Antimicrobial Resistance among Respiratory Pathogens in Spain: Latest Data and Changes over 11 Years (1996-1997 to 2006-2007)

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 g/ml. In S. pyogenes, nonsusceptibility to erythromycin was observed in 19.4% of isolates. Among the H. influenzae isolates, a ␤-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%), ␤-lactamase production (from 25.7% to 15.7%), and ␤-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.

Microbiological Features of Upper Respiratory Tract Infections in Bulgarian Children for the Period 1998-2014

“…Selective pressure from the common and not always well grounded use of macrolides in childhood leads to fast expansion of streptococcal strains with limited or absent susceptibility towards these antibiotics, which could lead to serious complications and sequels after infections caused by them (16)(17)(18)(19)(20). Confirmed data for appearance of new more virulent strains of М. сatarrhalis with obligatory production of ß-lactamase during the last years have been published even in Bulgaria (8,12).…”

“…In the year 2014 100% of all samples of outpatient cases with M. сatarrhalis and almost 90% from S. аureus, produce β-lactamase, which makes them resistant to aminopenicillins without inhibitor, and moraxellae are resistant also to all first generation cephalosporins (Figure 2c-3b). So far β-lactamase from M. catarrhalis, H. influenzae and S. aureus could be suppressed by the well-known inhibitors as sulbactam and clavulonic acid, but recently there were some reports for a broader spectrum of β-lactamase activity (5,7,16).…”

Compliance with Recommendations on Outpatient Antibiotic Prescribing for Respiratory Tract Infections: The Case of Spain

“…The majority of antibiotics prescribed are broad-spectrum agents, and there are remarkable seasonal fluctuations reflecting an inappropriate prescribing of antibiotic for RTIs caused by viruses [9]. Consequently, resistance rates of the main respiratory pathogens remain high in Spain, although a decreasing trend has been observed in the last years [10].According to the disease-specific quality indicators for outpatient antibiotic prescribing developed by the European Surveillance Antimicrobial Consumption (ESAC) [11], both the proportion of patients prescribed antibiotics and the choice of antibiotics should be taken into account when evaluating the quality of antibiotic use in general practice.This study aimed at investigating antibiotic prescribing rates and pattern of antibiotic use in patients with RTI in Spain. We assessed adherence to national recommendations in order to evaluate the extent of inappropriate antibiotic prescribing.…”

“…The majority of antibiotics prescribed are broad-spectrum agents, and there are remarkable seasonal fluctuations reflecting an inappropriate prescribing of antibiotic for RTIs caused by viruses [9]. Consequently, resistance rates of the main respiratory pathogens remain high in Spain, although a decreasing trend has been observed in the last years [10].…”

Comparison of in vitro susceptibility of Haemophilus influenzae strains to various antimicrobial drugs

“…In the study by Giufre et al (2011) the resistance rates in H.influenzae to ampicillin, chloramphenicol, ciprofloxacin, cefotaxime and imipenem were found as 10.3%, 2.6%, 0%, 0% and 2.6%, respectively. In the study by Perez-Trallero et al (2010) the authors found the resistance rates to ampicillin, cefuroxime, cefotaxime and ciprofloxacin as 13.3%, 0.1%, 0% and 0.2% respectively.…”