Successful treatment of postsurgical meningitis caused by Bacillus cereus: a case report and literature review.

Bacillus cereus is a spore-forming, gram-positive bacterium that is ubiquitous in the environment. Central nervous system involvement with B. cereus is rare. Despite aggressive treatment with broad-spectrum antibiotics and using them appropriately, the mortality is high. A 72-year-old patient suffered a central nervous system infection associated with postsurgical meningitis and was successfully treated with a novel antibiotic therapy. This study includes the first case report of postsurgical B. cereus meningitis in the last ten years. It provides a different line of treatment to the previous ones.

Outcomes by sex following treatment initiation with darunavir/cobicistat in a large Spanish cohort of the CODAR study (GeSIDA 9316).

BACKGROUND: Few women have been included in darunavir/cobicistat clinical development studies, and hardly any of them were antiretroviral experienced or treated with anything other than triple-based therapies. OBJECTIVES: Our aim was to increase our knowledge about women living with HIV undergoing darunavir/cobicistat-based regimens. METHODS: A multicentre (21 hospitals), retrospective study including a centrally selected random sample of HIV-1 patients starting a darunavir/cobicistat-based regimen from June 2014 to March 2017 was planned. Baseline characteristics, 24 and 48 week viral load response (<50 copies/mL), CD4+ lymphocyte count increase, time to change darunavir/cobicistat and adverse event occurrence were all compared by sex. The study was approved by each of the 21 ethics committees, and patients signed informed consent. RESULTS: Out of 761 participants, 193 were women. Similar characteristics were found for both sexes, except that the women had a longer duration of HIV infection (P = 0.001), and were less frequently pre-treated with darunavir/cobicistat in their previous regimen (P = 0.02). The main reason for using a darunavir/cobicistat-based regimen was simplification, without differences by sex, while monotherapy seems to be more frequently prescribed in women than in men (P = 0.067). The main outcomes, HIV viral load response, CD4+ lymphocyte count increase at 24 or 48 weeks, occurrence of adverse events, main reasons for changing and time to the modify darunavir/cobicistat regimen, did not show differences between the sexes. CONCLUSIONS: No sex disparities were found in the main study outcomes. These results support the use of a darunavir/cobicistat-based regimen in long-term pre-treated women. Clinical Trial.gov No. NCT03042390.

beta-lactam susceptibility of Escherichia coli isolates from urinary tract infections exhibiting different resistance phenotypes.

Susceptibility to beta-lactams was determined in 203 recent Spanish E. coli isolates from urinary tract infections exhibiting different resistance phenotypes: a) susceptible (n = 60); b) quinolone-resistant (n = 45); c) penicillinase (n=64); d) hyperproduction of penicillinase (n=8); e) inhibitor resistant TEM (IRT) (n=18), and f) extended spectrum betalactamase (ESBL) (n=8).Minimum inhibitory concentration (MIC) determination by agar dilution and susceptibility tests for ESBL detection by macrodilution were performed following CLSI recommendations. All the beta-lactams tested showed high activity against susceptible and penicillinase phenotypes, with close to 100 % susceptibility. Hyperproduction of penicillinase increased MIC90 values for all antibiotics except for meropenem, with 100% resistance to cefuroxime and amoxicillin/clavulanic acid, and 100% susceptibility to cefotaxime, piperacillin/tazobactam and meropenem. All the antibiotics, except for amoxicillin/clavulanic acid, exhibited high activity against IRT. Meropenem, cefminox and piperacillin/tazobactam exhibited the highest activity against ESBL, followed by amoxicillin/clavulanic acid. The most active compound among the parenteral antibiotics was meropenem, regardless of the resistance phenotype. Among the oral antibiotics, the most active compound was cefditoren with the exception of ESBL where amoxicillin/clavulanic acid where the MIC90 value was one dilution lower.

