Risk factors for levofloxacin-nonsusceptible Streptococcus pneumoniae in community-acquired pneumococcal pneumonia: a nested case–control study

  • C.-I. Kang
  • J.-H. Song
  • S. H. Kim
  • D. R. Chung
  • K. R. Peck
  • T. M. So
  • P.-R. Hsueh
  • on behalf of the ANSORP Study Group


This study was performed to evaluate the clinical features of community-onset levofloxacin-nonsusceptible pneumococcal pneumonia and to identify risk factors for levofloxacin resistance. Using the database of a surveillance study of community-acquired pneumococcal infections in Asian countries, we conducted a nested case–control study to identify risk factors for levofloxacin-nonsusceptible S. pneumoniae in community-acquired pneumonia in adults. Of 981 patients with pneumococcal pneumonia, 46 (4.7 %) had levofloxacin-nonsusceptible S. pneumoniae, of whom 39 evaluable cases were included in the analysis. All cases were from Korea, Taiwan, and Hong Kong. Among patients with levofloxacin-susceptible S. pneumoniae, 490 controls were selected based on patient country. Of the 39 cases of levofloxacin-nonsusceptible pneumococcal pneumonia, 23 (59.0 %) were classified as healthcare-associated, while 164 (33.5 %) of the 490 controls of levofloxacin-susceptible S. pneumoniae (P = 0.001) were classified as healthcare-associated. Multivariate analysis showed that previous treatment with fluoroquinolones, cerebrovascular disease, and healthcare-associated infection were significantly associated with levofloxacin-nonsusceptible pneumococcal pneumonia (all P < 0.05). Levofloxacin-nonsusceptible pneumococci pose an important new public health threat in our region, and more information on the emergence and spread of these resistant strains will be necessary to prevent spread throughout the population.


Cerebrovascular Disease Fluoroquinolone Moxifloxacin Identify Risk Factor Invasive Pneumococcal Disease 
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This study was supported by the Basic Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education, Science, and Technology (No. 2010-0021572). Bacterial isolates were obtained from the Asian Bacterial Bank (ABB) of the Asia Pacific Foundation for Infectious Diseases (APFID). We would like to thank all of the ANSORP study group investigators who participated in this study for their dedication and contribution.

