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Journal of Clinical Microbiology, December 2004, p. 5571-5577, Vol. 42, No. 12
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.12.5571-5577.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Trends in Antimicrobial Resistance in 1,968 Invasive Streptococcus pneumoniae Strains Isolated in Spanish Hospitals (2001 to 2003): Decreasing Penicillin Resistance in Children's Isolates

Jesús Oteo,1 Edurne Lázaro,2 Francisco J. de Abajo,2 Fernando Baquero,3 José Campos,1* and Spanish Members of the European Antimicrobial Resistance Surveillance System{dagger}

Centro Nacional de Microbiología,1 Agencia Española del Medicamento, Ministry of Health, Majadahonda,2 Department of Microbiology, Hospital Ramón y Cajal, Madrid, Spain3

Received 21 June 2004/ Returned for modification 26 July 2004/ Accepted 29 July 2004

To address the public health problem of antibiotic resistance, the European Union (EU) founded the European Antimicrobial Resistance Surveillance System. A network of 40 hospitals that serve approximately 30% of the Spanish population (about 12 million) participated. Each laboratory reported data on antimicrobial susceptibility testing using standard laboratory procedures that were evaluated by an external quality control program. The antibiotic consumption data were obtained from the National Health System. We compared the antibiotic susceptibility of Spanish isolates of invasive Streptococcus pneumoniae (2001 to 2003) with antibiotic consumption. Invasive S. pneumoniae was isolated from 1,968 patients, 20% of whom were children at or below the age of 14 years. Of non-penicillin-susceptible strains (35.6%; 95% confidence interval, 34 to 37.2), 26.4% were considered intermediate and 9.2% were considered resistant. Between 2001 and 2003, penicillin resistance decreased from 39.5 to 33% overall and from 60.4 to 41.2% in children at or below the age of 14 years (P = 0.002). Resistance to erythromycin was at 26.6%, and coresistance with penicillin was at 19.1%. Of total isolates, the ciprofloxacin MIC was >2 µg/ml for 2.1%, with numbers increasing from 0.4% (2001) to 3.9% (2003). Total antibiotic use decreased from 21.66 to 19.71 defined daily doses/1,000 inhabitants/day between 1998 and 2002. While consumption of broad-spectrum penicillins, cephalosporins, and erythromycin declined, use of amoxicillin-clavulanate and quinolones increased by 17.5 and 27%, respectively. The frequency of antibiotic resistance in invasive S. pneumoniae in Spain was among the highest in the EU. However, a significant decrease in penicillin resistance was observed in children. This decrease coincided with the introduction of a heptavalent conjugate pneumoccocal vaccine (June 2001) and with a global reduction in antibiotic consumption levels.

* Corresponding author. Mailing address: Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Pozuelo a Majadahonda, 28220, Majadahonda, Madrid, Spain. Phone: 34 91 822 3650. Fax: 34 91 509 7966. E-mail: jcampos{at}isciii.es.

{dagger} Spanish members of EARSS are listed in Acknowledgments.

Journal of Clinical Microbiology, December 2004, p. 5571-5577, Vol. 42, No. 12
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.12.5571-5577.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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