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JAC Advance Access published online on August 24, 2005
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dki286
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org
Received May 4, 2004
Revised July 6, 2005
Accepted July 24, 2005

Brief report

Resistance to macrolides, clindamycin and telithromycin in Streptococcus pyogenes isolated in Spain during 2004

J. Tamayo 1, E. Pérez-Trallero 2, J. L. Gómez-Garcés 1, J. I. Alós 1*, and on behalf of the Spanish Group for the Study of Infection in the Primary Health Care Setting (IAP-SEIMC) {dagger}

1 Servicio de Microbiología, Hospital de Móstoles, 28935 Móstoles, Madrid
2 Servicio de Microbiología, Hospital Donostia, San Sebastián, Spain

* To whom correspondence should be addressed.
J. I. Alós, E-mail: nachoalos{at}microb.net


  Abstract

Objectives: To study the antimicrobial susceptibility and prevalence of the different phenotypes and genotypes of macrolide resistance in group A streptococci isolated in Spain in 2004, and to compare the results with those obtained in 1998 and 2001 using the same methodology and centres.

Methods: A total of 530 unique isolates of Streptococcus pyogenes collected in 21 laboratories from 16 geographic areas (regions) in Spain were used. Antimicrobial susceptibility testing was performed using the agar dilution method. Discs containing erythromycin or clindamycin were used to recognize the phenotypes of macrolide-lincosamide-streptogramin (MLS) resistance. Genes encoding macrolide-lincosamide resistance were detected by PCR.

Results: Resistance to erythromycin was 21.7% [95% confidence interval (CI) 16.5-26.3]. The resistance to azithromycin was 21.5%, whereas the resistance to miocamycin and to clindamycin was 6.6% (95% CI 3.0-8.9). Thirty-one (5.8%) of the isolates were resistant to telithromycin. Of the 115 erythromycin-resistant isolates, 67.8% had the M phenotype, representing 14.7% of all the isolates tested. Thirty-five isolates (30.5% of the erythromycin-resistant strains and 6.6% of all the isolates) had the MLSB constitutive phenotype. There was a high prevalence of resistance to telithromycin (88.6%) among the 35 strains with the MLSB constitutive phenotype. When we compared these results with those from previous studies (1998 and 2001), we found a significant increase in the MLSB constitutive phenotype (P < 0.001), and a significant decrease in the M phenotype (P < 0.005) was noted.

Conclusions: The significant increase in the prevalence of resistance to clindamycin and miocamycin, and the prevalence of resistance to telithromycin reached in a short period of time from the introduction of its use, underscore the need for continuous surveillance of antimicrobial resistance in S. pyogenes in Spain.

Keywords: M phenotype; MLSB phenotype; mef genes; erm genes.
{dagger}The IAP-SEIMC project participants are listed in the Acknowledgements.
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