Abnormal morphology of bacteria in the sputa of patients treated with antibiotics

Filaments of Klebsiella pneumoniae were observed by Gram stain in the sputum of a patient with a respiratory infection who was treated with half the usual dose of cefazolin. Identical filaments were observed in vitro when this strain was incubated with subminimum inhibitory concentrations of cefazolin. Large gram-positive cocci containing multiple cross walls were observed by electron microscopy in the sputum of a patient with a respiratory infection who was treated with ampicillin and gentamicin. Antibiotic administration was suspended the night before the sputum was obtained. The ultrastructure of these cocci was very similar to the ultrastructure of Staphylococcus aureus incubated with subminimum inhibitory concentrations of cephaloridine or oxacillin. It was suspected that the low dose of cefazolin and the intermittent therapy with ampicillin resulted in a subminimum inhibitory concentration of antibiotic in the respiratory tract which induced the the abnormal morphology of the bacteria observed in the sputum of both patients. The presence of abnormal forms of bacteria in the specimen of a patient, rather than in the culture of a specimen, has clinical significance.