Asian Network for the Surveillance of Resistant Pathogens (ANSORP) study group

Hospitals and investigators participating in the ANSORP study group are as follows: Jae-Hoon Song (Organizer), Doo Ryeon Chung, Kyong Ran Peck, and Cheol-In Kang (Samsung Medical Center, Seoul), Joon-Sup Yeom (Kangbuk Samsung Hospital, Seoul), Hyun Kyun Ki (Konkuk University Hospital, Seoul), Jun Seong Son (Kyunghee University Hospital, Seoul), Yeon-Sook Kim (Chungnam National University Hospital, Daejeon), Ji-Young Rhee (Dankook University Hospital, Cheonan), Sook-In Jung and Kyung Hwa Park (Chonnam National University Hospital, Gwangju), Shin-Woo Kim and Hyun-Ha Chang (Kyungpook National University Hospital, Daegu), Ki Tae Kwon (Daegu Fatima Hospital, Daegu), Hyuck Lee (Dong-A University Hospital, Busan), Chisook Moon (Inje University Busan Paik Hospital, Busan), Sang Yop Shin (Cheju National University Hospital, Jeju), and Sang Taek Heo (Cheju National University Hospital, Jeju) in Korea; Hui Wang (Peking Union Medical College Hospital, Beijing; currently Peking University People’s Hospital, Beijing), Bin Cao and Yingmei Liu (Beijing Chaoyang Hospital, Beijing), Yunjian Hu and Tieyiing Sun (Beijing Hospital, Beijing), Chao Zhuo and Danhong Su (Guangzhou Institute of Respiratory Diseases, Guangzhou), Yunsong Yu and Yang Qing (First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou), Rong Zhang (Second Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou), Ziyong Sun and Shengdao Xiong (Tongji Hospital of Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan), Yong Liu (Shengjing Hospital of China Medical University, Shenyang), Yunzhou Chu, Baiyi Chen, and Xiaochun Ma (The First Hospital China Medical University, Shenyang), Yonghong Yang, Xuzhuang Shen, Sangjie Yu, Kaihu Yao, and Yinghui Hu (Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing), Libo Wang and Chuangqing Wang (Pediatric Hospital of Fudan University, Shanghai), Yuan Chen, Ying Huang and Lan Liu (Chongquing Children’s Hospital, Chongquing), Yuejie Zheng (Shenzhen Children’s Hospital, Shenzhen), and Min Lu, Hong Zhang, and Quan Lu (Shanghai Children’s Hospital, JiaoTong University) in China; Thomas M. K. So and Tak Keung Ng (Princess Margaret Hospital) and Wai-Keung Kwan and Wing-kin To (Yan Chai Hospital) in Hong Kong, Po-Ren Hsueh (National Taiwan University Hospital, Taipei), Cheng-Hsun Chiu and Lin-Hui Su (Chang-Gung Children’s Hospital, Taoyuan), and Yen-Hsu Chen (Chung-ho Memorial Hospital, Kaohsiung) in Taiwan; Visanu Thamlikitkul (Siriraj Hospital, Bangkok) and Anan Chongthaleong (Chulalongkorn University Hospital, Bangkok) in Thailand; Rohani Md Yasin and Norazah Ahmad (Institute for Medical Research, Kuala Lumpur), Adeeba Kamarulzaman, Sasheela Vanar, and Rina Karunakaran (University Malaya Medical Centre, Kuala Lumpur), Dato’ Jeyaindran Sinnadurai, Shanti Rudra Deva, and Mohamad Nazri Aziz (Hospital Kuala Lumpur, Kuala Lumpur), Tan Kah Kee, Suhailah Md Hanapiah, Jaideep Singh Sidhu, and Jenny Tong May Geok (Hospital Seremban, Seremban), Mahiran Mustafa, Nurahan Binti Maning, and Shaiful Azman Zakaria (Hospital Kota Bharu, Kelantan), Christopher Lee, Anuradha a/p, Radhakrishnan, Shanti a/p Ratnam, Zubaidah Abdul Wahab, and Ariza Adnan (Hospital Sungai Buloh, Sungai Buloh, Selangor), Lily Ng, Timothy William, Kausalia a/p Chinnaiah, and Azura Hussin (Hospital Queen Elizabeth, Pulau Pinang), Ganeswrie Balan, Subramaniam Balan, Chua Hoch Hin, Tan Cheng Cheng, and Kan Foong Kee (Hospital Sultanah Aminah, Johor Bahru), Salbiah Hj Nawi, Loh Eng Chang, and Tang Swee Ping (Hospital Salayang, Kuala Lumpur), and Ahmad Kashfi Abd Rahman, Siow Yen Ching, Mohd Ridwan mohd, Noor, Jimmy Lee Kok Foo, Fatimah Haslina Abdullah, and Noraznita Safie (Hospital Tuanku Nur Zahira, Kuala Terengganu) in Malaysia; Celia Carlos (Research Institute for Tropical Medicine, Manila), Sullian Naval (The Lung Center of the Philippines, Quezon), Media dora Saniel (The Medical City, Pasig), Joanne Lobo (Davao Medical Center, Davao), Consuelo Malaga (Vicente Sotto Memorial Hospital), and Thea Pamela Cajulao and Xenia Fabay (Baguio General Hospital and Medical Center, Baguio City) in the Philippines; Pham Hung Van and Pham Thai Binh (University of Medicine and Pharmacy, Ho Chi Minh), Tran Van Ngoc and Tran Thi Thanh Nga (Cho Ray Hospital, Ho Chi Minh), Le Tien Dung (Nguyen Tri Phuong Hospital, Ho Chi Minh), Doan Mai Phuong (Bach Mai Hospital, Ha Noi), Tung Vu Nguyen (National Institute of Tropical Diseases, Ha Noi), Huyen Dieu Thi Phan (Hospital C in Da Nang, Da Nang), and Chau Vinh (Tropical Diseases Hospital, Ho Chi Minh) in Vietnam; M. K. Lalitha (Madras Medical Mission, Chennai), Saradha Suresh (Institute of Child Health, Chennai), and Ranganathan Iyer (Global Hospital, Hyderabad) in India; Nobuyuki Shimono and Yujiro Uchida (Kyushu University Hospital, Fukuoka) in Japan; Jennifer Perera (University of Colombo, Colombo) in Sri Lanka; and Atef M. Shibl (King Saud University Hospital, Riyadh) in Saudi Arabia.

Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • C.-I. Kang
    • 1
  • J.-H. Song
    • 1
    • 2
  • S. H. Kim
    • 2
  • D. R. Chung
    • 1
  • K. R. Peck
    • 1
  • T. M. So
    • 3
  • P.-R. Hsueh
    • 4
  • on behalf of the ANSORP Study Group
  1. 1.Division of Infectious Diseases, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
  2. 2.Asia Pacific Foundation for Infectious Diseases (APFID)SeoulKorea
  3. 3.Princess Margaret HospitalKwai ChungHong Kong
  4. 4.National Taiwan University HospitalNational Taiwan University College of MedicineTaipeiTaiwan

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