We report the history of a 38-year-old male native of Sri Lanka admitted to the emergency ward because of
chest pain and
shortness of breath. On physical and radiographic examination a bilateral predominantly right-sided
pneumonia was found. The patient was admitted to the medical ICU and an
antibiotic regimen with
amoxicillin/clavulanic acid and
erythromycin was initiated. Shortly afterwards
septic shock developed. The patient was intubated and received high doses of
catecholamines. He died 30 hours after admission to the hospital. Cultures from sputum, tracheal aspirate and blood grew Acinetobacter baumanni. Acinetobacter is an ubiquitous gram-negative rod with coccobacillary appearance in clinical specimens, that may appear gram-positive due to poor discoloration on Gram-
stain. It is a well known causative agent of
nosocomial infections, particularly in intensive care units. Community-acquired
pneumonias, however, are quite rare. Sporadic cases have been reported from the US, Papua-New Guinea and Australia. Interestingly, these
pneumonias are fulminant and have a high mortality.
Chronic obstructive lung disease, diabetes, and tobacco and alcohol consumption appear to be predisposing factors. Due to the rapid course and poor prognosis, prompt diagnosis and adequate
antibiotic treatment are indicated.
Antibiotics use for community-acquired
pneumonias, such as
amoxicillin/clavulanic acid or
macrolides, are not sufficient. Appropriate
antibiotics for the initial treatment of suspected
Acinetobacter infections include
imipenem and carboxy- and ureidopenicillins combined with an
aminoglycoside.