Wargo Kurt A, McConnell Victoria J, Higginbotham Steven A
Harrison School of Pharmacy, Auburn University, Huntsville, AL, USA.
Ann Pharmacother. 2006 Jun;40(6):1208-10. doi: 10.1345/aph.1G704. Epub 2006 May 30.
To report a case of empyema caused by Streptococcus intermedius as a complication of community-acquired pneumonia (CAP).
An 85-year-old woman with a history of chronic obstructive pulmonary disease, asthma, heart failure, and hypothyroidism developed empyema as a result of 2 episodes of CAP and an acute exacerbation of chronic bronchitis within the past 2 months. Therapy with intravenous levofloxacin 750 mg every 48 hours was initiated. Culture results of the empyema fluid yielded pure growth of a rarely encountered microorganism, S. intermedius. Intravenous piperacillin/tazobactam 3.375 g every 6 hours was added to the antimicrobial therapy at that time. However, cultures continued to show S. intermedius. Surgical decortication was unsuccessful, and the patient died after a 30 day hospital stay.
Early, appropriate antimicrobial therapy is the mainstay of CAP treatment. Although rare, empyema or thoracic abscess can occur despite this therapy, due to mucosal changes caused by CAP. Historically, antimicrobial therapy used to treat organisms that typically cause CAP also has activity against S. intermedius. However, growth of this microorganism and failure to respond to therapy should alert clinicians to the possibility of empyema or abscess formation.
Despite historical in vitro susceptibility data of S. intermedius, antimicrobial therapy may be ineffective, and more extreme measures may be needed to achieve a successful outcome. Early, appropriate antimicrobial therapy needs to remain the mainstay of the treatment of CAP in an attempt to prevent fatal complications such as this from occurring.
报告1例由中间型链球菌引起的脓胸病例，该病例为社区获得性肺炎（CAP）的并发症。
一名85岁女性，有慢性阻塞性肺疾病、哮喘、心力衰竭和甲状腺功能减退病史，在过去2个月内发生2次CAP及慢性支气管炎急性加重，进而发展为脓胸。开始每48小时静脉注射750 mg左氧氟沙星进行治疗。脓胸积液培养结果显示一种罕见微生物中间型链球菌纯培养生长。当时在抗菌治疗中加用了每6小时静脉注射3.375 g哌拉西林/他唑巴坦。然而，培养结果仍显示为中间型链球菌。手术剥除术未成功，患者在住院30天后死亡。
早期、恰当的抗菌治疗是CAP治疗的主要手段。尽管少见，但即使进行了这种治疗，由于CAP引起的黏膜改变，仍可能发生脓胸或胸壁脓肿。从历史上看，用于治疗典型CAP病原体的抗菌治疗对中间型链球菌也有活性。然而，这种微生物生长且对治疗无反应应提醒临床医生注意脓胸或脓肿形成的可能性。
尽管中间型链球菌有既往体外药敏数据，但抗菌治疗可能无效，可能需要采取更极端的措施才能取得成功结果。早期、恰当的抗菌治疗仍应是CAP治疗的主要手段，以防止发生此类致命并发症。
