, Volume 41, Issue 1, pp 151–157 | Cite as

Association of levofloxacin resistance with mortality in adult patients with invasive pneumococcal diseases: a post hoc analysis of a prospective cohort

  • C.-I. Kang
  • J.-H. Song
  • S. H. Kim
  • D. R. Chung
  • K. R. Peck
  • V. Thamlikitkul
  • H. Wang
  • T. M. So
  • P.-R. Hsueh
  • R. M. Yasin
  • C. C. Carlos
  • P. H. Van
  • J. Perera
  • The Asian Network for Surveillance of Resistant Pathogens (ANSORP) Study Group
Clinical and Epidemiological Study



This study was conducted to identify risk factors for mortality and to evaluate the impact of antimicrobial resistance on outcome in adult patients with invasive pneumococcal disease (IPD).


A post hoc analysis of an observational cohort study on community-acquired pneumococcal infections was conducted and a total of 136 adult patients with IPD were analyzed in this study.


Pneumonia was the most common type of infection (n = 84, 61.8 %), followed by primary bacteremia (n = 15, 11.0 %) and meningitis (n = 15, 11.0 %). One hundred and three patients (75.7 %) had concomitant pneumococcal bacteremia. The overall 30-day mortality rate was 26.5 % (36/136), and factors associated with 30-day mortality were corticosteroid use, presentation with septic shock, and development of acute respiratory distress syndrome (ARDS) (all P < 0.05). While penicillin and erythromycin resistance were associated with a lower mortality, an association between levofloxacin resistance and increased mortality was found in the univariate analysis; however, statistical significance was not reached (P = 0.083). Multivariable analysis showed that presentation with septic shock, corticosteroid use, development of ARDS, and levofloxacin resistance were independent factors associated with 30-day mortality. Of the five patients with IPD caused by levofloxacin-resistant Streptococcus pneumoniae, three (60 %) died within 30 days of diagnosis.


Levofloxacin resistance was associated with increased mortality, along with septic shock, prior use of corticosteroids, and development of ARDS, in adult patients with IPD. Our data suggest that the emergence of levofloxacin resistance among invasive pneumococcal isolates is now becoming a challenge for clinicians managing community-acquired bacterial infections.


Streptococcus pneumoniae Pneumococcal infections Treatment outcome Mortality Risk factors 



We would like to thank all of the ANSORP study group investigators who participated in this study for their dedication and contribution. Wyeth Pharmaceuticals Inc. (currently, Pfizer Inc.) [0877X1-4448] and the Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Korea, supported this work. This study was also supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health and Welfare, Republic of Korea (A102065).

Conflict of interest

All authors have no conflicts of interest to declare.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • C.-I. Kang
    • 1
  • J.-H. Song
    • 1
    • 2
  • S. H. Kim
    • 2
  • D. R. Chung
    • 1
  • K. R. Peck
    • 1
  • V. Thamlikitkul
    • 3
  • H. Wang
    • 4
    • 5
  • T. M. So
    • 6
  • P.-R. Hsueh
    • 7
  • R. M. Yasin
    • 8
  • C. C. Carlos
    • 9
  • P. H. Van
    • 10
  • J. Perera
    • 11
  • The Asian Network for Surveillance of Resistant Pathogens (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.Siriraj HospitalMahidol UniversityBangkokThailand
  4. 4.Peking Union Medical College HospitalBeijingChina
  5. 5.Peking University People’s HospitalBeijingChina
  6. 6.Princess Margaret HospitalHong KongChina
  7. 7.National Taiwan University HospitalNational Taiwan University College of MedicineTaipeiTaiwan
  8. 8.Institute for Medical ResearchKuala LumpurMalaysia
  9. 9.Antimicrobial Resistance Surveillance Reference LaboratoryResearch Institute for Tropical MedicineManilaPhilippines
  10. 10.Faculty of MedicineUniversity of Medicine and PharmacyHo Chi MinhVietnam
  11. 11.University of ColomboColomboSri Lanka

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