Journal Article

Bacteremia Due to Viridans Group Streptococci with Diminished Susceptibility to Levofloxacin among Neutropenic Patients Receiving Levofloxacin Prophylaxis

Raymund R. Razonable, Mark R. Litzow, Yasmin Khaliq, Kerryl E. Piper, Mark S. Rouse and Robin Patel

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 34, issue 11, pages 1469-1474
Published in print June 2002 | ISSN: 1058-4838
Published online June 2002 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/340352
Bacteremia Due to Viridans Group Streptococci with Diminished Susceptibility to Levofloxacin among Neutropenic Patients Receiving Levofloxacin Prophylaxis

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Despite the use of levofloxacin prophylaxis during the neutropenic period after autologous peripheral blood stem cell transplantation, viridans group (VG) streptococcal bacteremia developed in 6 (16.2%) of 37 patients who underwent transplantation between 1 January and 25 February 2001 at the Mayo Clinic in Rochester, Minnesota. All 6 patients presented with fever and mucositis after a mean of 4.5 days of neutropenia, and 3 developed septic shock. All 6 VG streptococcal isolates from these patients exhibited distinct patterns on pulsed-field gel electrophoresis. All isolates had diminished susceptibility to levofloxacin, 5 to gatifloxacin, and 4 to moxifloxacin. Quinolone resistance was associated with mutations in the quinolone resistance–determining region of GyrA and (for 1 isolate) of ParC. The use of levofloxacin may select VG streptococci with diminished susceptibility to levofloxacin and other quinolones with enhanced activity against gram-positive organisms and, therefore, may not be optimal for preventing VG streptococcal bacteremia in neutropenic patients.

Journal Article.  3535 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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