Medline ® Abstract for Reference 3
of 'Acinetobacter infection: Epidemiology, microbiology, pathogenesis, clinical features, and diagnosis'
Fulminant community-acquired Acinetobacter baumannii pneumonia as a distinct clinical syndrome.
Leung WS, Chu CM, Tsang KY, Lo FH, Lo KF, Ho PL
STUDY OBJECTIVES: Acinetobacter baumannii (AB) is an important cause of hospital-acquired pneumonia (HAP), and an uncommon but important cause of community-acquired pneumonia (CAP) with high mortality. To better characterize CAP-AB, we compared its clinical features and outcomes with a control group of HAP-AB patients.
METHODS: This is a retrospective case-control study comparing CAP-AB and HAP-AB patients, which was performed at United Christian Hospital between July 2000 and December 2003.
RESULTS: There were 19 cases of CAP-AB and 74 cases of HAP-AB. When compared with the HAP-AB group, the CAP-AB group had more ever-smokers (84.3% vs 55.4%, respectively; p = 0.031), more COPD patients (63.2% vs 29.7%, respectively; p = 0.014), and fewer median days of hospitalization (HAP-AB group, median, 0 days; CAP-AB group, 0 days [range, 0 to 30 days]; p = 0.049) in the previous year. The CAP-AB group had more patients with positive blood culture findings (31.6% vs 0%, respectively; p<0.001), a higher frequency of ARDS (84.2% vs 17.6%, respectively; p<0.001), and disseminated intravascular coagulation (DIC) (57.9% vs 8.1%, respectively; p<0.001). The median survival time was only 8 days in the CAP-AB group, vs 103 days in the HAP-AB group (p = 0.003). Factors associated with the higher mortality in the CAP-AB group included the presence of AB bacteremia (p = 0.040), platelet count of<120 x 10(9) cells/L (p = 0.026), pH<7.35 on presentation (p = 0.047), and the presence of DIC (p = 0.004).
CONCLUSIONS: CAP-AB appears to be a unique clinical entity with a high incidence of bacteremia, ARDS, DIC, and death, when compared to HAP-AB. Further studies are needed to investigate the mechanism of the fulminant nature of CAP-AB.
Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong SAR, Peoples Republic of China.