Circulation of international clones of levofloxacin non-susceptible Streptococcus pneumoniae in Taiwan.
Levofloxacin susceptibility testing was carried out for a total of 2539 Streptococcus pneumoniae isolates obtained from January 2001 to February 2008 at the National Taiwan University Hospital (NTUH) and a further 228 pneumococcal isolates obtained from January 2004 to December 2006 at three other hospitals in different geographical areas in Taiwan. Levofloxacin non-susceptible S. pneumoniae isolates were subsequently analysed for serotype and molecular epidemiology. Rates of levofloxacin non-susceptibility of S. pneumoniae increased significantly from 1.2% in 2001 to 4.2% in 2007 at NTUH. A total of 30 isolates of levofloxacin non-susceptible S. pneumoniae isolates (MIC ≥ 4 mg/L) were available for evaluation of serotype, antimicrobial susceptibility, nucleotide sequence of the quinolone resistance-determining regions of parC, gyrA, parE and gyrB, reserpine effect on quinolone susceptibility and multilocus sequence type. Among these isolates, seven (23.3%) were from children, and two (6.7%; one from a 3- and one from a 93-year-old patient) were from blood. One levofloxacin-resistant isolate (MIC = 8 mg/L) was recovered from a previously healthy child with bacteraemic necrotizing pneumonia complicated by empyema and a haemolytic-uraemic syndrome. All isolates except two had Ser79 and/or Asp83 changes in ParC, and/or Ser81 or Glu85 changes in GyrA. An efflux phenotype concerning levofloxacin was detected in only one (3.3%) isolate. A novel clone (ST3642), genetically related to Spain(9V)-3 and belonging to serotype 11A, was identified. Dissemination of clonal complexes related to Spain(23F)-1, Taiwan(19F)-14, Spain(9V)-3 and Taiwan(23F)-15 has contributed to levofloxacin non-susceptibility among these S. pneumoniae isolates from Taiwan.
Hsieh
Y-C
YC
Division of Paediatric Infectious Diseases, Department of Paediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chang
L-Y
LY
Huang
Y-C
YC
Lin
H-C
HC
Huang
L-M
LM
Hsueh
P-R
PR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019943:Amino Acid Substitution; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001483:Base Sequence; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000382:microbiology; D027081:DNA Gyrase / Q000235:genetics; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D015242:Ofloxacin / Q000494:pharmacology*; D011008:Pneumococcal Infections / Q000382:microbiology*; D011018:Pneumonia, Pneumococcal / Q000382:microbiology; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D020539:Sequence Analysis, Protein; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D013624:Taiwan; D055815:Young Adult
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D064704:Levofloxacin; D015242:Ofloxacin; D027081:DNA Gyrase