(640) Community-Acquired Acinetobacter baumannii Pneumonia: An Unusual but Deadly Pathogen

Introduction: Acinetobacter baumannii is typically a nosocomial pathogen associated with pneumonia and catheter-associated bacteremia. The incidence of community-acquired Acinetobacter pneumonia is markedly lower, but it tends to be more severe than its nosocomial counterpart. Here, we describe a case of community-acquired Acinetobacter baumannii pneumonia presenting with fulminant septic shock, respiratory failure, and bacteremia.

Description: A 68 year-old with COPD and alcohol use disorder presented from home with respiratory distress. He was emergently intubated. Shortly afterwards, he suffered PEA arrest with return of spontaneous circulation after one round of ACLS protocol. His chest x-ray revealed left lower lobe pneumonia. His pH was 7.18 and lactic acid was 15.9. He was started on vancomycin and cefepime and given a fluid bolus. He was admitted to the ICU in septic shock requiring vasopressor support. Blood cultures returned positive for pan-sensitive Acinetobacter baumannii. Infectious disease recommended cefiderocol, metronidazole and a single dose of gentamicin. Despite mechanical ventilation and escalating doses of norepinephrine, vasopressin, and epinephrine, he developed refractory mixed metabolic and respiratory acidosis. Cardiothoracic surgery was consulted for consideration of ECMO, however he was too unstable to tolerate the procedure. Continuous inhaled epoprostenol was given. Less than 24 hours into hospitalization he again suffered cardiac arrest related to profound shock and refractory acidosis. Return of spontaneous circulation was achieved, but he suffered recurrent cardiac arrests. Family decided to cease further resuscitation efforts and the patient expired.

Discussion: Community-acquired Acinetobacter baumannii has most often been reported in tropical climates, typically affecting patients with serious comorbidities; it is very rare in the US. Alcohol abuse is thought to be a major risk factor. Others include tobacco use, COPD, and diabetes. Though often not as drug resistant as the nosocomial Acinetobacter, community-acquired infections are associated with higher mortality and more severe presentations. This rare and ultimately fatal case highlights the severity of Acinetobacter baumannii as a community-acquired pathogen.