title: Emergence of a Streptococcus pneumoniae isolate resistant to streptogramins by mutation in ribosomal protein L22 during pristinamycin therapy of pneumococcal pneumonia.
abstract: OBJECTIVE
  The aim of this study was to characterize the mechanism of resistance to macrolides and streptogramins of a Streptococcus pneumoniae strain isolated from blood cultures in an 80-year-old patient suffering from severe pneumonia unsuccessfully treated with pristinamycin.
  
  
  METHODS
  Resistance genes erm(B) and mef(A) were searched for by PCR. Portions of genes for domains V and II of the 23S rRNA (rrl) and genes for ribosomal proteins L4 (rplD) and L22 (rplV) were amplified by PCR from total genomic DNA and sequenced.
  
  
  RESULTS
  Resistance genes erm(B) and mef(A) were not detected. Only mutation in the rplV gene encoding ribosomal protein L22 was detected. The strain contained a six amino acid insertion ((107)KRTAHI(108)) in the C-terminus of the ribosomal protein L22.
  
  
  CONCLUSIONS
  This is the first report of emergence of a pneumococcus resistant to streptogramins by mutation in ribosomal protein L22 during treatment with pristinamycin.
authors: Laboratoire de Bactériologie-Virologie-Hygiène, CHU Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris XII, Créteil, France. vincent.cattoir@hmn.aphp.fr
authors: Vincent
authors: V
authors: Cattoir
authors: Lilia
authors: L
authors: Merabet
authors: Patrick
authors: P
authors: Legrand
authors: Claude-James
authors: CJ
authors: Soussy
authors: Roland
authors: R
authors: Leclercq
mesh_terms: D000369:Aged, 80 and over; D000595:Amino Acid Sequence; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000235:genetics; D006801:Humans; D008969:Molecular Sequence Data; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy* / Q000382:microbiology; D025762:Pristinamycin / Q000627:therapeutic use*; D012338:RNA, Ribosomal, 23S / Q000235:genetics; D012269:Ribosomal Proteins / Q000235:genetics*; D016415:Sequence Alignment; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D025361:Streptogramins / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; C506765:L22 protein, Streptococcus pneumoniae; D025762:Pristinamycin; D012338:RNA, Ribosomal, 23S; D012269:Ribosomal Proteins; D025361:Streptogramins