Severe community-acquired Acinetobacter baumannii pneumonia: an emerging highly lethal infectious disease in the Asia-Pacific.
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.
Ong
Catherine W M
CW
Division of Infectious Disease, Department of Medicine, National University Health System, Singapore 119074. c.ong09@imperial.ac.uk
Lye
David C B
DC
Khoo
Kay Leong
KL
Chua
Gerald Seng Wee
GS
Yeoh
Siang Fei
SF
Leo
Yee Sin
YS
Tambyah
Paul Ananth
PA
Chua
Arlene Christine
AC
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