Streptococcus Streptococcus pneumoniaepneumoniae

Patient:Patient: Alma Crost, 82 year old female. Alma Crost, 82 year old female.Conditions:Conditions: Nursing home patientNursing home patient Pneumonia symptomsPneumonia symptoms Sputum specimen sent for culture and Sputum specimen sent for culture and

sensitivitysensitivityLab Reports:Lab Reports: GPC and WBCs GPC and WBCs Organism identified as Organism identified as Streptococcus Streptococcus

pnemoniaepnemoniae Organism resistant to Penicillin, Organism resistant to Penicillin,

Ampicillin, and Amoxicillin.Ampicillin, and Amoxicillin.

Healthy LungsLungs infected with Streptococcus pneumoniae

Spherical Gram Positive bacterium.Spherical Gram Positive bacterium. Lancet-shaped.Lancet-shaped. Usually seen in pairs but can occur Usually seen in pairs but can occur

singly and in short chains.singly and in short chains. Cells are between 0.5 and 1.25 Cells are between 0.5 and 1.25

micrometers in diameter.micrometers in diameter. Organisms are able to ferment Organisms are able to ferment

glucose to lactic acid.glucose to lactic acid. Cell wall 6 layers thick.Cell wall 6 layers thick. Bacterium is encapsulatedBacterium is encapsulated

The capsule is made of polysaccharides. The capsule is made of polysaccharides. This will not cause an immune response in This will not cause an immune response in

systems that have not yet developed a systems that have not yet developed a humoral immunity such as neonates and humoral immunity such as neonates and very young children.very young children.

Streptococcus Pneumoniae

In the 1960’s almost all strains of S. In the 1960’s almost all strains of S. pneumoniae were susceptible to pneumoniae were susceptible to penicillin, but since then there has been penicillin, but since then there has been an increasing prevalence of resistance.an increasing prevalence of resistance.

Especially in areas of high antibiotic use.Especially in areas of high antibiotic use.

The polysaccharide capsule makes the The polysaccharide capsule makes the organism resistant to phagocytosis.organism resistant to phagocytosis.

If there is no pre-existing anticapsular If there is no pre-existing anticapsular antibody, alveolar macrophages cannot antibody, alveolar macrophages cannot kill the pneumococci.kill the pneumococci.

Has a natural transformation system Has a natural transformation system as a mechanism of genetic exchange.as a mechanism of genetic exchange. This process is of medical significance This process is of medical significance

because it clearly underlies the because it clearly underlies the explosion of antibiotic resistance in the explosion of antibiotic resistance in the bacterium in the past 20 years.bacterium in the past 20 years.

This bacteria can also be transformed This bacteria can also be transformed with genes from related and with genes from related and unrelated bacteria.unrelated bacteria. These conditions favor the occurrence of These conditions favor the occurrence of

natural transformation and the natural transformation and the emergence of spontaneous mutants emergence of spontaneous mutants resistant to the antibioticresistant to the antibiotic

Most used antibiotics for pneumoniaMost used antibiotics for pneumonia VancomycinVancomycin Cephalothin/CefazolinCephalothin/Cefazolin CeftriaxoneCeftriaxone CefpodoximeCefpodoxime

VancomycinVancomycin Patients that are older than 65 years of age are more likely to Patients that are older than 65 years of age are more likely to

experience all the side effects of the antibioticexperience all the side effects of the antibiotic Most recommended treatment for this kind of bacteria.Most recommended treatment for this kind of bacteria. Less desirable between the others because of dosing and tissue Less desirable between the others because of dosing and tissue

penetrationpenetration

CefazolinCefazolin Works better if not taking other medications such as alcohol or Works better if not taking other medications such as alcohol or

alcohol containing medicines, minoglycoside antibiotics, alcohol containing medicines, minoglycoside antibiotics, anticoagulants, diuretics, iron supplements, among some others.anticoagulants, diuretics, iron supplements, among some others.

Administered IV or IMAdministered IV or IM

CeftriaxoneCeftriaxone Is administered IV or IMIs administered IV or IM

Cefpodoxime Cefpodoxime Administered orallyAdministered orally

Vancomycin and Ceftriaxone Vancomycin and Ceftriaxone The normal side effects are nausea, dizziness, chills or The normal side effects are nausea, dizziness, chills or

rashes, diarrhearashes, diarrhea Cefpodoxime and Cefazolin don’t have these as normal Cefpodoxime and Cefazolin don’t have these as normal

side effects; they are rare effects of the medicines.side effects; they are rare effects of the medicines. All of the four antibiotics state that the All of the four antibiotics state that the

presence of other medical problems such as presence of other medical problems such as bleeding problems, kidney disease, liver bleeding problems, kidney disease, liver disease, poor nutritional status and stomach disease, poor nutritional status and stomach or gastrointestinal disease may affect the use or gastrointestinal disease may affect the use of them.of them.

Our patient should be treated with Our patient should be treated with CefpodoximeCefpodoxime

Vancomycin is not recommended for eldersVancomycin is not recommended for elders Administration of Ceftriaxone and Cefazolin Administration of Ceftriaxone and Cefazolin

Other treatments include rest, adequate fluid, Other treatments include rest, adequate fluid, and supplemental Oand supplemental O22

The medical history of Mrs. Crost isThe medical history of Mrs. Crost isunknown. unknown. If we assume that she is aIf we assume that she is a

completely healthy and active woman, completely healthy and active woman, she might have a chance to recover she might have a chance to recover from the pneumoniafrom the pneumonia

If there are other medical conditions If there are other medical conditions such as diabetes, heart disease, liver such as diabetes, heart disease, liver and/or kidney disease, the chances of and/or kidney disease, the chances of her fully recovering are not likely due to her fully recovering are not likely due to the fact that she can’t be treated with the fact that she can’t be treated with most antibiotics.most antibiotics.

PatientPatient Should be isolated from the other patientsShould be isolated from the other patients Precautionary measurements signs outside her doorPrecautionary measurements signs outside her door Supply tissue to cover her cough as much as possibleSupply tissue to cover her cough as much as possible

Health Care ProviderHealth Care Provider Discard protective gear before leaving the roomDiscard protective gear before leaving the room Wash handsWash hands Make sure the medications are given adequately to the Make sure the medications are given adequately to the

patientpatient

PublicPublic The pneumococcal vaccineThe pneumococcal vaccine

Highly recommended for people under the age of 55Highly recommended for people under the age of 55 The flu shot is another prevention because pneumonia is The flu shot is another prevention because pneumonia is

a complication of the flua complication of the flu