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A 16-year Prospective Study of Community-Onset Bacteremic Acinetobacter Pneumonia: Low Mortality With Appropriate Initial Empirical Antibiotic Protocols

Davis, Joshua S., McMillan, Mark, Swaminathan, Ashwin, Kelly, John A., Piera, Kim E., Baird, Robert W., Currie, Bart J. and Anstey, Nicholas M. (2014). A 16-year Prospective Study of Community-Onset Bacteremic Acinetobacter Pneumonia: Low Mortality With Appropriate Initial Empirical Antibiotic Protocols. Chest,146(4):1038-1045.

Document type: Journal Article
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IRMA ID cmartelxPUB183
Title A 16-year Prospective Study of Community-Onset Bacteremic Acinetobacter Pneumonia: Low Mortality With Appropriate Initial Empirical Antibiotic Protocols
Author Davis, Joshua S.
McMillan, Mark
Swaminathan, Ashwin
Kelly, John A.
Piera, Kim E.
Baird, Robert W.
Currie, Bart J.
Anstey, Nicholas M.
Journal Name Chest
Publication Date 2014
Volume Number 146
Issue Number 4
ISSN 0012-3692   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84907919353
Start Page 1038
End Page 1045
Total Pages 8
Place of Publication United States of America
Publisher American College of Chest Physicians
HERDC Category C1 - Journal Article (DIISR)
Abstract BACKGROUND:
The genus Acinetobacter, well known as a nosocomial pathogen, can also cause severe community-onset pneumonia. Previous small case series have suggested fulminant disease and a pooled hospital mortality of > 60%.

METHODS:

We conducted a prospective observational study of all episodes of bacteremic, community-onset, and radiologically confirmed pneumonia due to Acinetobacter species at a tertiary referral hospital in tropical Australia from 1997 to 2012 following the introduction of routine empirical treatment protocols covering Acinetobacter. Demographic, clinical, microbiologic, and outcome data were collected.

RESULTS:

There were 41 episodes of bacteremic community-onset Acinetobacter pneumonia, of which 36 had no indicators suggesting health-care-associated infection. Of these, 38 (93%) were Indigenous Australians, one-half were men, the average age was 44.1 years, and 36 episodes (88%) occurred during the rainy season. All patients had at least one risk factor, with hazardous alcohol intake in 82%. Of the 37 isolates available for molecular speciation, 35 were Acinetobacter baumannii and two were Acinetobacter nosocomialis. All isolates were susceptible in vitro to gentamicin, meropenem, and ciprofloxacin, but only one was fully susceptible to ceftriaxone. ICU admission was required in 80%. All 41 patients received appropriate antibiotics within the first 24 h of admission, and 28- and 90-day mortality were both low at 11%.

CONCLUSIONS:

Community-acquired Acinetobacter pneumonia is a severe disease, with the majority of patients requiring ICU admission. Most patients have risk factors, particularly hazardous alcohol use. Despite this severity, correct initial empirical antibiotic therapy in all patients was associated with low mortality.

DOI http://dx.doi.org/10.1378/chest.13-3065   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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