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Original Research: Chest Infections |

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

Joshua S. Davis, MBBS, PhD; Mark McMillan, BN; Ashwin Swaminathan, MBBS; John A. Kelly, MBBS; Kim E. Piera, BSc; Robert W. Baird, MBBS; Bart J. Currie, MBBS; Nicholas M. Anstey, MBBS, PhD
Author and Funding Information

From the Global and Tropical Health Division (Drs Davis, Currie, and Anstey; Mr McMillan; and Ms Piera), Menzies School of Health Research, Charles Darwin University; and Department of Infectious Diseases (Drs Davis, Swaminathan, Kelly, Baird, Currie, and Anstey) and Department of Microbiology (Drs Swaminathan, Kelly, and Baird), Royal Darwin Hospital, Darwin, NT, Australia.

CORRESPONDENCE TO: Joshua S. Davis, MBBS, PhD, Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia; e-mail: joshua.davis@menzies.edu.au


FUNDING/SUPPORT: This work was supported by the National Health and Medical Research Council of Australia [program grant 1037304, practitioner fellowship to Dr Anstey 1042072, and early career fellowship 1013411 to Dr Davis].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(4):1038-1045. doi:10.1378/chest.13-3065
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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.

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