â - lactam susceptibility of Escherichia coli isolates from urinary tract infections exhibiting different resistance phenotypes

Susceptibility to â-lactams was determined in 203 recentSpanish E. coli isolates from urinary tract infectionsexhibiting different resistance phenotypes: a) susceptible(n = 60); b) quinolone-resistant (n = 45); c) penicillinase(n=64); d) hyperproduction of penicillinase (n=8); e) inhibitorresistant TEM (IRT) (n=18), and f) extended spectrumbetalactamase (ESBL) (n=8). Minimum inhibitory concentration(MIC) determination by agar dilution and susceptibilitytests for ESBL detection by macrodilution were performedfollowing CLSI recommendations. All the â-lactamstested showed high activity against susceptible and penicillinasephenotypes, with close to 100 % susceptibility.Hyperproduction of penicillinase increased MIC90 values forall antibiotics except for meropenem, with 100% resistanceto cefuroxime and amoxicillin/clavulanic acid, and 100%susceptibility to cefotaxime, piperacillin/tazobactam andmeropenem. All the antibiotics, except for amoxicillin/clavulanicacid, exhibited high activity against IRT. Meropenem,cefminox and piperacillin/tazobactam exhibited thehighest activity against ESBL, followed by amoxicillin/clavulanicacid. The most active compound among the parenteralantibiotics was meropenem, regardless of the resistancephenotype. Among the oral antibiotics, the most activecompound was cefditoren with the exception of ESBL whereamoxicillin/clavulanic acid where the MIC90 value wasone dilution lower (AU)

Se determinó la susceptibilidad a betalactámicos de203 aislados recientes de E. coli procedentes de infeccionesdel tracto urinario en España y que presentaban distintosfenotipos de resistencia: a) susceptible (n = 60);b) resistente a quinolonas (n=45); c) productor de penicilinasa(n=64); d) hiperproductor de penicilinasa (n=8);e) resistente a inhibidores de TEM (IRT) (n=18), y f) productorde betalactamasas de espectro extendido (BLEE)(n=8). La determinación de la concentración mínima inhibitoria(CMI) por dilución en agar y los tests de susceptibilidadpara la detección de BLEE se realizaron siguiendolas recomendaciones del Clinical and Laboratory StandardsInstitute (CLSI). Frente a los fenotipos susceptible yproductor de penicilinasa, todos los betalactámicos ensayadosexhibieron gran actividad, con una sensibilidadcercana al 100% de los aislados. La hiperproducción depenicilinasa incrementó los valores de CMI90 de todos losantibióticos, excepto de meropenem, con un 100% de resistenciaa cefuroxima y amoxicilina/clavulánico y un 100% desensibilidad a cefotaxime, piperacilina/tazobactam y meropenem.Todos los antibióticos, excepto amoxicilina/clavulánico,presentaron gran actividad frente a las cepas IRT.Meropenem, cefminox y piperacilina/tazobactam presentaronla mayor actividad frente a BLEE, seguidas de amoxicilina/clavulánico. Entre los antibióticos parenterales, elcompuesto más activo fue meropenem, con independenciadel fenotipo de resistencia. Entre los antibióticos oralesel compuesto más activo fue cefditoren, excepto frentea las cepas BLEE, donde amoxicilina/clavulánico presentóen un valor de CMI90 una dilución menor (AU)

Evaluation of the in-vitro cidal activity and toxicity of a novel peroxygen biocide: 2-butanone peroxide.

The monomer of 2-butanone peroxide is a novel peroxygen derivative with potential use as biocide in the hospital environment. The aim of this study was to test the biocidal activity of different concentrations of the compound against American Tissue Culture Collection strains from 11 different micro-organisms, including bacteria, mycobacteria, spores, fungi and virus, following the European Standard guidelines. Toxicity tests were also carried out following United States Environmental Protection Agency Standards. 2-Butanone peroxide exhibited biocidal activity at 0.12% against Legionella pneumophila, at 0.5% against Escherichia coli, Pseudomonas aeruginosa and Enterococcus hirae, and at 1% against Staphylococcus aureus after 5 min contact at room temperature. Mycobactericidal activity was obtained at 0.5% after 60 min contact at 20 degrees C, and sporicidal activity was obtained at 4% after 60 min at 40 degrees C. Good fungicidal (against yeasts and moulds) and virucidal (adenovirus and poliovirus) activities were obtained at 0.5% after 60 min contact. Toxicity assessment showed negative results in the acute dermal irritation test, acute eye irritation test and acute oral toxicity test. The skin sensitisation test was negative. The safety profile in the toxicity tests and the basic cidal activity against the strains tested suggest that 2-butanone peroxide in the control of hospital infections.

Quinolone resistance in female outpatient urinary tract isolates of Escherichia coli: age-related differences.

