Skip to main content
NCBI home page
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
. 1996 Sep;40(9):2117–2120. doi: 10.1128/aac.40.9.2117

In vitro activities of eight macrolide antibiotics and RP-59500 (quinupristin-dalfopristin) against viridans group streptococci isolated from blood of neutropenic cancer patients.

F Alcaide 1, J Carratala 1, J Liñares 1, F Gudiol 1, R Martin 1
PMCID: PMC163483  PMID: 8878591

Abstract

From January 1988 to December 1994, 66 consecutive blood culture isolates of viridans group streptococci collected from febrile neutropenic cancer patients were tested for antimicrobial susceptibilities by the agar dilution method. The antibiotics studied were erythromycin, clarithromycin, roxithromycin, dirithromycin, azithromycin, josamycin, diacetyl-midecamycin, spiramycin, and quinupristin-dalfopristin. A total of 26 (39.4%) strains were resistant to erythromycin with an MIC range of 0.5 to > 128 micrograms/ml. The strains were classified into three groups according to their penicillin susceptibility: 42 (63.6%) were susceptible, 8 (12.1%) were intermediately resistant, and 16 (24.3%) were highly resistant. The percentages of erythromycin-resistant strains in each group were 23.8, 62.5, and 68.8%, respectively. Streptococcus mitis was the species most frequently isolated (83.3%) and showed the highest rates of penicillin (40%) and erythromycin (43.6%) resistance. MICs of all macrolide antibiotics tested and of quinupristin-dalfopristin were higher for penicillin-resistant strains than for penicillin-susceptible strains. All macrolide antibiotics tested had cross-resistance to erythromycin, which was not observed with quinupristin-dalfopristin. Our study shows a high rate of macrolide resistance among viridans group streptococci isolated from blood samples of neutropenic cancer patients, especially those infected with penicillin-resistant strains. These findings make macrolides unsuitable prophylactic agents against viridans group streptococcal bacteremia in this patient population.

