Severe Adenoviral Pneumonia in an Immunocompetent Host with Persistent Fevers Treated with Multiple Empiric Antibiotics for Presumed Bacterial Co-Infection: An Antibiotic Stewardship Perspective on De-Escalation Derailed

Burke A Cunha; John Gian; Natalie C Klein

doi:10.3390/jcm6040042

Severe Adenoviral Pneumonia in an Immunocompetent Host with Persistent Fevers Treated with Multiple Empiric Antibiotics for Presumed Bacterial Co-Infection: An Antibiotic Stewardship Perspective on De-Escalation Derailed

J Clin Med. 2017 Apr 4;6(4):42. doi: 10.3390/jcm6040042.

Authors

Burke A Cunha^{1

2}, John Gian³, Natalie C Klein^{4

5}

Affiliations

¹ Infectious Disease Division, Winthrop-University Hospital, 222 Station Plaza North (Suite #432), Mineola, New York, NY 11501, USA. bacunha@winthrop.org.
² School of Medicine, State University of New York, Stony Brook, New York, NY 11794, USA. bacunha@winthrop.org.
³ Infectious Disease Division, Winthrop-University Hospital, 222 Station Plaza North (Suite #432), Mineola, New York, NY 11501, USA. jgian@winthrop.org.
⁴ Infectious Disease Division, Winthrop-University Hospital, 222 Station Plaza North (Suite #432), Mineola, New York, NY 11501, USA. nklein@winthrop.org.
⁵ School of Medicine, State University of New York, Stony Brook, New York, NY 11794, USA. nklein@winthrop.org.

Abstract

We present a case of severe adenoviral pneumonia in a 20-year-old immunocompetent host with persistently high fevers. The patient was needlessly given multiple empiric antibiotics for non-existent bacterial co-infection. This case has important antibiotic stewardship lessons for practitioners in approaching fevers in the ICU.

Keywords: antibiotic de-escalation; benefits of fever; clinical significance of fever; conjunctival suffusion; empiric antibiotic therapy; viral and bacterial co-infection; viral pneumonia.

Publication types

Case Reports