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Association of levofloxacin resistance with mortality in adult patients with invasive pneumococcal diseases: a post hoc analysis of a prospective cohort

  • Clinical and Epidemiological Study
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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.

Conclusion

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.

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Acknowledgments

We would like to thank all of the ANSORP study group investigators who participated in this study for their dedication and contribution. Wyeth Pharmaceuticals Inc. (currently, Pfizer Inc.) [0877X1-4448] and the Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Korea, supported this work. This study was also supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health and Welfare, Republic of Korea (A102065).

Conflict of interest

All authors have no conflicts of interest to declare.

Author information

Author notes

  1. H. Wang

    Present address: Peking University People’s Hospital, Beijing, China

Authors and Affiliations

  1. Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 135-710, Korea

    C.-I. Kang, J.-H. Song, D. R. Chung & K. R. Peck

  2. Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Korea

    J.-H. Song & S. H. Kim

  3. Siriraj Hospital, Mahidol University, Bangkok, Thailand

    V. Thamlikitkul

  4. Peking Union Medical College Hospital, Beijing, China

    H. Wang

  5. Princess Margaret Hospital, Hong Kong, China

    T. M. So

  6. National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan

    P.-R. Hsueh

  7. Institute for Medical Research, Kuala Lumpur, Malaysia

    R. M. Yasin

  8. Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Manila, Philippines

    C. C. Carlos

  9. Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam

    P. H. Van

  10. University of Colombo, Colombo, Sri Lanka

    J. Perera

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  1. C.-I. Kang
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Consortia

The Asian Network for Surveillance of Resistant Pathogens (ANSORP) Study Group

Corresponding author

Correspondence to J.-H. Song.

Additional information

The Asian Network for Surveillance of Resistant Pathogens (ANSORP) study group is given in the “Appendix”.

Appendix: Asian Network for Surveillance of Resistant Pathogens (ANSORP) study group

Appendix: Asian Network for Surveillance of Resistant Pathogens (ANSORP) study group

