A Case of Antimicrobial Non-compliance in an Immunocompromised Patient Resulting in Invasive Pneumococcal Disease

Abstract

A 46-year-old male patient initially presented to the ED with purulent otitis media and was discharged with empirically prescribed oral and otic ciprofloxacin. Cultures of the otic discharge grew drug-resistant S. pneumoniae that was sensitive only to vancomycin, rifampin, and levofloxacin. Upon reviewing the culture and sensitivities, the physician attempted to contact the patient multiple times to change therapy to levofloxacin. The patient's phone line had been disconnected. Twelve days later, the patient presented with cardinal signs of meningitis and admittance to the Intensive Care Unit was required. The patient had not been compliant with the prescribed antimicrobial regimen. Imaging studies and microbiologic cultures revealed that the untreated otitis media had resulted in otomastoiditis, meningitis and bacteremia. Past medical history included recurrent ear infections, intrahepatic shunt placement, hepatic portal hypertension, and alcoholism. The patient had multiple chronic disease processes that suppressed immune function, predisposing him to invasive disease including end-stage liver disease (chronic Hepatitis C and alcoholic cirrhosis), and uncontrolled diabetes mellitus. The patient required extensive antimicrobial therapy to treat the infection and recovered without neurological sequelae.

ABBREVIATIONS: Streptococcus pneumoniae - S. pneumoniae, Emergency Department - ED, Diabetes Mellitus - DM, Complete Blood Count - CBC, Comprehensive Metabolic Panel - CMP, Hepatitis C Virus - HCV, Cerebrospinal fluid - CSF, Blood Urea Nitrogen - BUN, White Blood Cell - WBC, Red Blood Cell - RBC