Patient: Alma Crost, 82 year old female.
Nursing home patient
Sputum specimen sent for culture and
GPC and WBCs
Organism identified as Streptococcus
Organism resistant to Penicillin,
Ampicillin, and Amoxicillin.
Lungs infected with
Spherical Gram Positive bacterium.
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
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.
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.
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
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
Most used antibiotics for pneumonia
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
Works better if not taking other medications such as alcohol or
alcohol containing medicines, minoglycoside antibiotics,
anticoagulants, diuretics, iron supplements, among some
Administered IV or IM
Is administered IV or IM
Vancomycin and Ceftriaxone
The normal side effects are nausea, dizziness, chills or
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
The medical history of Mrs. Crost is
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.
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
Make sure the medications are given adequately to the patient
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