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Risk Factors for Community-Onset Pneumonia Caused by Levofloxacin-Nonsusceptible Streptococcus pneumoniae
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Risk Factors for Community-Onset Pneumonia Caused by Levofloxacin-Nonsusceptible Streptococcus pneumoniae
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Journal Article
Risk Factors for Community-Onset Pneumonia Caused by Levofloxacin-Nonsusceptible Streptococcus pneumoniae
2018
Overview
Background:
Fluoroquinolones are antibiotics commonly used in the treatment of infections caused by
Streptococcus pneumoniae
. However, rates of fluoroquinolone resistance are increasing with their frequent use. We designed this study to verify current fluoroquinolone resistance rates and risk factors for community-onset pneumococcal pneumonia.
Methods:
A retrospective case–control study was conducted in a tertiary referral hospital. The study population comprised patients admitted for pneumococcal pneumonia between January 2011 and May 2017. The case group included community-onset pneumonia caused by levofloxacin-nonsusceptible
S. pneumoniae
. The control group consisted of two patients with levofloxacin-susceptible
S. pneumoniae
who were admitted around the same time as each case.
Results:
A total of 198 pneumococcal pneumonia cases were identified during the study period. Twenty-five levofloxacin-resistant
S. pneumoniae
cases and 3 levofloxacin-intermediate
S. pneumoniae
cases were included in the case group (nonsusceptibility rate = 14.1%). Multivariate analysis showed that healthcare-associated factors (odds ratio [OR] 4.78, 95% confidence interval [CI] 1.39–16.43,
p
= 0.013), bronchopulmonary disease (OR 3.79, 95% CI 1.07–13.40,
p
= 0.039), cerebrovascular disease (OR 6.08, 95% CI 1.24–29.75,
p
= 0.026), and exposure to fluoroquinolones within the previous 3 months (OR 5.89, 95% CI 1.21–28.68,
p
= 0.028) were associated with nonsusceptibility to levofloxacin.
Conclusion:
Independent risk factors for levofloxacin-nonsusceptible pneumococcal pneumonia were recent hospitalization, bronchopulmonary disease, cerebrovascular disease, and prior antibiotic use within 3 months. Careful selection of empirical antibiotics is thus needed in at-risk patients. Similarly, efforts to prevent the interpersonal spread of drug-resistant pathogens in long-term care facilities and to restrict unnecessary fluoroquinolone prescriptions are important.
Publisher
Mary Ann Liebert, Inc., publishers,SAGE Publications,Mary Ann Liebert, Inc
Subject
/ Anti-Bacterial Agents - therapeutic use
/ Community-Acquired Infections - drug therapy
/ Community-Acquired Infections - microbiology
/ Disease
/ Female
/ Fluoroquinolones - therapeutic use
/ Humans
/ Levofloxacin - therapeutic use
/ Male
/ Medicine
/ Microbial Sensitivity Tests - methods
/ Ostomy
/ Patients
/ Pneumonia, Pneumococcal - drug therapy
