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Published on: October 24, 2018
Venovenous extracorporeal membrane oxygenation in severe community-acquired Acinetobacter baumannii pneumonia
Lei Jiang1, Lin Zhou2, Shicong Huang1
1Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Introduction:
Globally, Acinetobacter baumannii (A. baumannii) is a significant nosocomial pathogen. Community-acquired pneumonia (CAP) caused by A. baumannii is rare, but often associated with severe outcomes.
Case Presentation:
A 48-year-old man was admitted to a local hospital, presenting a 14-hour history of acute fever, cough, expectoration, chest pain, and dyspnea. Owing to the development of severe acute respiratory distress syndrome (ARDS) and septic shock, the patient was promptly transferred to our institution for veno-venous extracorporeal membrane oxygenation (VV-ECMO) following intubation and mechanical ventilation. Sputum culture, digital polymerase chain reaction (dPCR) assay of blood, and metagenomic next-generation sequencing (mNGS) assay of bronchoalveolar lavage fluid (BALF) all indicated A. baumannii. The patient responded favorably to treatment with meropenem and tigecycline. The amelioration of his respiratory function allowed for the cessation of ECMO after 7 days; and subsequently, the patient was successfully weaned from ventilatory support.
Conclusions:
A. baumannii should be considered as a possible causative organism of CAP based on presentation in the tropical or subtropical wet season, a very aggressive clinical course, typical chest imaging features, and the presence of A. baumannii in sputum. ECMO represents an efficacious treatment alternative for severe ARDS and septic shock complications associated with A. baumannii when conventional mechanical ventilation proves inadequate, particularly when initiated early in the clinical course.
Insights
Acinetobacter baumannii (A. baumannii) can cause severe community-acquired pneumonia (CAP). Early extracorporeal membrane oxygenation (ECMO) and antibiotics like meropenem and tigecycline can be life-saving for critical cases.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Acinetobacter baumannii (A. baumannii) is a major cause of hospital-acquired infections.
- Community-acquired pneumonia (CAP) due to A. baumannii is uncommon but frequently severe.
Purpose of the Study:
- To report a rare case of severe CAP caused by A. baumannii.
- To highlight the role of advanced respiratory support and antimicrobial therapy.
Main Methods:
- A 48-year-old male presented with severe CAP, leading to acute respiratory distress syndrome (ARDS) and septic shock.
- Diagnostic methods included sputum culture, blood digital PCR (dPCR), and bronchoalveolar lavage fluid metagenomic next-generation sequencing (mNGS).
- Treatment involved veno-venous extracorporeal membrane oxygenation (VV-ECMO), mechanical ventilation, meropenem, and tigecycline.
Main Results:
- Diagnostic assays confirmed A. baumannii as the causative agent.
- The patient showed a positive response to meropenem and tigecycline.
- VV-ECMO support was successfully discontinued after 7 days, and the patient was weaned from mechanical ventilation.
Conclusions:
- A. baumannii should be considered in severe CAP cases, especially with specific clinical and epidemiological features.
- Early initiation of VV-ECMO is a valuable option for severe ARDS and septic shock unresponsive to conventional ventilation.
- Prompt and appropriate antimicrobial treatment is crucial for favorable outcomes.
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