A hospital's antimicrobial stewardship and infectious diseases teams are reviewing several complex cases involving severe adverse drug events. Match each patient's clinical presentation of an antimicrobial-induced complication to the specific pharmacologic agent most likely responsible.
- A 54-year-old man receiving intravenous therapy for right-sided methicillin-resistant Staphylococcus aureus (MRSA) endocarditis develops new-onset fever, hypoxic respiratory failure, and diffuse pulmonary infiltrates with peripheral eosinophilia.Daptomycin
- A 36-year-old woman treated with oral therapy for a polymicrobial diabetic foot infection presents to the emergency department with severe, sudden-onset posterior ankle pain and swelling that worsened after walking.Levofloxacin
- A 45-year-old man receiving high-dose prophylaxis for Pneumocystis jirovecii is noted to have asymptomatic hyperkalemia and an elevation in serum creatinine, though his true glomerular filtration rate remains unchanged.Trimethoprim-sulfamethoxazole
- A 68-year-old woman on long-term oral therapy for vancomycin-resistant Enterococcus (VRE) osteomyelitis develops bilateral stocking-glove sensory loss, visual changes, and new-onset thrombocytopenia.Linezolid
- A 72-year-old man with chronic kidney disease receiving intravenous therapy for Pseudomonas aeruginosa pneumonia develops sudden myoclonus, encephalopathy, and non-convulsive status epilepticus.Cefepime
Cevap
Eosinophilic pneumonia matches with Daptomycin. Achilles tendinopathy matches with Levofloxacin. Hyperkalemia and pseudo-kidney injury match with Trimethoprim-sulfamethoxazole. Myelosuppression and neuropathy match with Linezolid. Neurotoxicity and seizures match with Cefepime.
Each clinical vignette describes a hallmark adverse reaction to a specific antimicrobial agent used in serious infections. Daptomycin is known to cause acute eosinophilic pneumonia. Levofloxacin carries a black box warning for Achilles tendinopathy. Trimethoprim-sulfamethoxazole blocks ENaC channels causing hyperkalemia and inhibits creatinine secretion without true renal injury. Linezolid causes mitochondrial toxicity leading to cytopenias and neuropathy after prolonged use. Cefepime accumulates in renal failure, lowering the seizure threshold and causing distinct encephalopathy.
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Anahtar Kavram
Recognizing classic and severe adverse pharmacological effects of commonly used targeted antimicrobial therapies.