During a 1-year period, from November 2003 to October 2004, urinary Escherichia coli isolates were collected from 20 clinical microbiology laboratories across Spain. The main objective was to assess the resistance of E. coli to the antimicrobials most commonly prescribed for community-acquired urinary tract infections depending on the patient's age. A total of 2,230 valid E. coli strains from female outpatients were isolated and sent to a single central reference laboratory for confirmation and susceptibility testing using an agar dilution method. A two-sided chi-squared test was used to assess the differences in resistance between age groups (< or =65 and >65 years). E. coli resistance was found to be more common to ampicillin (52.1%), cotrimoxazole (26%) and quinolones (18%), whereas resistance to amoxicillin-clavulanic acid, cefuroxime axetil and fosfomycin were below 3%. In women older than 65 years, resistance to ciprofloxacin reached up to 29% compared with 13% of those in the under 65 age group (p <0.001). For cotrimozaxole, rates were 32% vs. 23% (p <0.001) and for ampicillin 56% vs. 50% (p=0.02), respectively. It was concluded that fosfomycin, amoxicillin-clavulanic acid and cefuroxime axetil are the most suitable antimicrobials for empirical treatment in Spain given the high 18% and 26% resistance rates to quinolones and cotrimoxazole, respectively. Being older than 65 years of age was associated with higher resistance rates to ciprofloxacin (29%). These results should be considered when recommending empirical therapy for acute cystitis in women.

Antimicrobial use in Europe and antimicrobial resistance in Streptococcus pneumoniae.

The study presented here determined the relationship between antimicrobial resistance in Streptococcus pneumoniae and the use of antimicrobial agents in 15 different European countries. Pneumococcal isolates (n = 1974) recovered from patients with community-acquired respiratory tract infections during the winter of 2004-2005 in 15 European countries were characterized. The overall percentages of isolates demonstrating intermediate or complete resistance to penicillin, erythromycin, tetracycline, trimethoprim-sulfamethoxazole (TMP-SMX) and ciprofloxacin were 24, 24.6, 19.8, 26.7 and 2%, respectively, as determined using the broth microdilution MIC method recommended by the Clinical and Laboratory Standards Institute. The overall and mean antimicrobial consumption levels (ACL)--i.e., the defined daily doses per 1,000 inhabitants per day--were obtained from the European Surveillance of Antimicrobial Consumption project for each of the 15 countries for the years 1998-2004. Using linear regression analysis, the mean annual ACL for beta-lactams, macrolides, tetracyclines, TMP-SMX and fluoroquinolones in each country was compared to the country-specific resistance rates determined in 2004-2005. The rate of overall antimicrobial use in all 15 European countries was significantly associated with antimicrobial resistance in S. pneumoniae. There was variation among the different antimicrobial classes as drivers of resistance, with beta-lactams having the strongest association.

Quinolone resistance in female outpatient urinary tract isolates of Escherichia coli: age-related differences

Se recogieron a lo largo de un año (noviembre de 2003 a octubre de 2004) 2230 aislamientos de Escherichia coli de pacientes con infección urinaria adquirida en la comunidad procedentes de 20 laboratorios microbiológicos de toda España, que fueron enviados a un laboratorio central de referencia para realizar la confirmación del patógeno y las pruebas de sensibilidad antibacteriana, mediante el método de dilución en agar. El principal objetivo fue evaluar la resistencia a los antimicrobianos más prescritos en las cistitis agudas, en relación con la edad. Se utilizó el test de χ2 bilateral para valorar las diferencias de la resistencia entre los dos grupos de edad (≤65 años y ≥65 años). E. coli mostró una elevada resistencia a la ampicilina (52,1%), el cotrimoxazol (26%) y las quinolonas (18%), mientras que a amoxicilina-ácido clavulánico, cefuroxima-axetilo y fosfomicina fue inferior al 3%. En las mujeres mayores de 65 años, la resistencia al ciprofloxacino alcanzó el 29%, frente al 13% en las mujeres por debajo de esa edad (p 65 años se asoció con mayores tasas de resistencia al ciprofloxacino (29%). Estos resultados deberían tenerse en cuenta cuando se recomienda un tratamiento antimicrobiano empírico en mujeres con cistitis aguda comunitaria

