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.