Hospitals and investigators participating in the ANSORP study group are as follows: Jae-Hoon Song (Organizer), Doo Ryeon Chung, Kyong Ran Peck, and Cheol-In Kang (Samsung Medical Center, Seoul), Joon-Sup Yeom (Kangbuk Samsung Hospital, Seoul), Hyun Kyun Ki (Konkuk University Hospital, Seoul), Jun Seong Son (Kyunghee University Hospital, Seoul), Yeon-Sook Kim (Chungnam National University Hospital, Daejeon), Ji-Young Rhee (Dankook University Hospital, Cheonan), Sook-In Jung and Kyung Hwa Park (Chonnam National University Hospital, Gwangju), Shin-Woo Kim and Hyun-Ha Chang (Kyungpook National University Hospital, Daegu), Ki Tae Kwon (Daegu Fatima Hospital, Daegu), Hyuck Lee (Dong-A University Hospital, Busan), Chisook Moon (Inje University Busan Paik Hospital, Busan), Sang Yop Shin (Cheju National University Hospital, Jeju), and Sang Taek Heo (Gyeongsang National University Hospital, Jinju; currently Cheju National University Hospital, Jeju) in Korea; Hui Wang (Peking Union Medical College Hospital, Beijing; currently Peking University People’s Hospital, Beijing), Bin Cao and Yingmei Liu (Beijing Chaoyang Hospital, Beijing), Yunjian Hu and Tieyiing Sun (Beijing Hospital, Beijing), Chao Zhuo and Danhong Su (Guangzhou Institute of Respiratory Diseases, Guangzhou), Yunsong Yu and Yang Qing (First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou), Rong Zhang (Second Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou), Ziyong Sun and Shengdao Xiong (Tongji Hospital of Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan), Yong Liu (Shengjing Hospital of China Medical University, Shenyang), Yunzhou Chu, Baiyi Chen, and Xiaochun Ma (The First Hospital China Medical University, Shenyang), Yonghong Yang, Xuzhuang Shen, Sangjie Yu, Kaihu Yao, and Yinghui Hu (Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing), Libo Wang and Chuangqing Wang (Pediatric Hospital of Fudan University, Shanghai), Yuan Chen, Ying Huang and Lan Liu (Chongquing Children’s Hospital, Chongquing), Yuejie Zheng (Shenzhen Children’s Hospital, Shenzhen), and Min Lu, Hong Zhang, and Quan Lu (Shanghai Children’s Hospital, JiaoTong University) in China; Thomas M. K. So and Tak Keung Ng (Princess Margaret Hospital) and Wai-Keung Kwan and Wing-kin To (Yan Chai Hospital) in Hong Kong; Po-Ren Hsueh (National Taiwan University Hospital, Taipei), Cheng-Hsun Chiu and Lin-Hui Su (Chang-Gung Children’s Hospital, Taoyuan), and Yen-Hsu Chen (Chung-ho Memorial Hospital, Kaohsiung) in Taiwan; Visanu Thamlikitkul (Siriraj Hospital, Bangkok) and Anan Chongthaleong (Chulalongkorn University Hospital, Bangkok) in Thailand; Rohani Md Yasin and Norazah Ahmad (Institute for Medical Research, Kuala Lumpur), Adeeba Kamarulzaman, Sasheela Vanar, and Rina Karunakaran (University Malaya Medical Centre, Kuala Lumpur), Dato’ Jeyaindran Sinnadurai, Shanti Rudra Deva, and Mohamad Nazri Aziz (Hospital Kuala Lumpur, Kuala Lumpur), Tan Kah Kee, Suhailah Md Hanapiah, Jaideep Singh Sidhu, and Jenny Tong May Geok (Hospital Seremban, Seremban), Mahiran Mustafa, Nurahan Binti Maning, and Shaiful Azman Zakaria (Hospital Kota Bharu, Kelantan), Christopher Lee, Anuradha a/p, Radhakrishnan, Shanti a/p Ratnam, Zubaidah Abdul Wahab, and Ariza Adnan (Hospital Sungai Buloh, Sungai Buloh, Selangor), Lily Ng, Timothy William, Kausalia a/p Chinnaiah, and Azura Hussin (Hospital Queen Elizabeth, Pulau Pinang), Ganeswrie Balan, Subramaniam Balan, Chua Hoch Hin, Tan Cheng Cheng, and Kan Foong Kee (Hospital Sultanah Aminah, Johor Bahru), Salbiah Hj Nawi, Loh Eng Chang, and Tang Swee Ping (Hospital Salayang, Kuala Lumpur), and Ahmad Kashfi Abd Rahman, Siow Yen Ching, Mohd Ridwan mohd, Noor, Jimmy Lee Kok Foo, Fatimah Haslina Abdullah, and Noraznita Safie (Hospital Tuanku Nur Zahira, Kuala Terengganu) in Malaysia; Celia Carlos (Research Institute for Tropical Medicine, Manila), Sullian Naval (The Lung Center of the Philippines, Quezon), Media dora Saniel (The Medical City, Pasig), Joanne Lobo (Davao Medical Center, Davao), Consuelo Malaga (Vicente Sotto Memorial Hospital), and Thea Pamela Cajulao and Xenia Fabay (Baguio General Hospital and Medical Center, Baguio City) in the Philippines; Pham Hung Van and Pham Thai Binh (University of Medicine and Pharmacy, Ho Chi Minh), Tran Van Ngoc and Tran Thi Thanh Nga (Cho Ray Hospital, Ho Chi Minh), Le Tien Dung (Nguyen Tri Phuong Hospital, Ho Chi Minh), Doan Mai Phuong (Bach Mai Hospital, Ha Noi), Tung Vu Nguyen (National Institute of Tropical Diseases, Ha Noi), Huyen Dieu Thi Phan (Hospital C in Da Nang, Da Nang), and Chau Vinh (Tropical Diseases Hospital, Ho Chi Minh) in Vietnam; M. K. Lalitha (Madras Medical Mission, Chennai), Saradha Suresh (Institute of Child Health, Chennai), and Ranganathan Iyer (Global Hospital, Hyderabad) in India; Nobuyuki Shimono and Yujiro Uchida (Kyushu University Hospital, Fukuoka) in Japan; Jennifer Perera (University of Colombo, Colombo) in Sri Lanka; and Atef M. Shibl (King Saud University Hospital, Riyadh) in Saudi Arabia.

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Kang, CI., Song, JH., Kim, S.H. et al. Association of levofloxacin resistance with mortality in adult patients with invasive pneumococcal diseases: a post hoc analysis of a prospective cohort. Infection 41, 151–157 (2013). https://doi.org/10.1007/s15010-012-0299-5

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  • DOI: https://doi.org/10.1007/s15010-012-0299-5

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