Selection of a gyrA mutation and treatment failure with gatifloxacin in a patient with Streptococcus pneumoniae with a preexisting parC mutation.
Article Details
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Kays MB, Zhanel GG, Reimann MA, Jacobi J, Denys GA, Smith DW, Wack MF
Selection of a gyrA mutation and treatment failure with gatifloxacin in a patient with Streptococcus pneumoniae with a preexisting parC mutation.
Pharmacotherapy. 2007 Feb;27(2):221-6.
- PubMed ID
- 17253913 [ View in PubMed]
- Abstract
An 81-year-old woman had pneumonia caused by Streptococcus pneumoniae (levofloxacin Etest minimum inhibitory concentration [MIC] 1.5 microg/ml) and was treated with intravenous gatifloxacin 200 mg/day. After 3 days of therapy, repeat sputum cultures were positive for S. pneumoniae, which was resistant to levofloxacin (Etest MIC > 32 microg/ml). The isolate obtained before therapy showed a preexisting parC mutation of aspartic acid-83 to asparagine (Asp83-->Asn), and the isolate obtained during therapy showed an acquired gyrA mutation from serine-81 to phenylalanine (Ser81-->Phe) and a second parC mutation from lysine-137 to Asn (Lys137-->Asn). Both isolates were the same strain, as determined with pulsed-field gel electrophoresis. This case demonstrates the potential for resistance to emerge during 8-methoxy fluoroquinolone therapy for fluoroquinolone-susceptible S. pneumoniae with a preexisting parC mutation. Additional clinical failures with a fluoroquinolone may occur unless these first-step parC mutants can be identified to assist clinicians in selecting appropriate antimicrobial therapy.
DrugBank Data that Cites this Article
- Drug Targets
Drug Target Kind Organism Pharmacological Action Actions Gatifloxacin DNA gyrase subunit A Protein Streptococcus pneumoniae serotype 4 (strain ATCC BAA-334 / TIGR4) YesInhibitorDetails Gatifloxacin DNA gyrase subunit B Protein Streptococcus pneumoniae serotype 4 (strain ATCC BAA-334 / TIGR4) YesInhibitorDetails Gatifloxacin DNA topoisomerase 4 subunit A Protein Streptococcus pneumoniae serotype 4 (strain ATCC BAA-334 / TIGR4) YesInhibitorDetails Gatifloxacin DNA topoisomerase 4 subunit B Protein Streptococcus pneumoniae serotype 4 (strain ATCC BAA-334 / TIGR4) YesInhibitorDetails