title: Association of levofloxacin resistance with mortality in adult patients with invasive pneumococcal diseases: a post hoc analysis of a prospective cohort.
abstract: OBJECTIVE
  This study was conducted to identify risk factors for mortality and to evaluate the impact of antimicrobial resistance on outcome in adult patients with invasive pneumococcal disease (IPD).
  
  
  METHODS
  A post hoc analysis of an observational cohort study on community-acquired pneumococcal infections was conducted and a total of 136 adult patients with IPD were analyzed in this study.
  
  
  RESULTS
  Pneumonia was the most common type of infection (n = 84, 61.8 %), followed by primary bacteremia (n = 15, 11.0 %) and meningitis (n = 15, 11.0 %). One hundred and three patients (75.7 %) had concomitant pneumococcal bacteremia. The overall 30-day mortality rate was 26.5 % (36/136), and factors associated with 30-day mortality were corticosteroid use, presentation with septic shock, and development of acute respiratory distress syndrome (ARDS) (all P < 0.05). While penicillin and erythromycin resistance were associated with a lower mortality, an association between levofloxacin resistance and increased mortality was found in the univariate analysis; however, statistical significance was not reached (P = 0.083). Multivariable analysis showed that presentation with septic shock, corticosteroid use, development of ARDS, and levofloxacin resistance were independent factors associated with 30-day mortality. Of the five patients with IPD caused by levofloxacin-resistant Streptococcus pneumoniae, three (60 %) died within 30 days of diagnosis.
  
  
  CONCLUSIONS
  Levofloxacin resistance was associated with increased mortality, along with septic shock, prior use of corticosteroids, and development of ARDS, in adult patients with IPD. Our data suggest that the emergence of levofloxacin resistance among invasive pneumococcal isolates is now becoming a challenge for clinicians managing community-acquired bacterial infections.
authors: Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 135-710, Korea. collacin@hotmail.com
authors: C-I
authors: CI
authors: Kang
authors: J-H
authors: JH
authors: Song
authors: S H
authors: SH
authors: Kim
authors: D R
authors: DR
authors: Chung
authors: K R
authors: KR
authors: Peck
authors: V
authors: V
authors: Thamlikitkul
authors: H
authors: H
authors: Wang
authors: T M
authors: TM
authors: So
authors: P-R
authors: PR
authors: Hsueh
authors: R M
authors: RM
authors: Yasin
authors: C C
authors: CC
authors: Carlos
authors: P H
authors: PH
authors: Van
authors: J
authors: J
authors: Perera
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000494:pharmacology* / Q000627:therapeutic use; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D015242:Ofloxacin