Community-Acquired, Bacteraemic Acinetobacter Baumannii Pneumonia: A Retrospective Review of Cases in Tropical Queensland, Australia.

Abstract

Community-acquired Acinetobacter pneumonia (CAAP) typically presents with rapid progression to fulminant disease and is complicated by high mortality. Australian epidemiological studies are few. We conducted a retrospective study on bacteraemic cases of CAAP over twenty years (2000-2019) in North Queensland. Cases were selected on microbiologic, clinical, and radiographic parameters. Data on patient demographics were obtained, along with microbial, antibiotic, mortality and climatic data. 28 cases of CAAP were included. Nineteen (67.9%) were male, twenty-three (82.1%) were Indigenous Australians, and the mean age was 45.9 years. Most presentations were of moderate to severe pneumonia (25/28 (89.3%)). Furthermore, 90% of cases had two or more risk factors. The strongest risk factors for CAAP were alcohol excess and tobacco use. No statistically significant difference in presenting severity, ICU admission or mortality was seen between dry- and wet-season disease. Dry-season disease accounted for 35.7% of cases. Overall mortality was 28.6%. Early use of meropenem or gentamicin reduced mortality irrespective of presenting severity (mortality 17.6%) Non-targeted antibiotic therapy was associated with a non-significant difference in mortality of 44.4%. Early administration of targeted antibiotics can mitigate a high mortality rate. The choice of antibiotic therapy for community-acquired pneumonia should be based on severity, risk factors and clinical suspicion of CAAP rather than seasonality.