinical and Laboratory Standards Institute; 2009. Notes on term usage(Register, sociolect,…). Term used in formal situations by specialized people. Readership: doctors, institutes, chemists, students of medicine, laboratory workers.

Terminology Word Class: N Gender: N Type of T: Complex Simple Complex Equivalence: Resistencia a Múltiples Drogas (RMD) Word class: N Gender: F Term: Multidrug Resistance (MDR)

Fuente: http://www.incan.org.mx/revistaincan/elementos/documentosPortada/1172289440.pdf Type of term: complex Simple Complex Antonyms: Synonyms: Area of study: medicine Field: clinical medicine Subfield: clinical microbiology Definition of term + ref:Multiple-drug resistance occurs when bacteria are resistant to more than one antibiotic. Because of years of antibiotic overuse, multidrug resistance is now the rule rather than the exception among resistant bacteria. http://www.tufts.edu/med/apua/about_issue/multi_drug.shtml Usage example+Ref:These organisms are often referred to as multidrug-resistant or MDR strains. http://www.cdc.gov/drugresistance/about.html Definition of equivalence + ref: Resistencia a fármacos de diversas clases. Coleman, N., ¿Qué hacer con un diagnóstico de cáncer?, trad. Harari, C. y Harari, J., Ed. Pax, México, 2008, p. 91 Usage example+Ref: La rápida emergencia de Enterobacterias con fenotipos resistentes a múltiples drogas (RMD) es un serio desafío médico. http://buscadores.anii.org.uy/buscador_cvuy/exportador/ExportarHtml? hash=700b2be01a361704f0e08bb00619b140 Notes on term usage(Register, sociolect,…). Term used in formal situations by specialized people and students of the area. Readership: doctors, institutes, chemists, students of medicine, laboratory workers.

Term: decreased CIP susceptibility (DCS) Type of T: Complex Equivalence: sensibilidad disminuída a ciprofloxacina (SDC) Fuente: Type of term: complex

Terminology Word Class: N Gender: N Simple Complex Word class: N Gender: F Simple Complex

Antonyms: Synonyms: Area of study: medicine Field: microbiology Subfield: clinical microbiology Definition of term + ref:[ciprofloxacin minimum inhibitory concentration (MIC) 0.125-1.0 mg/I]. M. parrya and E.J. Threlfallb, Antimicrobial resistance in typhoidal and nontyphoidal salmonellae, Current Opinion in Infectious Diseases 2008, 21:531-538 http://www.globe-network.org/sites/default/files/en/network/resource/camlab-2013-antimicrobial-resistance-intyphoidal-and-nontyphoidal-salmonellae.pdf Usage example+Ref: …the incidence of decreased ciprofloxacin susceptibility has reached high levels, particularly in the Indian subcontinent, and isolates with full resistance to this antimicrobial are increasingly reported. http://www.globe-network.org/sites/default/files/en/network/resource/camlab-2013-antimicrobial-resistance-intyphoidal-and-nontyphoidal-salmonellae.pdf Definition of equivalence + ref: Se consideró que un aislamiento de Salmonella enterica presentaba sensibilidad reducida a ciprofloxacino cuando presentaba una concentración mínima inhibitoria(CMI)entre

0.125 µg/mL y 1.0 µg/mL. Usage example+Ref: Lepe, Jiménez, José Antonio; Garrido, Serrano, Antonio; Guerrero, Igea , Francisco Javier. (2003). Sensibilidad reducida a ciprofloxacino en los aislados de Salmonella entérica de la zona norte de Huelva. Revista Española de Salud Pública, noviembre-diciembre, 761-764. Notes on term usage(Register, sociolect,…). Specific term used in formal situations by specialized people and students of an specific area. Readership: doctors, institutes, chemists, students of medicine, laboratory workers, biologists.

Terminology Word Class: N Gender: N Simple Complex Equivalence: región determinante de resistencia a Word class: N quinolonas (QRDR) Gender: F Fuente: http://antimicrobianos.com.ar/ATB/wp-content/uploads/2012/11/Caracterizaci%C3%B3n-molecular-demec-de-SD-CIP-en-dos-N.-meningitidis.-Poster.pdf Type of term: Complex Simple Complex Antonyms: Synonyms: Area of study: medicine Field: microbillogy Subfield: clinical microbiology Definition of term + ref:Resistance to FQ typically results from alterations in a small region named the quinolone resistance-determining region (QRDR) of each DNA gyrase subunit. The main mechanism of FQ resistance is amino acid substitution within the quinolone resistance-determining region (QRDR) of the GyrA subunit of DNA gyrase… http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3318379/ Usage example+Ref: The predominant mutation causing nalidixic acid resistance in the quinolone-resistance determining region (QRDR) of gyr A gene of isolates from southern Viet Nam was a Ser83Phe substitution. Term: quinolone resistance–determining region (QRDR) Type of T: Complex

M. parrya and E.J. Threlfallb, Antimicrobial resistance in typhoidal and nontyphoidal salmonellae, Current Opinion in Infectious Diseases 2008, 21:531-538 Definition of equivalence + ref: Cada enzima blanco tiene una región determinante de resistencia a quinolona (QRDR [quinolone-resistance determining region]), porción ligada a ADN en la cual las sustituciones de aminoácidos pueden disminuir la unión a quinolonas. http://www.bago.com/bago/bagoarg/biblio/uroweb08.htm Usage example+Ref: Los mecanismos de resistencia involucrados en esas cepas fueron mutaciones en la región determinante de resistencia a quinolonas (QRDR) de la subunidad gyrA de la ADN girasa… http://antimicrobianos.com.ar/ATB/wp-content/uploads/2012/11/Caracterizaci%C3%B3n-molecular-de-mec-deSD-CIP-en-dos-N.-meningitidis.-Poster.pdf Notes on term usage(Register, sociolect,…). Specific term used in formal situations by specialized people and students of a specific area. Readership: doctors, institutes, chemists, students of medicine, laboratory workers, biologists.

Term:PMQR, plasmid - mediated quinolone resistance. Type of T: Complex Equivalence: Resistencia a Quinolonas Mediada por Plásmidos. (PMQR).

Terminology Word Class: N Gender: N Simple Complex Word class: N Gender: F

Fuente: http://www.proz.com/?sp=gloss/term&id=4798860 Robicsek A, Jacoby G, Hooper D, Actualización sobre Resistencia a Quinolonas Mediada por Plásmidos (trad), The Worldwide Emergence of Plasmid-Mediated Quinolone Resistance, Lancet Infectious Diseases 6(10):629-640, Oct 2006 Type of term: Complex Simple Complex Antonyms: Synonyms: Area of study: medicine Field: microbiology Subfield: clinical microbiology Definition of term + ref:Usually, genetic information for the efflux resistance mechanisms or the targeted site ischromosomally encoded. In this context however, there have been reports of resistance to fluoroquinolones mediated by plasmids, which renders such resistance transferable (Figure 5). This involves a number of mechanisms, such as: 1. Qnr 2. Aminoglycoside acetyltransferase AAC(6_)-Ib-cr 3. OqxAB, QepA [69-72] Plasmid-mediated resistance to quinolone was first found in 1998, emerging in strains of Klebsiella pneumoniae in one US region [73]. The emergence was determined to be induced by one of the members of the pentapeptide repeat (PPR) family of proteins, Qnr (subsequently referred to as QnrA).

http://cdn.intechopen.com/pdfs-wm/46480.pdf Usage example+Ref: Definition of equivalence + ref: Luis Martínez-Martínez y colaboradores descubrieron la PMQR a fines de la década de 1990, de manera inadvertida mientras estudiaban la capacidad del plásmido pMG252 de aumentar la resistencia a múltiples antibióticos en una cepa de Klebsiella pneumoniae deficiente de porinas. Inesperadamente, observaron un aumento sustancial de la concentración inhibitoria mínima (CIM) a quinolonas. También verificaron el incremento de 64 veces la CIM en una cepa de E. coli con porinas que, si bien no representó resistencia clínica, seleccionaba mayores niveles de resistencia a quinolonas. La cepa salvaje de E. coli con pMG252 tenía 100 veces más posibilidades de desarrollar mutantes resistentes espontáneas que las cepas libres de plásmidos. La secuenciación del gen responsable condujo a una proteína llamada Qnr (quinolone resistance). Luego se la renombró QnrA debido a la identificación de proteínas relacionadas.

Robicsek A, Jacoby G, Hooper D, Actualización sobre Resistencia a Quinolonas Mediada por Plásmidos (trad), The Worldwide Emergence of Plasmid-Mediated Quinolone Resistance, Lancet Infectious Diseases 6(10):629-640, Oct 2006 Usage example+Ref: Han pasado 36 años entre el descubrimiento del ácido nalidíxico y el primer informe validado de PMQR. Robicsek A, Jacoby G, Hooper D, Actualización sobre Resistencia a Quinolonas Mediada por Plásmidos (trad), The Worldwide Emergence of Plasmid-Mediated Quinolone Resistance, Lancet Infectious Diseases 6(10):629-640, Oct 2006 Notes on term usage(Register, sociolect,…). Specific term used in formal situations by specialized people and students of a specific area. Readership: doctors, institutes, chemists, students of medicine, laboratory workers, biologists.

Term: DNA gyrase Type of T: Complex Equivalence: ADN girasa

Terminology Word Class: N Gender: N Simple Complex Word class: N

Gender: F Fuente: Type of term: Complex

Simple Complex

Antonyms: Synonyms: Area of study: ciencias médicas Field: microbiology Subfield: genetics microbiology Definition of term + ref:a bacterial enzyme that catalyzes the breaking and rejoining of bonds linking adjacent nucleotides in circular DNA to generate supercoiled DNA helices. http://www.merriam-webster.com/medical/gyrase Usage example+Ref:The process of fluoroquinolone interference in cell replication, transcription and DNA repair consists in disabling DNA gyrase (previously topoisomerase II) and topoisomerase IV, two processes essential to bacterial enzymes. http://cdn.intechopen.com/pdfs-wm/46480.pdf Definition of equivalence + ref: enzima que interviene en el plegamiento de la doble hélice de ADN y es fundamental para que la estructura tridimensional del material genético sea correcta. http://iate.europa.eu/SearchByQuery.do? method=searchDetail&lilId=1685028&langId=&query=gyrase&sourceLanguage=en&domain=0&matching=&st art=0&next=1&targetLanguages=es Usage example+Ref: Existen 2 mecanismos de resistencia a quinolonas y fluoroquinolonas: el más importante, en las enterobacterias, es la acumulación de mutaciones en las enzimas bacterianas donde actúan las fluoroquinolonas: ADN girasa y ADN topoisomerasa. Robicsek A, Jacoby G, Hooper D, Actualización sobre Resistencia a Quinolonas Mediada por Plásmidos (trad), The Worldwide Emergence of Plasmid-Mediated Quinolone Resistance, Lancet Infectious Diseases 6(10):629-640, Oct 2006 Notes on term usage(Register, sociolect,…). Specific term used in formal situations by specialized people and students of a specific area. Readership: doctors, institutes, chemists, students of medicine, laboratory workers, biologists.

