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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
Summary
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.