Complicated Thoracic Empyema of Serotype 23F Streptococcus pneumoniae in an Adult Patient

We report a case of thoracic empyema in a 61-year-old male patient, a heavy smoker with malignancy undergoing chemotherapy. The patient's clinical symptoms included shortness of breath, productive cough, fever, and chest pain. This patient had never received antibiotics before. Streptococcus pneumoniae was isolated from a bedside culture of empyema fluid collected through thoracentesis. The empyema fluid was cultured on chocolate agar plates and in aerobic and anaerobic culture bottles. The isolate was identified as serotype 23F, a vaccine strain with sequence type 17532. The isolate was resistant to chloramphenicol, tetracycline, and cotrimoxazole. The patient clinically improved with the administration of combined intravenous ceftriaxone and levofloxacin antibiotics, along with chest tube drainage via thoracostomy. This is the first report of thoracic empyema caused by S. pneumoniae in an adult in Indonesia. Serotype 23F is multi-resistant with low invasiveness, typically causing infections in patients with underlying health conditions. The pneumococcal conjugate vaccine covers it; thus, it usually occurs in areas with low vaccine coverage. Our findings support the importance of improving adult pneumococcal vaccination coverage in Indonesia.