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A case of Streptococcus intermedius empyema.

Kurt A Wargo1, Victoria J McConnell, Steven A Higginbotham

  • 1Harrison School of Pharmacy, Auburn University, Huntsville, AL, USA. wargoka@auburn.edu

The Annals of Pharmacotherapy
|June 1, 2006
PubMed
Summary

Community-acquired pneumonia (CAP) can lead to rare complications like empyema, even with appropriate treatment. Streptococcus intermedius empyema may not respond to standard CAP antibiotics, requiring prompt clinical suspicion and potentially aggressive interventions.

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Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Critical Care Medicine

Background:

  • Community-acquired pneumonia (CAP) is a common respiratory infection, typically managed with antibiotics.
  • Complications of CAP can include pleural effusions and empyema, necessitating prompt diagnosis and treatment.
  • Certain microorganisms, though rare, can cause severe CAP complications resistant to standard therapies.

Observation:

  • A case of empyema caused by Streptococcus intermedius in an 85-year-old woman with multiple comorbidities is presented.
  • The patient experienced two episodes of CAP and a chronic bronchitis exacerbation preceding empyema development.
  • Despite initial and subsequent broad-spectrum antibiotic therapy, S. intermedius persisted in empyema fluid cultures.

Findings:

  • Empyema due to Streptococcus intermedius occurred as a complication of community-acquired pneumonia.

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  • Standard antimicrobial regimens effective against typical CAP pathogens were insufficient to eradicate S. intermedius.
  • Surgical decortication proved unsuccessful, highlighting the aggressive nature of this complication.

    • Implications:

    • Clinicians should maintain a high index of suspicion for empyema or thoracic abscess in CAP patients with persistent infections or treatment failures.
    • While S. intermedius is historically susceptible to CAP antibiotics, treatment failure warrants consideration of alternative pathogens and advanced therapies.
    • Prompt recognition and aggressive management, potentially including surgical intervention, are crucial for improving outcomes in rare, resistant empyema cases.