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Antimicrobial Agents and Chemotherapy, May 2005, p. 1965-1972, Vol. 49, No. 5
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.5.1965-1972.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Geographical and Ecological Analysis of Resistance, Coresistance, and Coupled Resistance to Antimicrobials in Respiratory Pathogenic Bacteria in Spain

Emilio Pérez-Trallero,1 Celia García-de-la-Fuente,2 César García-Rey,3* Fernando Baquero,4 Lorenzo Aguilar,5 Rafael Dal-Ré,3 Juan García-de-Lomas,6 the Spanish Surveillance Group for Respiratory Pathogens,{dagger}

Department of Microbiology, Hospital Donostia, San Sebastián, Spain,1 Department of Microbiology, Hospital Marqués de Valdecilla, Santander, Spain,2 Medical Department, GlaxoSmithKline S.A., Tres Cantos, Madrid, Spain,3 Department of Microbiology, Hospital Ramón y Cajal, Madrid, Spain,4 Universidad Complutense, Madrid, Spain,5 Department of Microbiology, University Hospital, School of Medicine and Valencian Institute for Microbiology, Valencia, Spain6

Received 21 September 2004/ Returned for modification 19 October 2004/ Accepted 4 January 2005

A multicenter susceptibility surveillance (the S.A.U.C.E. project) including 2,721 Streptococcus pneumoniae, 3,174 Streptococcus pyogenes, and 2,645 Haemophilus influenzae consecutive isolates was carried out in 25 hospitals all over Spain from November 2001 to October 2002 to evaluate the current epidemiology of resistance of the main bacteria involved in community-acquired respiratory tract infections. Susceptibility testing was performed in a single centralized laboratory by a broth microdilution method. The prevalence of resistant S. pneumoniae strains was 0.4% for cefotaxime, 4.4% for amoxicillin and amoxicillin-clavulanic acid, 25.6% for cefuroxime-axetil, 34.5% for erythromycin, clarithromycin, and azithromycin, and 36.0% for cefaclor. Phenotypes of resistance to erythromycin were MLSB (macrolide-lincosamide-streptogramin B) in 89.9% (gene ermB) and M (macrolide) in 9.7% of cases (gene mefA). No strain harbored both genes simultaneously. Serotypes 19, 6, 23, 14, and 3 were the most prevalent, accounting for 54.6% of the total isolates. Resistance to macrolides seems to be the most alarming point, since among penicillin-susceptible isolates it reached 15.1% compared to 55.8% among penicillin-resistant strains. Geographically, a number of regions had rates of erythromycin resistance above 40% (even higher in children). Resistance to erythromycin was also high in S. pyogenes isolates: mean regional 33.2%, beta-lactamase-producing H. influenzae were 20%, whereas 4.4% had a beta-lactamase-negative, ampicillin-resistant phenotype. We highlight the importance of different geographical frequencies of coresistance (associations of resistance to different drugs within the same species) and coupled resistance (association of resistance between different species) probably resulting from different local coselective events.

* Corresponding author. Mailing address: GlaxoSmithKline S.A., Medical Department, Parque Tecnológico de Madrid, C/ Severo Ochoa 2, Tres Cantos, 28760, Madrid, Spain. Phone: 34 91 807 5738. Fax: 34 91 807 0596. E-mail: cesar.garcia-rey{at}gsk.com.

{dagger} Members of the Spanish Surveillance Group for Respiratory Pathogens are as follows: Badalona, H. Germans Trias i Pujol: Vicente Ausina, Nieves Diosdado and Jose L. López-Hontangas; Baracaldo, H. de Cruces: Jorge Barrón and Begoña Vilar; Barcelona, H. Clinic i Provincial: Francesc Marco and María T. Jiménez-de-Anta; Ciudad Real, H. Nuestra Señora de Alarcos: Dolores Romero and Manuel González-Rodríguez; Córdoba, H. Reina Sofía: Manuel Casal and Ana Ibarra; Esplugués de Llobregat, H. Sant Joan de Deu: Cristina Latorre and Amadeo Gené; Granada, H. Virgen de las Nieves: Manuel De-la-Rosa and Antonio Martínez-Brocal; Jerez de la Frontera, H. General de Jerez: Luis Calbo and Juan C. Alados; Las Palmas de Gran Canaria, H. Insular: Antonio M. Martín-Sánchez and Fernando Cañas; Madrid, H. Gregorio Marañón: Emilio Bouza and Emilia Cercenado; Madrid, H. La Paz: Adela García-Perea and Ana Lozano; Madrid, H. Ramón y Cajal: Rafael Cantón; Majadahonda, National Reference Laboratory of S. pneumoniae, Instituto de Salud Carlos III: Asunción Fenoll; Málaga, H. Virgen de la Victoria: Alfonso Pinedo and María A. Sánchez-Bernal; Murcia, H. Virgen de la Arrixaca: Joaquín Ruiz and Encarnación Simarro; Palma de Mallorca, H. Son Dureta: Pedro Alomar and Jose L. Pérez; Salamanca, H. Clínico: Jose A. García-Rodríguez and Ignacio Trujillano; San Sebastián, H. de Donostia: Jose M. Marimón; Santander, H. Marqués de Valdecilla: Antonia Burgada; Santiago de Compostela, H. Clínico: Carlos García-Riestra and Benito García-Regueiro; Seville, H. Virgen del Rocío: Evelio Perea; Valencia, H. Doctor Peset: Jose M. Nogueira; Valencia, H. La Fe: Miguel Gobernado; Valencia, Instituto Valenciano de Microbiología: Encarnación Esteban and Mercedes Lerma; Valladolid, H. Clínico: Ricardo Landínez and Dolores Tejero; Vigo, H. Meixoeiro: Julio Torres and Francisco J. Vasallo; Zaragoza, H. Lozano Blesa: Carmen Rubio.

Antimicrobial Agents and Chemotherapy, May 2005, p. 1965-1972, Vol. 49, No. 5
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.5.1965-1972.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



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