Acinetobacter calcoaceticus pneumonia and the formation of pneumatoceles.
Pneumatoceles are cystic lesions of the lungs often seen in children with staphylococcal pneumonia and positive-pressure ventilation. Acinetobacter calcoaceticus is an aerobic, short immobile gram-negative rod, or coccobacillus, which is an omnipresent saprophyte. The variant anitratus is the most clinically significant pathogen in this family, usually presenting as a lower respiratory tract infection. Acinetobacter has been demonstrated to be one of the most common organisms found in the ICU. We present three critically ill surgery patients with Acinetobacter pneumonia, high inspiratory pressures, and the subsequent development of pneumatoceles. One of these patients died from a ruptured pneumatocele, resulting in tension pneumothorax. Treatment of pneumatoceles should center on appropriate intravenous antimicrobial therapy. This should be culture directed but is most often accomplished with Imipenem. Percutaneous, computed tomographic-guided catheter placement or direct tube thoracostomy decompression of the pneumatocele may prevent subsequent rupture and potentially lethal tension pneumothorax.
Hunt
J P
JP
Department of Surgery, Louisiana State University Medical Center, New Orleans 70112, USA.
Buechter
K J
KJ
Fakhry
S M
SM
D000151:Acinetobacter Infections / Q000150:complications* / Q000628:therapy*; D016954:Acinetobacter calcoaceticus; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015505:Chest Tubes; D003131:Combined Modality Therapy; D016638:Critical Illness; D003428:Cross Infection / Q000150:complications* / Q000628:therapy*; D003560:Cysts / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D004352:Drug Resistance, Microbial; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D008297:Male; D008826:Microbial Sensitivity Tests; D018410:Pneumonia, Bacterial / Q000150:complications* / Q000628:therapy*; D011030:Pneumothorax / Q000382:microbiology; D011175:Positive-Pressure Respiration / Q000009:adverse effects*; D011859:Radiography
D000900:Anti-Bacterial Agents