Terminology Term:nalidixic acid (NAL) Word Class: N

Gender: N Type of T: Complex Simple

Complex Equivalence: ácido nalidíxico NAL Word class:N

Gender: M Fuente: http://www.proz.com/?sp=gloss/term&id=4798050 Type of term: Complex Simple

Complex Antonyms: Synonyms: Area of study: medicina Field: farmacología Subfield: Definition of term + ref:an antibacterial agent C12H12N2O3 that is used especially in the treatment of genitourinary infections. http://www.merriam-webster.com/medical/nalidixic%20acid Usage example+Ref:The Qnr protein induces resistance to nalidixic acid and diminished susceptibility to fluoro‐quinolone resistance or low-levels of fluoroquinolone resistance. http://cdn.intechopen.com/pdfs-wm/46480.pdf Definition of equivalence + ref: Las quinolonas pertenecen a los antimicrobianos que alteran la síntesis de ADN bacteriano. El desarrollo de esta clase de fármacos comenzó en el año 1962 con la identificación del ácido nalidíxico. Esta droga, junto con el ácido oxolínico y la cinoxacina constituyen el grupo de las quinolonas no fluoradas, de escasa utilidad clínica en la actualidad debido a su actividad limitada a bacterias Gram negativas aerobias, a las bajas concentraciones plasmáticas (solo alcanzan concentraciones útiles en orina) y al rápido desarrollo de resistencia.

http://farmacomedia.files.wordpress.com/2010/05/quinolonas.pdf Usage example+Ref: El ácido nalidíxico y la pefloxacina se eliminan fundamentalmente por vías extrarrenales. http://farmacomedia.files.wordpress.com/2010/05/quinolonas.pdf Notes on term usage(Register, sociolect,…). Specific term used in formal situations by specialized people and students of a specific area. Readership: doctors, institutes, chemists, students of medicine, laboratory workers, biologists. It also can be used in general by not specialized people.

Term: DCS/NAL-resistant (DCS/NALR). Type of T: Complex

Terminology Word Class: N Gender: N Simple

Complex Equivalence: Resistencia a Ácido Nalidíxico y Word class: N Sensibilidad Disminuida a Ciprofloxacino. Gender: F Fuente: Delgado, N., Epidemiología molecular de la salmonelosis multirresistente en Castilla y León, Ediciones Universidad de Salamanca, Colección Vitor, España,2003. Type of term: Complex Simple Complex Antonyms: DCS/NALS, NAL-susceptible isolates with DCS (DCS/NALS) Synonyms: Area of study: Field: medicine Subfield: microbiology Definition of term + ref: …there has been a global increase in nalidixic acid (NAL)-resistant strains causing decreased ciprofloxacin susceptibility (DCS)… A. Tatavarthy, R. Sanderson, et. Al., Molecular Typing and Resistance Analysis of Travel-Associated Salmonella enterica Serotype Typhi, J Clin. Microbiol. Aug 2012; 50 (8): 2631-2638. Usage example+Ref: Definition of equivalence + ref: L. monocytogenes es intrínsecamente resistente al ácido nalidíxico y muestra susceptibilidad decreciente al tratamiento con fluoroquinolonas como ciprofloxacino. Parilla F., ESTUDIO DE INCIDENCIA DE LA LISTERIOSIS EN ESPAÑA, Universidad Autónoma de Barcelona, Facultad de Medicina,Departamento de Pediatría, Obstetricia y Medicina Preventiva, Programa de Doctorado en Salud Pública y Metodología de Investigación Biomédica, tesis doctoral, Barcelona, España, 2011. Usage example+Ref: Notes on term usage(Register, sociolect,…). Specific term used in formal situations by specialized people and students of a specific area. Readership: doctors, institutes, chemists, students of medicine, laboratory workers, biologists.

Terminology Term: European Committee Word Class: N for Antimicrobial Susceptibility Testing (EUCAST). Gender: N Type of T: Complex Simple Complex Equivalence: Comité Europeo de Antibiogramas Word class: N (EUCAST) Gender: M Fuente: http://iate.europa.eu/SearchByQuery.do? method=searchDetail&lilId=3517164&langId=&query=EUCAST&sourceLanguage=en&domain=3606&matchin g=&start=0&next=1&targetLanguages=es Type of term: Complex Simple Complex Antonyms: Synonyms: Area of study: medicine Field: microbiology Subfield: clinical microbiology Definition of term + ref:EUCAST is a standing committee jointly organized by ESCMID, ECDC and European national breakpoint committees. EUCAST deals with breakpoints and technical aspects of phenotypic in vitro antimicrobial susceptibility testing and functions as the breakpoint committee of EMA and ECDC. EUCAST does not deal with antibiotic policies, surveillance or containment of resistance or infection control.

http://www.eucast.org/ Usage example+Ref:EUCAST has a subcommittee on antifungal susceptibility testing and on methods for detection of resistance mechanisms of clinical and/or epidemiological importance. http://www.eucast.org/ Definition of equivalence + ref: El «Comité Europeo de Antibiogramas» (2004-2007) sienta las bases de la vigilancia de los patógenos resistentes a los antimicrobianos definiendo métodos de referencia comunes que permitan comparar resultados e interpretar los datos de resistencia a los antibióticos en toda Europa. Ha creado un comité permanente de antibiogramas y establecimiento de valores críticos en Europa. Segundo informe de la Comisión al Consejo basado en los informes de los Estados miembros relativos a la aplicación de la recomendación 2002/77/CE del Consejo sobre la utilización prudente de los agentes antimicrobianos en medicina. Comisión Europea. Usage example+Ref: El Comité Español del Antibiograma: En sintonía con EUCAST, Luis Martínez Martínez, presidente del COESANT. http://www.hoycomentamos.com/2013/11/08/la-agencia-de-los-medicamentos-organiza-una-jornada-sobre-lasbacterias-resistentes-a-los-antibioticos/ Notes on term usage(Register, sociolect,…). Specific term used in formal situations by specialized people and students of a specific area. Readership: doctors, institutes, chemists, students of medicine, laboratory workers, biologists. It can also be used by a general public.

Terminology Word Class: N Gender: N Type of T: Complex Simple Complex Equivalence: microdilución en caldo Word class: N Gender: F Fuente: http://www.wikiwords.org/dictionary/broth_microdilution/99722/198852 Type of term: Complex Simple Complex Antonyms: Synonyms: Area of study: medical science Field: biology Subfield: microbiology Definition of term + ref:Broth microdilution is performed with Mueller-Hinton broth containing serial two-fold dilutions of cefotaxime, ceftazidime and cefepime at concentrations ranging from 0.25 to 512 mg/L, with and without clavulanic acid at a fixed concentration of 4 mg/L. The test is positive if 8-fold reduction is observed in the MIC of the cephalosporin combined with clavulanic acid compared with the MIC of the cephalosporin alone. In all other cases the test result is negative. Term: broth microdilution

EUCAST guidelines for detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance Version 1.0 December 2013 A variety of laboratory methods can be used to measure the in vitro susceptibility of bacteria to antimicrobial agents, since there is no uniform harmonised methodology of AST in human and veterinary medicine. In general, the two most commonly used methods are agar disc diffusion and broth microdilution. However, there is a tendency to prefer broth microdilution over agar disc diffusion, since this is the more robust test method and provides quantitative results. ISO report 20776-1:2006 (9) describes the broth microdilution reference method to determine MICs, although clinical interpretation of the MIC value is beyond the scope of ISO 20776-1:2006.

P. Silley, Susceptibility testing methods, resistance and breakpoints: what do these terms really mean?, Rev. sci. tech. Off. int. Epiz., 2012, 31 (1), 33-41. Usage example+Ref:Indeterminate test results (Etest) and false-negative test results (CDT, DDST, Etest and broth microdilution) may result from the high-level expression of AmpC β-lactamases… EUCAST guidelines for detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance Version 1.0 December 2013 Definition of equivalence + ref: Microdilución en caldo o dilución en agar: se emplea el medio BHI (brain heart infusión) al que se añaden 500 mg/L de gentamicina o bien 1.000 o 2.000 mg/L de estreptomicina (microdilución en caldo o dilución en agar, respectivamente); tras una incubación durante 24 horas a 35ºC, cualquier tipo de crecimiento será indicativo de resistencia y por tanto de ausencia de posible sinergia con agentes activos sobre la pared celular. Cuando se determina la sensibilidad por el método de microdilución en caldo, generalmente se utilizan métodos comerciales, se deben seguir las instrucciones del fabricante e incluir los correspondientes controles de calidad requeridos. Cuando se realiza este método, la detección de la resistencia a la meticilina requiere el uso de caldo Mueller Hinton con concentración ajustada de cationes, tanto si el antimicrobiano utilizado es la oxacilina como si es la cefoxitina y además debe contener NaCl al 2% en el caso de oxacilina. La incubación debe ser de 24 horas completas a una temperatura no superior a 35ºC. Determinación de la CMI por microdilución en caldo y por dilución en agar. Carmen Ardanuy, et. Al., Detección fenotípica de mecanismos de resistencia en grampositivos, 2011, ed. Emilia Cercenado y Rafael Cantón, Procedimientos en Microbiología Clínica, Recomendaciones de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC). Usage example+Ref: Los resultados de las pruebas que utilizan cefoxitina (tanto en la microdilución en caldo como en las pruebas de difusión con discos de cefoxitina de 30 μg) y los puntos de corte alternativos (véase la tabla 2C del documento M1009) pueden usarse para predecir la resistencia a oxacilina mediada por mecA de aislados de S. aureus. Instituto de Estándares Clínicos y de Laboratorio. Normas para realizar las pruebas de sensibilidad a los antimicrobianos con discos. Norma aprobada, décima edición. Documento CLSI M02-A10. Wayne, PA: Clinical and Laboratory Standards Institute; 2009. Notes on term usage(Register, sociolect,…). Specific term used in formal situations by specialized people and students of a specific area. Readership: doctors, institutes, chemists, students of medicine, laboratory workers, biologists.

Terminology Word Class: N Gender: N Type of T: Complex Simple Complex Equivalence:CIM de ciprofloxacino Word class: N Gender: F Fuente: José A., Celia Salcedo, et. al., Evolución de la sensibilidad de Neisseria meningitidis a diversos antimicrobianos en el curso de intervenciones con quimioprofilaxis durante un brote epidémico, España, Enferm Infecc Microbiol Clin 2006;24(10):608-12 Type of term: Complex Simple Complex Antonyms: Synonyms: Area of study: medicine Field: microbiology Subfield: clinical microbiology Definition of term + ref: Usage example+Ref:In this study, the effects of an efflux pump inhibitor 1-(1-naphthylmethyl)-piperazine on ciprofloxacin (CIP) minimum inhibitory concentration (MIC) values in gram-negative bacteria including Term: CIP MIC

Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae were investigated. CIP MIC values of each isolate were determined by broth microdilution method as recommended by CLSI. Coban AY, Bayram Z, et. al., Effect of efflux pump inhibitor 1-(1-naphthylmethyl)-piperazine to MIC values of ciprofloxacin in ciprofloxacin resistant gram-negative bacteria, Mikrobiyol Bul. 2009 Jul;43(3):457-61. Definition of equivalence + ref: Usage example+Ref: El cambio en la distribución de CIM de ciprofloxacino del segundo al tercer estudio podría tener una base similar a la de rifampicina. José A., Celia Salcedo, et. al., Evolución de la sensibilidad de Neisseria meningitidis a diversos antimicrobianos en el curso de intervenciones con quimioprofilaxis durante un brote epidémico, España, Enferm Infecc Microbiol Clin 2006;24(10):608-12 Notes on term usage(Register, sociolect,…). Specific term used in formal situations by specialized people and students of a specific area. Readership: doctors, institutes, chemists, students of medicine, laboratory workers, biologists.

