BOF: 6
A 76-year-old male has been
admitted to your ward following a stroke that has resulted in a left hemiplegia.
He is a mild diabetic and is hypertensive but both these conditions are well
controlled.
Seven days after admission the patient develops fever, tachycardia and
tachypnoea. On auscultation of his chest crepitations are heard over both lung
bases. Chest X-ray demonstrates bilateral basal pulmonary infiltrates.
Your decision regarding empirical antibiotic treatment for this condition will
be based on the assumption that the most likely causative organisms would be
a) Methicillin-resistant
Staphylococcus aureus
b) Methicillin-sensitive
Staphylococcus aureus
c) Pneumococcus
d) Gram-negative
organisms
e) Legionella
Answer
d)
The diagnosis in this
patient is most likely to be hospital-acquired pneumonia. After taking appropriate cultures, the patient should be
started on antibiotics.
Gram-negative organisms are the most likely cause of hospital-acquired
pneumonia.
Pneumococci are seldom isolated from culture and the most common gram-positive
organism that causes hospital-acquired pneumonia is Staphylococcus aureus,
particularly MRSA.
Revision Tip
Revise pneumonia
KEYS to SUCCESS in Medicine page 205-208
