title: Severe community-acquired Acinetobacter baumannii pneumonia: an emerging highly lethal infectious disease in the Asia-Pacific.
abstract: OBJECTIVE
  Patients with community-acquired Acinetobacter baumannii (AB) pneumonia have been reported from subtropical countries. We investigated the epidemiology, clinical and microbiological characteristics of community-acquired pneumonia (CAP) due to AB in Singapore.
  
  
  METHODS
  A retrospective case series was performed over a 21-month period at two institutions.
  
  
  RESULTS
  From 1 January 2007 to 30 September 2008, eight patients were diagnosed with CAP due to AB. Seven had bacteraemia and five were sputum culture-positive. The median age at presentation was 58.5 years (range 45-76 years). Five patients (71.4%) acquired the pneumonia in the warmer months of June to September. Presentation was acute, with a median duration of 2.5 days (range 1-7 days). The median Acute Physiology and Chronic Health Evaluation II score was 28.5 (range 6-36). Six patients presented with septic shock, lactic acidosis, acute kidney injury and respiratory failure, necessitating ICU care; five of these patients eventually died. All patients received empirical antibiotics, including third-generation cephalosporins, which were inactive against the organism. All isolates were susceptible to ampicillin/sulbactam, ciprofloxacin, co-trimoxazole, aminoglycosides and imipenem.
  
  
  CONCLUSIONS
  Community-acquired AB pneumonia have a fulminant course. In a region endemic for melioidosis and severe community-acquired Klebsiella pneumoniae, the challenge lies in rapid identification and initiation of appropriate empirical antibiotics to improve the survival of patients with AB CAP.
authors.affiliation: Division of Infectious Disease, Department of Medicine, National University Health System, Singapore 119074. c.ong09@imperial.ac.uk
authors.forename: Catherine W M
authors.initials: CW
authors.lastname: Ong
authors.forename: David C B
authors.initials: DC
authors.lastname: Lye
authors.forename: Kay Leong
authors.initials: KL
authors.lastname: Khoo
authors.forename: Gerald Seng Wee
authors.initials: GS
authors.lastname: Chua
authors.forename: Siang Fei
authors.initials: SF
authors.lastname: Yeoh
authors.forename: Yee Sin
authors.initials: YS
authors.lastname: Leo
authors.forename: Paul Ananth
authors.initials: PA
authors.lastname: Tambyah
authors.forename: Arlene Christine
authors.initials: AC
authors.lastname: Chua
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D040981:Acinetobacter baumannii / Q000472:pathogenicity*; D000368:Aged; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012846:Singapore / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology; D015996:Survival Rate