[Failure of levofloxacin therapy in two cases of community-acquired pneumonia caused by fluoroquinolone-resistant Streptococcus pneumoniae and complicated with empyema]. / Fracaso terapéutico de levofloxacino en dos casos de neumonía adquirida en la comunidad complicada con empiema causados por Streptococcus pneumoniae resistente a fluoroquinolonas.

BACKGROUND: Community acquired pneumonia (CAP) due to Streptococcus pneumoniae is a frequent cause of morbidity and mortality. We communicate two cases of CAP with complications. In both cases levofloxacin-resistant S. pneumoniae was isolated in pleural effusion. Patient 1: A 51-year-old man who had not received previous treatment with quinolones was admitted to the hospital for CAP and initially treated with levofloxacin (500 mg/24h iv). Four days later pleural effusion developed and fluid culture isolated levofloxacin-resistant S. pneumoniae (MIC > 32 .g/ml). The outcome was favorable following chest tube placement and treatment with beta-lactam antibiotics. Patient 2: A 73-year-old man with a history of chronic obstructive pulmonary disease was admitted due to CAP and was initially treated with levofloxacin (500 mg/24 h iv). He was transferred to our hospital after 10 days of treatment with this antibiotic, following the development of pleural effusion with isolation of levofloxacin-resistant S. pneumoniae (MIC = 12 .g/ml). The patient was treated with chest tube placement and beta-lactam antibiotics with a favorable outcome. CONCLUSIONS: Patients with CAP treated empirically must be closely followed, both clinically and radiologically, to facilitate early detection of complications due to bacterial resistance to the prescribed antibiotic. Patients with CAP who have received quinolones in the weeks before the development of pneumonia should not been treated empirically with these antibiotics because of the risk of resistance development.

Fracaso terapéutico de levofloxacino en dos casos de neumonía adquirida en la comunidad complicada con empiema causados por Streptococcus pneumoniae resistente a fluoroquinolonas / Failure of levofloxacin therapy in two cases of community-acquired pneumonia caused by fluoroquinolone-resistant Streptococcus pneumoniae and complicated with empyema

Antecedentes. La neumonía adquirida en la comunidad (NAC) por Streptococcus pneumoniae es una causa frecuente de mortalidad y morbilidad. Se describen 2 casos de NAC tratadas con levofloxacino que se complicaron. En ambos casos se aisló en líquido pleural S. pneumoniae resistente al antibiótico empleado. El primer caso correspondía a un varón de 51 años, no tratado previamente con quinolonas. Ingresó en el hospital por NAC tratada inicialmente con levofloxacino (500 mg/24 h i.v.). A los 4 días aparece un derrame pleural en el que se aísla S. pneumoniae resistente a levofloxacino (concentración inhibitoria mínima [CIM] > 32 µg/ml). El paciente evolucionó favorablemente mediante drenaje del derrame y tratamiento con antibiótico betalactámico. El segundo caso era un varón de 73 años con antecedentes de enfermedad pulmonar obstructiva crónica. Ingresa por NAC tratada inicialmente con levofloxacino (500 mg/24 h i.v.). Fue remitido a nuestro hospital por presencia de derrame pleural en el que creció S. pneumoniae resistente a levofloxacino (CIM = 12 µg/ml) tras 10 días de tratamiento antibiótico. El paciente evolucionó de manera favorable mediante drenaje del derrame y tratamiento con antibiótico betalactámico. Conclusiones. Los pacientes con NAC en los que se inicia tratamiento antibiótico empírico deben vigilarse estrechamente desde el punto de vista clínico y radiológico, para la detección precoz de complicaciones por resistencia bacteriana al antibiótico empleado. En los pacientes con NAC que hayan recibido quinolonas en las semanas previas al desarrollo de la neumonía no es recomendable iniciar tratamiento empírico con estos antibióticos dado el riesgo de desarrollo de resistencias (AU)

Background. Community acquired pneumonia (CAP) due to Streptococcus pneumoniae is a frequent cause of morbidity and mortality. We communicate two cases of CAP with complications. In both cases levofloxacin-resistant S. pneumoniae was isolated in pleural effusion. Patient 1: A 51-year-old man who had not received previous treatment with quinolones was admitted to the hospital for CAP and initially treated with levofloxacin (500 mg/24h iv). Four days later pleural effusion developed and fluid culture isolated levofloxacin-resistant S. pneumoniae (MIC > 32 µg/ml). The outcome was favorable following chest tube placement and treatment with beta-lactam antibiotics. Patient 2: A 73-year-old man with a history of chronic obstructive pulmonary disease was admitted due to CAP and was initially treated with levofloxacin (500 mg/24 h iv). He was transferred to our hospital after 10 days of treatment with this antibiotic, following the development of pleural effusion with isolation of levofloxacin-resistant S. pneumoniae (MIC = 12 µg/ml). The patient was treated with chest tube placement and beta-lactam antibiotics with a favorable outcome. Conclusions. Patients with CAP treated empirically must be closely followed, both clinically and radiologically, to facilitate early detection of complications due to bacterial resistance to the prescribed antibiotic. Patients with CAP who have received quinolones in the weeks before the development of pneumonia should not been treated empirically with these antibiotics because of the risk of resistance development (AU)