Hospital-acquired pneumonia caused by multidrug-resistant Streptococcus pneumoniae serotype 15A.

IF 3.6 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-09-23 DOI:10.1007/s15010-025-02652-3

Hidemasa Akazawa, Shinnosuke Fukushima, Kenta Nakamoto, Kohei Oguni, Madoka Shimbe, Bin Chang, Yukihiro Akeda, Hideharu Hagiya

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引用次数: 0

Abstract

Background: Streptococcus pneumoniae remains a common cause of community-acquired pneumonia but is an infrequent pathogen in hospital-acquired pneumonia (HAP). Non-vaccine serotypes of multidrug-resistant (MDR) S. pneumoniae strains have been emerging globally, posing an increased risk of nosocomial infection.

Case: A 71 year-old man developed pneumonia on postoperative day 4 following spinal fusion surgery. Despite initial treatment with ampicillin/sulbactam, his condition deteriorated, requiring ICU admission and mechanical ventilation. Microbiological testing confirmed S. pneumoniae as a causative pathogen, and ceftriaxone was empirically administered based on the local antibiogram. However, antimicrobial susceptibility testing revealed resistant profiles to penicillin (minimum inhibitory concentration [MIC], 8 µg/mL), ceftriaxone (MIC, 16 µg/mL), meropenem (MIC, 1 µg/mL), macrolides, and clindamycin, while demonstrating susceptibility to levofloxacin and vancomycin. The therapeutic regimen was subsequently adjusted to levofloxacin, resulting in clinical improvement. The isolate was later identified as serotype 15A, sequence type 63 (ST63).

Conclusion: This case highlights that MDR S. pneumoniae can cause early-onset HAP and may not be covered by standard empiric therapies, emphasizing the need for careful evaluation of treatment response. Continued surveillance of infections caused by vaccine-escape clones like MDR serotype 15A is essential, given their increasing clinical relevance.

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15A型多重耐药肺炎链球菌引起的医院获得性肺炎

背景：肺炎链球菌仍然是社区获得性肺炎的常见原因，但在医院获得性肺炎（HAP）中是一种罕见的病原体。多药耐药肺炎链球菌菌株的非疫苗血清型已在全球出现，增加了医院感染的风险。病例：一名71岁男性在脊柱融合术后第4天出现肺炎。尽管最初使用氨苄西林/舒巴坦治疗，但病情恶化，需要进入ICU并进行机械通气。微生物学检测证实肺炎链球菌为病原菌，并根据局部抗生素谱经验给予头孢曲松。然而，药敏试验显示对青霉素（最低抑制浓度[MIC]， 8µg/mL）、头孢曲松（MIC, 16µg/mL）、美罗培南（MIC, 1µg/mL）、大环内酯类药物和克林霉素耐药，同时对左氧氟沙星和万古霉素敏感。随后将治疗方案调整为左氧氟沙星，导致临床改善。该分离物经鉴定为15A血清型，序列63型（ST63）。结论：该病例强调耐多药肺炎链球菌可引起早发性HAP，可能不包括在标准的经验性治疗中，强调需要仔细评估治疗反应。鉴于耐多药15A血清型等疫苗逃逸克隆引起的感染日益增加的临床相关性，继续监测这些克隆引起的感染至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.