Page 5 / Case 01/01
The audience attending the conference commented that penicillin-resistant Streptococcus pneumoniae is in the differential diagnosis, and so some would have added Vancomycin to cover this possibility in a child sick enough to go to the ICU.
The patient went to the wards 36 hours, 0.5 LPM O2. He was switched to penicillin after Strep pneumoniae grew from the blood with an MIC of 0.016.
24 hours later (day 5), the patient looked worse again. T° 39.6, RR 70 - 80, O2 sat 95% on room air. Capillary Blood Gas: pH 7.52, pCO2 - 30
A CXR was repeated.
WHAT DO YOU THINK?