Full Text

The Full Text of this article is available as a PDF (183.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alcaide F., Liñares J., Pallares R., Carratala J., Benitez M. A., Gudiol F., Martin R. In vitro activities of 22 beta-lactam antibiotics against penicillin-resistant and penicillin-susceptible viridans group streptococci isolated from blood. Antimicrob Agents Chemother. 1995 Oct;39(10):2243–2247. doi: 10.1128/aac.39.10.2243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Awada A., van der Auwera P., Meunier F., Daneau D., Klastersky J. Streptococcal and enterococcal bacteremia in patients with cancer. Clin Infect Dis. 1992 Jul;15(1):33–48. doi: 10.1093/clinids/15.1.33. [DOI] [PubMed] [Google Scholar]
  3. Barry A. L., Fuchs P. C. In vitro activities of a streptogramin (RP59500), three macrolides, and an azalide against four respiratory tract pathogens. Antimicrob Agents Chemother. 1995 Jan;39(1):238–240. doi: 10.1128/aac.39.1.238. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bochud P. Y., Eggiman P., Calandra T., Van Melle G., Saghafi L., Francioli P. Bacteremia due to viridans streptococcus in neutropenic patients with cancer: clinical spectrum and risk factors. Clin Infect Dis. 1994 Jan;18(1):25–31. doi: 10.1093/clinids/18.1.25. [DOI] [PubMed] [Google Scholar]
  5. Burden A. D., Oppenheim B. A., Crowther D., Howell A., Morgenstern G. R., Scarffe J. H., Thatcher N. Viridans streptococcal bacteraemia in patients with haematological and solid malignancies. Eur J Cancer. 1991;27(4):409–411. doi: 10.1016/0277-5379(91)90373-l. [DOI] [PubMed] [Google Scholar]
  6. Carratalá J., Alcaide F., Fernández-Sevilla A., Corbella X., Lińares J., Gudiol F. Bacteremia due to viridans streptococci that are highly resistant to penicillin: increase among neutropenic patients with cancer. Clin Infect Dis. 1995 May;20(5):1169–1173. doi: 10.1093/clinids/20.5.1169. [DOI] [PubMed] [Google Scholar]
  7. Coykendall A. L. Classification and identification of the viridans streptococci. Clin Microbiol Rev. 1989 Jul;2(3):315–328. doi: 10.1128/cmr.2.3.315. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Devaux Y., Archimbaud E., Guyotat D., Plotton C., Maupas J., Fleurette J., Fiere D. Streptococcal bacteremia in neutropenic adult patients. Nouv Rev Fr Hematol. 1992;34(2):191–195. [PubMed] [Google Scholar]
  9. Dybedal I., Lamvik J. Respiratory insufficiency in acute leukemia following treatment with cytosine arabinoside and septicemia with streptococcus viridans. Eur J Haematol. 1989 Apr;42(4):405–406. [PubMed] [Google Scholar]
  10. Elting L. S., Bodey G. P., Keefe B. H. Septicemia and shock syndrome due to viridans streptococci: a case-control study of predisposing factors. Clin Infect Dis. 1992 Jun;14(6):1201–1207. doi: 10.1093/clinids/14.6.1201. [DOI] [PubMed] [Google Scholar]
  11. Guiot H. F., Peters W. G., van den Broek P. J., van der Meer J. W., Kramps J. A., Willemze R., van Furth R. Respiratory failure elicited by streptococcal septicaemia in patients treated with cytosine arabinoside, and its prevention by penicillin. Infection. 1990 May-Jun;18(3):131–137. doi: 10.1007/BF01642100. [DOI] [PubMed] [Google Scholar]
  12. Johnson C. C., Slavoski L., Schwartz M., May P., Pitsakis P. G., Shur A. L., Levison M. E. In vitro activity of RP 59500 (quinupristin/dalfopristin) against antibiotic-resistant strains of Streptococcus pneumoniae and enterococci. Diagn Microbiol Infect Dis. 1995 Mar;21(3):169–173. doi: 10.1016/0732-8893(95)00068-l. [DOI] [PubMed] [Google Scholar]
  13. Kern W. V., Hay B., Kern P., Marre R., Arnold R. A randomized trial of roxithromycin in patients with acute leukemia and bone marrow transplant recipients receiving fluoroquinolone prophylaxis. Antimicrob Agents Chemother. 1994 Mar;38(3):465–472. doi: 10.1128/aac.38.3.465. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Krcmery V., Trupl J. Bacteraemia due to penicillin-resistant Streptococcus viridans in cancer patients, before and after prophylaxis with penicillin. Lancet. 1995 Nov 18;346(8986):1362–1363. doi: 10.1016/s0140-6736(95)92374-8. [DOI] [PubMed] [Google Scholar]
  15. McWhinney P. H., Gillespie S. H., Kibbler C. C., Hoffbrand A. V., Prentice H. G. Streptococcus mitis and ARDS in neutropenic patients. Lancet. 1991 Feb 16;337(8738):429–429. doi: 10.1016/0140-6736(91)91205-9. [DOI] [PubMed] [Google Scholar]
  16. McWhinney P. H., Patel S., Whiley R. A., Hardie J. M., Gillespie S. H., Kibbler C. C. Activities of potential therapeutic and prophylactic antibiotics against blood culture isolates of viridans group streptococci from neutropenic patients receiving ciprofloxacin. Antimicrob Agents Chemother. 1993 Nov;37(11):2493–2495. doi: 10.1128/aac.37.11.2493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Rolston K. V., Elting L. S., Bodey G. P. Bacteremia due to viridans streptococci in neutropenic patients. Am J Med. 1995 Oct;99(4):450–450. doi: 10.1016/s0002-9343(99)80216-2. [DOI] [PubMed] [Google Scholar]
  18. Rozenberg-Arska M., Dekker A., Verdonck L., Verhoef J. Prevention of bacteremia caused by alpha-hemolytic streptococci by roxithromycin (RU-28 965) in granulocytopenic patients receiving ciprofloxacin. Infection. 1989 Jul-Aug;17(4):240–244. doi: 10.1007/BF01639528. [DOI] [PubMed] [Google Scholar]
  19. Santini C., Venditti M., Baiocchi P., Brandimarte C., Serra P., Mandelli F., Girmenia C., Micozzi A., Martino P. Emergence of penicillin-resistant viridans streptococci causing septicemia in granulocytopenic patients. Eur J Epidemiol. 1988 Sep;4(3):391–392. doi: 10.1007/BF00148932. [DOI] [PubMed] [Google Scholar]
  20. Sotiropoulos S. V., Jackson M. A., Woods G. M., Hicks R. A., Cullen J., Freeman A. I. Alpha-streptococcal septicemia in leukemic children treated with continuous or large dosage intermittent cytosine arabinoside. Pediatr Infect Dis J. 1989 Nov;8(11):755–758. doi: 10.1097/00006454-198911000-00005. [DOI] [PubMed] [Google Scholar]
  21. Spangler S. K., Jacobs M. R., Appelbaum P. C. Susceptibilities of penicillin-susceptible and -resistant strains of Streptococcus pneumoniae to RP 59500, vancomycin, erythromycin, PD 131628, sparfloxacin, temafloxacin, win 57273, ofloxacin, and ciprofloxacin. Antimicrob Agents Chemother. 1992 Apr;36(4):856–859. doi: 10.1128/aac.36.4.856. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Steiner M., Villablanca J., Kersey J., Ramsay N., Haake R., Ferrieri P., Weisdorf D. Viridans streptococcal shock in bone marrow transplantation patients. Am J Hematol. 1993 Apr;42(4):354–358. doi: 10.1002/ajh.2830420405. [DOI] [PubMed] [Google Scholar]
  23. Venditti M., Baiocchi P., Santini C., Brandimarte C., Serra P., Gentile G., Girmenia C., Martino P. Antimicrobial susceptibilities of Streptococcus species that cause septicemia in neutropenic patients. Antimicrob Agents Chemother. 1989 Apr;33(4):580–582. doi: 10.1128/aac.33.4.580. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Weisman S. J., Scoopo F. J., Johnson G. M., Altman A. J., Quinn J. J. Septicemia in pediatric oncology patients: the significance of viridans streptococcal infections. J Clin Oncol. 1990 Mar;8(3):453–459. doi: 10.1200/JCO.1990.8.3.453. [DOI] [PubMed] [Google Scholar]
  25. Wimperis J. Z., Baglin T. P., Marcus R. E., Warren R. E. An assessment of the efficacy of antimicrobial prophylaxis in bone marrow autografts. Bone Marrow Transplant. 1991 Nov;8(5):363–367. [PubMed] [Google Scholar]

Articles from Antimicrobial Agents and Chemotherapy are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES