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(Chest. 2006;129:102-109.)
© 2006 American College of Chest Physicians

Fulminant Community-Acquired Acinetobacter baumannii Pneumonia as a Distinct Clinical Syndrome*

Wah-Shing Leung, MRCP; Chung-Ming Chu, FCCP; Kay-Yang Tsang, MRCP; Fu-Hang Lo, MRCP; King-Fan Lo, MRCP and Pak-Leung Ho, MRCPath

* From the Department of Medicine and Geriatrics (Drs. Leung, Chu, Tsang, F.-H. Lo, and K.-F. Lo), United Christian Hospital, Hong Kong SAR, Peoples Republic of China; and the Department of Microbiology (Dr. Ho), Division of Infectious Disease, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, Peoples Republic of China.

Correspondence to: Pak-Leung Ho, Division of Infectious Disease, Department of Microbiology and Centre of Infection, Queen Mary Hospital, University of Hong Kong, Pokfulam Rd, Pokfulam, Hong Kong SAR, Peoples Republic of China; e-mail: plho{at}hkucc.hku.hk

Abstract

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 109 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.

Key Words: Acinetobacter baumannii • community-acquired pneumonia • hospital-acquired pneumonia






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