title: Macrolide-resistant pneumococcal endocarditis and epidural abscess that develop during erythromycin therapy.
abstract: Suppurative complications of Streptococcus pneumoniae infections have become uncommon in the antibiotic era. We report a case of pneumococcal bacteremia and pneumonia complicated with epidural abscess and endocarditis in which macrolide resistance (the MLS(B) phenotype) emerged during erythromycin therapy. Genetic determinants known to mediate the most common mechanisms of macrolide resistance (methylation of the 23S rRNA and antibiotic efflux) were not detected by polymerase chain reaction or DNA hybridization. Sequence analysis of the DNA encoding the 23S rRNA of the macrolide-resistant isolate from the patient demonstrated the replacement of adenine by thymine at position 2058 (A2058T) in 2 of 4 alleles. Clinicians should be alert to the possibility of the emergence of resistance during macrolide therapy for community-acquired pneumonia, particularly if suppurative complications of pneumococcal infection are suspected.
authors.affiliation: Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska 99508, USA. Jbutler@cdc.gov
authors.forename: Jay C
authors.initials: JC
authors.lastname: Butler
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Lennox
authors.forename: Linda K
authors.initials: LK
authors.lastname: McDougal
authors.forename: Joyce A
authors.initials: JA
authors.lastname: Sutcliffe
authors.forename: Amelia
authors.initials: A
authors.lastname: Tait-Kamradt
authors.forename: Fred C
authors.initials: FC
authors.lastname: Tenover
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D004697:Endocarditis, Bacterial / Q000150:complications*; D020802:Epidural Abscess / Q000150:complications*; D004917:Erythromycin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000150:complications* / Q000188:drug therapy; D017354:Point Mutation; D012338:RNA, Ribosomal, 23S / Q000032:analysis / Q000235:genetics; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D012338:RNA, Ribosomal, 23S; D004917:Erythromycin