Terminology Term: pharmacokinetic-pharmacodynamic (PK-PD) Word Class: Adj Gender: N Type of T: Complex Simple Complex Equivalence:farmacocinético, farmacodinámico Word class: Adj Gender: M, F Fuente: http://iate.europa.eu/SearchByQuery.do? method=searchDetail&lilId=3535755&langId=&query=pharmacokinetic&sourceLanguage=en&domain=0&matc hing=&start=0&next=1&targetLanguages=es http://iate.europa.eu/SearchByQuery.do? method=searchDetail&lilId=3535754&langId=&query=pharmacodynamic&sourceLanguage=en&domain=0&ma tching=&start=0&next=1&targetLanguages=es Type of term: complex Simple Complex Antonyms: Synonyms: Area of study: medical sciences Field: pharmacology Subfield: Definition of term + ref:An important consideration is that the efficacy of an antimicrobial agent is dependent on the relationship between the MIC for the microorganism and the exposure of the microorganism to the agent in the patient (or other host). Clinical outcome is dependent on the triangular relationship between MIC, exposure and efficacy [5]. In turn, exposure of the microorganism to the agent in the patient is dependent on the dose and the pharmacokinetic properties of the drug. For many agents the efficacy of the non-protein bound, free (f) agent in serum is correlated with the area under the concentration–time curve (AUC) and inversely correlated with the MIC (Fig. 1). In other words, the effect is dependent on the fAUC/MIC ratio. For other antimicrobial agents this relationship is different. For instance, for β-lactam agents it is not the fAUC/MIC relationship that best correlates with outcome but the time, expressed as a percentage of the dosing interval, that the concentration of the antimicrobial agent remains above the MIC for the microorganism, in short the %fT > MIC. These factors correlating with efficacy are called PK/PD indices, because they incorporate pharmacokinetic (drug concentration over time) and pharmacodynamic (drug effect over time) factors. J. W. Mouton, D. F. J. Brown, et. al., The role of pharmacokinetics/pharmacodynamics in setting clinical MIC

breakpoints: the EUCAST approach, Clin Microbiol Infect 2012; 18: E37–E45. http://onlinelibrary.wiley.com/enhanced/doi/10.1111/j.1469-0691.2011.03752.x/ Usage example+Ref:The relationship between a PK/PD index and response to treatment allows for the definition of a pharmacodynamic target (PDT). J. W. Mouton, D. F. J. Brown, et. al., The role of pharmacokinetics/pharmacodynamics in setting clinical MIC breakpoints: the EUCAST approach, Clin Microbiol Infect 2012; 18: E37–E45. http://onlinelibrary.wiley.com/enhanced/doi/10.1111/j.1469-0691.2011.03752.x/ Definition of equivalence + ref: Los principios farmacocinéticos-farmacodinámicos (PK/PD)fueron descritos por primera vez por Eagle en los años cuarenta y cincuenta del pasado siglo, tras evaluar los resultados obtenidos en modelos animales de roedores. Identificó el patrón dependiente del tiempo de la actividad bactericida de la penicilina y el patrón dependiente de la concentración de la estreptomicina y la bacitracina, así como un patrón mixto para las tetraciclinas1,2. En las décadas de los ochenta y los noventa los experimentos en modelos de roedores del Dr. William Craig y otros grupos re describieron los conceptos PK/PD3. Hoy en día el conocimiento acumulado sobre los principios PK/PD es utilizado para el diseño de ensayos clínicos de antimicrobianos en desarrollo, y la Agencia Europeadel Medicamento (EMA), en la Guideline on the Evaluation ofMedicinal Products Indicated for the Treatment of Bacterial Infections(CPMP/EWP/558/95, rev 2, febrero 2010)4, indica la utilidad del análisis PK/PD para seleccionar el régimen de dosificación en ensayos clínicos, así como para establecer los puntos de corte de sensibilidad microbiana. Canut Blasco A, et al. Análisis farmacocinético-farmacodinámico en microbiología: herramienta para evaluar el tratamiento antimicrobiano. Enferm Infecc Microbiol Clin. 2013. http://dx.doi.org/10.1016/j.eimc.2013.04.023 Usage example+Ref: La optimización de los regímenes terapéuticos mediante la utilización del análisis farmacocinético/farmacodinámico (PK/PD) sin duda contribuirá a alargar la vida útil de los antimicrobianos y a la contención de la resistencia bacteriana. Canut Blasco A, et al. Análisis farmacocinético-farmacodinámico en microbiología: herramienta para evaluar el tratamiento antimicrobiano. Enferm Infecc Microbiol Clin. 2013. http://dx.doi.org/10.1016/j.eimc.2013.04.023 Notes on term usage(Register, sociolect,…). Specific term used in formal situations by specialized people and students of a specific area. Readership: doctors, institutes, chemists, students of medicine, laboratory workers.

Terminology Word Class: N Gender: N Type of T: Complex Simple Complex Equivalence: diffusion con discos Word class: N Gender: F Fuente: http://www.proz.com/kudoz/english_to_spanish/science_general/670830-disk_diffusion_method.html Type of term: Complex Simple Complex Antonyms: Synonyms: Area of study: medical science Field: microbiology Subfield: clinical microbiology Definition of term + ref:Disk diffusion is one of the oldest approaches to antimicrobial susceptibility testing and remains one of the most widely used antimicrobial susceptibility testing methods in routine clinical laboratories. It is suitable for testing the majority of bacterial pathogens, including the more common fastidious bacteria, is versatile in the range of antimicrobial agents that can be tested and requires no special equipment. Term:disk diffusion (DD) testing

In common with several other disk diffusion techniques, the EUCAST method is a standardised method based on the principles defined in the report of the International Collaborative Study of Antimicrobial Susceptibility Testing, 1972, and the experience of expert groups worldwide.

The zone diameter breakpoints in the EUCAST method are calibrated to the harmonised European breakpoints that are published by EUCAST and are freely available from the EUCAST website (http://www.eucast.org). EUCAST Disk Diffusion Method for Antimicrobial Susceptibility Testing - Version 3.0 (April 2013) www.eucast.org http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Disk_test_documents/Manual_v_3.0_EUCAST _Disk_Test.pdf Usage example+Ref:The following methodology (Table A1) must be adhered to when performing disk diffusion testing of Campylobacter jejuni and coli according to EUCAST. EUCAST Disk Diffusion Method for Antimicrobial Susceptibility Testing - Version 3.0 (April 2013) www.eucast.org http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Disk_test_documents/Manual_v_3.0_EUCAST _Disk_Test.pdf Definition of equivalence + ref: Entre los métodos de estudio de la susceptibilidad antimicrobiana in vitro de N. gonorrhoeae están la dilución en agar, la difusión con tiras (E-test) y la difusión con discos. Los 2 primeros ofrecen resultados cuantitativos, es decir permiten conocer la concentración inhibitoria mínima necesaria para impedir el crecimiento del microorganismo, sin embargo, resultan costosos, requieren de un personal entrenado para su ejecución y no están al alcance de todos los laboratorios; en tanto el método de difusión con discos es sencillo, de costo permisible, no requiere de un personal calificado para su uso y aunque cualitativo, brinda resultados confiables, lo que hace a este método útil, no sólo para los laboratorios de microbiología de instituciones altamente especializadas, sino también para laboratorios menos especializados. Llanes, R., Acosta,C., et. Al., Susceptibilidad antimicrobiana de cepas de Neisseria gonorrhoeae por difusión con discos, REV CUBANA MED TROP 1999;51(2):116-9. http://bvs.sld.cu/revistas/mtr/vol51_2_99/mtr09299.htm En los estafilococos, la resistencia a los macrólidos (eritromicina, claritromicina, azitromicina, midecamicina) puede asociarse a diferentes fenotipos de sensibilidad o de resistencia a las lincosamidas (clindamicina) que se pueden identificar en el laboratorio mediante el método de difusión con discos de eritromicina y clindamicina o mediante dilución en caldo utilizando una combinación de ambos antimicrobianos. Los fenotipos que se observan mediante difusión con discos son: 1) resistencia a la eritromicina y a la clindamicina; 2) resistencia a la eritromicina y sensibilidad a la clindamicina pero con un achatamiento del halo de la clindamicina en la proximidad de la eritromicina (D-test positivo); 3) resistencia a la eritromicina y sensibilidad a la clindamicina sin achatamiento del halo (D-test negativo). En el primer caso se trata de resistencia constitutiva a la eritromicina y a la clindamicina (fenotipo cMLSB), en el segundo de resistencia constitutiva de expresión inducible (fenotipo iMLSB) y en el tercero de resistencia a la eritromicina mediada por una bomba de expulsión activa (fenotipo MSB). Se puede identificar también un cuarto fenotipo de resistencia a la clindamicina y sensibilidad a la eritromicina debido a la acción de enzimas que inactivan las lincosamidas (codificadas por los genes lnu) aunque es poco frecuente. Carmen Ardanuy, et. Al., Detección fenotípica de mecanismos de resistencia en grampositivos, 2011, ed. Emilia Cercenado y Rafael Cantón, Procedimientos en Microbiología Clínica, Recomendaciones de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC). Usage example+Ref: El documento aborda la preparación de las placas de agar, las condiciones de la prueba (incluida la preparación y ajuste del inóculo, el tiempo y la temperatura de incubación), la interpretación de los resultados, los procedimientos de control de calidad y las limitaciones de los métodos de difusión por disco. Instituto de Estándares Clínicos y de Laboratorio. Normas para realizar las pruebas de sensibilidad a los antimicrobianos con discos. Norma aprobada, décima edición. Documento CLSI M02-A10. Wayne, PA: Clinical and Laboratory Standards Institute; 2009. Notes on term usage(Register, sociolect,…). Specific term used in formal situations by specialized people and students of a specific area. Readership: doctors, institutes, chemists, students of medicine, laboratory workers.

