Tags

Type your tag names separated by a space and hit enter

Therapeutic options among broad-spectrum beta-lactams for infections caused by levofloxacin-nonsusceptible Streptococcus pneumoniae.
Diagn Microbiol Infect Dis. 2005 Jun; 52(2):129-33.DM

Abstract

Streptococcus pneumoniae has consistently become more resistant to primary, orally administered treatment regimens used for community-acquired respiratory tract infections (CARTI; sinusitis, bronchitis, pneumonia). As resistance rates approach 40-50% in the United States and North America for penicillin and macrolides, other agents also have exhibited coresistance rates of 10-20% (tetracycline, clindamycin, trimethoprim/sulfamethoxazole). These facts led to altered clinical treatment guidelines (IDSA) supporting the use of respiratory fluoroquinolones (levofloxacin, gatifloxacin, gemifloxacin, and moxifloxacin). This report from the SENTRY Antimicrobial Surveillance Program lists possible parenterally administered treatment alternatives for the fluoroquinolone (levofloxacin)-nonsusceptible pneumococci. The SENTRY Program isolates from CARTI (1997-2003), totaling 21605 strains from Europe, Asia Pacific, and the Americas, were screened for fluoroquinolone-resistant S. pneumoniae. A total of 157 (0.7%) levofloxacin-nonsusceptible (MIC > or = 4 microg/mL) strains were identified and tested by reference broth microdilution methods against 27 antimicrobials. Quinolone resistance-determining region (QRDR) mutations were determined by PCR amplification and gene sequencing. The entire population of S. pneumoniae had the following antibiogram demographics: penicillin-nonsusceptible (32%), macrolide resistance (24%), tetracycline resistance (21%), clindamycin resistance (11%), trimethoprim/sulfamethoxazole resistance (33%), and 6% of strains were resistant to all 5 drugs. Levofloxacin-resistant strains routinely had 2 or more QRDR mutations most frequently in gyrA at Ser81Phe or Tyr and in parC at Ser79Phe or Tyr and Lys137Asn. Four agents had extremely low rates of resistance when tested against the 157 levofloxacin-nonsusceptible strains (e.g., quinupristin/dalfopristin, 0% resistance; vancomycin, 0%; cefepime, 1%; ceftriaxone, 1%). Levofloxacin-nonsusceptible pneumococcal isolates remain uncommon, but are a growing problem in CARTI (1.4% in 2003), especially in previously fluoroquinolone-treated cases. Parenteral cephalosporins (cefepime or ceftriaxone) continue to be potent and safe for use in hospitalized patients with S. pneumoniae community-acquired pneumonia, used with or without co-drugs according to published guidelines.

Authors+Show Affiliations

The JONES Group/JMI Laboratories, North Liberty, IA 52317, USA. ronald-jones@jmilabs.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15964501

Citation

Jones, Ronald N., et al. "Therapeutic Options Among Broad-spectrum Beta-lactams for Infections Caused By Levofloxacin-nonsusceptible Streptococcus Pneumoniae." Diagnostic Microbiology and Infectious Disease, vol. 52, no. 2, 2005, pp. 129-33.
Jones RN, Fritsche TR, Sader HS. Therapeutic options among broad-spectrum beta-lactams for infections caused by levofloxacin-nonsusceptible Streptococcus pneumoniae. Diagn Microbiol Infect Dis. 2005;52(2):129-33.
Jones, R. N., Fritsche, T. R., & Sader, H. S. (2005). Therapeutic options among broad-spectrum beta-lactams for infections caused by levofloxacin-nonsusceptible Streptococcus pneumoniae. Diagnostic Microbiology and Infectious Disease, 52(2), 129-33.
Jones RN, Fritsche TR, Sader HS. Therapeutic Options Among Broad-spectrum Beta-lactams for Infections Caused By Levofloxacin-nonsusceptible Streptococcus Pneumoniae. Diagn Microbiol Infect Dis. 2005;52(2):129-33. PubMed PMID: 15964501.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Therapeutic options among broad-spectrum beta-lactams for infections caused by levofloxacin-nonsusceptible Streptococcus pneumoniae. AU - Jones,Ronald N, AU - Fritsche,Thomas R, AU - Sader,Helio S, PY - 2004/10/28/received PY - 2004/12/10/accepted PY - 2005/6/21/pubmed PY - 2005/9/16/medline PY - 2005/6/21/entrez SP - 129 EP - 33 JF - Diagnostic microbiology and infectious disease JO - Diagn Microbiol Infect Dis VL - 52 IS - 2 N2 - Streptococcus pneumoniae has consistently become more resistant to primary, orally administered treatment regimens used for community-acquired respiratory tract infections (CARTI; sinusitis, bronchitis, pneumonia). As resistance rates approach 40-50% in the United States and North America for penicillin and macrolides, other agents also have exhibited coresistance rates of 10-20% (tetracycline, clindamycin, trimethoprim/sulfamethoxazole). These facts led to altered clinical treatment guidelines (IDSA) supporting the use of respiratory fluoroquinolones (levofloxacin, gatifloxacin, gemifloxacin, and moxifloxacin). This report from the SENTRY Antimicrobial Surveillance Program lists possible parenterally administered treatment alternatives for the fluoroquinolone (levofloxacin)-nonsusceptible pneumococci. The SENTRY Program isolates from CARTI (1997-2003), totaling 21605 strains from Europe, Asia Pacific, and the Americas, were screened for fluoroquinolone-resistant S. pneumoniae. A total of 157 (0.7%) levofloxacin-nonsusceptible (MIC > or = 4 microg/mL) strains were identified and tested by reference broth microdilution methods against 27 antimicrobials. Quinolone resistance-determining region (QRDR) mutations were determined by PCR amplification and gene sequencing. The entire population of S. pneumoniae had the following antibiogram demographics: penicillin-nonsusceptible (32%), macrolide resistance (24%), tetracycline resistance (21%), clindamycin resistance (11%), trimethoprim/sulfamethoxazole resistance (33%), and 6% of strains were resistant to all 5 drugs. Levofloxacin-resistant strains routinely had 2 or more QRDR mutations most frequently in gyrA at Ser81Phe or Tyr and in parC at Ser79Phe or Tyr and Lys137Asn. Four agents had extremely low rates of resistance when tested against the 157 levofloxacin-nonsusceptible strains (e.g., quinupristin/dalfopristin, 0% resistance; vancomycin, 0%; cefepime, 1%; ceftriaxone, 1%). Levofloxacin-nonsusceptible pneumococcal isolates remain uncommon, but are a growing problem in CARTI (1.4% in 2003), especially in previously fluoroquinolone-treated cases. Parenteral cephalosporins (cefepime or ceftriaxone) continue to be potent and safe for use in hospitalized patients with S. pneumoniae community-acquired pneumonia, used with or without co-drugs according to published guidelines. SN - 0732-8893 UR - https://www.unboundmedicine.com/medline/citation/15964501/Therapeutic_options_among_broad_spectrum_beta_lactams_for_infections_caused_by_levofloxacin_nonsusceptible_Streptococcus_pneumoniae_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0732-8893(05)00005-2 DB - PRIME DP - Unbound Medicine ER -