Yonsei Med J.  2014 Jul;55(4):987-993. 10.3349/ymj.2014.55.4.987.

Clinical Factors Associated with Acquisition of Resistance to Levofloxacin in Stenotrophomonas maltophilia

• Baek JH
• Kim CO
• Jeong SJ
• Ku NS
• Han SH
• Choi JY
• Yong D
• Song YG
• Lee K
• Kim JM

• KMID: 2130824
• DOI: http://doi.org/10.3349/ymj.2014.55.4.987

Abstract

PURPOSE
Fluoroquinolones, rapidly gaining prominence in treatment of Stenotrophomonas maltophilia (SMP), are noted for their potency and tolerability. However, SMP may rapidly acquire resistance to fluoroquinolones. We evaluated associations of clinical factors with acquisition of levofloxacin resistance (LFr) in SMP.
MATERIALS AND METHODS
Our retrospective cohort study was based on patient data collected between January 2008 and June 2010. Through screening of 1275 patients, we identified 122 patients with data for SMP antibiotic susceptibility testing in > or =3 serial SMP isolates.
RESULTS
We assigned the 122 patients to either the SS group (n=54) in which levofloxacin susceptibility was maintained or the SR group (n=31) in which susceptible SMP acquired resistance. In multivariate regression analysis, exposure to levofloxacin for more than 3 weeks [odds ratio (OR) 15.39, 95% confidential interval (CI) 3.08-76.93, p=0.001] and co-infection or co-colonization with Klebsiella pneumoniae resistant to levofloxacin (OR 4.85, 95% CI 1.16-20.24, p=0.030) were independently associated with LFr acquisition in SMP.
CONCLUSION
Acquisition of LFr during serial sampling of SMP was related to the levofloxacin exposure.

Keyword

Stenotrophomonas maltophilia; fluoroquinolones; levofloxacin; drug resistance

MeSH Terms

Aged
Anti-Bacterial Agents/*pharmacology/*therapeutic use
Fluoroquinolones/pharmacology/therapeutic use
Gram-Negative Bacterial Infections/drug therapy
Humans
Levofloxacin/*pharmacology/*therapeutic use
Microbial Sensitivity Tests
Middle Aged
Retrospective Studies
Stenotrophomonas maltophilia/drug effects/*pathogenicity
Anti-Bacterial Agents
Fluoroquinolones
Levofloxacin

Figure

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  Fig. 1 Selection of S. maltophilia isolates and patients. SMP, Stenotrophomonas maltophilia; AST, antimicrobial susceptibility test; S, susceptible; R, resistant.

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