Empey P E, Jennings H R, Thornton A C, Rapp R P, Evans M E
University of Kentucky Chandler Medical Center, Lexington, KY, USA.
Ann Pharmacother. 2001 Jun;35(6):687-90. doi: 10.1345/aph.10229.
To report a case of levofloxacin failure in a patient with a penicillin-sensitive Streptococcus pneumoniae pneumonia.
A previously healthy, immunocompetent, 53-year-old white man presented with penicillin-sensitive S. pneumoniae pneumonia. The patient was empirically placed on levofloxacin monotherapy, which was continued due to a local penicillin shortage. When the patient failed to improve, further susceptibility testing was ordered. The organism was found to have a penicillin minimum inhibitory concentration (MIC) of 0.023 microgram/mL and a levofloxacin MIC of 6 micrograms/mL. Effective antimicrobial therapy was delayed, as clinicians did not anticipate fluoroquinolone resistance.
Newer fluoroquinolones such as levofloxacin have good activity against most S. pneumoniae isolates and are used for the treatment of pneumonia. Although resistance to these agents is rare, it has been reported. Current guidelines from the National Committee for Clinical Laboratory Standards do not recommend initial fluoroquinolone susceptibility testing.
As fluoroquinolone resistance may not be identified by susceptibility patterns to other antibiotics, early fluoroquinolone susceptibility testing and increased awareness of resistance may aid clinicians in their treatment of pneumococcal disease.
报告1例对青霉素敏感的肺炎链球菌肺炎患者使用左氧氟沙星治疗失败的病例。
一名53岁、既往健康、免疫功能正常的白人男性患对青霉素敏感的肺炎链球菌肺炎。患者经验性接受左氧氟沙星单药治疗，因当地青霉素短缺而持续使用。患者病情未见改善时，医嘱进行进一步药敏试验。结果发现该病原体的青霉素最低抑菌浓度（MIC）为0.023微克/毫升，左氧氟沙星MIC为6微克/毫升。由于临床医生未预料到氟喹诺酮耐药，有效的抗菌治疗被延误。
新型氟喹诺酮类药物如左氧氟沙星对大多数肺炎链球菌分离株具有良好活性，用于治疗肺炎。虽然对这些药物的耐药罕见，但已有报道。美国国家临床实验室标准委员会的现行指南不建议进行初始氟喹诺酮药敏试验。
由于氟喹诺酮耐药可能无法通过对其他抗生素的药敏模式来识别，早期进行氟喹诺酮药敏试验并提高对耐药的认识可能有助于临床医生治疗肺炎球菌疾病。