During a 1-year period, from November 2003 to October 2004, urinary Escherichia coli isolates were collected from 20 clinical microbiology laboratories across Spain. The main objective was to assess the resistance of E. coli to the antimicrobials most commonly prescribed for community- acquired urinary tract infections depending on the patient’s age. A total of 2,230 valid E. coli strains from female outpatients were isolated and sent to a single central reference laboratory for confirmation and susceptibility testing using an agar dilution method. A two-sided chi-squared test was used to assess the differences in resistance between age groups (≤65 and >65 years). E. coli resistance was found to be more common to ampicillin (52.1%), cotrimoxazole (26%) and quinolones (18%), whereas resistance to amoxicillin-clavulanic acid, cefuroxime axetil and fosfomycin were below 3%. In women older than 65 years, resistance to ciprofloxacin reached up to 29% compared with 13% of those in the under 65 age group (p <0.001). For cotrimozaxole, rates were 32% vs. 23% (p <0.001) and for ampicillin 56% vs. 50% (p=0.02), respectively. It was concluded that fosfomycin, amoxicillin-clavulanic acid and cefuroxime axetil are the most suitable antimicrobials for empirical treatment in Spain given the high 18% and 26% resistance rates to quinolones and cotrimoxazole, respectively. Being older than 65 years of age was associated with higher resistance rates to ciprofloxacin (29%). These results should be considered when recommending empirical therapy for acute cystitis in women

Antimicrobial susceptibility of clinical Escherichia coli isolates from uncomplicated cystitis in women over a 1-year period in Spain.

High usage of antibiotics in Spain has led to an increase in resistance in urinary Escherichia coli isolates in different geographic regions. The problem of resistance in urinary E. coli in Spain was investigated by gathering a large number of isolates from 20 different sites nationwide over a 1-year period from November 2003 to October 2004 in a large population of women. The objectives of this study were to assess the resistance to the antibiotics most commonly prescribed for community-acquired urinary tract infections (UTIs), according to age and different geographical areas of Spain, and to evaluate the potential association between geographical differences in quinolone consumption and resistance to E. coli. A total of 2,292 valid E. coli strains from female outpatients were isolated and sent to a single central reference laboratory for confirmation and susceptibility testing. Of these, 2,230 isolates were available for the age analysis. A two-sided chi2 test was used to identify differences in resistance between age groups. Antibiotic units per province were purchased from IMS and consumption was expressed in units per 1,000 people per year. Univariate correlation (Pearson coefficient) between resistance to ciprofloxacin and quinolone consumption was calculated using a two-sided p-value. Resistance shown by E. coli was more common to ampicillin (52.1%) and cotrimoxazole (26%), followed by quinolones (18%), whereas resistance to amoxicillin-clavulanic acid, cefuroxime-axetil and fosfomycin was less than 3%. In the subgroup of women aged >65 years, resistance to ciprofloxacin was 29% compared to 13% for the subgroup of women <65 years (p<0.001). For these same subgroups, resistance rates were 32% vs. 23% for cotrimoxazole (p<0.001) and 56% vs. 50% for ampicillin (p=0.02), respectively. Statistically significant correlations were found between consumption of quinolones and E. coli resistance to ciprofloxacin (r=0.5; p=0.025). Resistance of E. coli isolates to quinolones varied significantly according to geographical areas, ranging from a high of 16.5% and 16.6% in the southern and eastern regions of Spain, respectively, to a low of 8% in the north in women aged <65 years. Additionally, the susceptibility to quinolones of E. coli isolates recovered from women aged >65 years was significantly lower across all regions of Spain than that of isolates recovered from younger women. Fosfomycin, amoxicillin/clavulanic acid and cefuroxime-axetil are the most suitable antibiotics for empirical treatment in Spain given the high 18% and 26% resistance rates to quinolones and cotrimoxazole, respectively. Higher resistance rates to ciprofloxacin were associated with being aged 65 years and over. These data need to be considered when recommending empirical therapy for acute cystitis.

