Weiss K, Restieri C, Gauthier R, Laverdière M, McGeer A, Davidson R J, Kilburn L, Bast D J, de Azavedo J, Low D E
Department of Microbiology and Infectious Diseases, Hôpital Maisonneuve-Rosemont, University of Montreal, 5415 L'Assomption, Montreal, Quebec, Canada, H1T 2M4.
Clin Infect Dis. 2001 Aug 15;33(4):517-22. doi: 10.1086/322658. Epub 2001 Jul 20.
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.
在20个月的时间里，在一家医院的呼吸病房中，环丙沙星常被用作下呼吸道感染（LRTIs）的经验性抗菌治疗药物，16例慢性支气管炎患者发生了由对青霉素和环丙沙星耐药的肺炎链球菌（23F血清型）引起的医院获得性LRTIs。前9例患者所有分离株中环丙沙星的最低抑菌浓度（MIC）为4μg/mL，伴有parC突变。随后7例患者的分离株中环丙沙星MIC均为16μg/mL，伴有gyrA的额外突变。该分离株对左氧氟沙星的MIC为8μg/mL（耐药），对莫西沙星和加替沙星的MIC为2μg/mL（中介耐药），对吉米沙星的MIC为0.12μg/mL。此次暴发表明肺炎链球菌能够获得多个突变，导致对氟喹诺酮类药物的耐药水平增加，并能在人与人之间传播。
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