A 16-Year Prospective Study of Community-Onset Bacteremic Acinetobacter Pneumonia Low Mortality With Appropriate Initial Empirical Antibiotic Protocols
A 16-Year Prospective Study of Community-Onset Bacteremic Acinetobacter Pneumonia Low Mortality With Appropriate Initial Empirical Antibiotic Protocols
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DOI：
10.1378/chest.13-3065
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发表时间：
2014-10-01
期刊：
影响因子：
9.6
通讯作者：
Anstey, Nicholas M.
中科院分区：
文献类型：
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作者：
Davis, Joshua S.;McMillan, Mark;Anstey, Nicholas M.
背景：不动杆菌属是一种众所周知的医院内致病菌，也可引起严重的社区发病性肺炎。以前的小病例系列表明暴发性疾病和合并医院死亡率> 60%.METHODS：我们进行了一项前瞻性观察研究，研究对象是1997 - 2012年在澳大利亚热带地区的一家三级转诊医院，在引入涵盖不动杆菌属的常规经验性治疗方案后，所有由不动杆菌属引起的菌血症、社区发病和放射学证实的肺炎。收集人口统计学、临床、微生物学和结局数据。结果：有41例菌血症社区发病不动杆菌肺炎，其中36例无指标提示与医疗相关的感染。其中38人（93%）是澳大利亚土著人，一半是男性，平均年龄为44.1岁，36起（88%）发生在雨季。所有患者都至少有一个危险因素，其中82%的患者有危险的酒精摄入。在可用于分子形态分析的37株分离株中，35株为鲍曼不动杆菌，2株为医院不动杆菌。所有分离株在体外对庆大霉素、美罗培南和环丙沙星敏感，但只有一株对头孢曲松完全敏感。80%的患者需要入住ICU。所有41例患者均在入院后24 h内接受了适当的抗生素治疗，28 d和90 d的死亡率均较低，为11%.CONCLUSIONS：社区获得性不动杆菌肺炎是一种严重疾病，大多数患者需要入住ICU。大多数患者都有危险因素，特别是危险的酒精使用。尽管如此，所有患者正确的初始经验性抗生素治疗与低死亡率相关。
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.