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Prophylactic administration of oral fluoroquinolones such as levofloxacin to neutropenic patients to prevent infection is common. Emergence of fluoroquinolone resistance in gram-negative organisms resident in such patients has been a concern. Recent experience at 1 institution, however, suggests that fluoroquinolone resistance can also occur in viridans group (VG) streptococci, which can translocate from the gastrointestinal tract to the blood and lead to septic shock in neutropenic patients, particularly bone-marrow transplant recipients.
Over an 8-week period in 2001, 6 of 37 neutropenic patients who underwent autologous peripheral-blood stem cell transplantation at a center that routinely employed levofloxacin prophylaxis developed bacter…