Community-acquired pneumonia caused by carbapenem-resistant Streptococcus pneumoniae: re-examining its prevention and treatment

Abstract

Asako Doi,1,2 Kentaro Iwata,3 Hiroshi Takegawa,4 Kanji Miki,5 Yumi Sono,1,2 Hiroaki Nishioka,2 Jumpei Takeshita,6 Keisuke Tomii,7 Tsunekazu Haruta11Department of Infectious Diseases, 2Department of General Internal Medicine, Kobe City Medical Center General Hospital, 3Division of Infectious Diseases, Kobe University Hospital, Japan; 4Department of Laboratory Medicine, Kobe City Medical Center General Hospital, Japan; 5Hyogo Health Service Association, Hyogo, 6Foundation of Biochemical Research and Innovation, Osaka, 7Department of Pulmonary Medicine, Kobe City Medical Center General Hospital, Hyogo, JapanAbstract: A 73-year-old man with no significant past medical history or any history of health care visits was hospitalized for pneumonia. Sputum culture revealed multidrug-resistant Streptococcus pneumoniae, even to carbapenems. The patient was later treated successfully with levofloxacin. Throat cultures from his two grandchildren revealed S. pneumoniae with the same susceptibility pattern. Analysis for resistant genes revealed gPRSP (pbp1a + pbp2x + pbp2b gene variants) in both the patient and his grandchildren, none of whom had received pneumococcal vaccines of any kind. This case illustrates the importance of the emergence of carbapenem-resistant S. pneumoniae. Non-rational use of carbapenems for community-acquired infections may be counterproductive. This case also highlights the importance of pneumococcal vaccinations in children and the elderly.Keywords: carbapenem resistance, Streptococcus pneumoniae, pneumonia