Terminology Word Class: N Gender: N Type of T: Complex Simple Complex Equivalence: El cribado por difusión con Word class: N discos de (oxacilina) Gender: M Fuente: Carmen Ardanuy, et. Al., Detección fenotípica de mecanismos de resistencia en grampositivos, 2011, ed. Emilia Cercenado y Rafael Cantón, Procedimientos en Microbiología Clínica, Recomendaciones de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC). Type of term: Complex Simple Complex Antonyms: Synonyms: Area of study: medicine Field: microbiology Subfield: clinical microbiology Definition of term + ref: Term:NAL DD screening

Usage example+Ref: These laboratories have found NAL DD screening to be a reliable method for the detection of DCS to inform typhoid fever treatment. Romney, M., Ferris, C., et. Al., In Vitro Susceptibility Testing of Fluoroquinolone Activity Against Salmonella: Recent Changes to CLSI Standards, Clinical Infectious Diseases 2012;55(8):1107–13. Definition of equivalence + ref: Usage example+Ref: El cribado por difusión con discos de oxacilina (1μg) se considera el mejor método para detectar las CMIs de penicilina con valores superiores a 0,06 mg/L. La sensibilidad a la oxacilina implica sensibilidad a todos los betalactámicos. Carmen Ardanuy, et. Al., Detección fenotípica de mecanismos de resistencia en grampositivos, 2011, ed. Emilia Cercenado y Rafael Cantón, Procedimientos en Microbiología Clínica, Recomendaciones de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC). Notes on term usage(Register, sociolect,…). Specific term used in formal situations by specialized people and students of a specific area. This term can have other meaning in other areas or fields. Readership: doctors, institutes, chemists, students of medicine, laboratory workers.

Terminology Word Class: N Gender: N Simple Complex Equivalence: Administración de Alimentos y Word class: N Medicamentos de los Estados Unidos (FDA). Gender: F Fuente: Instituto de Estándares Clínicos y de Laboratorio. Normas para realizar las pruebas de sensibilidad a los antimicrobianos con discos. Norma aprobada, décima edición. Documento CLSI M02-A10. Wayne, PA: Clinical and Laboratory Standards Institute; 2009. Type of term: Complex Simple Complex Term:FDA, US Food and Drug Administration Type of T: Complex

Antonyms: Synonyms: Area of study: medicine Field: microbiology Subfield: clinical microbiology Definition of term + ref:agency established by the Federal Food, Drug, and Cosmetic Act* within the United States Department of Health and Human Services responsible for protecting the public health by assuring the safety, efficacy and security of human and veterinary drugs, biological products, medical devices, the nation’s food supply, cosmetics, and products that emit radiation. U.S. Food and Drug Administration > About FDA > What We Do, http://www.fda.gov/AboutFDA/... [11.1.2014]. http://iate.europa.eu/SearchByQuery.do?method=searchDetail&lilId=1450208&langId=&query=US%20Food %20and%20Drug %20Administration&sourceLanguage=en&domain=0&matching=&start=0&next=1&targetLanguages=es Usage example+Ref:Finally, FDA plays a significant role in the Nation’s counterterrorism capability. http://iate.europa.eu/SearchByQuery.do?method=searchDetail&lilId=1450208&langId=&query=US%20Food %20and%20Drug %20Administration&sourceLanguage=en&domain=0&matching=&start=0&next=1&targetLanguages=es Definition of equivalence + ref: La FDA es responsable de: Proteger la salud pública mediante la regulación de los medicamentos de uso humano y veterinario, vacunas y otros productos biológicos, dispositivos médicos, el abastecimiento de alimentos en nuestro país, los cosméticos, los suplementos dietéticos y los productos que emiten radiaciones. Favorecer la salud pública mediante el fomento de las innovaciones de productos. Proveer al público la información necesaria, exacta, con base científica, que le permita utilizar medicamentos y alimentos para mejorar su salud. Las responsabilidades de la FDA se extienden a los 50 estados de Estados Unidos, el Distrito de Columbia, Puerto Rico, Guama, las Islas Vírgenes, Samoa Americana y otros territorios y posesiones de Estados Unidos. http://www.fda.gov/AboutFDA/Transparency/Basics/EnEspanol/ucm196467.htm, (25-04-2014). Usage example+Ref: Es responsabilidad de la FDA aprobar los dispositivos comerciales usados en los Estados Unidos. Instituto de Estándares Clínicos y de Laboratorio. Normas para realizar las pruebas de sensibilidad a los antimicrobianos con discos. Norma aprobada, décima edición. Documento CLSI M02-A10. Wayne, PA: Clinical and Laboratory Standards Institute; 2009. Notes on term usage(Register, sociolect,…). Specific term used in formal situations by specialized people and students of a specific area. It can be used by people requiring knowing about the term. A wide range of readership uses this word. Readership: doctors, institutes, chemists, students of medicine, laboratory workers, people interested in the subject, companies, people in general.

Terminology Word Class: N Gender: N Type of T: Complex Simple Complex Equivalence: Prueba-E o Epsilométrica Word class: N Gender: M Fuente: Stephen J., [et al.], Manual de pruebas de susceptibilidad antimicrobiana, editora coordinadora, Marie B. Coyle, 2005. http://www.paho.org/hq/index.php? option=com_docman&task=doc_view&gid=22691&Itemid= Type of term: Simple Simple Complex Antonyms: Term: Etest

Synonyms: Area of study: medicine Field: microbiology Subfield: clinical biochemistry Definition of term + ref: Etest® is a well-established method for antimicrobial resistance testing in microbiology laboratories around the world. Etest consists of a predefined gradient of antibiotic concentrations on a plastic strip and is used to determine the Minimum Inhibitory Concentration (MIC) of antibiotics, antifungal agents and antimycobacterial agents. http://www.biomerieux-usa.com/servlet/srt/bio/usa/dynPage?doc=USA_PRD_LST_G_PRD_USA_11 Usage example+Ref:Etest® is a predefined, stable gradient of 15 antimicrobial concentrations on a plastic strip. http://www.biomerieux-diagnostics.com/etest#sthash.9HaxyDyT.dpuf Definition of equivalence + ref: La prueba E o método PDM de epsilómetro ha sido usado exitosamente para analizar anaerobios y otros organismos aeróbicos. El término epsilómetro se refi ere a una tira fina, de 5 x 50 mm, inerte y no porosa con un gradiente continuo exponencial de agente antimicrobiano inmovilizado en un lado y una escala de interpretación impresa en el otro lado. El gradiente de agente antimicrobiano cubre un amplio rango de concentración, que corresponde aproximadamente diluciones dobles. La pendiente de los cambios y los rangos de concentración están óptimamente diseñados para corresponder a rangos y límites de CIM clínicamente relevantes que son seleccionados para categorizar grupos de susceptibilidad. Stephen J., [et al.], Manual de pruebas de susceptibilidad antimicrobiana, editora coordinadora, Marie B. Coyle, 2005. http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=22691&Itemid= Usage example+Ref: El método epsilométrico (E-test) también tiene buen desempeño en la detección de estos organismos. Stephen J., [et al.], Manual de pruebas de susceptibilidad antimicrobiana, editora coordinadora, Marie B. Coyle, 2005. http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=22691&Itemid= Notes on term usage(Register, sociolect,…). Specific term used in formal situations by specialized people and students of a specific area. Readership: doctors, institutes, biologists, chemists, students of medicine, laboratory workers, students of biology.

TRANSLATION CARDS

SOURCE TEXT

This change is supported by accumulating clinical, microbiological, and pharmacokinetic-pharmacodynamic (PK-PD) studies that indicate that such a TYPE OF PROBLEM -ING SUFFIX AS TRANSLATION METHOD Transposition revised break point is more appropriate for determining CIP susceptibility RELATIVE among contemporary Salmonella isolates causing systemic infection. PROBLEM

The –ing suffix in this case introduces a present participle clause that modifies the noun preceded. The present participle of English can function as a postmodifying clause using verbs that are stative in meaning (Biber, D. et al., 2000).If the same structure is maintained in the TL, it will create an error and the TT would look unnatural.

SOLUTION (theory)

The –ing structure is eliminated and transferred into a relative clause by transposition. If the continuous tense were to be maintained, the sense and meaning would change. The relative pronoun of Spanish functions as a referent to other elements

previously mentioned (Alarcos, 1994). The relative structure is most common when constructing a post modifier clause in Spanish. Moreover, a Spanish relative pronoun can be used with static verbs and replace the gerund (Alarcos, 1994). Therefore, the relative clause included in the TT refers and describes to the previous element complying with the same function of the ST clause. FINAL TRANSLATION

La acumulación de estudios clínicos, microbiológicos y farmacocinéticosfarmacodinámicos (PK-PD por sus siglas en inglés) que muestran que dicho valor límite actualizado es el más adecuado para determinar la susceptibilidad a la ciprofloxacina entre los aislados contemporáneos de la Salmonella que causan infecciones sistémicas respaldan el cambio a estos valores.

TYPE OF PROBLEM

-ing suffix structure after preposition

TRANSLATION METHOD

Transposition

SOURCE TEXT

BecauseEtest is a Food and Drug Administration–approved commercial test, laboratories will need to perform a verification study before applying the new break points.

PROBLEM

We can appreciate a gerund form (applying) that must be changed in order to respect TL´s syntax and style. The transference of the same structure would create an error in the TT. Newmark (1988) mentions that English gerund has unique functions that no other language has. It can function as a noun and can also be defined as a verbal noun or gerundial noun (Huddleston and Pullum, 21010). Therefore, in English the gerund can be the object of a preposition functioning as a noun but Spanish gerund lacks of this function.

SOLUTION (theory)

The method used in here was a transposition from gerund to infinitive. In this way, the sentence is correct and a suitable syntax in the TT is achieved. Both gerund and infinitive are non-conjugated and non-personal verbs but they differ in their functions. It is incorrect to use the Spanish gerund in noun complements by influence of English (Bosque, 2010). Instead, Spanish prepositions are mainly followed by infinitives. Alarcos (1995) states that the

infinitive tends to be preceded by prepositions because of its fundamental noun function. Therefore, the resultant structure presents grammar rules of the TL that are accepted. FINAL TRANSLATION

Los laboratorios deberán realizar un estudio de verificación antes de aplicar los nuevos valores límite debido a que la prueba Épsilon es una prueba comercial aprobada por la Administración de Alimentos y Medicamentos.

