title: The first telithromycin-resistant Streptococcus pneumoniae isolate in Japan associated with erm(B) and mutations in 23S rRNA and riboprotein L4.
abstract: This report presents the case of a patient associated with a Streptococcus pneumoniae isolate that was resistant to a new ketolide antibiotic, telithromycin (minimum inhibitory concentration: 4 microg/ml). The patient, a 61-year-old female with bronchiectasis, was treated with 200-400 mg of clarithromycin daily for 6 years until the isolation of the resistant strain but without prior exposure to telithromycin. The strain was isolated from her sputum but not from the nasopharynx. This isolate carried erm(B) and had mutations in 23S rRNA and riboprotein L4. To our knowledge, this is the first case report concerning a telithromycin-resistant S. pneumoniae isolate in Japan by mutation in L4. Although the long-term clarithromycin administration may have contributed to the induction of resistance in this patient, this could not be confirmed, since S. pneumoniae was not isolated until the present episode.
authors.affiliation: Second Department of Internal Medicine, Nagasaki University School of Medicine and Dentistry, Nagasaki 852-8501, Japan. hirakata@nagasaki-u.ac.jp
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hirakata
authors.forename: Yohei
authors.initials: Y
authors.lastname: Mizuta
authors.forename: Akihito
authors.initials: A
authors.lastname: Wada
authors.forename: Akira
authors.initials: A
authors.lastname: Kondoh
authors.forename: Shintaro
authors.initials: S
authors.lastname: Kurihara
authors.forename: Koichi
authors.initials: K
authors.lastname: Izumikawa
authors.forename: Masafumi
authors.initials: M
authors.lastname: Seki
authors.forename: Katsunori
authors.initials: K
authors.lastname: Yanagihara
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Kazunori
authors.initials: K
authors.lastname: Tomono
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics*; D001987:Bronchiectasis / Q000188:drug therapy* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007564:Japan; D048628:Ketolides / Q000494:pharmacology*; D008780:Methyltransferases / Q000235:genetics*; D008875:Middle Aged; D009154:Mutation; D012338:RNA, Ribosomal, 23S / Q000235:genetics*; D012269:Ribosomal Proteins / Q000235:genetics*; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D048628:Ketolides; D012338:RNA, Ribosomal, 23S; D012269:Ribosomal Proteins; C056368:ribosomal protein L4; D008780:Methyltransferases; C431709:ErmA protein, Bacteria; C106791:telithromycin