Razonable Raymund R, Litzow Mark R, Khaliq Yasmin, Piper Kerryl E, Rouse Mark S, Patel Robin
Division of Infectious Diseases, Mayo Clinic, Rochester, MN, 55905, USA.
Clin Infect Dis. 2002 Jun 1;34(11):1469-74. doi: 10.1086/340352. Epub 2002 May 7.
Despite the use of levofloxacin prophylaxis during the neutropenic period after autologous peripheral blood stem cell transplantation, viridans group (VG) streptococcal bacteremia developed in 6 (16.2%) of 37 patients who underwent transplantation between 1 January and 25 February 2001 at the Mayo Clinic in Rochester, Minnesota. All 6 patients presented with fever and mucositis after a mean of 4.5 days of neutropenia, and 3 developed septic shock. All 6 VG streptococcal isolates from these patients exhibited distinct patterns on pulsed-field gel electrophoresis. All isolates had diminished susceptibility to levofloxacin, 5 to gatifloxacin, and 4 to moxifloxacin. Quinolone resistance was associated with mutations in the quinolone resistance-determining region of GyrA and (for 1 isolate) of ParC. The use of levofloxacin may select VG streptococci with diminished susceptibility to levofloxacin and other quinolones with enhanced activity against gram-positive organisms and, therefore, may not be optimal for preventing VG streptococcal bacteremia in neutropenic patients.
尽管在明尼苏达州罗切斯特市梅奥诊所于2001年1月1日至2月25日期间接受自体外周血干细胞移植的37例患者的中性粒细胞减少期使用了左氧氟沙星进行预防，但仍有6例（16.2%）发生了草绿色链球菌（VG）菌血症。所有6例患者在中性粒细胞减少平均4.5天后均出现发热和粘膜炎，3例发生感染性休克。从这些患者分离出的所有6株VG链球菌在脉冲场凝胶电泳上呈现出不同的图谱。所有分离株对左氧氟沙星的敏感性均降低，5株对加替沙星敏感性降低，4株对莫西沙星敏感性降低。喹诺酮耐药性与GyrA喹诺酮耐药决定区的突变有关，1株还与ParC的突变有关。使用左氧氟沙星可能会选择对左氧氟沙星和其他对革兰氏阳性菌活性增强的喹诺酮敏感性降低的VG链球菌，因此，对于预防中性粒细胞减少患者的VG链球菌菌血症可能并非最佳选择。
