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[Pneumococcal pneumonia resistant to penicillin]
V Garrait1, T Vassal, V Barakett
1Service de Réanimation Polyvalente, Hôpital Saint-Antoine, Paris, France.
Abstract:
The authors report a case of community-acquired pneumonia in a patient with chronic obstructive lung disease. The initial antibiotic therapy consisted of an amoxicillin-clavulanic acid combination and intravenous macrolides. Twenty-four hours after admission, blood cultures were positive for pneumococcus. Pending the results of disc sensitivity tests, the antibiotic therapy was modified and amoxicillin alone was prescribed. Clinical deterioration then developed rapidly, as the pathogen was amoxicillin-resistant. Subsequently, the patient recovered under erythromycin therapy. As illustrated by this case, the emergence of pneumococci resistant, or showing low sensitivity to penicillins raises the problem of the antibiotic therapy to be used against community-acquired lung diseases.
Insights
Community-acquired pneumonia in COPD patients can be complicated by antibiotic-resistant Streptococcus pneumoniae. This case highlights the need for careful antibiotic selection and monitoring due to emerging penicillin resistance in pneumococcus.
Area of Science:
- Pulmonology
- Infectious Diseases
- Clinical Microbiology
Background:
- Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality, particularly in patients with chronic obstructive lung disease (COPD).
- Antibiotic resistance, especially among Streptococcus pneumoniae, poses a growing challenge in treating respiratory infections.
Observation:
- A patient with COPD developed CAP and was initially treated with amoxicillin-clavulanic acid and intravenous macrolides.
- Blood cultures identified Streptococcus pneumoniae, and antibiotic therapy was switched to amoxicillin alone pending sensitivity results.
- The patient experienced rapid clinical deterioration, indicating amoxicillin resistance of the pathogen.
Findings:
- The identified pneumococcus strain demonstrated resistance to amoxicillin, leading to treatment failure with monotherapy.
- Subsequent treatment with erythromycin resulted in patient recovery, confirming the pathogen's susceptibility to macrolides.
Implications:
- This case underscores the critical issue of emerging penicillin-resistant Streptococcus pneumoniae in CAP management.
- Judicious antibiotic selection and susceptibility testing are crucial for effective treatment of CAP in vulnerable populations like COPD patients.
- The findings necessitate a re-evaluation of empirical antibiotic strategies for CAP, considering local resistance patterns.