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Acinetobacter Baumannii as a Cause of Community Acquired Pneumonia
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A3611 - Acinetobacter Baumannii as a Cause of Community Acquired Pneumonia
Author Block: F. Alghoula1, A. Nayfeh2, N. Addasi1, J. D. Parekh3, M. Krishnan1, T. Kassim1, M. Reddy4; 1Internal medicine, Creighton university, Omaha, NE, United States, 2Chi Health Clinic, Omaha, NE, United States, 3Internal Medicine, Creighton University School of Medicine, Omaha, NE, United States, 4Creighton university, St. Louis, MO, United States.
Introduction:
Acinetobacter Baumannii (AB) is an important cause of ventilator associated pneumonia. However, it can rarely cause community acquired pneumonia which is usually fulminant and life threatening.
Case Description:A 66-year-old gentleman with a PMH significant for DM and homelessness. Presented complaining of a cough and hemoptysis of three days. On physical examination; the patient was tachypneic, Oxygen saturation was 82% on room air and auscultation revealed rales in the right lung zone. Laboratory workup was significant for a WBC of 3.1k/ul (normal 4-12 k/ul),a serum creatinine of 2.7 mg/dl (normal 0.5-1.5 mg/dl), and a serum Lactate of 11.5 mmol/L (normal 0.4-2 mmol/L). CXR showed consolidation involving the entire right lung. Patient progressively became more hypoxic, needed intubation and was transferred to the ICU for septic shock within four hours of presentation. He was started on IV Piperacillin-Tazobactam, Vancomycin and Levofloxacin empirically with no significant improvement. Patient's blood and sputum cultures later grew Acinetobacter Baumannii sensitive to Sulbactam, and he was switched to IV Ampicillin-Sulbactam and IV Amikacin. The patient improved significantly, was extubated on day four and discharged on IV Ampicillin-Sulbactam for a total duration of 14 days. Repeat blood cultures showed no growth.
Discussion:
Acinetobacter Baumannii is a typical nosocomial pathogen. However, it is increasingly implicated in highly fatal cases of community-acquired pneumonia. Fatality rates up to 60% have been reported. These patients usually present with a rapidly progressive productive cough, severe dyspnea, and hemoptysis sometimes. Early diagnosis, antibiotic susceptibility identification, and appropriate treatment had a significant impact on patients' prognosis. A low threshold to treat should be considered in patients with risk factors, including age above 50, alcoholism, tobacco dependence, diabetes mellitus and chronic lung disease. Sulbactam remains the antibiotic of choice for susceptible organisms but resistance is increasingly reported. Alternative choices include Carbapenems, Polymyxins, and Tigecycline. Combination therapy seems promising; however, more studies are needed to evaluate it.
Author Block: F. Alghoula1, A. Nayfeh2, N. Addasi1, J. D. Parekh3, M. Krishnan1, T. Kassim1, M. Reddy4; 1Internal medicine, Creighton university, Omaha, NE, United States, 2Chi Health Clinic, Omaha, NE, United States, 3Internal Medicine, Creighton University School of Medicine, Omaha, NE, United States, 4Creighton university, St. Louis, MO, United States.
Introduction:
Acinetobacter Baumannii (AB) is an important cause of ventilator associated pneumonia. However, it can rarely cause community acquired pneumonia which is usually fulminant and life threatening.
Case Description:A 66-year-old gentleman with a PMH significant for DM and homelessness. Presented complaining of a cough and hemoptysis of three days. On physical examination; the patient was tachypneic, Oxygen saturation was 82% on room air and auscultation revealed rales in the right lung zone. Laboratory workup was significant for a WBC of 3.1k/ul (normal 4-12 k/ul),a serum creatinine of 2.7 mg/dl (normal 0.5-1.5 mg/dl), and a serum Lactate of 11.5 mmol/L (normal 0.4-2 mmol/L). CXR showed consolidation involving the entire right lung. Patient progressively became more hypoxic, needed intubation and was transferred to the ICU for septic shock within four hours of presentation. He was started on IV Piperacillin-Tazobactam, Vancomycin and Levofloxacin empirically with no significant improvement. Patient's blood and sputum cultures later grew Acinetobacter Baumannii sensitive to Sulbactam, and he was switched to IV Ampicillin-Sulbactam and IV Amikacin. The patient improved significantly, was extubated on day four and discharged on IV Ampicillin-Sulbactam for a total duration of 14 days. Repeat blood cultures showed no growth.
Discussion:
Acinetobacter Baumannii is a typical nosocomial pathogen. However, it is increasingly implicated in highly fatal cases of community-acquired pneumonia. Fatality rates up to 60% have been reported. These patients usually present with a rapidly progressive productive cough, severe dyspnea, and hemoptysis sometimes. Early diagnosis, antibiotic susceptibility identification, and appropriate treatment had a significant impact on patients' prognosis. A low threshold to treat should be considered in patients with risk factors, including age above 50, alcoholism, tobacco dependence, diabetes mellitus and chronic lung disease. Sulbactam remains the antibiotic of choice for susceptible organisms but resistance is increasingly reported. Alternative choices include Carbapenems, Polymyxins, and Tigecycline. Combination therapy seems promising; however, more studies are needed to evaluate it.
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