TRANSLATION ANTIBIOGRAMA IN VITRO DE LA ACTIVIDAD DE FLUOROQUINOLONAS AL USARSE CONTRA LA SALMONELLA: RECIENTES CAMBIOS A LAS NORMAS DEL CLSI Romney M. Humphries,1 Ferric C. Fang,2,3,4 Frank M. Aarestrup,5 and Janet A. Hindler1

1

Departamento de Patología y medicina de laboratorio, David Geffen , (Facultad de medicina de la UCLA Los Ángeles California; Departamentos de 2

medicina de laboratorio 3Microbiología y 4medicina, Centro Médico Harborview y la Escuela de Medicina de Washington, Seattle; 5EU Referencia Laboratorio de Resistencia Antimicrobiana WHO Centro de Investigación para la Resistencia Antimicrobiana en el Instituto Nacional de Patógenos Transmitidos por Alimentos, Universidad Técnica de Denmark Kemitorvet

La resistencia de la Salmonellaentérica a las flouroquinolonas (FQ por sus siglas en inglés), es una gran preocupación médica; los laboratorios clínicos han tenido dificultades para identificar dicha resistencia debido a los múltiples mecanismos de resistencia presentes en la Salmonella. ElInstituto de Estándares Clínicos y de Laboratorio (CLSI por sus siglas en

inglés), recientemente abordó este problema mediante la revisión de los valores límite al usar ciprofloxacina en diversas especies de Salmonella. Es de suma importancia para los médicos y el personal de laboratorio tener conocimiento de los diversos aspectos técnicos que rodean a estos valores límite actualizados. En este artículo revisamos los mecanismos de resistencia de la Salmonellaentérica a las flouroquinolonas, su significado clínico y la información que justifica los valores límite actualizados al usar ciprofloxacina. Exhortamos a los laboratorios clínicos a que adopten los valores límite actualizados al usar ciprofloxacina del CLSI para tratar todas los aislados de Salmonella en las cuales se recomienda el uso de antibiograma y, en el caso de los laboratorios que utilizan sistemas de antibiogramas comerciales, examinar los aspectos técnicos. La Salmonella no tifoidea es uno de los principales patógenos transmitidos a través de los alimentos [1–4]. En la mayoría de los casos, la Salmonellaentérica se auto limita y generalmente no se recomienda la terapia antimicrobial por la posible prolongación del estado de portador [5, 6]. No obstante, esta terapia se sugiere para el tratamiento de diarrea severa y para el tratamiento de pacientes con mayor susceptibilidad a la Salmonella. Además la terapia antimicrobial es esencial para tratar infecciones extra intestinales y fiebre tifoidea causada por los serotipos Typhi y Paratyphi A–C de la Salmonella. Aunque las infecciones graves por Salmonella no tifoidea son relativamente raras en Europa y el Norte de América, las infecciones invasivas de Salmonella no tifoidea son frecuentes en el África subsahariana [7–9]. La fiebre tifoidea es endémica en muchos países en vías de desarrollo, particularmente en el subcontinente indio [10,11], donde es común la resistencia a múltiples drogas (o RMD): ampicilina, cloranfenicol y al sulfametoxazol/trimetoprima. A causa de esta resistencia generalizada, la Organización Mundial de la Salud recomienda el uso de la ceftriaxona o de alguna flouroquinolona para el tratamiento de una fiebre tifoidea simple, ya sea inducida por organismos completamente susceptibles o resistencia a múltiples drogas [12]. Generalmente, se prefiere el uso de las flouroquinolonas ciprofloxacinas (CIP) y ofloxacinas (OFO

por sus siglas en inglés), como opciones de tratamiento, ya que se encuentran disponibles para su uso por vía oral y tienen un menor costo que la ceftriaxona.

Ha comenzado a aparecer una resistencia de alto nivel a las flouroquinolonas [13,14], históricamente definida como concentración inhibitoria mínima (CIM) a la ciprofloxacina con un valor de >4 μg/ml (CLSI M100 2011) [13,14], pero es poco común entre aislados de Salmonella clínica alrededor del mundo [15,18]. Sin embargo, durante la última década, han surgido serotipos de Salmonella con una susceptibilidad disminuida a la ciprofloxacina (SDC), definidos como aislados con concentración inhibitoria mínima a la ciprofloxacina con valor de 0.12–1.0 μg/ml. Las concentraciones inhibitorias mínimas de los serotipos con susceptibilidad disminuida a la ciprofloxacina son mayores que la distribución concentración inhibitoria mínima con valor de 0.008–0.06 μg/ml (Tabla 1) [19,20] de la Salmonella, pero menor que el histórico valor límite de resistencia con valor de 4 μg/ml (Figura 1) [21, 24]. Al ser analizadas, se descubrió que la mayoría de los aislados con susceptibilidad disminuida a la ciprofloxacina albergan mutaciones aisladas en el gen gyrA, el cual codifica una subunidad de ADN girasa y se localiza en la región determinante de resistencia a quinolonas (QRDR por sus siglas en inglés),[25]. Las mutaciones en el gen gyrA también confieren resistencia de alto nivel (concentración inhibitoria mínima, con valor de 128-512 µ g/ml) al ácido nalidíxico (o NAL), el cual es una quinolona no fluorada (Tabla 1). El surgimiento

de una segunda mutación en la región determinante de resistencia a quinolonas en tales aislados Tabla 1. Genotipos y Fenotipos de los Mecanismos de Resistencia de la Fluoroquinolona común

Fenotipo Genotipo

Ácido nalidíxico

Ciprofloxacina CIM (μg/mL)

Tipo normal (sin resistencia)

Generalmente susceptible

0.008-0.06

Cromosoma gyrA (una sola mutación)

Generalmente resistente

0.12-2.0

Cromosoma gyrB (una sola mutación)

Generalmente susceptible

0.12-0.5

Cromosoma gyrA, gyrB (mutaciones múltiples )

Resistente

≥ 4.0

PMQR (tal como qnr o aac(6′)-lb-cr)

más a menudo susceptible

0.12-2.0

Abreviaturas: CIM, concentración mínima inhibitoria; PMQR, resistencia a quinolonas mediada por plámidos.

puede dar como resultado una resistencia de alto nivel a las flouroquinolonas (concentración inhibitoria mínima, con valor de =4 µ g/ml). Hoy en día, el fenotipo con sensibilidad disminuida a la ciprofloxacina y resistencia al ácido nalidíxico(SDC/NALR) es predominante en todo el mundo tanto en los serotipos de la tifoidea como en los serotipos de la no tifoidea [26-28]. La técnica de genotipado ha identificado al menos 15 mutaciones independientes del gen gyrA que han aparecido en el periodo de una década en la Salmonella Typhi en Asia y África, lo cual puede ser indicio de una rápida evolución por parte de la susceptibilidad disminuida a la ciprofloxacina, que se mantiene a través de selección natural [29,30]. Es importante mencionar que en varios estudios el fenotipo que presenta sensibilidad disminuida a la ciprofloxacina y resistencia al ácido nalidíxico está relacionado con respuestas atrasadas, fallas clínicas y con mortalidad incrementada entre pacientes que reciben ciprofloxacina para tratar la infección de la Salmonella Typhi [23, 31-42], inclusive al suministrar dosis adecuadas de ciprofloxacina [43, 44] y concentraciones de medicinas terapéuticas documentadas [45].

Asimismo, los informes han presentado resultados deficientes de tratamientos con flouroquinolonas para tratar infecciones generalizadas causadas por serotipos no tifoideos de Salmonella con sensibilidad disminuida a la ciprofloxacina y resistencia al ácido nalidíxico (Tabla 3). A causa de la importancia clínica de los serotipos de sensibilidad disminuida a la ciprofloxacina y resistencia al ácido nalidíxico en infecciones generalizadas, se ha motivado a laboratorios clínicos a identificar estos aislados durante antibiogramas rutinarios. Debido a que la mayoría de la Salmonella con resistencia al ácido nalidíxico hospeda el fenotipo que presenta susceptibilidad disminuida a la ciprofloxacina, el CLSI recomendó en el 2004 que los laboratorios detectaran la presencia de Salmonella extra intestinal con concentraciones inhibitorias mínimas al usar ciprofloxacina con valor de ≤1 µ g/ml en la resistencia de ácido nalidíxico como un indicador de susceptibilidad disminuida a la ciprofloxacina. Si se detectaba resistencia al ácido nalidíxico, se le instruiría al laboratorioindicar a los médicos clínicos que el tratamiento con flouroquinolonas podría no ser eficaz, y a pesar de la falta de datos clínicos de serotipos no tifoideos en aquel tiempo, esta recomendación se hizo a nivel mundial para todo aislado de Salmonella extra intestinal. Esta estrategia se lleva a cabo en todo el mundo y también fue apoyada por el Comité Europeo de Antibiogramas (EUCAST por sus siglas en inglés)hasta hace poco tiempo. EL

PROBLEMA:

LA

CRECIENTE

RESISTENCIA

EVOLUTIVA

A

LAS

FLOUROQUINOLONAS EN ESPECIES DESALMONELLA Datos recientes han causado preocupación debido a que la resistencia al ácido nalidíxico pueda no ser una referencia confiable para indicar susceptibilidad disminuida a la ciprofloxacina como consecuencia de la evolución y diversidad en los mecanismos de resistencia

a las

flouroquinolonaspor parte de la Salmonella. Actualmente, hay numerosos informes de aislados que presentan susceptibilidad al ácido

nalidíxico y susceptibilidad disminuida a la ciprofloxacina (SDC/NALS) [46-51]. Al parecer, este fenotipo se media con mecanismos de resistencia fuera del gen gyrA.Se dan mutaciones en el gen gyrB entre el 1% y el 11,6% de la S. Typhi en los Estados Unidos y Reino Unido [22, 53], las cuales causan concentraciones inhibitorias mínimas con valor de 0,125-0,5 μg/ml al usar ciprofloxacina y concentraciones inhibitorias mínimas con valor de 2-16 μg/ml al usar ácido nalidíxico, ambas dentro de la gama con sensibilidad [54, 55]. Del mismo modo, los determinantes de resistencia a quinolonas mediada por plásmidos (PMQR por sus siglas en inglés), tal como como la qnr y los genes aac-6'-Ib-cr [56], se asocian con una susceptibilidad disminuida a la ciprofloxacina [57-60] que sólo resulta en mínimas elevaciones de ácido nalidíxico y concentración inhibitoria mínima (832 μg/ml) (Tabla 1) [61, 62]. En la actualidad, la resistencia a quinolonas mediada por plásmidos parece ser poco común entre las cepas no tifoideas de Salmonella en los Estados Unidos [51, 63],

Tabla 2. Criterio de Interpretación de Ciprofloxacina y Salmonella Criterios de Interpretación de CIM de CIP (μg/mL) Salmonella Criterio CLSI (M100 S21; todas las Salmonella) CLSI (M100 S22; extraintestinal & S. Typhi) CLSI (M100 S22; Salmonella intestinal) CLSI (documento propuesto M100 S23, todas las Salmonella) EUCASTa FDA

Susceptible

Intermedio

Resistente

2.0

≥4.0

≤0.06

0.12–1.0

≥2.0

≤1.0

2.0

≥4.0

≤0.06

0.12–1.0

≥2.0

≤0.5

1.0

≥2.0

2.0

≥4.0

≤1.0

≤1.0

a

Valor límite de la EUCAST que es para todas las Enterobacteriáceas, el cual tiene una nota al margen para señalar que las especies de Salmonella con una resistencia a los flouroquinolonas de bajo nivel (MIC, con valor de >0.06 mg/L) presentan una pobre reacción al tratamiento con ciprofloxacina. Abreviaturas: CLSI - Instituto de Normas Clínicas y de Laboratorio, CIP – ciprofloxacina, EUCAST - Comité Europeo de Pruebas de Sensibilidad Antimicrobial, FDA - Organismo para el Control de Alimentos y Medicamentos de los E.U., CIM: concentración mínima inhibitoria.

