title: Call for the international adoption of microbiological breakpoints for fluoroquinolones and Streptococcus pneumoniae.
abstract: The use of current Clinical and Laboratory Standards Institute levofloxacin breakpoints for assessing fluoroquinolone resistance in Streptococcus pneumoniae is inadequate for detecting isolates possessing first-step parC mutations. Consequently, the risk for development of fluoroquinolone resistance is greatly underestimated. Adopting microbiological breakpoints for fluoroquinolones and S. pneumoniae, where parC mutations are rare in susceptible isolates, more accurately describes the emergence of resistance and may help to prevent a number of future fluoroquinolone treatment failures. Additionally, we propose that the use of a second fluoroquinolone marker, such as ciprofloxacin, offers the best prediction for detecting an isolate possessing a first-step parC mutation.
authors.affiliation: Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, 5th Floor Basic Medical Sciences Building, 730 William Avenue, Winnipeg, Manitoba, Canada R3E 0W3. kris_schurek@yahoo.com
authors.forename: Kristen N
authors.initials: KN
authors.lastname: Schurek
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Adam
authors.forename: Daryl J
authors.initials: DJ
authors.lastname: Hoban
authors.forename: George G
authors.initials: GG
authors.lastname: Zhanel
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology* / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D024841:Fluoroquinolones / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D064704:Levofloxacin; D008826:Microbial Sensitivity Tests / Q000592:standards*; D009656:North America; D015242:Ofloxacin / Q000627:therapeutic use; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000382:microbiology; D017354:Point Mutation; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000235:genetics*
chemical_list: D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D064704:Levofloxacin; D015242:Ofloxacin