Multiple Antimicrobial-Resistant Bacteremia and Fungal Infection Pneumonia in Elderly Patient: A Case Study

Abstract

Introduction: The spread of multidrug-resistant bacterial pathogens has become alarming globally. Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) have been recognized as a major multidrug-resistant bacteria implicated in hospital and community-acquired infections worldwide.Case: We present the case of an elderly male, 74-year-old, with multiple comorbidities, who came to the hospital with main symptoms of cough. Three months previously, he was diagnosed with pneumonia. Nevertheless, he was treated as an outpatient, with Cefixime prescribed as an oral antibiotic. His non-contrast chest CT Scan showed opacities at the upper zone, middle zone and lower zone of the left lung and the lower zone of the right lung. The patient’s symptoms and imaging expertise strongly suggest a pulmonary infection. Sputum culture and sensitivity test result eventually confirmed positive E. coli isolates demonstrated resistance to Augmentin, Ceftazidime, Gentamicin, Ampicillin sulbactam, Aztreonam, Cefotaxime, Cefepime. Fungal culture by sputum specimen revealed growth of Candida, non-Candida albicans. Concurrently, history of hospitalization and antibiotic treatment exposure are considered risk factors for the acquisition of multidrug resistance in this patient. Furthermore, corticosteroids in elderly patients are alleged as a risk factor of fungal infection.Conclusion: The increasing case of antimicrobial resistance in elderly patients is challenging for the clinician. Culture and sensitivity tests performed before starting antimicrobial treatment in hospitalized geriatric patients can reduce unnecessary and inappropriate antimicrobial use. Fungal test is considered to be done in a susceptible case of the elderly patients. The rapid diagnosis followed with prompt initiation of appropriate antibiotic and antifungal therapy is urgently required.