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  • Title: Are fluoroquinolone-susceptible isolates of Streptococcus pneumoniae really susceptible? A comparison of resistance mechanisms in Canadian isolates from 1997 and 2003.
    Author: Schurek KN, Adam HJ, Siemens CG, Hoban CJ, Hoban DJ, Zhanel GG.
    Journal: J Antimicrob Chemother; 2005 Oct; 56(4):769-72. PubMed ID: 16126779.
    Abstract:
    OBJECTIVES: To assess the prevalence of efflux and amino acid substitutions in ParC and GyrA in Canadian clinical isolates of fluoroquinolone-susceptible Streptococcus pneumoniae with levofloxacin MICs of 1 mg/L collected before the introduction of the respiratory fluoroquinolones (1995-1997) and after 7 years of use (2003). METHODS: Quinolone resistance determining regions of parC and gyrA were sequenced for 111 clinical isolates collected from 1995 to 1997 and 665 isolates collected in 2003. Efflux was assessed using a reserpine agar dilution method. RESULTS: No isolates exhibited efflux. No significant increase in isolates harbouring amino acid substitutions was observed over time (0.9% in 1995-1997 to 2.1% in 2003, P = 0.32). However, the proportion of isolates with a ciprofloxacin MIC = 2 mg/L and a levofloxacin MIC = 1 mg/L versus ciprofloxacin MIC = 1 mg/L and a levofloxacin MIC = 1 mg/L increased over time (3.6% to 6.5%, P = 0.0021). CONCLUSIONS: No increase in prevalence of first-step parC mutations was observed among all fluoroquinolone-susceptible clinical isolates of S. pneumoniae with levofloxacin MICs of 1 mg/L after the introduction of the respiratory fluoroquinolones; however, fluoroquinolones appear to be selecting for isolates with elevated ciprofloxacin MICs.
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