title: Resistance to macrolides, clindamycin and telithromycin in Streptococcus pyogenes isolated in Spain during 2004.
abstract: OBJECTIVE
  To study the antimicrobial susceptibility and prevalence of the different phenotypes and genotypes of macrolide resistance in group A streptococci isolated in Spain in 2004, and to compare the results with those obtained in 1998 and 2001 using the same methodology and centres.
  
  
  METHODS
  A total of 530 unique isolates of Streptococcus pyogenes collected in 21 laboratories from 16 geographic areas (regions) in Spain were used. Antimicrobial susceptibility testing was performed using the agar dilution method. Discs containing erythromycin or clindamycin were used to recognize the phenotypes of macrolide-lincosamide-streptogramin (MLS) resistance. Genes encoding macrolide-lincosamide resistance were detected by PCR.
  
  
  RESULTS
  Resistance to erythromycin was 21.7% [95% confidence interval (CI) 16.5-26.3]. The resistance to azithromycin was 21.5%, whereas the resistance to miocamycin and to clindamycin was 6.6% (95% CI 3.0-8.9). Thirty-one (5.8%) of the isolates were resistant to telithromycin. Of the 115 erythromycin-resistant isolates, 67.8% had the M phenotype, representing 14.7% of all the isolates tested. Thirty-five isolates (30.5% of the erythromycin-resistant strains and 6.6% of all the isolates) had the MLS(B) constitutive phenotype. There was a high prevalence of resistance to telithromycin (88.6%) among the 35 strains with the MLS(B) constitutive phenotype. When we compared these results with those from previous studies (1998 and 2001), we found a significant increase in the MLS(B) constitutive phenotype (P < 0.001), and a significant decrease in the M phenotype (P < 0.005) was noted.
  
  
  CONCLUSIONS
  The significant increase in the prevalence of resistance to clindamycin and miocamycin, and the prevalence of resistance to telithromycin reached in a short period of time from the introduction of its use, underscore the need for continuous surveillance of antimicrobial resistance in S. pyogenes in Spain.
authors.affiliation: Servicio de Microbiología, Hospital de Móstoles, 28935 Móstoles, Madrid.
authors.forename: J
authors.initials: J
authors.lastname: Tamayo
authors.forename: E
authors.initials: E
authors.lastname: Pérez-Trallero
authors.forename: J L
authors.initials: JL
authors.lastname: Gómez-Garcés
authors.forename: J I
authors.initials: JI
authors.lastname: Alós
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000378:metabolism; D002981:Clindamycin / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D015964:Gene Expression Regulation, Bacterial; D015971:Gene Expression Regulation, Enzymologic; D006801:Humans; D048628:Ketolides / Q000494:pharmacology*; D018942:Macrolides / Q000494:pharmacology*; D008565:Membrane Proteins / Q000378:metabolism; D008780:Methyltransferases / Q000235:genetics / Q000378:metabolism; D013030:Spain; D013290:Streptococcal Infections / Q000382:microbiology*; D013297:Streptococcus pyogenes / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D048628:Ketolides; D018942:Macrolides; C117866:MefA protein, Streptococcus; C431304:MefE protein, Streptococcus pneumoniae; D008565:Membrane Proteins; D002981:Clindamycin; D008780:Methyltransferases; C431709:ErmA protein, Bacteria; C035181:rRNA (adenosine-O-2'-)methyltransferase; C106791:telithromycin