Antimicrobial Resistance among Respiratory Pathogens in Spain: Latest Data and Changes over 11 Years (1996-1997 to 2006-2007)
AbstractAntimicrobial Resistance among Respiratory Pathogens in Spain: Latest Data and Changes over 11 Years (1996-1997 to 2006-2007) ▿ Emilio Pérez-Trallero 1 , Jose E. Martín-Herrero 2 , Ana Mazón 3 , Celia García-Delafuente 4 , Purificación Robles 5 , Victor Iriarte 2 , * , Rafael Dal-Ré 2 , Juan García-de-Lomas 6 and the Spanish Surveillance Group for Respiratory Pathogens 1 Department of Microbiology and CIBERES, Hospital Donostia, San Sebastián, Gipuzkoa, Spain 2 Medical Department, GlaxoSmithKline S.A., Tres Cantos, Madrid, Spain 3 Department of Microbiology, Centro San Martin, Pamplona, Spain 4 Department of Microbiology, Hospital Marqués de Valdecilla, Santander, Spain 5 Department of Microbiology, Hospital General Universitario, Albacete, Spain 6 Department of Microbiology, Hospital Universitario, School of Medicine and Valencian Institute for Microbiology, Valencia, Spain ABSTRACT 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 ≥2 μg/ml. In S. pyogenes , nonsusceptibility to erythromycin was observed in 19.4% of isolates. Among the H. influenzae isolates, a β-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%), β-lactamase production (from 25.7% to 15.7%), and β-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.