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 >4 g/ml for 7% of S. pneumoniae and 3.5% of S. pyogenes isolates. Ciprofloxacin resistance (MIC, >4 g/ml) was significantly (P < 0.05) associated with macrolide resistance in both S. pyogenes and S. pneumoniae and with penicillin nonsusceptibility in S. 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.

A multicenter susceptibility surveillance (the S.A.U.C.E. project) including 2,721 Streptococcus pneumoniae, 3,174 Streptococcus pyogenes, and 2,645 Haemophilus influenzae consecutive isolates was carried out in 25 hospitals all over Spain from November 2001 to October 2002 to evaluate the current epidemiology of resistance of the main bacteria involved in community-acquired respiratory tract infections. Susceptibility testing was performed in a single centralized laboratory by a broth microdilution method. The prevalence of resistant S. pneumoniae strains was 0.4% for cefotaxime, 4.4% for amoxicillin and amoxicillin-clavulanic acid, 25.6% for cefuroxime-axetil, 34.5% for erythromycin, clarithromycin, and azithromycin, and 36.0% for cefaclor. Phenotypes of resistance to erythromycin were MLS B (macrolide-lincosamide-streptogramin B) in 89.9% (gene ermB) and M (macrolide) in 9.7% of cases (gene mefA). No strain harbored both genes simultaneously. Serotypes 19, 6, 23, 14, and 3 were the most prevalent, accounting for 54.6% of the total isolates. Resistance to macrolides seems to be the most alarming point, since among penicillin-susceptible isolates it reached 15.1% compared to 55.8% among penicillin-resistant strains. Geographically, a number of regions had rates of erythromycin resistance above 40% (even higher in children). Resistance to erythromycin was also high in S. pyogenes isolates: mean regional 33.2%, beta-lactamase-producing H. influenzae were 20%, whereas 4.4% had a beta-lactamase-negative, ampicillin-resistant phenotype. We highlight the importance of different geographical frequencies of coresistance (associations of resistance to different drugs within the same species) and coupled resistance (association of resistance between different species) probably resulting from different local coselective events.Surveillance of antimicrobial resistance should be considered an important tool helping clinicians tailor empirical prescriptions for common infectious diseases. Surveillance data also serve as sentinel checkpoints for emerging phenotypes of resistance and enable performance of studies aiming at characterizing molecular resistance determinants alongside the possibility of tracking the genotypic or clonal relatedness of the isolates harboring the resistance traits detected (4). Besides, when coupled with appropriate data of antimicrobial consumption, they contribute to the understanding of the complex dynamics of the pharmacoepidemiology of resistance. Ideally, they should also serve to assess the impact of measures implemented in response to resistance warnings.The most prevalent bacteria causing community-acquired respiratory tract infections are Streptococcus pneumoniae, Streptococcus pyogenes, and Haemophilus influenzae. In all of

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.