pero se encuentran comúnmente en Europa y Asia [54, 57, 64]. Son pocos los casos conocidos de Salmonellano tifoidea en países de África, sin embargo sí han sido reportados [65]. Se desconoce el impacto clínico del fenotipo susceptibilidad disminuida a la ciprofloxacina y susceptibilidad al ácido nalidíxico en el tratamiento de salmonelosis con flouroquinolonas, ya que no se han presentado estudios que documenten los resultados de dichas infecciones cuando se tratan con flouroquinolonas. Sin embargo, es probable que el fenotipo que presenta susceptibilidad disminuida a la ciprofloxacina sea el determinante más importante de la respuesta clínica a la terapia [23]; independientemente del mecanismo de resistencia, ya sea resistencia al ácido nalidíxico o susceptibilidad al ácido nalidíxico [66, 67]. Por otra parte, existe preocupación significativa de que la realización de informes incompletos de la susceptibilidad disminuida a la ciprofloxacina, a causa de la detección fallida de aislados con susceptibilidad al ácido nalidíxico y

susceptibilidad disminuida a la ciprofloxacina, pueda facilitar la aparición posterior de una resistencia de alto nivel a las flouroquinolonas [56, 62]. Los aislados con susceptibilidad disminuida a la ciprofloxacina y susceptibilidad al ácido nalidíxico requieren mayores concentraciones de flouroquinolonas para prevenir la selección in vivo que resulte en mutaciones adicionales con un alto nivel de resistencia a las flouroquinolonas [68]. REEVALUACIÓN DE LOS VALORES LÍMITE AL USAR FLOUROQUINOLONAS Dada la distribución de concentración inhibitoria mínima a la ciprofloxacina de 0,008 - 0,06 μg/ml de la Salmonella, se ha sugerido la disminución del valor límite de ciprofloxacina a ≤ 0,06 μg/ml. La acumulación de estudios clínicos, microbiológicos y farmacocinéticos-farmacodinámicos (PKPD por sus siglas en inglés) que muestran que dicho valor límite actualizado es el más adecuado para determinar la susceptibilidad a la ciprofloxacina entre los aislados contemporáneos de la Salmonella que causan infecciones sistémicas respaldan el cambio a estos valores. La EUCAST determinó su valor límite susceptible a la ciprofloxacina en ≤0,5 μg/ml para todas las enterobacteriáceas puntualizando que la concentración inhibitoria mínima con valor de >0,06 μg/ml predice una posible reacción débil para tratar una infección sistémica de Salmonella. El CLSI aprobó un valor límite de susceptibilidad con valor de ≤0,06 μg/ml para la Salmonella Typhi y aislados extra intestinales de Salmonella, y decidió eliminar el monitoreo con ácido nalidíxico en la reunión del subcomité de Antibiogramas en enero del 2011 (Tabla 2).Sin embargo, después de varias peticiones por parte de individuos en países donde la fiebre tifoidea es endémica, en junio del 2011, se restableció la recomendación para utilizar el monitoreo con ácido nalidíxico.El CLSI sugiere actualmente que el ácido nalidíxico puede usarse para analizar la susceptibilidad reducida a las flouroquinolonas en Salmonella Typhi o en aislados de Salmonella extraintestinal.No obstante, el personal de laboratorio y los médicos deben estar conscientes de que el monitoreo con ácido nalidíxico no detecta todos los mecanismos de resistencia a las flouroquinolonas, por tanto, la ciprofloxacina también debería analizarse e interpretarse utilizando el nuevo valor límite susceptible

de la concentración inhibitoria mínima con valor de ≤ 0,06 μg/ml o la medida del área de ≥ 31 mm con pruebas de difusión en disco (DD). Los fundamentos del CLSI para mantener el monitoreo con ácido nalidíxico surgieron al tomar en consideración los desafíos técnicos que enfrentan los laboratorios clínicos en los países con recursos limitados. Dichos laboratorios han confirmado que el monitoreo con la difusión en discode ácido nalidíxico es un método fiable para la detección de susceptibilidad disminuida a la ciprofloxacina para proporcionar tratamiento a la fiebre tifoidea. Los países en que se ubican estos laboratorios omiten generalmente la prueba de la concentración inhibitoria mínima de ciprofloxacina debido al costo y disponibilidad limitada de materiales.Además, los laboratorios en países con recursos limitados encontraron que es difícil interpretar la difusión en discode ciprofloxacina, lo cual puede ser debido a los materiales locales, cepas u otros factores. Debido a que el fenotipo susceptibilidad al ácido nalidíxico y susceptibilidad disminuida a la ciprofloxacina actualmente es poco común en muchas partes del mundo, el monitoreo mediante el uso de ácido nalidíxico para predecir una susceptibilidad disminuida a la ciprofloxacina todavía se asocia con una sensibilidad del 92,9 % y con una especificidad del 98,4 % en la Salmonella Typhi [19, 69] y, por tanto, continua siendo de uso en áreas donde la tifoidea es endémica. El CLSI está en la actualidad investigando pruebas alternativas, que incluyen la difusión en disco de ofloxacina, para reemplazar el monitoreo con ácido nalidíxico el cual se asocia con una sensibilidad del 97,3 % y una especificidad de 99,3 % en el monitoreo de susceptibilidad disminuida a la ciprofloxacina [69].El uso de discos con un menor contenido (por ejemplo, 1 mg de ciprofloxacina en vez de 5 mg) también puede mejorar tanto la sensibilidad como la especificidad [19]. El CLSI indicó en el 2012 que los médicos pueden considerar regímenes máximos de dosificación parentales o por vía oral de ciprofloxacina, junto con el valor límite de ciprofloxacina actualizado en aislados de Salmonella Typhi y Salmonella extraintestinal, en los aislados de Salmonella con concentraciones inhibitorias mínimas a la ciprofloxacina o diámetros de zona de difusión en disco

en el rango intermedio.El CLSI optó por eliminar esta observación en el documento M100-S23, ya que los aislados que se probaron en el rango intermedio del valor límite actualizado al usar ciprofloxacina incluyen aquéllos que tienen determinantes de resistencia a quinolonas mediada por plásmidos que se relacionan posiblemente con la selección in vivo de la resistencia de alto nivel a las flouroquinolonas, tal como se ha señalado anteriormente.Además, ya que no existe registro de resultados de tratamientos favorables que usen altas dosis en la monoterapia con ciprofloxacina para tales aislados; y que altas dosis de ciprofloxacina pueden relacionarse con un mayor riesgo de toxicidad, los autores consideran que el tratamiento utilizando un agente alternativo, por ejemplo la ceftriaxona, es preferible para casos de este tipo.La susceptibilidad a la ceftriaxona debería confirmarse, pues se ha reportado por todo el mundo resistencia mediada por β-lactamasas de amplio espectro y cefalosporinasas mediadas por plásmidos [70]. En el 2010, 70 (2,8%) de 2474 aislados de Salmonella no tifoidea, a diferencia de los aislados de Salmonella Typhi o Paratyphi incluidos en el informe de los Centros Nacionales para el Control y Prevención de Enfermedades Antimicrobianas del Sistema de Vigilancia de la Resistencia, fueron resistentes a la ceftriaxona (concentración inhibitoria mínima, con valor de ≥ 4 mg / ml) [71]. Se ha comprobado que la azitromicina promueve mayores tasas de curación y fiebre de menor duración, más que la ofloxacina, para el tratamiento de Salmonella tifoidea con susceptibilidad disminuida a la ciprofloxacina [72, 73]; sin embargo, no se aprueba para el tratamiento de la salmonelosis en los Estados Unidos.

OBSTÁCULOS TÉCNICOS PARA LA IMPLEMENTACIÓN DE NUEVOS VALORES LÍMITE DE CIM EN LOS ESTADOS UNIDOS Los laboratorios clínicos presentan complicaciones al momento de implementar los valores límite al usar ciprofloxacina establecidos en el 2012 en la Salmonella dentro de los Estados Unidos a causa de la exigencia de que los fabricantes de sistemas de prueba comerciales se adhieran a los valores límite antimicrobianos establecidos por las oficinas de la Administración de Medicamentos y Alimentos de los Estados Unidos, los cuales son los mismos para todas las Enterobacteriáceas mediante el uso de la ciprofloxacina (Tabla 2). Paneles no comerciales de concentraciones inhibitorias mínimas producidos en los Estados Unidos contienen actualmente concentraciones de ciprofloxacina suficientemente bajas como para permitir el uso de los valores límite de la Salmonella del CLSI establecidos en el 2012 (Tabla 2). Para utilizar los valores límite establecidos en el 2012, los laboratorios pueden tener en consideración determinar la concentración inhibitoria mínima mediante el uso de ciprofloxacina a través de la Prueba Epsilón (Etest), la cual parece correlacionarse adecuadamente con las concentraciones inhibitorias mínimas obtenidas por la dilución de agar en Salmonella tifoidea con alto nivel de resistencia a las flouroquinolonas [74] y detectará de forma confiable la susceptibilidad disminuida a la ciprofloxacina [19,75]. Los laboratorios deberán realizar un estudio de verificación antes de poder aplicar los nuevos valores límite debido a que la prueba Épsilon es una prueba comercial aprobada por la Administración de Alimentos y Medicamentos. La amplitud de este estudio de verificación es a criterio del director del laboratorio, no obstante, la fiabilidad de la Prueba Épsilon para detectar resultados de ciprofloxacina, ya sea susceptibles, intermedios o resistentes con el uso de los nuevos valores límite debe comprobarse. Como una alternativa al uso de la Prueba Épsilon, los laboratorios podrían llevar a cabo la difusión en disco mediante el uso de ácido nalidíxico y ciprofloxacina de forma paralela en aislados con concentraciones inhibitorias mínimas al usar ciprofloxacina con valor de ≤ 1 μg/ml, para así detectar la resistencia a quinolonas mediada por plásmidos y el fenotipo más

común de resistencia al ácido nalidíxicocon susceptibilidad disminuida a la ciprofloxacina mediante la evaluación de los diámetros de zona del método de difusión en disco mediante el uso de ciprofloxacina. Por lo menos, los laboratorios deberían interpretar las concentraciones inhibitorias mínimas al usar ciprofloxacina basándose en los valores límite anteriores, realizándose la observación de que los aislados de Salmonella con concentraciones inhibitorias mínimas al usar ciprofloxacina con valor de ≤1 μg/mL pero >0.06 μg/mL se asocian con respuestas retardadas o fallas clínicas después de la terapia con flouroquinolonas. DOS GRUPOS DE VALORES LÍMITE

PARA LA SALMONELLA AL USAR

CIPROFLOXACINA:RETOS PARA REPORTAR La controversia sobre cuándo aplicar los nuevos valores límite al usar ciprofloxacina es otra causa de confusión para muchos laboratorios. La intención del CLSI era que los valores límite se usarán en todas las Salmonella tifoideas (es decir, serotipos Typhi y Paratyphi), incluyéndose los recuperados en fuentes intestinales, aunque el serotipo Paratyphi no se menciona de manera explícita en el documento M100-S22. Debido a que algunos laboratorios clínicos confían en los laboratorios de salud pública de su localidad para subtipificacar la Salmonella e identificar los serotipos Typhi y Paratyphi, se podrían aplicar valores límite incorrectos al usar ciprofloxacina en Salmonella typhi y paratyphi, las cuales fueron recuperadas de muestras de heces y que están en espera de que sean identificadas

por dichos laboratorios. Exhortamos a los laboratorios clínicos a descartar

rutinariamente estos organismos para asegurar que los resultados de susceptibilidad al usar ciprofloxacina se interpreten correctamente y, por otra parte, para proporcionar una detección oportuna de estos patógenos nocivos. La identificación de la Salmonellatyphi y paratyphi puede lograrse mediante la evaluación de reacciones en un agar inclinado de triple azúcar y hierro (TSI por sus siglas en inglés), un sistema automatizado, o mediante el método API 20E (bioMérieux), seguido de la confirmación por un laboratorio de salud pública.

