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Pneumonia Due to Pan-Resistant Acinetobactor Baumannii
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A5311 - Pneumonia Due to Pan-Resistant Acinetobactor Baumannii
Author Block: M. Elahee, A. Talat, M. Khalid, M. Shah, R. S. Bailey; Western Reserve Health Education/NEOMED, Youngstown, OH, United States.
Introduction:
Acinetobactor is a gram-negative coccobacillus notorious for causing nosocomial infections. We present a case of pan-resistant pneumonia by A. baumannii.
Case Presentation:
72-year-old Caucasian male presented with shortness of breath, dry cough, fever and chills. He was recently admitted for exacerbation of copd and was treated with antibiotics. On this admission, his heart rate was 170 and EKG showed atrial fibrillation. He underwent cardioversion and was started on amiodarone drip with conversion to sinus rhythm. CT chest showed near-complete consolidation of left upper lobe with air bronchograms compatible with lobar pneumonia which was absent on the CT scan 10 days ago. He was started on intravenous vancomycin, piperacillin-tazobactam and levofloxacin for healthcare associated pneumonia. On day 4, his oxygen requirements increased and eventually he had to be intubated. Bronschoscopy was planned but the patient further deteriorated, requiring 2 vasopressors to maintain blood pressure. Meropenem was added to medications but he continued to spike fevers with temperature of 105F. His kidney function worsened and eventually he became anuric. Nephrology planned to start hemodialysis via temporary dialysis catheter. His blood cultures came back positive for Acinetobactor baumannii which was resistant to most of the medications and sputum cultures showed heavy growth of the same organism. Ceftazidime/avibactum was added to his medications. On day 6, despite treatment, he developed multi-organ failure and passed away.
Discussion:
Risk factors for infection with resistant strains of Acinetobacter include prior use of antibiotics, ICU admission, mechanical ventilation, hemodialysis or prior colonization with MRSA. Community acquired infection although rare, has been reported in certain cases. In our patient, even though he was in the hospital few days ago, he did not require intubation. Community-acquired Acinetobacter pneumonia is typically characterized by a fulminant illness with an abrupt onset and rapid progression, as seen in this patient. When infections are caused by antibiotic- susceptible Acinetobacter isolates, therapeutic options include a broad-spectrum cephalosporin, a beta-lactam/beta- lactamase inhibitor or a carbapenem. In our patient A. baumannii was pan-resistant and did not respond to antibiotics. Inhaled colistin may be beneficial in selected patients, although not all studies suggest a benefit. In an observational study of 2500 patients, the overall mortality rate was 33 percent, and carbapenem resistance was associated with a greater risk of death. Despite treatment, A. baumannii infections are difficult to treat and mortality rates remain high.
Author Block: M. Elahee, A. Talat, M. Khalid, M. Shah, R. S. Bailey; Western Reserve Health Education/NEOMED, Youngstown, OH, United States.
Introduction:
Acinetobactor is a gram-negative coccobacillus notorious for causing nosocomial infections. We present a case of pan-resistant pneumonia by A. baumannii.
Case Presentation:
72-year-old Caucasian male presented with shortness of breath, dry cough, fever and chills. He was recently admitted for exacerbation of copd and was treated with antibiotics. On this admission, his heart rate was 170 and EKG showed atrial fibrillation. He underwent cardioversion and was started on amiodarone drip with conversion to sinus rhythm. CT chest showed near-complete consolidation of left upper lobe with air bronchograms compatible with lobar pneumonia which was absent on the CT scan 10 days ago. He was started on intravenous vancomycin, piperacillin-tazobactam and levofloxacin for healthcare associated pneumonia. On day 4, his oxygen requirements increased and eventually he had to be intubated. Bronschoscopy was planned but the patient further deteriorated, requiring 2 vasopressors to maintain blood pressure. Meropenem was added to medications but he continued to spike fevers with temperature of 105F. His kidney function worsened and eventually he became anuric. Nephrology planned to start hemodialysis via temporary dialysis catheter. His blood cultures came back positive for Acinetobactor baumannii which was resistant to most of the medications and sputum cultures showed heavy growth of the same organism. Ceftazidime/avibactum was added to his medications. On day 6, despite treatment, he developed multi-organ failure and passed away.
Discussion:
Risk factors for infection with resistant strains of Acinetobacter include prior use of antibiotics, ICU admission, mechanical ventilation, hemodialysis or prior colonization with MRSA. Community acquired infection although rare, has been reported in certain cases. In our patient, even though he was in the hospital few days ago, he did not require intubation. Community-acquired Acinetobacter pneumonia is typically characterized by a fulminant illness with an abrupt onset and rapid progression, as seen in this patient. When infections are caused by antibiotic- susceptible Acinetobacter isolates, therapeutic options include a broad-spectrum cephalosporin, a beta-lactam/beta- lactamase inhibitor or a carbapenem. In our patient A. baumannii was pan-resistant and did not respond to antibiotics. Inhaled colistin may be beneficial in selected patients, although not all studies suggest a benefit. In an observational study of 2500 patients, the overall mortality rate was 33 percent, and carbapenem resistance was associated with a greater risk of death. Despite treatment, A. baumannii infections are difficult to treat and mortality rates remain high.
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