Antimicrobial-resistant InvasiveEscherichia coli, Spain

To address the public health problem of antimicrobial resistance, the European Union founded the European Antimicrobial Resistance Surveillance System.A network of 32 Spanish hospitals, serving ≈9.6 million persons, submitted antimicrobial-susceptibility data on 7,098 invasive Escherichia coli species (2001)(2002)(2003).Resistance to ampicillin, cotrimoxazole, ciprofloxacin, gentamicin, and tobramycin was found at rates of 59.9%, 32.6%, 19.3%, 6.8%, and 5.3%, respectively.Resistance to multiple drugs increased from 13.8% in 2001 to 20.6% in 2003 (p < 0.0001).Antimicrobial consumption data were obtained from the Spanish National Health System.In spite of decreased cephalosporin and β-lactam use, overall extended-spectrum β-lactamase production increased from 1.6% (2001) to 4.1% (2003) (p < 0.0001), mainly due to the rising prevalence of cefotaximases.Resistance to ciprofloxacin significantly increased, mostly in communityonset infections, which coincided with a rise in community quinolone use.Cotrimoxazole resistance remained stable at ≈30%, even though its use was dramatically reduced.A ntimicrobial resistance is a well-known clinical and public health problem (1).For example, in the United States in 2002, resistance to ampicillin and ciprofloxacin among 5,192 Escherichia coli blood isolates was 47.8% and 13.3%, respectively (2).The World Health Organization (WHO), the European Commission, and the U.S. Centers for Disease Control and Prevention (CDC) have recognized the importance of studying the emergence and determinants of resistance as well as the need for control strategies (1,3,4).The European Antimicrobial Resistance Surveillance System (EARSS) is an international network of national surveillance systems that attempts to collect reliable and comparable antimicrobial resistance data of invasive pathogens.The International Network for the Study and Prevention of Emerging Antimicrobial Resistance has similar goals (3).The purpose of EARSS is to document variations in antimicrobial resistance over time and space to provide the basis for developing prevention programs, making policy decisions, and assessing the effectiveness of both.E. coli is one of the main causes of both nosocomial and community-acquired infections in humans (5) and one of the microorganisms most frequently isolated from blood (2,6-8).Pathogenic isolates of E. coli have a relatively large potential for developing resistance (2,5,7,9).In recent years, fluoroquinolone resistance has increased in some countries (2,10,11), CTX-M-type extended-spectrum β-lactamase (ESBL) dissemination has been described (12,13), and reports of multidrug resistance are not infrequent (9,14,15).