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Clin Infect Dis. 2001 Aug 15;33(4):517-22. Epub 2001 Jul 20.

A nosocomial outbreak of fluoroquinolone-resistant Streptococcus pneumoniae.

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Department of Microbiology and Infectious Diseases, Hôpital Maisonneuve-Rosemont, University of Montreal, 5415 L'Assomption, Montreal, Quebec, Canada, H1T 2M4.


Over the course of a 20-month period, in a hospital respiratory ward in which ciprofloxacin was often used as empirical antimicrobial therapy for lower respiratory tract infections (LRTIs), 16 patients with chronic bronchitis developed nosocomial LRTIs caused by penicillin- and ciprofloxacin-resistant Streptococcus pneumoniae (serotype 23 F). The minimum inhibitory concentration (MIC) of ciprofloxacin for all isolates from the first 9 patients was 4 microg/mL, in association with a parC mutation. Isolates from the subsequent 7 patients all had a ciprofloxacin MIC of 16 microg/mL, in association with an additional mutation in gyrA. The MICs for this isolate were 8 microg/mL of levofloxacin (resistant), 2 microg/mL of moxifloxacin and gatifloxacin (intermediately resistant), and 0.12 microg/mL of gemifloxacin. This outbreak demonstrates the ability of S. pneumoniae to acquire multiple mutations that result in increasing levels of resistance to the fluoroquinolones and to be transmitted from person to person.

[Indexed for MEDLINE]

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