Susceptibility to levofloxacin of Mycobacterium tuberculosis isolates from patients with HIV-related tuberculosis and characterization of a strain with levofloxacin monoresistance

David C. Perlman, Wafaa M. El Sadr, Leonid B. Heifets, Eileen T. Nelson, John P. Matts, Keith Chirgwin, Nadim Salomon, Edward E. Telzak, Oscar Klein, Barry N. Kreiswirth, James M. Musser, Richard Hafner

Research output: Contribution to journalArticle

51 Scopus citations

Abstract

Objective: To characterize the susceptibility to levofloxacin of clinical isolates of Mycobacterium tuberculosis (MTB) obtained from patients with HIV-related tuberculosis and to characterize the molecular genetics of levofloxacin resistance. Design and methods: Isolates from culture-positive patients in a United States multicenter trial of HIV-related TB were tested for susceptibility to levofloxacin by minimum inhibitory concentration (MIC) determinations in Bactec 7H12 broth. Automated sequencing of the resistance determining region of gyrA was performed. Results: Of the 135 baseline MTB isolates tested, 134 (99%; 95% exact binomial confidence interval, 95.9-99.9%) were susceptible to levofloxacin with an MIC ≤ 1.0 μg/ml. We identified a previously unrecognized mis-sense mutation occurring at codon 88 of gyrA in a levofloxacin mono-resistant MTB isolate obtained from a patient with AIDS who had received ofloxacin for 8 months prior to the diagnosis of tuberculosis. Conclusions: Clinical MTB isolates from HIV-infected patients were generally susceptible to levofloxacin. However, the identification of a clinical isolate with mono-resistance to levofloxacin highlights the need for circumspection in the use of fluoroquinolones in the setting of potential HIV-related tuberculosis and for monitoring of rates of resistance of MTB isolates to fluoroquinolones.

Original languageEnglish (US)
Pages (from-to)1473-1478
Number of pages6
JournalAIDS
Volume11
Issue number12
DOIs
StatePublished - 1997

Keywords

  • Drug resistance
  • Fluoroquinolones
  • Levofloxacin
  • Mycobacterium tuberculosis
  • Tuberculosis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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