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Levofloxacin linked to increased incidence of viridans streptococci
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The use of levofloxacin for neutropenic prophylaxis is associated with an increased incidence of Streptococcus viridans infection among patients with cancer, according to data presented at the 2014 European Congress of Clinical Microbiology and Infectious Diseases.
Janelle Wierenga, PhD, of Massey University in New Zealand, and colleagues assessed 261 patients who tested positive for viridans streptococci between 2006 and 2012. Of these, 142 patients had cancer and 69 patients received hematopoietic cell transplants. Study participants were aged at least 18 years.
Analysis indicated an increase in viridans streptococci with time among patients with cancer. S. mitis was more common in patients with cancer compared with those without (75.8% vs. 52.7%). Regarding antimicrobial resistance, there were no significant differences between patients with cancer and patients without. Thirty-nine percent of isolates were fluoroquinolone-resistant.
However, the majority of resistant isolates were from patients with cancer. Prophylactic levofloxacin use was the most significant risk factor for drug-resistant viridans streptococci. When excluding levofloxacin, primary diagnosis of an acute leukemia was associated with drug-resistant viridans streptococci, specifically from 2009 to 2012. Overall mortality was higher among patients with fluoroquinolone-resistant viridans streptococci.
“In a large tertiary health care system, we demonstrated that an increase in [viridans streptococci] bacteremia cases was almost exclusively found in cancer and [hematopoietic cell transplant] patients. Not surprisingly, the use of levofloxacin for neutropenic prophylaxis at the cancer center was associated with [fluoroquinolone] resistance,” the researchers concluded.
For more information:
Wierenga JR. Presented at: European Congress of Clinical Microbiology and Infectious Diseases; May 10-13, 2014; Barcelona, Spain.
Disclosure: Wierenga reports no relevant financial disclosures.