Evolution of Staphylococcus aureus resistance to erythromycin in Denmark, 1959 to 1988: correlations between characteristics of erythromycin-resistant bacteraemia strains

J Hosp Infect. 1991 May;18(1):35-43. doi: 10.1016/0195-6701(91)90091-l.

Abstract

In an attempt to characterize erythromycin-resistant Staphylococcus aureus we present the intricate relationships between the following factors: phage type, period of isolation, antibiogram, minimum inhibitory concentration (MIC) to erythromycin, inducible or constitutive resistance, spectinomycin susceptibility, hospital- or community-acquired infection, and mortality rate. We studied 718 cases of bacteraemia with erythromycin-resistant S. aureus, occurring between 1959 and 1988. Central factors were phage type pattern, period of isolation, and antibiogram. Between 1959 and 1973 the majority of the erythromycin-resistant strains were multiresistant and belonged to the 83A complex and the related group III. They were mainly inducibly resistant, spectinomycin resistant, and had intermediate MICs (1-4 mg l-1) to erythromycin. The majority of these strains came from hospital-acquired infections and still exist today, although in decreased numbers. By contrast, erythromycin-resistant S. aureus isolated in recent years are usually co-resistant only to penicillin and more rarely also to tetracycline. These strains have inducible resistance, are spectinomycin susceptible, and have a high erythromycin MIC. They are isolated both from hospital- and community-acquired infections. Strains with constitutive resistance to macrolides occurred at a stable low level (13%) during the whole observation period and always had high MICs to erythromycin. The mortality rate among patients with S. aureus bacteraemia due to an erythromycin-resistant strain was only associated with the year of infection and decreased from 61% in the first 15-year period to 40% in the subsequent 15 years.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bacteriophage Typing / methods
  • Cross Infection / microbiology
  • Cross Infection / mortality
  • Denmark
  • Drug Resistance, Microbial
  • Erythromycin / pharmacology
  • Microbial Sensitivity Tests
  • Models, Biological
  • Phenotype
  • Sepsis / microbiology
  • Species Specificity
  • Spectinomycin / therapeutic use*
  • Staphylococcal Infections / microbiology
  • Staphylococcal Infections / mortality
  • Staphylococcus aureus / classification
  • Staphylococcus aureus / drug effects*
  • Time Factors

Substances

  • Erythromycin
  • Spectinomycin