El CLSI determina que los valores límite establecidos en el 2012 serán aplicados a serotipos de Salmonella no tifoidea sólo cuando éstos sean aislados de fuentes extra intestinales. Sin embargo, es opinión de los autores que los laboratorios deberían considerar la aplicación de los nuevos valores límite en todas los aislados de Salmonella al momento de realizarse el antibiograma, sin importar el espécimen de cuál cepa se recolecte. No hay datos clínicos que sugieran que la Salmonella intestinal con susceptibilidad disminuida a la ciprofloxacina responderá mejor a la terapia que usa ciprofloxacina de lo que lo harían los aislados extra intestinales, y de hecho se ha probado que el tratamiento de una salmonelosis sin complicaciones prolonga la eliminación fecal [5, 6]. Por lo tanto, la solicitud de antibiogramas en aislados de Salmonella puede indicar una infección complicada y/o un anfitrión inmunodeprimido, en el cual puede fallar la terapia que usa ciprofloxacina aplicada a aislados con susceptibilidad disminuida a la ciprofloxacina. En reconocimiento de este hecho, el CLSI votó por aplicar el valor límite actualizado a todas las especies de Salmonella, si se justificaran los antibiogramas, en junio del 2012. Los laboratorios deben tener en claro que se descarta el uso de antibiogramas de rutina de aislados de Salmonella no tifoidea tomados de heces fecales, debido a que una terapia es raramente recomendada; y un informe de susceptibilidad puede llevar a algunos médicos a comenzar un tratamiento. El CLSI aún no ha actualizado los valores límite de Salmonella de otras flouroquinolonas, con la excepción de ofloxacina y levofloxacina, de los cuales se han propuesto sólo los valores límite con concentración inhibitoria mínima, pero todavía no se han publicado. El fenotipo con sensibilidad disminuida a la ciprofloxacina y resistencia al ácido nalidíxico proporciona disminución de susceptibilidad en SalmonellaTyphi y Paratyphi A al usar ofloxacina [76], el cual es una mezcla racémica de enantiómeros levofloxacinos activos e inactivos. El fenotipo con susceptibilidad disminuida a la ciprofloxacina, independientemente del fenotipo con ácido nalidíxico, proporciona susceptibilidad reducida a ofloxacina, norfloxacina, y levofloxacino en la Salmonella no tifoidea [19]. Los resultados del tratamiento con ofloxacina son tan pobres como los resultados del

tratamiento con ciprofloxacina en pacientes infectados con SalmonellaTyphi que presenta sensibilidad disminuida a la ciprofloxacina y resistencia al ácido nalidíxico [73,77]. De igual manera, los aislados de Salmonella que presentan concentraciones inhibitorias mínimas al usar ofloxacina, y que usan valores límite propuestos en el 2013(por ejemplo, ≥0,25 μg/ml, según lo indicado por datos PK/PD [78], clínicos [77] y microbiológicos [20]), o que son no susceptibles al levofloxacino son indicadoras de que poseen un fenotipo con susceptibilidad disminuida a la ciprofloxacina y debería promoverse la precaución en el uso de levofloxacina u ofloxacina en un tratamiento. En estos casos; agentes alternativos, como lo es la ceftriaxona, si es que la cepa es susceptible a la ceftriaxona, o la azitromicina, pueden ser opciones de tratamiento. La gatifloxacina permanece activa y clínicamente efectiva contra la SalmonellaTyphi resistente a las flouroquinolonas con mutaciones en el gen gyrA [29,79], aunque esta flouroquinolona no está disponible para uso sistémico en los Estados Unidos y en muchos otros países debido a los efectos adversos en el metabolismo de la glucosa. Se estarán evaluando los valores límite adicionales de las flouroquinolonas en un futuro cercano por el CLSI. CONCLUSIONES La resistencia a las flouroquinolonas en las distintas Salmonella es una preocupación constante en todo el mundo, pero el reconocimiento de la resistencia se ha complicado en la última década por un número cada vez mayor de mecanismos de resistencia a las flouroquinolonas. A pesar de que se ha abordado esta cuestión de manera limitada por el CLSI mediante la introducción de un nuevo valor límite al usar ciprofloxacina en aislados de Salmonella (Tabla 2), es fundamental que los médicos y personal de laboratorio estén conscientes de las limitaciones asociadas a esta estrategia. En los Estados Unidos, la susceptibilidad de la Salmonella a la ciprofloxacina se analiza de manera óptima mediante la obtención de una concentración inhibitoria mínima e interpretación de acuerdo a los valores límite del CLSI propuestos en el 2012 (Tabla 2), independientemente de la fuente o del serotipo aislado. El uso de los criterios de interpretación para todas los aislados de Salmonella

realizada en el 2012 reducirá la confusión en laboratorios clínicos y predecirá de manera más confiable la relevancia de la ciprofloxacina en el tratamiento de las infecciones por Salmonella que justifica la terapia. Los laboratorios podrán realizar un estudio de verificación CLIA mediante una Prueba Épsilon para obtener una concentración inhibitoria mínima al usar ciprofloxacina para la implementación de valores límite nuevos hasta que los fabricantes de sistemas comerciales AST sean capaces de incorporar las diluciones de ciprofloxacina más bajas requeridas para detectar susceptibilidad disminuida a la ciprofloxacina. No obstante, debido a la complejidad de tal estudio de verificación, las pruebas pueden llevarse a cabo utilizando el método de difusión en disco con el uso de ciprofloxacina y ácido nalidíxico para detectar

tanto Susceptibilidad disminuida a la

ciprofloxacina como resistencia a las flouroquinolonas de alto nivel. En los países con recursos limitados, sólo la realización del método de difusión en disco con el uso de ácido nalidíxico para predecir susceptibilidad disminuida a la ciprofloxacina puede ser una opción viable, sin embargo, se justifica la vigilancia en estos países para aumentar la prevalencia de cepas con fenotipos que presentan susceptibilidad al ácido nalidíxico y susceptibilidad disminuida a la ciprofloxacina.

CL INICAL PRAC TICE

INVITED ARTICLE

Ellie J. C. Goldstein, Section Editor

In Vitro Susceptibility Testing of Fluoroquinolone Activity Against Salmonella: Recent Changes to CLSI Standards Romney M. Humphries,1 Ferric C. Fang,2,3,4 Frank M. Aarestrup,5 and Janet A. Hindler1 1Department

of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles California; Departments of 2Laboratory Medicine, 3Microbiology, and 4Medicine, Harborview Medical Center and University of Washington School of Medicine, Seattle; 5EU Reference Laboratory for Antimicrobial Resistance WHO Collaborating Centre for Antimicrobial Resistance in Foodborne Pathogens National Food Institute, Technical University of Denmark Kemitorvet

Downloaded from http://cid.oxfo rdjournals.org / by guest on February 24, 2014

Fluoroquinolone (FQ) resistance in Salmonella enterica is a significant clinical concern. Recognition of resistance by the clinical laboratory is complicated by the multiple FQ resistance mechanisms found in Salmonella. The Clinical Laboratory Standards Institute (CLSI) recently addressed this issue by revising the ciprofloxacin break points for Salmonella species. It is critical for clinicians and laboratory workers to be aware of the multiple technical issues surrounding these revised break points. In this article, we review FQ resistance mechanisms in Salmonella, their clinical significance, and data supporting the revised ciprofloxacin break points. We encourage clinical laboratories to adopt the revised CLSI ciprofloxacin break points for all Salmonella isolates in which susceptibility testing is indicated and discuss the technical issues for laboratories using commercial antimicrobial susceptibility systems.

Nontyphoidal Salmonella is one of the most important foodborne pathogens [1–4]. In most cases, Salmonella enteritis is self-limiting, and antimicrobial therapy is not generally recommended because of potential prolongation of the carrier state [5, 6]. However, antimicrobial therapy is indicated for management of severe diarrhea and treatment of patients with enhanced susceptibility to Salmonella. Antimicrobial therapy is also essential for extra-intestinal infections and typhoid fever caused by the human-adapted Salmonella serovars Typhi and Paratyphi A–C. Although severe infections with nontyphoidal Salmonella are relatively rare in Europe and North America, invasive nontyphoidal Salmonella infections are endemic in sub-Saharan Africa [7–9]. Typhoid fever is endemic in many

Received 4 May 2012; accepted 11 June 2012; electronically published 2 July 2012. Correspondence: Romney M. Humphries PhD, D(ABMM), 10833 Le Conte Ave, Brentwood Annex, Los Angeles, CA 90095 ([email protected]).

developing countries, particularly on the Indian subcontinent [10], where multidrug resistance (MDR) to ampicillin, chloramphenicol, and trimethoprimsulfamethoxazole is common [10, 11]. Because of this widespread resistance, ceftriaxone or a fluoroquinolone (FQ) is recommended by the World Health Organization for the treatment of uncomplicated typhoid fever, whether caused by MDR or fully susceptible organisms [12]. The FQs ciprofloxacin (CIP) and ofloxacin (OFO) are often preferred as treatment options, because they are available for oral use and are less expensive than ceftriaxone. High-level resistance to the FQs, defined historically as a CIP minimum inhibitory concentration (MIC) ≥4 µg/mL (CLSI M100 2011), has started to emerge [13, 14] but remains rare among clinical Salmonella isolates worldwide [15–18]. However, over the past decade, strains of Salmonella with decreased CIP susceptibility (DCS) have emerged, defined as isolates with CIP MICs of 0.12–1.0 µg/mL. The MICs of strains with DCS are greater than the wild-type Salmonella MIC distribution of 0.008–0.06 µg/mL (Table 1) [19, 20] but less than the historical 4 µg/mL resistance break point (Figure1)

Clinical Infectious Diseases 2012;55(8):1107–13 © The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected]. DOI: 10.1093/cid/cis600

CLINICAL PRACTICE

•

CID 2012:55 (15 October)

•

1107

Table 1. Genotype and Phenotype of Common Fluoroquinolone Resistance Mechanisms Phenotype

Genotype

Nalidixic Acid

Ciprofloxacin MIC (µg/mL)

Wild Type (no resistance) Chromosomal gyrA (single mutation)

Usually susceptible

0.008–0.06

Usually resistant

0.12–2.0

Chromosomal gyrB (single mutation)

Usually susceptible

0.12–0.5

Chromosomal gyrA, gyrB (multiple mutations)

Resistant

PMQR (such as qnr or aac (6′)-lb-cr)

Often susceptible

≥4.0 0.12–2.0

Abbreviations: MIC, minimum inhibitory concentration; PMQR, plasmidmediated quinolone resistance.

