title: Cross-resistance, relatedness and allele analysis of fluoroquinolone-resistant US clinical isolates of Streptococcus pneumoniae (1998-2000).
abstract: OBJECTIVE
  To detect relatedness among 68 (0.5%) of 13 795 US clinical isolates of Streptococcus pneumoniae from the TRUST 3 (1998-1999) and TRUST 4 (1999-2000) surveillance studies that were resistant to levofloxacin (MIC > or = 8 mg/l).
  
  
  METHODS
  All levofloxacin-resistant isolates were analysed by broth microdilution reference method for susceptibility to four fluoroquinolones, DNA sequencing of quinolone resistance determining region (QRDR) of topoisomerase IV and DNA gyrase genes, serotyping, and pulsed-field gel electrophoresis (PFGE).
  
  
  RESULTS
  All levofloxacin-resistant isolates were ciprofloxacin resistant (MIC > or = 4 mg/l, FDA breakpoint) and non-susceptible to gatifloxacin (MIC > or = 2 mg/l); 62 were non-susceptible to moxifloxacin (MIC > or = 2 mg/l). Resistant isolates were in 48 (20%) of 238 institutions in 29 states. Three institutions had levofloxacin-resistant isolates in both surveillance studies. Among the resistant isolates were 17 serotypes and 48 different PFGE patterns. Fourteen isolates had PFGE patterns closely related to the Spain(23F)-1 clone; one strain had a PFGE pattern closely related to the French(9V)-3 clone. All levofloxacin-resistant isolates had two or more mutations within the QRDR of parC, parE, gyrA and gyrB.
  
  
  CONCLUSIONS
  US levofloxacin-resistant S. pneumoniae isolates were rare and most were unrelated with minimal clonal spread, and were associated with multiple QRDR mutations with extensive cross-resistance noted among fluoroquinolones.
authors.affiliation: Johnson and Johnson Pharmaceutical Research and Development, L.L.C., 1000 Route 202, Raritan, NJ 08869, USA. tdavies@prdus.jnj.com
authors.forename: Todd A
authors.initials: TA
authors.lastname: Davies
authors.forename: Raul
authors.initials: R
authors.lastname: Goldschmidt
authors.forename: Sharon
authors.initials: S
authors.lastname: Pfleger
authors.forename: Mike
authors.initials: M
authors.lastname: Loeloff
authors.forename: Karen
authors.initials: K
authors.lastname: Bush
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Sahm
authors.forename: Alan
authors.initials: A
authors.lastname: Evangelista
mesh_terms: D000293:Adolescent; D000328:Adult; D000483:Alleles; D000890:Anti-Infective Agents / Q000494:pharmacology*; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D005260:Female; D024841:Fluoroquinolones; D006801:Humans; D008297:Male; D008875:Middle Aged; D012703:Serotyping / Q000706:statistics & numerical data; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D014481:United States / Q000453:epidemiology
chemical_list: D000890:Anti-Infective Agents; D024841:Fluoroquinolones