Multidrug Resistant Acinetobacter buamanii-Infected Pseudocyst of the Pancreas in an Immunocompetent Patient

Abstract

Introduction:Acinetobacter buamanii is a pleomorphic, nonmotile gram-negative aerobic bacillus that is being increasingly reported as a causative organism of various nosocomial infections. A. buamanii is an opportunistic pathogen having a high incidence among immunocompromised individuals. We present a case of infected pseudocyt of pancreas with A. buamanii in an immunocompetent patient. Only 1 such case has been reported so far in literature. Case Report: A 50-year-old male with history of hypertension and chronic alcoholism who was recently discharged from another hospital about 1 month ago for an admission for acute severe pancreatitis, presented with complaints of abdominal pain and distention for 3 days. Patient was febrile with temperature of 38.3 C, heart rate of 104 bpm. Physical exam was significant for mildly distended abdomen, tenderness in the left lower quadrant and epigastric region, and decreased bowel sounds in all quadrants. CT abdomen showed loculated complex fluid collection surrounding the pancreas with fat necrosis and no pancreatic parenchymal necrosis, suggestive of pancreatic pseudocyst. He was started on intravenous zosyn and vancomycin. After the current management, patient did not show clinical improvement. Repeat CT abdomen showed enlarged anterior abdominal fluid collection replacing the pancreas most consistent with pancreatic necrosis, which prompted switching vancomycin and zosyn to meropenem and tobramycin, pending cultures per infectious disease recommendations. Subsequently, CT-guided pancreatic percutaneous drainage followed by surgery was done due to persistent symptoms. Exudate culture was sent, which grew multidrug resistant A. buamanii. Patient’s condition declined despite aggressive treatment and the patient unfortunately died. Conclusion: We propose that the prolonged hospital stay and history of alcoholism made the patient susceptible to infection with A. buamanii. A. buamanii should therefore be considered as a differential for infected pseudocysts in high-risk patients.Figure 1: CT abdomen showing fluid collection in the pancreas.