CASE HISTORY
Brian,a 14-year-old boy with fever (39° C,or 102.2° F),chills,and left-sided pleuritic chest pain (pain when inhaling)was referred to a hospital emergency department by his general practitioner.A chest X-ray showed left lower lobe pneumonia.The boy reported that he was allergic to amoxicillin and cephalosporins (as a child he had developed a rash to these agents)and had been taking daily doxycycline (tetracycline)for the previous three months to treat mild acne.He was admitted to the hospital and treated with intravenous erythromycin because of his reported beta-lactam allergies,but he continued to feel sick.The day after admission,both sputum and blood cultures grew Streptococcus pneumoniae.After 48 hours,antibiotic susceptibility results indicated that the microbe was resistant to penicillin,erythromycin,and tetracycline.Armed with this information,the clinician immediately changed antibiotic treatment to vancomycin,a drug still effective in the face of these resistance mechanisms.The boy's fever resolved over the next 12 hours,and he made a slow but full recovery over the next week.
Would you have predicted the resistance profile of the Streptococcus pneumoniae causing Brian's infection? Why?

Question

Quizplus · Accepted Answer

The Answer of CASE HISTORY
Brian,a 14-year-old boy with fever (39° C,or 102.2° F),chills,and left-sided pleuritic chest pain (pain when inhaling)was referred to a hospital emergency department by his general practitioner.A chest X-ray showed left lower lobe pneumonia.The boy reported that he was allergic to amoxicillin and cephalosporins (as a child he had developed a rash to these agents)and had been taking daily doxycycline (tetracycline)for the previous three months to treat mild acne.He was admitted to the hospital and treated with intravenous erythromycin because of his reported beta-lactam allergies,but he continued to feel sick.The day after admission,both sputum and blood cultures grew Streptococcus pneumoniae.After 48 hours,antibiotic susceptibility results indicated that the microbe was resistant to penicillin,erythromycin,and tetracycline.Armed with this information,the clinician immediately changed antibiotic treatment to vancomycin,a drug still effective in the face of these resistance mechanisms.The boy's fever resolved over the next 12 hours,and he made a slow but full recovery over the next week.
Would you have predicted the resistance profile of the Streptococcus pneumoniae causing Brian's infection? Why?

CASE HISTORY Brian,a 14-Year-Old Boy with Fever (39° C,or 102.2° F),chills,and Left-Sided