Streptococcus pneumoniae

Patient: Alma Crost, 82 year old female. Conditions: Nursing home patient Pneumonia symptoms Sputum specimen sent for culture and sensitivity Lab Reports: GPC and WBCs Organism identified as Streptococcus pnemoniae Organism resistant to Penicillin, Ampicillin, and Amoxicillin.

Lungs infected with Streptococcus pneumoniae Healthy Lungs

Etiologic Agent Spherical Gram Positive bacterium. Lancet-shaped. Usually seen in pairs but can occur singly and in short chains. Cells are between 0.5 and 1.25 micrometers in diameter. Organisms are able to ferment glucose to lactic acid. Cell wall 6 layers thick. Bacterium is encapsulated The capsule is made of polysaccharides. This will not cause an immune response in systems that have not yet developed a humoral immunity such as neonates and very young children. Etiologic Agent

Streptococcus Pneumoniae

Meaning of Resistance In the 1960’s almost all strains of S. pneumoniae were susceptible to penicillin, but since then there has been an increasing prevalence of resistance. Especially in areas of high antibiotic use. The polysaccharide capsule makes the organism resistant to phagocytosis. If there is no pre-existing anticapsular antibody, alveolar macrophages cannot kill the pneumococci.

Exchange of DNA Has a natural transformation system as a mechanism of genetic exchange. This process is of medical significance because it clearly underlies the explosion of antibiotic resistance in the bacterium in the past 20 years. This bacteria can also be transformed with genes from related and unrelated bacteria. These conditions favor the occurrence of natural transformation and the emergence of spontaneous mutants resistant to the antibiotic

Treatments Most used antibiotics for pneumonia Cefazolin Vancomycin Cephalothin/Cefazolin Ceftriaxone Cefpodoxime Patients that are older than 65 years of age are more likely to experience all the side effects of the antibiotic Most recommended treatment for this kind of bacteria. Less desirable between the others because of dosing and tissue penetration Cefazolin Works better if not taking other medications such as alcohol or alcohol containing medicines, minoglycoside antibiotics, anticoagulants, diuretics, iron supplements, among some others. Administered IV or IM Is administered IV or IM

Vancomycin and Ceftriaxone Cefpodoxime Administered orally Vancomycin and Ceftriaxone The normal side effects are nausea, dizziness, chills or rashes, diarrhea Cefpodoxime and Cefazolin don’t have these as normal side effects; they are rare effects of the medicines. All of the four antibiotics state that the presence of other medical problems such as bleeding problems, kidney disease, liver disease, poor nutritional status and stomach or gastrointestinal disease may affect the use of them. Our patient should be treated with Cefpodoxime Vancomycin is not recommended for elders Administration of Ceftriaxone and Cefazolin Other treatments include rest, adequate fluid, and supplemental O2

Prognosis The medical history of Mrs. Crost is unknown. If we assume that she is a completely healthy and active woman, she might have a chance to recover from the pneumonia If there are other medical conditions such as diabetes, heart disease, liver and/or kidney disease, the chances of her fully recovering are not likely due to the fact that she can’t be treated with most antibiotics.

Precautions and Preventions Patient Should be isolated from the other patients Precautionary measurements signs outside her door Supply tissue to cover her cough as much as possible Health Care Provider Discard protective gear before leaving the room Wash hands Make sure the medications are given adequately to the patient Public The pneumococcal vaccine Highly recommended for people under the age of 55 The flu shot is another prevention because pneumonia is a complication of the flu