Antimicrobial resistance among respiratory pathogens in Spain: latest data and changes over 11 years (1996-1997 to 2006-2007).
A nationwide multicenter susceptibility surveillance study (Susceptibility to the Antimicrobials Used in the Community in España [SAUCE] project), SAUCE-4, including 2,559 Streptococcus pneumoniae, 2,287 Streptococcus pyogenes, and 2,736 Haemophilus influenzae isolates was carried out from May 2006 to June 2007 in 34 Spanish hospitals. Then, the results from SAUCE-4 were compared to those from all three previous SAUCE studies carried out in 1996-1997, 1998-1999, and 2001-2002 to assess the temporal trends in resistance and the phenotypes of resistance over the 11-year period. In SAUCE-4, on the basis of the CLSI breakpoints, penicillin (parenteral, nonmeningitis breakpoint) and cefotaxime were the antimicrobials that were the most active against S. pneumoniae (99.8% and 99.6%, respectively). Only 0.9% of isolates had a penicillin MIC of > or = 2 microg/ml. In S. pyogenes, nonsusceptibility to erythromycin was observed in 19.4% of isolates. Among the H. influenzae isolates, a beta-lactamase-positive prevalence of 15.7% was found. A statistically significant temporal decreasing trend over the 11-year period was observed for nonsusceptibility (from 60.0% to 22.9%) and resistance (from 36.5% to 0.9%) to penicillin and for the proportion of erythromycin-resistant isolates of S. pneumoniae of the macrolide-lincosamide-streptogramin B (MLS(B)) phenotype (from 98.4% to 81.3%). A similar trend was observed for the prevalence of ampicillin resistance (from 37.6% to 16.1%), beta-lactamase production (from 25.7% to 15.7%), and beta-lactamase-negative ampicillin resistance (BLNAR) in H. influenzae (from 13.5% to 0.7%). Among erythromycin-resistant isolates of S. pyogenes, a significant increasing trend in the prevalence of MLS(B) was observed (from 7.0% to 35.5%). SAUCE-4 confirms a generalized decline in the resistance of the main respiratory pathogens to the antimicrobials as well as a shift in their resistance phenotypes.
Pérez-Trallero
Emilio
E
Department of Microbiology and CIBERES, Hospital Donostia, San Sebastián, Gipuzkoa, Spain.
Martín-Herrero
Jose E
JE
Mazón
Ana
A
García-Delafuente
Celia
C
Robles
Purificación
P
Iriarte
Victor
V
Dal-Ré
Rafael
R
García-de-Lomas
Juan
J
D000667:Ampicillin / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002439:Cefotaxime / Q000494:pharmacology; D004917:Erythromycin / Q000494:pharmacology; D006193:Haemophilus influenzae / Q000187:drug effects* / Q000472:pathogenicity; D055231:Lincosamides / Q000494:pharmacology; D018942:Macrolides / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D010406:Penicillins / Q000494:pharmacology; D012141:Respiratory Tract Infections / Q000382:microbiology*; D013030:Spain; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000472:pathogenicity; D013297:Streptococcus pyogenes / Q000187:drug effects* / Q000472:pathogenicity; D025381:Streptogramin B / Q000494:pharmacology
D000900:Anti-Bacterial Agents; D055231:Lincosamides; D018942:Macrolides; D010406:Penicillins; D025381:Streptogramin B; D004917:Erythromycin; D000667:Ampicillin; D002439:Cefotaxime