INTRAVENOUS STREPTOMYCIN USE IN A PATIENT INFECTED WITH HIGH-LEVEL, GENTAMICIN-RESISTANT STREPTOCOCCUS-FAECALIS

OBJECTIVE: To report a case of intravenous streptomycin sulfate use in a patient infected with high-level, gentamicin-resistant Streptococcu s faecalis. CASE SUMMARY: A 37-year-old woman with a history of schizo affective disorder, diabetes insipidus possibly induced by lithium, ch ronic renal insufficiency, and anemia presented with a two-day history of decreased responsiveness, decreased verbalization, and tremulousne ss. Her hospital course was complicated by polymicrobial sepsis (S.fae calis, coagulase-negative staphylococci, Citrobacter diversus, Enterob acter aerogenes, and unidentified gram-negative bacilli #2) requiring vancomycin and gentamicin therapy. Gentamicin was discontinued after t wo doses because she developed acute-on-chronic renal insufficiency. S ubsequent susceptibility data showed the enterococcus to be highly res istant to gentamicin. The patient deteriorated clinically when treated only with vancomycin. She remained septic with a blood pressure of 80 /40 mm Hg; streptomycin was added to her regimen. We were concerned th at streptomycin concentrations obtained following intramuscular admini stration would not be adequate because of possible hypoperfusion. Base d on limited published literature, streptomycin was administered intra venously via a central intravenous catheter. DISCUSSION: A review of h igh-level aminoglycoside-resistant S. faecalis and treatment with intr avenous streptomycin therapy are discussed. The availability and monit oring of streptomycin therapy are also described. CONCLUSIONS: Strepto mycin is an antimicrobial agent that must be used with vancomycin in s erious infections to eradicate high-level, gentamicin-resistant S.faec alis. Its unique administration and monitoring concerns require indivi dual patient assessment.