Antimicrobial susceptibility of clinical Escherichia coli isolates from uncomplicated cystitis in women over a 1-year period in Spain

La frecuente utilización de antibióticos en España ha permitido la aparición de resistencias en las cepas de E. coli urinarias aisladas en distintas regiones geográficas. Nosotros hemos analizado el problema de las resistencias de E. coli urinaria en España recogiendo un gran número de muestras en 20 centros distintos de todo el país durante un periodo de un año (noviembre de 2003 a octubre de 2004), procedentes de una gran población de mujeres. Los objetivos de este estudio fueron valorar las resistencias a los antibióticos que con más frecuencia se prescriben como tratamiento de las infecciones de vías urinarias adquiridas en la comunidad, así como según la edad de las pacientes y las distintas regiones geográficas de España, y valorar una posible asociación entre las diferencias geográficas en la utilización de quinolonas y las resistencias de E. coli. Se aislaron en total 2292 cepas de E. coli válidas de mujeres en régimen ambulatorio y se remitieron a un único laboratorio de referencia central para la confirmación del diagnóstico y la realización de las pruebas de sensibilidad. De todas estas muestras, 2230 estuvieron disponibles para el análisis por edad. Se realizó una prueba de χ2 de dos colas para analizar las diferencias de las resistencias entre los grupos de edad. La información sobre unidades de antibióticos en cada provincia se obtuvo del IMS y el consumo se expresó en unidades por mil personas-año. Se realizó una correlación univariable (coeficiente de Pearson) entre la resistencia al ciprofloxacino y el consumo de quinolonas usando un valor de p bilateral. Las resistencias que mostró E. coli fueron principalmente frente a ampicilina (52,1%), cotrimoxazol (26%) y después quinolonas (18%), mientras que las resistencias a amoxicilina-ácido clavulánico, cefuroxima axetilo y fosfomicina fueron inferiores al 3%. En el grupo de mujeres mayores de 65 años, las resistencias al ciprofloxacino alcanzaron el 29%, lo que contrasta con el 13% en las de menor edad (p <0.001). En el caso del cotrimoxazol estos valores fueron del 32% y el 23% (p <0.001), y para ampicilina del 56% y el 50% (p=0.02). Se encontró una correlación estadísticamente significativa entre el consumo de quinolonas y la resistencia de E. coli al ciprofloxacino (r=0.5; p=0.025). Las resistencias a las quinolonas de los aislamientos de E. coli variaron de forma significativa en función de las regiones geográficas, oscilando entre una elevada frecuencia, del 16,5% y 16,6%, en las regiones sur y este de España, hasta otras bajas como el 8% descrito en la zona norte del país en mujeres menores de 65 años. Además, la sensibilidad a las quinolonas de las cepas de E. coli aisladas en mujeres mayores de 65 años fue significativamente menor en todas las regiones de España en comparación con las aisladas de mujeres más jóvenes. Fosfomicina, amoxicilina-ácido clavulánico y cefuroxima axetilo son los antibióticos más adecuados para el tratamiento empírico en España, dadas las elevadas frecuencias de resistencia a las quinolonas y el cotrimoxazol, del 18% y el 26%, respectivamente. La edad mayor de 65 años se asoció a una frecuencia de resistencias al ciprofloxacino superior a la observada en mujeres más jóvenes. Esta información se debe tener en cuenta a la hora de recomendar un tratamiento empírico para la cistitis aguda

High usage of antibiotics in Spain has led to an increase in resistance in urinary Escherichia coli isolates in different geographic regions. The problem of resistance in urinary E. coli in Spain was investigated by gathering a large number of isolates from 20 different sites nationwide over a 1-year period from November 2003 to October 2004 in a large population of women. The objectives of this study were to assess the resistance to the antibiotics most commonly prescribed for community-acquired urinary tract infections (UTIs), according to age and different geographical areas of Spain, and to evaluate the potential association between geographical differences in quinolone consumption and resistance to E. coli. A total of 2,292 valid E. coli strains from female outpatients were isolated and sent to a single central reference laboratory for confirmation and susceptibility testing. Of these, 2,230 isolates were available for the age analysis. A two-sided χ2 test was used to identify differences in resistance between age groups. Antibiotic units per province were purchased from IMS and consumption was expressed in units per 1,000 people per year. Univariate correlation (Pearson coefficient) between resistance to ciprofloxacin and quinolone consumption was calculated using a two-sided p-value. Resistance shown by E. coli was more common to ampicillin (52.1%) and cotrimoxazole (26%), followed by quinolones (18%), whereas resistance to amoxicillin-clavulanic acid, cefuroxime-axetil and fosfomycin was less than 3%. In the subgroup of women aged >65 years, resistance to ciprofloxacin was 29% compared to 13% for the subgroup of women 65 years was significantly lower across all regions of Spain than that of isolates recovered from younger women. Fosfomycin, amoxicillin/clavulanic acid and cefuroxime-axetil are the most suitable antibiotics for empirical treatment in Spain given the high 18% and 26% resistance rates to quinolones and cotrimoxazole, respectively. Higher resistance rates to ciprofloxacin were associated with being aged 65 years and over. These data need to be considered when recommending empirical therapy for acute cystitis

The Meropenem Yearly Susceptibility Test Information Collection antimicrobial susceptibility program in Spain: a 5-year analysis.

