Journal Article

Macrolide-Resistant Pneumococcal Endocarditis and Epidural Abscess that Develop during Erythromycin Therapy

Jay C. Butler, Jeffrey L. Lennox, Linda K. McDougal, Joyce A. Sutcliffe, Amelia Tait-Kamradt and Fred C. Tenover

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 36, issue 2, pages e19-e25
Published in print January 2003 | ISSN: 1058-4838
Published online January 2003 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/344965
Macrolide-Resistant Pneumococcal Endocarditis and Epidural Abscess that Develop during Erythromycin Therapy

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Suppurative complications of Streptococcus pneumoniae infections have become uncommon in the antibiotic era. We report a case of pneumococcal bacteremia and pneumonia complicated with epidural abscess and endocarditis in which macrolide resistance (the MLSB phenotype) emerged during erythromycin therapy. Genetic determinants known to mediate the most common mechanisms of macrolide resistance (methylation of the 23S rRNA and antibiotic efflux) were not detected by polymerase chain reaction or DNA hybridization. Sequence analysis of the DNA encoding the 23S rRNA of the macrolide-resistant isolate from the patient demonstrated the replacement of adenine by thymine at position 2058 (A2058T) in 2 of 4 alleles. Clinicians should be alert to the possibility of the emergence of resistance during macrolide therapy for community-acquired pneumonia, particularly if suppurative complications of pneumococcal infection are suspected.

Journal Article.  4070 words.  Illustrated.

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

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