Bacteremia due to viridans group streptococi with diminished susceptibility to levofloxacin among neutropenic patients receiving levofloxacin prophylaxis

Raymund R. Razonable, Mark R. Litzow, Yasmin Khaliq, Kerryl E. Piper, Mark S. Rouse, Robin Patel

Research output: Contribution to journalArticle

98 Scopus citations

Abstract

Despite the use of levofloxacin prophylaxis during the neutropenic period after autologous peripheral blood stem cell transplantation, viridans group (VG) streptococcal bacteremia developed in 6 (16.2%) of 37 patients who underwent transplantation between 1 January and 25 February 2001 at the Mayo Clinic in Rochester, Minnesota. All 6 patients presented with fever and mucositis after a mean of 4.5 days of neutropenia, and 3 developed septic shock. All 6 VG streptococcal isolates from these patients exhibited distinct patterns on pulsed-field gel electrophoresis. All isolates had diminished susceptibility to levofloxacin, 5 to gatifloxacin, and 4 to moxifloxacin. Quinolone resistance was associated with mutations in the quinolone resistance-determining region of GyrA and (for 1 isolate) of ParC. The use of levofloxacin may select VG streptococci with diminished susceptibility to levofloxacin and other quinolones with enhanced activity against gram-positive organisms and, therefore, may not be optimal for preventing VG streptococcal bacteremia in neutropenic patients.

Original languageEnglish (US)
Pages (from-to)1469-1474
Number of pages6
JournalClinical Infectious Diseases
Volume34
Issue number11
DOIs
StatePublished - Jun 1 2002

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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