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Journal of Antimicrobial Chemotherapy (2001) 48, 553-555
© 2001 The British Society for Antimicrobial Chemotherapy

Brief report

In vivo selection of a target/efflux double mutant of Pseudomonas aeruginosa by ciprofloxacin therapy

I. Le Thomasa, G. Couetdicb, O. Clermonta, N. Brahimia, P. Plésiatb and E. Bingena,*

a Laboratoire de Microbiologie, Hôpital Robert Debré, 48 Boulevard Serurier, F-75395 Paris cedex 19; b Laboratoire de Bactériologie, Hôpital Jean Minjoz, F-25030 Besançon, France

We report the emergence after 4 days of ciprofloxacin monotherapy of a double mutant of Pseudomonas aeruginosa overexpressing the multidrug efflux system MexAB-OprM and harbouring a mutation in the gyrB gene. Compared with its initial susceptible counterpart, this mutant exhibited a significant increase in resistance to most of the ß-lactam antibiotics tested (16 x MIC of ticarcillin) and to ciprofloxacin (128 x MIC). Combined ceftazidime and amikacin therapy finally eradicated the resistant isolate and cured the patient of his infection. This case illustrates how strains of P. aeruginosa may develop high levels of fluoroquinolone resistance by combining efflux mechanisms and target alterations.

* Corresponding author. Tel: +33-1-40-03-23-40; Fax: +33-1-40-03-24-50; E-mail: edouard.bingen{at}rdb.ap-hop-paris.fr


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