The Meropenem Yearly Susceptibility Test Information Collection program is a global study providing in vitro surveillance data on antimicrobial susceptibility in centers prescribing meropenem. This study summarizes data on the activity of meropenem and 5 comparators against 4022 clinical isolates from 7 centers in Spain (1999-2003). Those bacteria intrinsically resistant to meropenem were excluded. Among Enterobacteriaceae, 100% of Enterobacter spp., Citrobacter spp., and Serratia spp. were susceptible to meropenem. Escherichia coli and Klebsiella pneumoniae susceptibilities to carbapenems were 100% and > or =98%, respectively. Extended-spectrum beta-lactamase-producing Enterobacteriaceae were 3.8% of isolates, and all of them were susceptible to meropenem. Ciprofloxacin resistance in E. coli was around 20%. Meropenem and piperacillin/tazobactam were the most active agents against Pseudomonas aeruginosa. Acinetobacter baumannii were 61-90% susceptible to carbapenems, but only 6-21% susceptible to ciprofloxacin. In this period, around 100% of oxacillin-susceptible staphylococci were susceptible to meropenem. There was no significant decrease in susceptibility to the carbapenems throughout the 5-year period. The clinical use of meropenem in 7 Spanish centers did not increase bacterial resistance to this agent in the microorganisms evaluated.

Discrepancy between antibiotics administered in acute exacerbations of chronic bronchitis and susceptibility of isolated pathogens in respiratory samples: multicentre study in the primary care setting.

A national multicentre prevalence study was undertaken to determine the bacterial strains associated with mild-to-moderate acute exacerbations of chronic bronchitis (AECB) in the primary care setting and the susceptibility of isolated pathogens to different antimicrobials usually prescribed to these patients. All samples were processed by a central reference laboratory. Microdilution tests were carried out to establish the minimum inhibitory concentration (MIC) of various antimicrobials. A double-disk test was performed to establish the macrolide resistance phenotype in Streptococcus pneumoniae. Tests to detect the presence of beta-lactamase in Haemophilus influenzae and Moraxella catarrhalis and polymerase chain reaction to detect the presence of ermB and mefA genes in S. pneumoniae isolates were also performed. A total of 1537 patients were included in the trial and 468 microorganisms were isolated from sputum samples, with the most frequent isolates being S. pneumoniae (34.8%), M. catarrhalis (23.9%) and H. influenzae (12.6%). Resistance rates of pneumococci were 47.2% for penicillin, 1.2% for amoxicillin, 34.3% for macrolides (87.5% of which showed high-level resistance), 13.6% for cefuroxime/axetil and 4.2% for levofloxacin. No bacterial isolates showed resistance to telithromycin. Empirical antibiotic treatment was prescribed to 98.3% of patients, including macrolides to 36.6%, amoxicillin with or without clavulanic acid to 32.3% and fluoroquinolones to 16.1%. In conclusion, S. pneumoniae was the most frequently isolated bacteria in patients with mild-to-moderate AECB. Despite the high rates of resistance of pneumococci to macrolides, they continue to be the most widely used antibiotics in primary care to treat AECB.

Etiological misidentification by routine biochemical tests of bacteremia caused by Gordonia terrae infection in the course of an episode of acute cholecystitis.

Gordonia terrae has been reported to be a rare cause of bacteremia. We report the first case of bacteremia associated with acute cholecystitis. Commercial biochemical testing was not able to identify the strain at the genus level, classifying it instead as Rhodococcus sp. Definitive identification was obtained by sequencing of the 16S rRNA gene.

Evolution of penicillin and erythromycin co-resistance in Streptococcus pneumoniae in Spain.

