A. Torres1, F. de la Torre1, M. Díez-Alonso2, J. Romanyck2,
A. Torrellas3 and L. Aguilar3
Sir,
REFERENCES
1Surgery and Microbiology Departments, Hospital San Carlos, Madrid; 2Surgery and Microbiology
Departments,
Hospital "Príncipe de Asturias", Alcalá de Henares; 3Medical Department SmithKline Beecham Pharmaceuticals,
Madrid, Spain.
In a recent publication (1), the authors report a percent-
age of 4.3% resistance to co-amoxiclav of 185 Escherichia
coli strains collected in a study conducted in two
centers from each of the followmg countries Spain, France
and Germany.
If antibiotic resistance is accepted to be related with
antibiotic consumption (2), the expected resistance rate to
penicillins in Spain should be very high, as a recent
survey showed that 88% of the Spanish population take
antibiotics at least once a year (50% of the total
consumption are aminopenicillins or their combinations
with beta-lactamase inhibitors) (3). This fact may explain
the high amoxicillin resistance rate (56.2%) obtained in
the E. coli strains provided by the two Spanish centers
participating in the referenced study (1), as compared to a
resistance rate of 47% obtained in the German and French
centers. When clavulanate is added to the susceptibility
test (2:1), this high amoxicillin resistance rate is
significantly reduced. Co-amoxiclav resistance rate
(4.2%) is similar to the one obtained in the German and
French centers (4.4%), even though Spain has one of the
highest E. coli aminopenicillin resistance rates within the
European Union countries (3).
The sample (n = 97) of E. coli strains from the Spanish
centers was prospectively collected from patients admitted
to hospital surgical wards between March to November
1994, from the following sources: 58.1% from peritoneal
fluid, 22.6% abscess material, 16.1% urine and 3.2%
other sources. The resistance rates shown in this letter
were obtained following NCCLS guidelines (4).
The high ampicillin/amoxicillin E. coli resistance rate
of our strains is similar to the one described by other
authors in our country from urinary tract isolates (5-8).
However, despite the high aminopenicillin consumption
when compared to other European countries (3), the
incidence of E. coli co-amoxiclav resistance in our
community remains in a similar range to that of the
German and French centers participating in the study.
1. Durodie, J., Simpson, I. Effect of NCCLS, SFM and DIN breakpoints
upon the incidence of co-amoxiclav resistance in Escherichia coli. J
Antimicrob Chemother 1995; 36: 1105-1106.
2. Moellering, R.C. Interaction between antimicrobial consumption and
selection of resistant bacterial strains. Scan J Infect Dis 1990; 70
(Suppl.): 18-24.
3. Baquero, F. and the Task Force of the General Direction for Health
Planning of the Spanish Ministry of Health. Antibiotic resistance in
Spain: What can be done? Clin Infect Dis 1996; 23: 819-823.
4. National Committee for Clinical Laboratory Standards. Antimicrobial
Susceptibility Testing SC-3B. NCCLS, Villanova, PA 1993.
5. Grupo de Estudio Multicéntrico, Román Pumar, J.L. Estudio de ámbito
nacional para valorar la actividad in vitro de la norfloxacina y otros
seis antibacterianos frente a patógenos urinarios. Med Clin (Barc.)
1986; 86: 741.
6. Cercenado, E., Aguiar, J.M., González-Palacios, R., Delgado Iribarren,
A., Baquero, F. Situación actual de la resistencia de bacterias
aisladas de bacteriurias intra y extrahospitalarias. Med Clin (Barc.)
1987; 88: 93-96.
7. Alós, J.I., Chacón, J. Bacteriología de las infecciones urinarias extra
hospitalarias. Med Clin (Barc.) 1988; 90: 395-398.
8. Alós, J.I., Gómez-Garcés, J.L., García-Bermejo, I., García-Gómez, J.J.,
González-Palacios, R., Padilla, B. Prevalencia de susceptibilidad de
Escherichia coli a quinolonas y otros antibióticos en bacteriurias
extrahospitalarias de Madrid. Med Clin (Barc.) 1993; 101: 87-90.
Haga
click aquí para obtener el artículo
(formato Word Perfect 5.1)