Nosocomial epiglottitis associated with penicillin- and cephalosporin-resistant Streptococcus pneumoniae bacteremia.

We cared for a 4-year-old male with nosocomially acquired epiglottitis caused by Streptococcus pneumoniae. He had been receiving ceftazidime therapy when this infection was recognized. The S. pneumoniae isolate was of serotype 15B and was resistant to beta-lactam antibiotics, cephalosporins (including those with extended spectra), and trimethoprim-sulfamethoxazole. Clinicians and clinical microbiologists must be aware that cephalosporin susceptibility may no longer be assumed for penicillin-resistant S. pneumoniae isolates and that susceptibility testing for the extended-spectrum cephalosporins should be performed whenever this species is isolated from a normally sterile body fluid.