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Antimicrobial Agents and Chemotherapy, September 2007, p. 3240-3246, Vol. 51, No. 9
0066-4804/07/$08.00+0     doi:10.1128/AAC.00157-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Serotypes, Clones, and Mechanisms of Resistance of Erythromycin-Resistant Streptococcus pneumoniae Isolates Collected in Spain

Microbiology Department, Hospital Universitari de Bellvitge, University of Barcelona, IDIBELL, Barcelona, Spain,¹ Ciber de Enfermedades Respiratorias, ISCIII, Madrid, Spain,² Microbiology Department, Hospital Gregorio Marañón, Madrid, Spain,³ Microbiology Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain,⁴ Infectious Diseases Department, Clinical Research Unit, Hospital Universitari de Bellvitge, University of Barcelona, IDIBELL, Barcelona, Spain⁵

Received 2 February 2007/ Returned for modification 9 April 2007/ Accepted 26 June 2007

The aim of this study was to analyze the distributions of antibiotic susceptibility patterns, serotypes, phenotypes, genotypes, and macrolide resistance genes among 125 nonduplicated erythromycin-resistant Streptococcus pneumoniae clinical isolates collected in a Spanish point prevalence study. The prevalence of resistance to macrolides in this study was 34.7%. Multiresistance (to three or more antimicrobials) was observed in 81.6% of these strains. Among 15 antimicrobials studied, cefotaxime, moxifloxacin, telithromycin, and quinupristin-dalfopristin were the most active drugs. The most frequent serotypes of erythromycin-resistant isolates were 19F (25%), 19A (17%), 6B (12%), 14 (10%), and 23F (10%). Of the 125 strains, 109 (87.2%) showed the MLS_B phenotype [103 had the erm(B) gene and 6 had both erm(B) and mef(E) genes]. Sixteen (12.8%) strains showed the M phenotype [14 with mef(E) and 2 with mef(A)]. All isolates were tested by PCR for the presence of the int, xis, tnpR, and tnpA genes associated with conjugative transposons (Tn916 family and Tn917). Positive detection of erm(B), tet(M), int, and xis genes related to the Tn916 family was found in 77.1% of MLS_B phenotype strains. In 16 strains, only the tndX, erm(B), and tet(M) genes were detected, suggesting the presence of Tn1116, a transposon recently described for Streptococcus pyogenes. Five clones, namely, Sweden^15A-25, clone^19F ST87, Spain^23F-1, Spain^6B-2, and clone^19A ST276, accounted for half of the MLS_B strains. In conclusion, the majority of erythromycin-resistant pneumococci isolated in Spain had the MLS_B phenotype, belonged to multiresistant international clones, and carried the erm(B), tet(M), xis, and int genes, suggesting the spread of transposons of the Tn916 family.

Published ahead of print on 2 July 2007.

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