{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T03:43:23Z","timestamp":1790480603120,"version":"4.1.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T00:00:00Z","timestamp":1695686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To describe and analyse erythromycin resistance trends in blood isolates of <jats:italic>Staphylococcus aureus<\/jats:italic> (EARS-Net Spain, 2004\u20132020) and the association of these trends with the consumption of macrolide, lincosamide, and streptogramin B (MLS<jats:sub>B<\/jats:sub>) antibiotics. To assess molecular changes that could be involved in erythromycin resistance trends by whole genome analysis of representative isolates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>We collected antibiotic susceptibility data for all first-blood <jats:italic>S. aureus<\/jats:italic> isolates in patients from 47 Spanish hospitals according to EARS-Net criteria. MLS<jats:sub>B<\/jats:sub> antibiotic consumption was obtained from the Spanish Agency for Medicines and Medical Devices (2008\u20132020). We sequenced 137 representative isolates for core genome multilocus sequence typing, resistome and virulome analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For the 36,612 invasive <jats:italic>S. aureus<\/jats:italic> isolates, methicillin resistance decreased from 26.4% in 2004 to 22.4% in 2020. Erythromycin resistance in methicillin-susceptible <jats:italic>S. aureus<\/jats:italic> (MSSA) increased from 13.6% in 2004 to 28.9% in 2020 (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001); however, it decreased from 68.7 to 61.8% (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.0001) in methicillin-resistant <jats:italic>S. aureus<\/jats:italic> (MRSA). Total consumption of MLS<jats:sub>B<\/jats:sub> antibiotics increased from 2.72 defined daily doses per 1,000 inhabitants per day (DID) in 2014 to 3.24 DID in 2016. By WGS, the macrolide resistance genes detected were <jats:italic>erm<\/jats:italic> (59.8%), <jats:italic>msrA<\/jats:italic> (46%), and <jats:italic>mphC<\/jats:italic> (45.2%). The <jats:italic>erm<\/jats:italic> genes were more prevalent in MSSA (44\/57, 77.2%) than in MRSA (38\/80, 47.5%). Most of the <jats:italic>erm<\/jats:italic> genes identified in MSSA after 2013 differed from the predominant <jats:italic>ermC<\/jats:italic> gene (17\/22, 77.3%), largely because <jats:italic>ermT<\/jats:italic> was significantly associated with MSSA after 2013 (11\/29, 37.9%). All 13 <jats:italic>ermT<\/jats:italic> isolates in this study, except one, belonged to ST398 and came from 10 hospitals and six Spanish provinces.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The significant increase in erythromycin resistance in blood MSSA correlated with the consumption of the MLS<jats:sub>B<\/jats:sub> antibiotics in Spain. These preliminary data seem support the hypothesis that the human ST398 MSSA clade with <jats:italic>ermT<\/jats:italic>-mediated resistance to erythromycin may be involved in this trend.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmicb.2023.1220286","type":"journal-article","created":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T05:01:56Z","timestamp":1695790916000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":25,"title":["An increase in erythromycin resistance in methicillin-susceptible Staphylococcus aureus from blood correlates with the use of macrolide\/lincosamide\/streptogramin antibiotics. EARS-Net Spain (2004\u20132020)"],"prefix":"10.3389","volume":"14","author":[{"given":"Achraf","family":"El Mammery","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Ram\u00edrez de Arellano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier E.","family":"Ca\u00f1ada-Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Cercenado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Villar-G\u00f3mara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ver\u00f3nica","family":"Casquero-Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Garc\u00eda-Cobos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Antonio","family":"Lepe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"Ruiz de Gopegui Bordes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Calvo-Montes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nieves","family":"Larrosa Escart\u00edn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Cant\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"P\u00e9rez-V\u00e1zquez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bel\u00e9n","family":"Aracil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Oteo-Iglesias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"ii30","DOI":"10.1093\/jac\/dkab175","article-title":"Consumption of macrolides, lincosamides and streptogramins in the community, European Union\/European economic area, 1997-2017","volume":"76","author":"Adriaenssens","year":"2021","journal-title":"J. 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