Fulminant Community-Acquired Acinetobacter baumannii Pneumonia as a Distinct Clinical Syndrome: Treatment and Antimicrobial Sensitivity

Fulminant Community-Acquired Acinetobacter baumannii Pneumonia as a Distinct Clinical Syndrome: Treatment and Antimicrobial SensitivityModerate and heavy growths of AB were reported in the respiratory specimens of CAP-AB patients in 21.1% and 78.9% of patients, respectively; the AB growth in HAP-AB patients was 24.3% and 75.7%, respectively. No patient underwent diagnostic BAL or protected specimen brush procedures in this study. Empirical antibiotics received by CAP-AB patients before culture and sensitivity usually comprised a combination of a (3-lactam and a macrolide. All of the AB isolates in the CAP-AB group were sensitive to amikacin, ticarcillin/clavulanate, cefoperazone/sulbactam, and ampicillin/sulbactam, while they were less sensitive to gentamicin (14 of 19 patients; 73.7%), tobramycin (14 of 19 patients; 73.7%), ciprofloxacin (9 of 19 patients; 47.4%), cotrimoxazole (9 of 19 patients; 47.4%), and piperacillin (6 of 19 patients; 31.6%). generic for doxycycline

When compared to the HAP-AB group, the CAP-AB group had a higher percentage of patients with positive blood culture findings, while positive findings in sputum or tracheal aspirates was not significantly different (Table 2). Bacteria other than AB cultured in the respiratory specimen was more commonly observed in the HAP-AB group than in the CAP-AB group (66.2% vs 21.1%, respectively; p = 0.001). However, AB was considered to be the predominant organism on direct Gram smear, and so it was considered as a probable pathogen. The antibiotics that were initially used are listed in Table 3. Thirty-two percent of CAP-AB patients received adequate antibiotic coverage for the strains of AB isolated vs 20.3% of HAP-AB patients, and this was not statistically significant. This indicated that most patients were not receiving adequate bacterial coverage before the sensitivity result. The antibiotic was changed in 52.6% of CAP-AB patients and in 67.6% of HAP-AB patients, and again this was not statistically significant. There were significant differences in the antibiotic sensitivity pattern between the two groups. Strains found in the CAP-AB group had lower sensitivity rate to ciprofloxacin (47.4% vs 78.4%, respectively; p = 0.011), cotrimoxazole (47.4% vs 81.1%, respectively; p = 0.006), and tobramycin (73.7% vs 97.3%, respectively; p = 0.004), but higher sensitivity rates to ticarcillin/clavulanate (100% vs 73.0%, respectively; p = 0.010) than those found in the HAP-AB group.

Table 3—Comparison of the Initial Antimicrobial Treatment for CAP-AB and HAP-AB

Parameters CAP-AB Group (n = 19) HAP-AB Group (n = 74) p Value
Appropriate initial antibiotic within 12 h Initial treatment according to antibiotic class 6(31.6) 15 (20.3) 0.36
P-lactam/|3-lactamase inhibitorst 6(31.6) 43 (58.1)
Cephalosporins 8(42.1) 28 (37.8)
Carbapenems 4 (21.1) 1 (1.4)
Macrolides 9 (47.4) 4 (5.4)
Fluoroquinolones 1 (5.3) 6(8.1)

 

This entry was posted in Pulmonary Function and tagged Acinetobacter baumannii, community-acquired pneumonia, hospital-acquired pneumonia.