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Failure of levofloxacin treatment in community-acquired pneumococcal pneumonia

Andrea Endimiani1, Gioconda Brigante, Alessia A Bettaccini

  • 1Laboratory of Microbiology and Virology, University of Insubria and Ospedale di Circolo e Fondazione Macchi, Varese, Italy. aendimiani@tin.it

BMC Infectious Diseases
|November 26, 2005
PubMed
Abstract

Insights

This case report details the first documented instance in Italy of community-acquired pneumonia caused by fluoroquinolone-resistant Streptococcus pneumoniae. Effective treatment was achieved with piperacillin/tazobactam, highlighting its potential against resistant strains.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Clinical Medicine

Background:

  • Streptococcus pneumoniae is a primary cause of community-acquired pneumonia (CAP).
  • Rising macrolide and penicillin resistance contrasts with uncommon fluoroquinolone resistance.
  • Guidelines recommend fluoroquinolones or macrolides for CAP in high-risk patients.

Observation:

  • A 72-year-old patient with COPD and prior fluoroquinolone use presented with CAP symptoms.
  • Initial levofloxacin treatment failed, necessitating hospitalization and combination therapy.
  • The isolated S. pneumoniae strain exhibited resistance to macrolides and fluoroquinolones.

Findings:

  • Molecular analysis revealed specific gyrA, parE, and parC gene mutations in the S. pneumoniae isolate.
  • These mutations confer fluoroquinolone resistance.
  • This represents the first reported case of fluoroquinolone-resistant S. pneumoniae CAP in Italy.

Implications:

  • Levofloxacin treatment failure was documented in this Italian patient.
  • The identified mutation profile is rare globally and novel for Italy.
  • Piperacillin/tazobactam demonstrated efficacy against this fluoroquinolone-resistant S. pneumoniae strain.

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