Emergence of high-level fluoroquinolone-resistant Streptococcus pneumoniae in Turkey

Öznur Ak, Nur Benzonana, Serdar Özer, Haluk Eraksoy
2003 International Journal of Infectious Diseases  
oznur Ak,(r) Nur Benzonana, (r) Serdar ozer(l) and Haluk Eraksoy@) Int J Infect Dis 2003; 7: 288-289 Streptococcus pneumoniae resistant to penicillin and macrolides has become increasingly prevalent in all parts of the world, and newer fluoroquinolones (FQs) with improved Gram-positive activity have been introduced as alternative first-line therapy in community-acquired lower respiratory tract infecti0ns.r So far, in Turkey, the incidence of high-level penicillin resistance in pneumococci is
more » ... n pneumococci is still low (3.9%), as confirmed in a national multicenter study; 2 however, here we report the first strain of S. pneumoniae, isolated from a bacteremic cancer patient, exhibiting a high level of resistance to all FQs. A 63-year-old male with small-cell lung cancer was hospitalized because of a febrile neutropenia episode after 7 days of his third course of chemotherapy. On the third day of hospitalization, S. pneumoniae grew in two consecutive bottles of blood culture taken before empirical antimicrobial therapy was started. Oral ciprofloxacin 500 mg b.i.d. for 10 days had been empirically prescribed for a non-neutropenic febrile episode occurring after his second course of chemotherapy, 20 days previously. The isolate was susceptible to all antibiotics tested, except for FQs. MICs for penicillin G (0.016 mg/L), ampicillin (0.064 mg/L), co-amoxiclav (0.032/0.015 mg/L), cefuroxime (0.12 mg/L), cotrimoxazole (0.2Y4.75 mg/L), tetracycline (0.5 mg/L), erythromycin (0.047 mg/L), clarithromycin (0.015 mg/L), azithromycin (0.125 mg/L), moxifloxacin (6 mg/L), gatifloxacin (12 mg/L), trovafloxacin (12 mg/L), grepafloxacin (16 mg/L), levofloxacin (16 mg/L), ofloxacin (32 mg/L) and ciprofloxacin (>32 mg/L) were determined by E test (AB Biodisk, Solna, Sweden) in Mueller-Hinton agar plus 5% sheep blood, following the manufacturer's recommendations.
doi:10.1016/s1201-9712(03)90110-x pmid:14656422 fatcat:b7rjfa6dbrbkzgzcticjm6zl7e