Oteo Jesús, Cruchaga Susana, Campos José, Sáez-Nieto Juan A, Baquero Fernando
Centro Nacional de Microbiología. Instituto de Salud Carlos III. Majadahonda. Madrid. España.
Enferm Infecc Microbiol Clin. 2003 Jan;21(1):12-9. doi: 10.1016/s0213-005x(03)72868-7.
In 1998 the European Union founded the European Antimicrobial Resistance Surveillance System (EARSS) for the control of antimicrobial resistance in invasive pathogens. This report present the results obtained for S. pneumoniae in the year 2000 in Spain.
Participants included 33 hospitals covering approximately 25% of the Spanish population. The laboratories carried out isolation, identification and sensitivity studies with their usual methods. Quality control was performed by the UK National External Quality Assurance Scheme (NEQAS). A form was filled out with clinical information on the patient and data on the hospital, department and specimen isolated. This information was entered in a central database for analysis and validation by the Whonet.5 program.
Invasive S. pneumoniae was isolated in 622 patients. Overall incidence was 6.4 cases/100,000 inhabitants. Among the strains isolated, 33.1% (CI 95%: 29.6-37) showed resistance to penicillin (22.2% intermediate; 10.9% resistant); 11% showed resistance to cefotaxime (10.1% intermediate; 0.9% resistant); and 21.1% were resistant to erythromycin. Erythromycin resistance was 7% in penicillin-sensitive strains and 46.4% in penicillin-resistant strains (p < 0.001). A total of 51.7% of strains were resistant to penicillin in children < or = 4 years old, as compared to 29% in patients > 4 years old (p < 0.001). A ciprofloxacin MIC > 2 mg/L was found for 2.4% of isolates.
Penicillin resistance in invasive S. pneumoniae in Spain is among the highest in the European Union. The decrease in sensitivity to penicillin was significantly associated with cefotaxime and erythromycin resistance. Children < or = 4 years old have a significantly higher risk than adults of acquiring infection with strains resistant to penicillin, cefotaxime and erythromycin.
1998年，欧盟建立了欧洲抗菌药物耐药性监测系统（EARSS），以控制侵袭性病原体中的抗菌药物耐药性。本报告展示了2000年西班牙肺炎链球菌的监测结果。
参与者包括33家医院，覆盖了约25%的西班牙人口。各实验室采用常规方法进行分离、鉴定和敏感性研究。质量控制由英国国家外部质量保证计划（NEQAS）执行。一份包含患者临床信息以及医院、科室和分离标本数据的表格被填写。这些信息被录入一个中央数据库，由Whonet.5程序进行分析和验证。
622例患者中分离出侵袭性肺炎链球菌。总体发病率为6.4例/10万居民。在分离出的菌株中，33.1%（95%置信区间：29.6 - 37）对青霉素耐药（22.2%为中介；10.9%为耐药）；11%对头孢噻肟耐药（10.1%为中介；0.9%为耐药）；21.1%对红霉素耐药。青霉素敏感菌株中红霉素耐药率为7%，青霉素耐药菌株中为46.4%（p < 0.001）。4岁及以下儿童中51.7%的菌株对青霉素耐药，而4岁以上患者中这一比例为29%（p < 0.001）。2.4%的分离株环丙沙星最低抑菌浓度> 2 mg/L。
西班牙侵袭性肺炎链球菌对青霉素的耐药性在欧盟中处于最高水平之一。对青霉素敏感性的下降与头孢噻肟和红霉素耐药性显著相关。4岁及以下儿童感染对青霉素、头孢噻肟和红霉素耐药菌株的风险显著高于成年人。
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