[21–24]. When investigated, most isolates with DCS were found to harbor single mutations in the gyrA gene, which encodes a subunit of DNA gyrase and is located in the quinolone resistance–determining region (QRDR) [25]. Mutations in gyrA also confer high-level resistance (MIC, 128–512 µg/mL) to the nonfluorinated quinolone nalidixic acid (NAL) (Table 1). A second QRDR mutation arising in such isolates may result in highlevel FQ resistance (MIC, ≥4 µg/mL). The DCS/NAL-resistant (DCS/NALR) phenotype is now prevalent worldwide among both typhoid and nontyphoid serovars [26–28]. Genotyping has identified at least 15 independent gyrA mutations that have occurred within a decade among Salmonella Typhi from Asia and Africa, suggestive of rapid evolution of DCS, which is maintained through selective

pressure [29, 30]. Of importance, the DCS/NALR phenotype is correlated in multiple studies with delayed responses, clinical failures, and increased mortality among patients receiving CIP for Salmonella Typhi infection [23, 31–42], even with adequate CIP doses [43, 44] and documented therapeutic drug concentrations [45]. Similarly, reports have documented poor FQ treatment outcomes for systemic infections caused by DCS/ NALR nontyphoidal serovars of Salmonella (Table 3). Because of the clinical significance of DCS/NALR strains in systemic infections, clinical laboratories have been encouraged to identify these isolates during routine susceptibility testing. Because nearly all NALR Salmonella harbor the DCS phenotype, the CLSI recommended in 2004 that laboratories screen extra-intestinal Salmonella with CIP MICs ≤1 µg/mL for NAL resistance as a predictor for DCS. If NAL resistance was identified, the laboratory was instructed to indicate to clinicians that FQ treatment might not be efficacious. Despite the paucity of clinical data at the time for nontyphoidal serovars, this recommendation was made universally for all extra-intestinal isolates of Salmonella. This strategy is performed across the globe and was, until recently, also supported by the European Committee for Antimicrobial Susceptibility Testing (EUCAST).

THE PROBLEM: EVOLVING FQ RESISTANCE AMONG SALMONELLA SPECIES Recent data have raised concern that NAL resistance may no longer be a reliable marker for DCS as a result of evolving and diverse Salmonella FQ resistance mechanisms. There are now numerous reports of NAL-susceptible isolates with DCS (DCS/ NALS) [46–51]. This phenotype appears to be mediated by

Dow nloa ded from http: //cid .oxf ordj ourn als. org/ by gue st on Febr uary 24, 201 4

Figure 1. Distribution of 2010 US Salmonella ciprofloxacin (CIP) minimum inhibitory concentrations (MICs), measured by broth microdilution. Shaded area indicates the decreased CIP susceptibility MIC zone. Data adapted from [20].

1108

•

CID 2012:55 (15 October)

•

CLINICAL PRACTICE

Table 2.

Interpretive Criteria for Ciprofloxacin and Salmonella CIP MIC (µg/mL) Interpretive Criteria Salmonella

Criterium

Susceptible

Intermediate

Resistant

CLSI (M100 S21; all Salmonella) CLSI (M100 S22; extraintestinal &S. Typhi)

≤1.0

2.0

≥4.0

≤0.06

0.12–1.0

≥2.0

CLSI (M100 S22; intestinal Salmonella) CLSI (proposed M100 S23, all Salmonella)

≤1.0

2.0

≥4.0

≤0.06

0.12–1.0

≥2.0

EUCASTa FDA

≤0.5 ≤1.0

1.0 2.0

≥2.0 ≥4.0

a

The EUCAST break point is for all Enterobacteriaceae, with a footnote to indicate Salmonella species with low-level fluoroquinolone resistance (MIC, >0.06 mg/L) respond poorly to CIP treatment. Abbreviations: CLSI, Clinical Laboratory Standards Institute; CIP, ciprofloxacin; EUCAST, European Committee for Antimicrobial Susceptibility Testing; FDA, US Food and Drug Administration; MIC, minimum inhibitory concentration.

resistance mechanisms outside the gyrA gene [52]. Mutations in gyrB occur among 1%–11.6% of S. Typhi in the United States and United Kingdom [22, 53] and result in CIP MICs of 0.125–0.5 µg/mL and NAL MICs of 2–16 µg/mL, both within the susceptible range [54, 55]. Similarly, plasmid-mediated quinolone resistance (PMQR) determinants, such as the qnr and aac-6′-Ib-cr genes [56], are associated with DCS [57–60] but result in only modest NAL MIC elevations (8–32 µg/mL) (Table 1) [61, 62]. PMQR appears to be uncommon among nontyphoidal Salmonella strains in the United States at present [51, 63] but are commonly found in Europe and Asia [54, 57, 64]. Occurrence among nontyphoidal Salmonella in African countries is less well known but has been reported [65]. The clinical impact of the DCS-NALS phenotype on FQ treatment of salmonellosis is unknown, because there have been no studies that document outcomes for such infections when treated with FQs. However, the DCS phenotype is likely to be the most important determinant of the clinical response to therapy [23], regardless of the resistance mechanism, whether NALR or NALS [66, 67]. Furthermore, significant concern exists that under-reporting of DCS by a failure to detect DCS-NALS isolates may facilitate the subsequent emergence of high-level FQ resistance [56, 62]. DCS-NALS isolates require higher concentrations of FQ to prevent in vivo selection of additional mutations that result in high-level FQ resistance [68].

susceptible break point for CIP to ≤0.06 ug/mL. This change is supported by accumulating clinical, microbiological, and pharmacokinetic-pharmacodynamic (PK-PD) studies that indicate that such a revised break point is more appropriate for determining CIP susceptibility among contemporary Salmonella isolates causing systemic infection. EUCAST revised their CIP susceptible break point to ≤0.5 ug/mL for all Enterobacteriaceae, with a comment that MICs>0.06 µg/mL predict a poor response for systemic Salmonella infection. The CLSI approved a ≤0.06 ug/mL susceptibility break point for Salmonella Typhi and extraintestinal isolates of Salmonella and decided to eliminate the NAL screen at the January 2011 Antimicrobial Susceptibility Testing subcommittee meeting (Table 2). However, in June 2011, after appeals from individuals in countries where typhoid fever is endemic, the NAL screen recommendation was reinstated. CLSI currently suggests that NAL may be used to test for reduced FQ susceptibility in Salmonella Typhi or extraintestinal Salmonella isolates. However, laboratory workers and clinicians should be aware that NAL screening does not detect all mechanisms of FQ resistance, and thus, CIP should also be tested and interpreted using the new susceptible MIC break point of ≤0.06 µg/mL or zone measurement of ≥31 mm with disk diffusion (DD) testing. CLSI rationale for maintaining the NAL screen arose from consideration of technical challenges faced by clinical laboratories in resource-limited countries. These laboratories have found NAL DD screening to be a reliable method for the detection of DCS to inform typhoid fever treatment. CIP MIC testing is generally not an option in these countries because of cost and limited availability of materials. In addition, laboratories in resource-limited countries have found that CIP DD id difficult to interpret, which may relate to local materials, strains, or other factors. Because the DCS/NALS phenotype is currently uncommon in many parts of the world, NAL screening to predict DCS is still associated with a sensitivity of 92.9% and specificity of 98.4% for Salmonella Typhi [19, 69] and, thus, continues to be of use in areas where typhoid is endemic. The CLSI is presently investigating alternative tests to replace the NAL screen, including OFO DD, which is associated with a sensitivity of 97.3% and specificity of 99.3% for the prediction of DCS [69]. Using disks with a lower content (eg, 1 mg CIP rather than 5 mg) can also improve both sensitivity and specificity [19]. Along with the revised CIP break point for Salmonella Typhi and extraintestinal Salmonella isolates, the CLSI in 2012 indicated that clinicians may consider maximal oral or parenteral CIP dosage regimens for those Salmonella isolates with CIP MICs or DD zone diameters in the intermediate range. The CLSI voted to remove this comment in M100-S23, because isolates that test in the intermediate range of the revised CIP break point include those that harbor PMQR

RE-EVALUATING THE FQ BREAK POINTS Given the wild-type Salmonella CIP MIC distribution of 0.008–0.06 µg/mL, many have suggested lowering the

CLINICAL PRACTICE

•

CID 2012:55 (15 October)

•

1109

determinants that may be associated with in vivo selection of high-level FQ resistance, as detailed above. Furthermore, because no data document favorable treatment outcomes using high dose CIP monotherapy for such isolates and highdose CIP may be associated with an increased risk of toxicity, it is the opinion of the authors that treatment with an alternative agent, such as ceftriaxone, may be preferable for such cases. Susceptibility to ceftriaxone should be confirmed, because resistance mediated by extended-spectrum β-lactamases and plasmidmediated cephalosporinases has been reported worldwide [70]. In 2010, 70 (2.8%) of 2474 nontyphoidal Salmonella isolates but none of the Salmonella Typhi or Paratyphi isolates included in the Centers for Disease Control and Prevention National Antimicrobial Resistance Monitoring System report were resistant to ceftriaxone (MIC, ≥4 µg/mL) [71]. Azithromycin has been shown to yield higher cure rates and lower mean duration of fever than OFO for the treatment of Salmonella Typhi with DCS [72, 73] but is not approved for the treatment of salmonellosis in the United States.

Downloaded from http://cid.oxfo rdjournals.org / by guest on February 24, 2014

TECHNICAL HURDLES TO IMPLEMENTING THE NEW MIC BREAK POINTS IN THE UNITED STATES Implementation of the 2012 CIP break points for Salmonella by a clinical laboratory is complicated in the United States by the requirement of commercial test system manufacturers to adhere to antimicrobial break points set by the US Food and Drug Administration, which for CIP, are currently the same for all Enterobacteriaceae (Table 2). No commercial MIC panels produced in the United States currently contain CIP concentrations low enough to allow use of the 2012 CLSI Salmonella break points (Table 2). To use the 2012 breakpoints, laboratories may consider determining CIP MIC by Etest, which appears to correlate well with MICs obtained by agar dilution for Salmonella Typhi with high-level FQ resistance [74] and will reliably detect DCS [19, 75]. Because Etest is a Food and Drug Administration–approved commercial test, laboratories will need to perform a verification study before applying the new break points. The extent of this verification study is at the discretion of the laboratory director, but reliability of Etest to detect CIP-susceptible, -intermediate, and -resistant results with use of the new break points should be confirmed. As an alternative to using Etest, laboratories could perform both NAL and CIP DD in parallel for isolates with CIP MICs ≤1 µg/mL, thereby testing for the more common NALR DCS phenotype and for PMQR by evaluation of CIP DD zone diameters. At the very least, laboratories should interpret CIP MICs using the old break points, while providing a comment that Salmonella isolates with CIP MICs ≤1 µg/mL

1110

•

CID 2012:55 (15 October)

•

CLINICAL PRACTICE