Selection of a gyrA mutation and treatment failure with gatifloxacin in a patient with Streptococcus pneumoniae with a preexisting parC mutation

Michael B. Kays, George G. Zhanel, Megan A. Reimann, Judi Jacobi, Gerald A. Denys, David W. Smith, Matthew F. Wack

Research output: Contribution to journalArticle

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Abstract

An 81-year-old woman had pneumonia caused by Streptococcus pneumoniae (levofloxacin Etest minimum inhibitory concentration [MIC] 1.5 μg/ml) and was treated with intravenous gatifloxacin 200 mg/day After 3 days of therapy repeat sputum cultures were positive for S. pneumoniae, which was resistant to levofloxacin (Etest MIC > 32 μg/ml). The isolate obtained before therapy showed a preexisting parC mutation of aspartic acid-83 to asparagine (Asp83→Asn), and the isolate obtained during therapy showed an acquired gyrA mutation from serine-81 to phenylalanine (Ser81→Phe) and a second parC mutation from lysine-137 to Asn (Lys137→Asn). Both isolates were the same strain, as determined with pulsed-field gel electrophoresis. This case demonstrates the potential for resistance to emerge during 8-methoxy fluoroquinolone therapy for fluoroquinolone-susceptible S. pneumoniae with a preexisting parC mutation. Additional clinical failures with a fluoroquinolone may occur unless these first-step parC mutants can be identified to assist clinicians in selecting appropriate antimicrobial therapy.

Original languageEnglish (US)
Pages (from-to)221-226
Number of pages6
JournalPharmacotherapy
Volume27
Issue number2
DOIs
StatePublished - Feb 1 2007

Fingerprint

Streptococcus pneumoniae
Treatment Failure
Fluoroquinolones
Disk Diffusion Antimicrobial Tests
Mutation
Levofloxacin
Microbial Sensitivity Tests
Therapeutics
Pulsed Field Gel Electrophoresis
Asparagine
Sputum
Phenylalanine
Aspartic Acid
Serine
Lysine
Pneumonia
gatifloxacin

Keywords

  • Fluoroquinolone
  • Gatifloxacin
  • Resistance
  • Streptococcus pneumoniae

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Selection of a gyrA mutation and treatment failure with gatifloxacin in a patient with Streptococcus pneumoniae with a preexisting parC mutation. / Kays, Michael B.; Zhanel, George G.; Reimann, Megan A.; Jacobi, Judi; Denys, Gerald A.; Smith, David W.; Wack, Matthew F.

In: Pharmacotherapy, Vol. 27, No. 2, 01.02.2007, p. 221-226.

Research output: Contribution to journalArticle

Kays, Michael B. ; Zhanel, George G. ; Reimann, Megan A. ; Jacobi, Judi ; Denys, Gerald A. ; Smith, David W. ; Wack, Matthew F. / Selection of a gyrA mutation and treatment failure with gatifloxacin in a patient with Streptococcus pneumoniae with a preexisting parC mutation. In: Pharmacotherapy. 2007 ; Vol. 27, No. 2. pp. 221-226.
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