The temporal dynamics of penicillin and erythromycin co-resistance in Streptococcus pneumoniae based on two extensive multicentre Spanish surveillance SAUCE studies (1996-1997 and 1998-1999) is presented. Erythromycin resistance among penicillin non-susceptible isolates seems to have reached a limit as evidenced by a null increase between the two surveys, whereas it is growing among penicillin-susceptible pneumococci.

Activities of six different quinolones against clinical respiratory isolates of Streptococcus pneumoniae with reduced susceptibility to ciprofloxacin in Spain.

Six quinolones were tested on 817 consecutive pneumococcal isolates for which ciprofloxacin MICs were high (> or =2 microg/ml); the isolates had been collected during two recent Spanish surveillance studies. For strains for which the ciprofloxacin MIC was >or =4 microg/ml, the MICs at which 90% of the isolates tested against gemifloxacin, moxifloxacin, gatifloxacin, sparfloxacin, levofloxacin, and ofloxacin were inhibited were 0.25, 1, 1, 1, 4 and 16 microg/ml, respectively, and the corresponding prevalences of resistance were 0, 1, 4.5, 9.5, 8.4 and 23%. The proportion of isolates for which the ciprofloxacin MIC is high has increased over time.

Susceptibility patterns of bacteria causing community-acquired respiratory infections in Spain: the SAUCE project.

Multicentre surveillance is essential in order to monitor the prevalence of certain resistance phenotypes and to identify rapidly the emergence of new ones. However, many surveillance studies are based either on a relatively small number of isolates from a single country, or on a large number of isolates from many different countries and so are not equally meaningful. Extensive national multicentre surveillance would provide a more reliable strategy for assessing the extent of antimicrobial resistance in individual countries. This article describes Spanish experience with the surveillance network SAUCE, and summarizes the main results on antimicrobial resistance in the three key bacterial pathogens involved in community-acquired respiratory tract infections in Spain: Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes.

Antimicrobial susceptibilities of 1,684 Streptococcus pneumoniae and 2,039 Streptococcus pyogenes isolates and their ecological relationships: results of a 1-year (1998-1999) multicenter surveillance study in Spain.

A nationwide multicenter susceptibility surveillance study which included 1,684 Streptococcus pneumoniae and 2,039 S. pyogenes isolates was carried out over 1 year in order to assess the current resistance patterns for the two most important gram-positive microorganisms responsible for community-acquired infections in Spain. Susceptibility testing was done by a broth microdilution method according to National Committee for Clinical Laboratory Standards M100-S10 interpretative criteria. For S. pneumoniae, the prevalences of highly resistant strains were 5% for amoxicillin and amoxicillin-clavulanic acid; 7% for cefotaxime; 22% for penicillin; 31% for cefuroxime; 35% for erythromycin, clarithromycin, and azithromycin; and 42% for cefaclor. For S. pyogenes, the prevalence of erythromycin resistance was 20%. Efflux was encountered in 90% of S. pyogenes and 5% of S. pneumoniae isolates that exhibited erythromycin resistance. Erythromycin resistance was associated with clarithromycin and azithromycin in both species, regardless of phenotype. Despite the different nature of the mechanisms of resistance, a positive correlation (r = 0.612) between the two species in the prevalence of erythromycin resistance was found in site-by-site comparisons, suggesting some kind of link with antibiotic consumption. Regarding ciprofloxacin, the MIC was >or=4 microg/ml for 7% of S. pneumoniae and 3.5% of S. pyogenes isolates. Ciprofloxacin resistance (MIC, >or=4 microg/ml) was significantly (P < 0.05) associated with macrolide resistance in both S. pyogenes and S. pneumoniae and with penicillin nonsusceptibility in S. pneumoniae.

Antimicrobial susceptibilities of 1,730 Haemophilus influenzae respiratory tract isolates in Spain in 1998-1999.

A beta-lactamase prevalence of 23% was found among 1,730 Haemophilus influenzae isolates. Ampicillin susceptibility was 70%, and 12% of beta-lactamase-negative strains presented diminished susceptibility to ampicillin (BLNAR phenotype). Susceptibility of 90% was found for cefaclor and clarithromycin, whereas it was nearly 100% for cefotaxime, cefixime, azithromycin, and cefuroxime. Ciprofloxacin-resistant (0.1%) and beta-lactamase-positive amoxicillin/clavulanate-resistant (BLPACR) phenotypes (0.1%) are anecdotal so far.