{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T04:26:29Z","timestamp":1788323189062,"version":"build-2803163510"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2005,11,24]],"date-time":"2005-11-24T00:00:00Z","timestamp":1132790400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2005,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>\n              <jats:italic>Streptococcus pneumoniae<\/jats:italic> is the leading cause of community-acquired pneumonia (CAP). High global incidence of macrolide and penicillin resistance has been reported, whereas fluoroquinolone resistance is uncommon. Current guidelines for suspected CAP in patients with co-morbidity factors and recent antibiotic therapy recommend initial empiric therapy using one fluoroquinolone or one macrolide associated to other drugs (amoxicillin, amoxicillin\/clavulanate, broad-spectrum cephalosporins). Resistance to fluoroquinolones is determined by efflux mechanisms and\/or mutations in the <jats:italic>parC<\/jats:italic> and <jats:italic>parE<\/jats:italic> genes coding for topoisomerase IV and\/or <jats:italic>gyrA<\/jats:italic> and <jats:italic>gyrB<\/jats:italic> genes coding for DNA gyrase. No clinical cases due to fluoroquinolone-resistant <jats:italic>S. pneumoniae<\/jats:italic> strains have been yet reported from Italy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Case presentation<\/jats:title>\n            <jats:p>A 72-year-old patient with long history of chronic obstructive pulmonary disease and multiple fluoroquinolone treatments for recurrent lower respiratory tract infections developed fever, increased sputum production, and dyspnea. He was treated with oral levofloxacin (500 mg bid). Three days later, because of acute respiratory insufficiency, the patient was hospitalized. Levofloxacin treatment was supplemented with piperacillin\/tazobactam. Microbiological tests detected a <jats:italic>S. pneumoniae<\/jats:italic> strain intermediate to penicillin (MIC, 1 mg\/L) and resistant to macrolides (MIC &gt;256 mg\/L) and fluoroquinolones (MIC &gt;32 mg\/L). Point mutations were detected in <jats:italic>gyrA<\/jats:italic> (Ser81-Phe), <jats:italic>parE<\/jats:italic> (Ile460-Val), and <jats:italic>parC<\/jats:italic> gene (Ser79-Phe; Lys137-Asn). Complete clinical response followed treatment with piperacillin\/tazobactam.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>This is the first Italian case of community-acquired pneumonia due to a fluoroquinolone-resistant <jats:italic>S. pneumoniae<\/jats:italic> isolate where treatment failure of levofloxacin was documented. Molecular analysis showed a group of mutations that have not yet been reported from Italy and has been detected only twice in Europe. Treatment with piperacillin\/tazobactam appears an effective means to inhibit fluoroquinolone-resistant strains of <jats:italic>S. pneumoniae<\/jats:italic> causing community-acquired pneumonia in seriously ill patients.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/1471-2334-5-106","type":"journal-article","created":{"date-parts":[[2005,11,25]],"date-time":"2005-11-25T07:14:01Z","timestamp":1132902841000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Failure of levofloxacin treatment in community-acquired pneumococcal pneumonia"],"prefix":"10.1186","volume":"5","author":[{"given":"Andrea","family":"Endimiani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gioconda","family":"Brigante","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia A","family":"Bettaccini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Luzzaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Grossi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Q","family":"Toniolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2005,11,24]]},"reference":[{"key":"254_CR1","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1093\/jac\/dkg465","volume":"52","author":"R Canton","year":"2003","unstructured":"Canton R, Morosini M, Enright MC, Morrissey I: Worldwide incidence, molecular epidemiology and mutations implicated in fluoroquinolone-resistant Streptococcus pneumoniae : data from the global PROTEKT surveillance programme. 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