Fluoroquinolone resistance in patients with newly diagnosed tuberculosis.
Fluoroquinolones are widely used for the treatment of bacterial infections and are also second-line therapy for tuberculosis. However, fluoroquinolone resistance in patients with newly diagnosed cases of tuberculosis is not routinely assessed. We performed in vitro susceptibility testing of Mycobacterium tuberculosis to fluoroquinolones for all culture-confirmed tuberculosis cases in adults that were diagnosed at Johns Hopkins Hospital (Baltimore) between January 1998 and March 2002. Fifty-five patients were included in the study; 19 received fluoroquinolone monotherapy before the initiation of antituberculosis therapy. Two of 55 M. tuberculosis isolates (4%; 95% CI, 1%-13%) had decreased susceptibility to fluoroquinolones, including 2 of 19 of those from patients who had received fluoroquinolones (11%; 95% CI, 1%-33%) and 0 of 36 isolates from those who had not (95% CI, 0%-10%). The 2 fluoroquinolone-resistant M. tuberculosis strains were both from patients with acquired immunodeficiency syndrome and a CD4+ lymphocyte count of <50 cells/mm3. The incidence of M. tuberculosis fluoroquinolone resistance in this small sample of patients with newly diagnosed tuberculosis was high, particularly among patients with prior fluoroquinolone exposure.
Ginsburg
Amy Sarah
AS
Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Hooper
Nancy
N
Parrish
Nikki
N
Dooley
Kelly E
KE
Dorman
Susan E
SE
Booth
Jay
J
Diener-West
Marie
M
Merz
William G
WG
Bishai
William R
WR
Sterling
Timothy R
TR
D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000494:pharmacology*; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial / Q000502:physiology*; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D012189:Retrospective Studies; D014376:Tuberculosis / Q000382:microbiology*
D000995:Antitubercular Agents; D024841:Fluoroquinolones