The first case is a 54-year-old man with a history of liquor consumption every weekend until the embarrassment, four days of cough with purulent expectoration, fever of moderated effort hemimedicationC.
He was admitted with fever, tachycardia, tachypnea, hypoxemic and chest X-ray showed signs of pleural effusion and consolidation in the right base.
Laboratory evaluation showed leukocytosis of 14.500 per mm3, neutrophilia of 96%, hyperglycemia of 638 mg/dl, hyperazoemia (ureaic nitrogen in blood of 27.45 mg/dl).
The patient was hospitalized with a diagnosis of severe community-acquired pneumonia IIIA, according to the national guidelines for the management of this disease (6).
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The patient progressed rapidly to hypoxemic respiratory failure, septic shock and subsequently multiple organ dysfunction.
Ceftriaxone was administered to the intensive care unit. Antibiotic management was initiated with 2 g intravenous daily and clarithromycin 500 mg intravenous every 12 hours.
A computed tomography scan of the chest showed multilobar consolidation in the lower lobes with bilateral pleural effusion, not free in the right base.
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The pleural fluid study indicated empyema with presence in the stain of Gram positive cocci.
She required closed drainage anastomosis and later a more decortication was indicated.
During the first 72 hours after surgery, signs of systemic inflammatory response persist.
The deterioration of renal function required dialysis and the antibiotic was switched to linezolid.
Adequate change of antimicrobial agent was observed, which allowed its removal from the ventilator without the need for vasopressive support.
21 days of treatment were completed with satisfactory response and no need for additional outpatient antimicrobial therapy.
