title: [Community-acquired Staphylococcus aureus pneumonia following influenza and the choice of empirical antibiotic treatment].
abstract: A 30-year-old man presented with community-acquired pneumonia (CAP), directly following influenza. Sputum Gram stain confirmed Staphylococcus aureus pneumonia. Initial empirical antimicrobial therapy did not cover S. aureus. The isolated S. aureus strain contained genes encoding exotoxins, such as Panton-Valentine leukocidin (PVL). This exotoxin is associated with high mortality and methicillin resistance, but in this patient the strain was susceptible to methicillin. The patient died. In the Netherlands the risk of methicillin resistance in PVL-positive S. aureus CAP is low but real. This should be taken into account when selecting empirical treatment, which can include the combination of flucloxacillin and rifampicin. This case report illustrates the difficulty in predicting the causative agent in CAP and highlights the usefulness of the sputum Gram stain. Moreover, clinical awareness and recognition of S. aureus CAP remains essential to the early initiation of directed therapy.
authors.affiliation: Leids Universitair Medisch Centrum, Afd. Infectieziekten, Leiden. c.van_nieuwkoop@lumc.nl
authors.forename: C
authors.initials: C
authors.lastname: van Nieuwkoop
authors.forename: A T
authors.initials: AT
authors.lastname: Bernards
authors.forename: E A
authors.initials: EA
authors.lastname: Compier
authors.forename: C V Elzo
authors.initials: CV
authors.lastname: Kraemer
authors.forename: L G
authors.initials: LG
authors.lastname: Visser
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001427:Bacterial Toxins / Q000096:biosynthesis*; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D005098:Exotoxins / Q000096:biosynthesis*; D017809:Fatal Outcome; D006801:Humans; D007251:Influenza, Human / Q000150:complications; D007956:Leukocidins / Q000096:biosynthesis*; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D011023:Pneumonia, Staphylococcal / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D013183:Sputum / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin