Chapter 15: Infectious Diseases: Gentamicin/<i>MT-RNR1</i> Case

Mark S. is a 5'7", 140-lbs., 36-year-old male of East Asian ancestry with a history of chronic vape use (10+ years: when at home he typically puffs his vape pen every few minutes), presenting at the urgent care clinic affiliated with the regional hospital. He is complaining of extreme fatigue, fever, chills, shortness of breath, and a productive cough with discolored sputum. Mark states he felt like he was “getting a bug” a few days ago and thought that it would just go away, saying, “I normally get a cold a few times a year, but I have never had anything like this before. I took Tylenol® and Mucinex® DM, but nothing is helping.” During a physical assessment, the NP discovers bilateral wheezing, rales, and rhonchi. Mark’s O2 saturation is 88%, and the NP decides that it would be appropriate to admit Mark to the hospital with a diagnosis of pneumonia. Upon admission, chest x-ray shows bilateral infiltrates characteristic of pneumonia. Additionally, culture and susceptibility reports come back positive for Klebsiella pneumoniae. Due to Mark’s listed medication allergies, the attending hospitalist would like to start him on gentamicin. Prior to starting the medication, the hospitalist stops and ask you if ototoxicity is a concern in this patient, as he recently read something about MT-RNR1 and hearing loss with aminoglycoside exposure.