Journal Article

Emergence of Levofloxacin-Resistant Pneumococci in Immunocompromised Adults after Therapy for Community-Acquired Pneumonia

Kevin B. Anderson, James S. Tan, Thomas M. File, Joseph R. DiPersio, Barbara M. Willey and Donald E. Low

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 37, issue 3, pages 376-381
Published in print August 2003 | ISSN: 1058-4838
Published online August 2003 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/376642
Emergence of Levofloxacin-Resistant Pneumococci in Immunocompromised Adults after Therapy for Community-Acquired Pneumonia

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We describe 4 patients infected with levofloxacin-resistant pneumococci after therapy for community-acquired pneumonia (CAP). The 4 patients had 15 episodes of CAP; Streptococcus pneumoniae was isolated from blood or sputum samples obtained during 14 of the episodes. The underlying medical condition was Bruton agammaglobulinemia in 3 patients and chronic lymphoid leukemia in the other. The initial episode of CAP in each patient was due to a levofloxacin-susceptible strain. One of 4 reinfections and 5 of 6 relapses were due to levofloxacin-resistant strains. All of these strains had amino acid substitutions in the quinolone-resistance–determining region of the genes parC and gyrA. The time between episodes of pneumonia varied from 1 to 4 months. In immunocompromised patients with suspected or proven pneumococcal infection, it may be prudent not to use fluoroquinolone monotherapy empirically when the patient has a history of fluoroquinolone therapy in at least the past 4 months.

Journal Article.  4330 words.  Illustrated.

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

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