ID/CC A 25-year-old male presents with spiking fevers, malaise, left-sided chest pain, and cough.
HPI His symptoms started two weeks ago and have progressively worsened despite a full course of oral antibiotics. He also reports a history of prior IV drug abuse.
PE VS: fever (39.2°C); tachycardia (HR 105); tachypnea. PE: "amphoric" breath sounds heard over left lower lobe; SI and S2 normally heard without murmurs, gallops or rubs.
Labs CBC: leukocytosis, predominantly neutrophilic. Blood cultures negative; Induced sputum cultures grew methicillin-resistant Staphylococcus aureus.
Imaging XR, chest: 2- by 3-cm cavity in left lower lobe of lung with air-fluid level. CT, chest: confirmed a left lower lobe lung abscess.
Treatment Intravenous vancomycin therapy; add an aminoglycoside for synergistic bactericidal effect.
Discussion Antibiotic resistance is continuing to increase in both the hospital (nosocomial infections) and the community. Major resistant nosocomial organisms include S. aureus, vancomycin-resistant enterococcus (VRE), Klebsiella, Enterobacter, Escherichia coli, Pseudomonas, and Acinetobacter. Multidrug-resistant bacteria causing community-acquired infections include pneumococcus, gonococcus, Mycobacterium tuberculosis, group A streptococci, and E. coli. Methicillin-resistant S. aureus (MRSA) is becoming widespread in a number of communities and is more commonly seen in IV drug abusers, patients with recent hospitalizations, and residents in chronic care facilities. Antibiotic resistance arises from numerous factors, including colonization in hospital patients and frequent antibiotic use/abuse in the community.
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