Case Study 5

Read the following case study and derive what you can to assist the patient. This should involve assessment of the facts, development of a hypothesis, and use of data to resolve the hypothesis.

This 53-year-old man with a past medical history of non-insulin-dependent diabetes mellitus and hypertension was in his usual state of health until 4 days prior to admission when he developed fatigue, fever, chills, and a cough occasionally productive of green sputum. Over the 2 days prior to admission, he had drenching sweats, increasing dyspnea, and left-side pleuritic chest pain. The patient had smoked 2 packs of cigarettes a day for 40 years.

His physical examination was notable for an increased respiratory rate of 22/min, and crackles were heard over the right middle, left middle, and left lower lung fields. A chest radiograph demonstrated right lower lobe, left lingular, and left lower lobe infiltrates.

A Gram stain of the patient’s sputum contained >25 polymorphonuclear leukocytes per low-power field and 4+ (many) Gram-positive diplococci. Culture of the sputum grew 4+ (many) Streptococcus pneumoniae as well as normal respiratory biota. One set (both bottles) of two sets of blood cultures drawn prior to the administration of antibiotics grew the organisms shown on Gram stain in Fig. 1. The organism growing from a subculture of the blood is shown in Fig. 2. (sheep blood agar). Further biochemical testing revealed the organism to be catalase positive and coagulase negative.

⦁ What is the blood culture isolate?
⦁ What is the significance of the patient’s blood culture isolate?
⦁ How can one determine the clinical significance of this organisms in a given patient?
⦁ What is the clinical impact of this type of blood culture isolate in terms of length of stay, Antibiotic administration, and additional testing?
⦁ What can be done to present this type of blood culture isolate in a health care facility?