Acinetobacter Pneumonia: A Review

Joshua D. Hartzell, MD, Andrew S. Kim, MD, Mark G. Kortepeter, MD, MPH, Kimberly A. Moran, MD

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In This Article

Clinical Features

Patients with hospital-acquired or ventilator-associated Abc pneumonia present similarly to patients with VAP or HAP caused by other nosocomial pathogens. Community-acquired Acinetobacter pneumonia is unusual but has been reported in the literature, mainly from Australia and Asia.[55,56,57,58,59,60,61,62,63,64,65,66] Cases tend to occur in patients who are smokers, have diabetes, or have chronic obstructive pulmonary disease.[55,56,57] However, cases have been reported in healthy individuals.[55,56,57,58,59]

In a case-control study of A baumannii community-acquired pneumonia (ACAP) vs AHAP (19 and 74 cases, respectively),[55] fever was present in over 80% of cases in both groups. Cough was more common in outpatients (84% vs 49%; P = .008), although this may be result from inpatients being mechanically ventilated. Sputum production was more common in inpatients (93 vs 68%; P = .008). Sputum or tracheal cultures were positive in 95% of outpatients and 100% of inpatients in this cohort. Limited data were presented on findings on chest radiography, but lobar consolidation was found more consistently in outpatients (68% vs 16%; P = .013.). Pulmonary cavitations were absent in both groups, and only AHAP was associated with small pleural effusions (12%). The ACAP cases had a higher incidence of bacteremia, acute respiratory distress syndrome, and death. All ACAP isolates were sensitive to amikacin, ticarcillin/clavulanate, and ampicillin/sulbactam, whereas only 9 of 19 (47.4%) were sensitive to ciprofloxacin.[55] These results differ strikingly from the higher levels of resistance seen in hospital-acquired Acinetobacter profiles.

Rates of bacteremia associated with Abc pneumonia are inconsistent in the literature.[40,55] Leung and colleagues stated that bacteremia was more commonly associated with ACAP than with AHAP (32% vs 0%).[55] Garnacho-Montero and coworkers found a 12% incidence of bacteremia in 41 cases of AHAP.[40] Another study reported that only 1 of 8 patients with AVAP had bacteremia.[67]

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