@article{oai:nagasaki-u.repo.nii.ac.jp:00016472,
 author = {Hirakata, Yoichi and Mizuta, Yohei and Wada, Akihito and Kondoh, Akira and Kurihara, Shintaro and Izumikawa, Koichi and Seki, Masafumi and Yanagihara, Katsunori and Miyazaki, Yoshitsugu and Tomono, Kazunori and Kohno, Shigeru},
 issue = {1},
 journal = {Japanese journal of infectious diseases},
 month = {Feb},
 note = {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 microg/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., Japanese journal of infectious diseases, 60(1), pp.48-50; 2007},
 pages = {48--50},
 title = {The first telithromycin-resistant Streptococcus pneumoniae isolate in Japan associated with erm(B) and mutations in 23S rRNA and riboprotein L4.},
 volume = {60},
 year = {2007}
}