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Antimicrobial Agents and Chemotherapy, August 1998, p. 2032-2035, Vol. 42, No. 8
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Prevalence of a Putative Efflux Mechanism among Fluoroquinolone-Resistant Clinical Isolates of Streptococcus pneumoniae

Nigel P. Brenwald,1 Martin J. Gill,2 and Richard Wise1,*

Department of Microbiology, City Hospital NHS Trust, Birmingham B18 7QH,1 and Department of Infection, University of Birmingham Medical School, Birmingham B15 2TT,2 United Kingdom

Received 2 February 1998/Returned for modification 16 March 1998/Accepted 28 May 1998

Twenty-three norfloxacin-selected first-step mutants of Streptococcus pneumoniae showed low-level fluoroquinolone resistance. Their susceptibility to norfloxacin in the presence or absence of reserpine and known efflux pump substrates was determined by an agar dilution method. Five mutants showed four- to eightfold increases in their susceptibility to norfloxacin in the presence of reserpine and four- to eightfold decreases in their susceptibility to acriflavine and ethidium bromide. This phenotype is suggestive of an efflux mechanism of resistance. A representative of these mutants, 1N27, accumulated significantly less ethidium bromide than the parent strain; reserpine abolished these differences. No changes in the quinolone resistance-determining regions of parC, parE, gyrA, or gyrB were found in this mutant. By our validated agar dilution method, the efflux phenotype was sought in clinical isolates of S. pneumoniae. Of 1,037 clinical isolates examined from the United Kingdom, 273 showed reduced susceptibility to norfloxacin or ciprofloxacin. Of these, 45.4% showed the efflux phenotype. Our findings suggest that an efflux mechanism may be a frequent cause of clinically significant fluoroquinolone resistance in pneumococci.

* Corresponding author. Mailing address: Department of Microbiology, City Hospital NHS Trust, Dudley Road, Birmingham B18 7QH, United Kingdom. Phone: 44 121 507 4255. Fax: 44 121 551 7763. E-mail: r.wise{at}bham.ac.uk.

Antimicrobial Agents and Chemotherapy, August 1998, p. 2032-2035, Vol. 42, No. 8
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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