[Nosocomial Aeromonas hydrophila pneumonia complicating toxic coma]

A 24-year-old male homosexual drug addict was admitted in coma and circulatory failure after a 10 g overdose of acebutolol. The usual resuscitative measures were undertaken, together with administration of adrenaline and gastric lavage. Six hours of external cardiac massage and pacing, and high catecholamine doses (36 mg.h-1 of adrenaline and 60 micrograms.kg-1 x min-1 of dobutamine) were required before the circulatory system became again spontaneously efficient. After this acute episode, the patient improved despite acute tubular necrosis. On the third day, bilateral alveolar and interstitial lesions were found on the chest film. Bronchoalveolar lavage and protected distal brushings were carried out. Both Aeromonas hydrophila and Staphylococcus aureus were found in the cultured brushings. Treatment with ceftriaxone, vancomycin and amikacin was introduced. This nosocomial pneumonia was very haemorrhagic, resulting in several bloody casts responsible for several episodes of atelectasis. The patient was definitely extubated on the 18th day, and left the ICU 23 days later without any sequela. His HIV status was negative. Four other infections with the same strain of Aeromonas hydrophila occurred at the same time as this patient's. The common source for this germ was found to be soft water. Several measures have since been undertaken: removal of a centralized water softener, filtration and higher chlorine content in the water circuit, and updating of intensive care protocols for disinfection of equipment.