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Macrolide-resistant pneumococcal endocarditis and epidural abscess that develop during erythromycin therapy

Jay C Butler1, Jeffrey L Lennox, Linda K McDougal

  • 1Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska 99508, USA. Jbutler@cdc.gov

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|January 11, 2003
PubMed

Insights

Emergence of macrolide resistance in Streptococcus pneumoniae during erythromycin treatment is rare but possible. A novel A2058T mutation in 23S rRNA caused resistance, complicating pneumonia and bacteremia.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Genetics

Background:

  • Suppurative complications from Streptococcus pneumoniae infections are infrequent in the current antibiotic era.
  • Macrolide antibiotics are commonly used for community-acquired pneumonia.

Observation:

  • A patient with pneumococcal bacteremia and pneumonia developed an epidural abscess and endocarditis.
  • Macrolide resistance (MLS(B) phenotype) emerged during erythromycin therapy.

Findings:

  • Standard genetic mechanisms for macrolide resistance (23S rRNA methylation, antibiotic efflux) were absent.
  • Sequence analysis revealed a novel A2058T mutation in the 23S rRNA gene of the resistant isolate.

Implications:

  • Clinicians must consider the potential for emergent macrolide resistance during treatment for community-acquired pneumonia.
  • This case highlights a new mechanism of macrolide resistance in Streptococcus pneumoniae.
  • Vigilance is crucial, especially when suppurative complications are suspected.

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