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A5224 - A Rare Case of Fulminant Community Acquired Acinetobacter Pneumonia in Northeast Pennsylvania
Author Block: D. Saha; Critical Care Medicine, Geisinger Medical Center, Danville, PA, United States.
Community-acquired pneumonia secondary to Acinetobacter species is associated with warmer regions of the world with maximum cases reported in Australia and South Asia. Although hospital-acquired pneumonia and ventilator-associated Pneumonia secondary to Acinetobacter species are not uncommon in the US, Acinetobacter species as the causative organism for community acquired pneumonia is extremely rare. Few cases reported come from the warmer regions of United States.
This case is a 37-year-old male residing in northeast Pennsylvania with community-acquired pneumonia secondary to Acinetobacter Baumanii which ran a fulminant course complicated by septic shock, bacteremia and multi-organ failure. Past medical history was significant for alcohol abuse, chronic pancreatitis, C diff, DM( controlled ), HTN, history of substance abuse on suboxone, active smoking history of 19 pack years. He endorsed binge drinking for one week prior to the onset of his symptoms. The patient required ventilator support for seven days. Antibiotic therapy comprised of Meropenem, Azithromycin, and Vancomycin before speciation which was later deescalated to Meropenem only. Besides initially being on multiple pressors and sodium bicarbonate infusion he also received stress dose steroids and high dose thiamine. Gram stain of tracheal aspirate and pleural fluid showed gram-negative cocco bacilli with blood and sputum cultures growing Acinetobacter Baumanii. He successfully recovered from his shock state and was liberated from the ventilator in six days with ICU discharge in ten days.
There is data mostly from studies from South Asia and Australia suggesting the strong association of community-acquired Acinetobacter with one or more of the putative risk factors of hazardous alcohol use, chronic lung disease, and diabetes mellitus. Therefore, although the incidence of Acinetobacter species as a causative organism for community-acquired pneumonia is rare in the US it should be considered in patients with these above mentioned typical risk factors especially in ones with a fulminant disease as evidenced by this case. In those cases, Meropenem should be the initial choice of empirical antibiotic till sensitivity is reported as Acinetobacter is notorious for development of drug resistance and is often resistant to the commonly adopted empirical drugs of choice for severe Community-Acquired Pneumonia.