A nosocomial outbreak of fluoroquinolone-resistant Streptococcus pneumoniae

被引:89
作者
Weiss, K
Restieri, C
Gauthier, R
Laverdière, M
McGeer, A
Davidson, RJ
Kilburn, L
Bast, DJ
de Azavedo, J
Low, DE
机构
[1] Univ Montreal, Hop Maisonneuve Rosemont, Dept Microbiol, Montreal, PQ H3C 3J7, Canada
[2] Univ Montreal, Hop Maisonneuve Rosemont, Dept Infect Dis, Montreal, PQ H3C 3J7, Canada
[3] Dalhousie Univ, Elizabeth II Hlth Sci Ctr, Halifax, NS, Canada
[4] Univ Toronto, Toronto Med Labs, Toronto, ON, Canada
[5] Univ Toronto, Mt Sinai Hosp, Dept Microbiol, Toronto, ON, Canada
关键词
D O I
10.1086/322658
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Over the course of a 20-month period, in a hospital respiratory ward in which ciprofloxacin was often used as empirical antimicrobial therapy for lower respiratory tract infections (LRTIs), 16 patients with chronic bronchitis developed nosocomial LRTIs caused by penicillin- and ciprofloxacin-resistant Streptococcus pneumoniae (serotype 23 F). The minimum inhibitory concentration (MIC) of ciprofloxacin for all isolates from the first 9 patients was 4 mug/mL, in association with a parC mutation. Isolates from the subsequent 7 patients all had a ciprofloxacin MIC of 16 mug/mL, in association with an additional mutation in gyrA. The MICs for this isolate were 8 mug/mL of levofloxacin (resistant), 2 mug/mL of moxifloxacin and gatifloxacin (intermediately resistant), and 0.12 mug/mL of gemifloxacin. This outbreak demonstrates the ability of S. pneumoniae to acquire multiple mutations that result in increasing levels of resistance to the fluoroquinolones and to be transmitted from person to person.
引用
收藏
页码:517 / 522
页数:6
相关论文
共 33 条
[1]   ANTIBIOTIC-THERAPY IN EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY-DISEASE [J].
ANTHONISEN, NR ;
MANFREDA, J ;
WARREN, CPW ;
HERSHFIELD, ES ;
HARDING, GKM ;
NELSON, NA .
ANNALS OF INTERNAL MEDICINE, 1987, 106 (02) :196-204
[2]   Etiology, susceptibility, and treatment of acute bacterial exacerbations of complicated chronic bronchitis in the primary care setting: Ciprofloxacin 750 mg BID Versus clarithromycin 500 mg BID [J].
Anzueto, A ;
Niederman, MS ;
Tillotson, GS .
CLINICAL THERAPEUTICS, 1998, 20 (05) :885-900
[3]   Ciprofloxacin concentrations in lung tissue following a single 400 mg intravenous dose [J].
Birmingham, MC ;
Guarino, R ;
Heller, A ;
Wilton, JH ;
Shah, A ;
Hejmanowski, L ;
Nix, DE ;
Schentag, JJ .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 1999, 43 :43-48
[4]  
Campbell GD, 1998, CLIN INFECT DIS, V26, P1188, DOI 10.1086/520286
[5]   Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada [J].
Chen, DK ;
McGeer, A ;
de Azavedo, JC ;
Low, DE .
NEW ENGLAND JOURNAL OF MEDICINE, 1999, 341 (04) :233-239
[6]   Efficacy of oral ciprofloxacin vs. clarithromycin for treatment of acute bacterial exacerbations of chronic bronchitis [J].
Chodosh, S ;
Schreurs, A ;
Siami, G ;
Barkman, HW ;
Anzueto, A ;
Shan, M ;
Moesker, H ;
Stack, T ;
Kowalsky, S .
CLINICAL INFECTIOUS DISEASES, 1998, 27 (04) :730-738
[7]  
COOPER B, 1989, AM J MED, V87, P475
[8]   Pharmacokinetic/pharmacodynamic parameters: Rationale for antibacterial dosing of mice and men [J].
Craig, WA .
CLINICAL INFECTIOUS DISEASES, 1998, 26 (01) :1-10
[9]  
DAVIDSON RJ, 2000, 40 INT C ANT AG CHEM, P127
[10]   CIPROFLOXACIN IN THE TREATMENT OF ACUTE EXACERBATIONS OF CHRONIC-BRONCHITIS [J].
DAVIES, BI ;
MAESEN, FPV ;
BAUR, C .
EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, 1986, 5 (02) :226-231