SHM Converge Scientific Abstract ePoster Gallery-Infections on Infections; Resistant Streptococcal Pneumoniae in Severely Immunocompromised Patient

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This case report describes a rare instance of multidrug-resistant <em>Streptococcus pneumoniae</em> bacteremia in a 37-year-old man with advanced HIV/AIDS, active Kaposi sarcoma, chronic hepatitis C, substance use, heart failure, and a long-standing indwelling portacath. He had a history of multiple serious infections, including cryptococcal meningitis, neurosyphilis, VZV encephalitis, and ESBL urinary tract infection, indicating significant immunosuppression and repeated healthcare exposure.

He presented with three days of dyspnea and septic shock. Initial empiric treatment included cefepime and IV vancomycin. Imaging did not show pneumonia, but suggested pancreatitis and duodenitis. Blood cultures grew multidrug-resistant <em>S. pneumoniae</em>. His CD4 count was undetectable, and echocardiography showed no evidence of endocarditis. The portacath was removed, though the tip culture was negative. Repeat blood cultures cleared, and he was discharged on two weeks of parenteral cefepime.

The organism showed an unusual resistance pattern, remaining sensitive only to vancomycin, cefepime, levofloxacin, and chloramphenicol, while being resistant to azithromycin, cefaclor, cefuroxime, clindamycin, erythromycin, meropenem, penicillin, tetracycline, and trimethoprim-sulfamethoxazole. The authors emphasize that although the patient had multiple risk factors for bacteremia, multidrug-resistant pneumococcal infection is still highly unusual in the United States.

The report highlights major risk factors for pneumococcal resistance, including chronic illness, repeated antibiotic exposure, and immunosuppression. It also notes that pneumococcal vaccination is associated with reduced resistance. Overall, the case underscores the importance of recognizing antimicrobial resistance in common pathogens, especially in vulnerable immunocompromised patients, because resistance can lead to treatment failure and worse outcomes.

Asset Subtitle

Anna E. Schwab

Meta Tag

Author List Aaron Sidhu, Anna E. Schwab, Harneet Grewal, Randy Odero, Sajani Jivan

Category Clinical Vignettes

Concept Streptococcus pneumoniae bacteremia

Concept Multidrug-resistant Streptococcus pneumoniae

Concept Immunocompromised State

Concept Antibiotic susceptibility

Concept Antibiotic Resistance

Distinguished Non-Finalist

Presenter Organization Abrazo

Presenting Author Anna E. Schwab

Track Adult

Keywords

multidrug-resistant Streptococcus pneumoniae

bacteremia

advanced HIV/AIDS

septic shock

immunosuppression

portacath

antimicrobial resistance

cefepime

vancomycin

pneumococcal infection

Streptococcus pneumoniae bacteremia

Multidrug-resistant Streptococcus pneumoniae

Immunocompromised State

Antibiotic susceptibility

Antibiotic Resistance