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

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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

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Levofloxacin
Bacteremia
Quinolones
Viridans Streptococci
Peripheral Blood Stem Cell Transplantation
Mucositis
Pulsed Field Gel Electrophoresis
Septic Shock
Neutropenia
Fever
Transplantation
Mutation

ASJC Scopus subject areas

  • Immunology

Cite this

Bacteremia due to viridans group streptococi with diminished susceptibility to levofloxacin among neutropenic patients receiving levofloxacin prophylaxis. / Razonable, Raymund R; Litzow, Mark R; Khaliq, Yasmin; Piper, Kerryl E.; Rouse, Mark S.; Patel, Robin.

In: Clinical Infectious Diseases, Vol. 34, No. 11, 01.06.2002, p. 1469-1474.

Research output: Contribution to journalArticle

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