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The performance of the Binax NOW immunochromatographic test for detecting Streptococcus pneumoniae antigen in urine specimens from 103 children presenting underlying pulmonary diseases with no recent pneumococcal infection was assessed. Our data indicate that this assay is unlikely to be useful for discriminating between children with and without pneumococcal pneumonia.Streptococcus pneumoniae is the leading bacterial agent causing community-acquired pneumonia among children in developed countries (9,12). A rapid urinary pneumococcal antigen test (Binax NOW S. pneumoniae urinary antigen test; Binax, Portland, Maine) has been approved by the U.S. Food and Drug Administration for the diagnosis of pneumococcal pneumonia. The test appears to be highly specific and moderately sensitive for adults (3,7,11,13); however, some concerns have been raised as to its specificity among children (2, 4), particularly in developing countries where nasopharyngeal colonization rates are high (1,4,5,8). In this study, we assessed the performance of the Binax NOW assay among children presenting underlying pulmonary diseases with no recent pneumococcal infection, this being a subset of patients in whom rapid and accurate diagnosis of pneumococcal pneumonia is of particular clinical interest.One hundred three children (54 males and 49 females) aged 1 to 15 years (mean, 5.8 years) with no recent history of respiratory tract infections were enrolled in the study. Children had been diagnosed previously with the following pulmonary diseases: recurrent pneumonia and atelectasis (n ϭ 38), bronchial hyperreactivity and asthma (n ϭ 27), cystic fibrosis (n ϭ 12), recurrent upper respiratory infections (n ϭ 8), bronchial tree malformations (n ϭ 8), pulmonary bronchodysplasia (n ϭ 5), and bronchiolitis obliterans (n ϭ 5).Fifty-six children had been vaccinated against pneumococcus before enrollment (37 with Prevenar and 19 with 23-valent vaccine).Informed consent was obtained from the parents of the subjects. The study was approved by the Clinical Research Ethics Committee of the University Clinical Hospital. Nasopharyngeal samples were obtained by calcium alginate swabbing and were cultured within 1 h of collection on nalidixic acid-supplemented Trypticase soy agar containing 5% sheep blood and brain heart infusion broth (BHI). The plates and the BHI were incubated at 37°C in 5% CO 2 for 24 h. The BHI was subcultured at 24 h onto nalidixic acid-supplemented Trypticase soy agar containing 5% sheep blood plates which were incubated as indicated above. S. pneumoniae was identified on the basis of colonial morphology, Gram stain characteristics, optochin sensitivity, and positive latex agglutination (Slidex Pneumo-Kit; bioMérieux SA). At least 10 colonies/ plate were screened for pneumococcal identity. Clean-catch midstream urine specimens were obtained within 24 h of collection of the nasopharyngeal specimens and tested within 1 h of collection. Urine specimens were concentrated 25-fold by selective ultrafiltration (Minicon; Millipore Corp., Bedford...

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. CASE REPORTA 61-year-old male patient with longstanding hepatitis C, hypertension, and calculous gallbladder presented with a fever (38.5°C) of 2 days' duration, lack of urinary sphincter control, and altered mental status, without other accompanying signs/ symptoms at admission. Serum and urine laboratory data were unremarkable, a thorax chest film was normal, and abdominal sonographic findings consisted of dilated lumen of gallbladder and the presence of stones. Pretreatment cerebrospinal fluid and blood samples were taken for culturing, and antibiotic treatment with intravenous piperacillin-tazobactam (4 g every 8 h for 20 days) plus intravenous gentamicin (240 mg every 24 h for the first 4 days) was initiated due to a clinical diagnosis of acute cholecystitis. During the antibiotic course, the patient remained apyretic and asymptomatic. Afterward, cholecystectomy was performed; the gallbladder, of 11 by 6.5 cm, was sent to the laboratory for pathological study; and a bile sample was collected for culturing. After being discharged from the hospital, the patient remained asymptomatic upon outpatient follow-up.Cerebrospinal fluid samples taken at admission showed no biochemical alterations, and culturing yielded no bacterial growth. The blood culture set taken at admission was incubated in BACTEC 9050 (Becton Dickinson, Cockeysville, Md.). On the fourth day of incubation, the aerobic bottle was positive for growth and subcultures in chocolate agar incubated at 37°C under aerobiosis with 5% CO 2 were performed. After 72 h, smooth, salmon-pink, catalase-positive and oxidase-negative colonies were obtained. Microscopic examination showed gram-positive coccobacilli that were negative for Ziehl-Neelsen staining. API CORYNE (bioMérieux, MarcylЈEtoile, France) was used for initial identification. The isolate gave a profile number of 1110004 and was identified as Rhodococcus sp. (98.1% identification; T index, 0.94). The strain was sent to the reference laboratory at Instituto Valenciano de Microbiología for further analysis.Cultures of bile samples taken at surgery after 20 days of piperacillin-tazobactam treatment were negative.Macroscopic and histological examination of the gallbladder wall revealed intense ulceration, calcification areas, adherences of external surfaces to hepatic tissues, and moderate acute and chronic inflammation. A stone of 3 by 1.5 cm was found. A definite diagnosis of acute and chronic cholecystitis was made.At the reference laboratory, the metabolic characteristics of the strain, determined by standard methods (3), were acid production from mannitol, rhamnose, galactose, raffinose, sorbitol, and citrate; hydrolysis of urea and esculin; reduction of n...