Jpn. J. Infect. Dis., 60 (1), 48-50, 2007

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Short Communication

The First Telithromycin-Resistant Streptococcus pneumoniae Isolate in Japan Associated with erm(B) and Mutations in 23S rRNA and Riboprotein L4

Yoichi Hirakata1,2*, Yohei Mizuta1, Akihito Wada3, Akira Kondoh1, Shintaro Kurihara1,2, Koichi Izumikawa1, Masafumi Seki1, Katsunori Yanagihara1,2, Yoshitsugu Miyazaki1, Kazunori Tomono1** and Shigeru Kohno1,2

1Second Department of Internal Medicine, Nagasaki University School of Medicine and Dentistry and 2Nagasaki University Infection Control and Education Center, Nagasaki 852-8501, and 3Department of Bacteriology, National Institute of Infectious Diseases, Tokyo 162-8640, Japan

(Received July 10, 2006. Accepted October 23, 2006)

*Corresponding author: Mailing address: Second Department of Internal Medicine, Nagasaki University School of Medicine and Dentistry, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Tel: +81-95-849-7276, Fax: +81-95-849-7285, E-mail:

**Present address: Division of Infection Control, Osaka University Hospital, Osaka 565-0871, Japan.

SUMMARY: This report presents the case of a patient associated with a Streptococcus pneumoniae isolate that was resistant to a new ketolide antibiotic, telithromycin (minimum inhibitory concentration: 4 µg/ml). The patient, a 61-year-old female with bronchiectasis, was treated with 200-400 mg of clarithromycin daily for 6 years until the isolation of the resistant strain but without prior exposure to telithromycin. The strain was isolated from her sputum but not from the nasopharynx. This isolate carried erm(B) and had mutations in 23S rRNA and riboprotein L4. To our knowledge, this is the first case report concerning a telithromycin-resistant S. pneumoniae isolate in Japan by mutation in L4. Although the long-term clarithromycin administration may have contributed to the induction of resistance in this patient, this could not be confirmed, since S. pneumoniae was not isolated until the present episode.

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