Association of levofloxacin resistance with mortality in adult patients with invasive pneumococcal diseases: a post hoc analysis of a prospective cohort
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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.
KeywordsStreptococcus 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.
- 4.Yu VL, Chiou CC, Feldman C, Ortqvist A, Rello J, Morris AJ, Baddour LM, Luna CM, Snydman DR, Ip M, Ko WC, Chedid MB, Andremont A, Klugman KP; International Pneumococcal Study Group. An international prospective study of pneumococcal bacteremia: correlation with in vitro resistance, antibiotics administered, and clinical outcome. Clin Infect Dis. 2003;37:230–7.PubMedCrossRefGoogle Scholar
- 5.Song JH, Jung SI, Ki HK, Shin MH, Ko KS, Son JS, Chang HH, Kim SW, Lee H, Kim YS, Oh WS, Peck KR, Chongthaleong A, Lalitha MK, Perera J, Yee TT, Jamal F, Kamarulzaman A, Carlos CC, So T; Asian Network for Surveillance of Resistant Pathogens Study Group. Clinical outcomes of pneumococcal pneumonia caused by antibiotic-resistant strains in Asian countries: a study by the Asian Network for Surveillance of Resistant Pathogens. Clin Infect Dis. 2004;38:1570–8.PubMedCrossRefGoogle Scholar
- 8.Pletz MW, McGee L, Jorgensen J, Beall B, Facklam RR, Whitney CG, Klugman KP. Levofloxacin-resistant invasive Streptococcus pneumoniae in the United States: evidence for clonal spread and the impact of conjugate pneumococcal vaccine. Antimicrob Agents Chemother. 2004;48:3491–7.PubMedCrossRefGoogle Scholar
- 12.Rodríguez-Avial I, Ramos B, Ríos E, Cercenado E, Ordobás M, Sanz JC; Madrid Streptococcus pneumoniae Microbiological Group. Clonal spread of levofloxacin-resistant Streptococcus pneumoniae invasive isolates in Madrid, Spain, 2007 to 2009. Antimicrob Agents Chemother. 2011;55:2469–71.PubMedCrossRefGoogle Scholar
- 14.Kim SH, Song JH, Chung DR, Thamlikitkul V, Yang Y, Wang H, Lu M, So TM, Hsueh PR, Yasin RM, Carlos CC, Pham HV, Lalitha MK, Shimono N, Perera J, Shibl AM, Baek JY, Kang CI, Ko KS, Peck KR; ANSORP Study Group. Changing trends in antimicrobial resistance and serotypes of Streptococcus pneumoniae isolates in Asian Countries: an Asian Network for Surveillance of Resistant Pathogens (ANSORP) study. Antimicrob Agents Chemother. 2012;56:1418–26.PubMedCrossRefGoogle Scholar
- 16.Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, Lamm W, Clark C, MacFarquhar J, Walton AL, Reller LB, Sexton DJ. Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med. 2002;137:791–7.PubMedGoogle Scholar
- 22.Alanee SR, McGee L, Jackson D, Chiou CC, Feldman C, Morris AJ, Ortqvist A, Rello J, Luna CM, Baddour LM, Ip M, Yu VL, Klugman KP; International Pneumococcal Study Group. Association of serotypes of Streptococcus pneumoniae with disease severity and outcome in adults: an international study. Clin Infect Dis. 2007;45:46–51.PubMedCrossRefGoogle Scholar