AB Bacterial Infections in Pneumonia Patients: Treatment Options

Pneumonia hospital-acquired infection caused by Acinetobacter bacteria?

Dear Dr.
Huang,
My mother developed a fever on June 24 and visited a clinic for medication.
After more than a week, her fever did not completely subside.
On June 30, she went to the emergency department of a large hospital, where she was diagnosed with pneumonia and started on antibiotic treatment.
My mother has undergone two open-heart surgeries, and her heart is functioning at double the normal size, which affects her lung function.
On the third day of hospitalization, she was transferred to the intensive care unit.

On July 5, due to her heart rate dropping below 50 beats per minute, the physician performed intubation and escalated her antibiotics to the third-line treatment.
During the treatment, all cultures were normal, but her fever did not improve.
On July 13, the antibiotics were increased to the fourth-line treatment.
On July 14, cultures were taken again, and on July 15, it was discovered that the patient was infected with Acinetobacter baumannii, which is pan-resistant to antibiotics.
I would like to ask Dr.
Huang if there are truly no medications available to treat Acinetobacter baumannii.
Is there anything we, as family members, can do to help? If there is a chance for improvement, will she require lifelong respiratory care? We sincerely request your advice.

Wang Chengguo, 50~59 year old female. Ask Date: 2013/07/17

Dr. Huang Yiwen reply Pulmonology

Dear Mr.
Wang,
First, let us pray for your aunt.
This particular bacteria is indeed challenging; we need to clarify whether it is a true infection or just local colonization.
If it is a pneumonia-causing infection, the mortality rate can range from 30% to 75%.
There are still medications available, such as Polymyxin (colistin) and Sulbactam combinations, Rifampicin/amikacin combinations, and Tigecycline, which should be considered based on hospital protocols and infectious disease specialists' opinions.
The overall condition will determine the subsequent course of action, so we cannot predict the outcome at this time.
Thank you for your understanding.
Sincerely,
Huang Yi-Wen

Reply Date: 2013/07/17

More Info

AB bacteria, particularly when referring to Acinetobacter baumannii, are known for their multidrug resistance, making infections challenging to treat, especially in vulnerable populations such as patients with underlying health conditions or those who have undergone significant medical procedures. In your mother's case, the situation is complicated by her history of heart surgery and the subsequent impact on her lung function, which can further exacerbate her risk for severe infections.

Treatment Options
1. Antibiotic Therapy: The first line of treatment for infections caused by multidrug-resistant Acinetobacter baumannii typically involves the use of last-resort antibiotics. According to the information provided, options may include:
- Polymyxin B or Colistin: These are often used in cases of multidrug-resistant Gram-negative infections. However, they can have significant nephrotoxic and neurotoxic side effects.

- Combination Therapy: Using combinations of antibiotics such as sulbactam with polymyxins or rifampicin with amikacin can sometimes enhance efficacy against resistant strains.

- Tigecycline: This is another option, though its effectiveness can vary based on the specific strain and site of infection.

2. Consultation with Infectious Disease Specialists: It is crucial to involve an infectious disease specialist in the management of such complex cases. They can provide insights into the most effective treatment regimens based on susceptibility patterns and the patient's overall clinical status.

3. Supportive Care: Given your mother's critical condition, supportive care in the ICU is essential. This includes monitoring vital signs, managing respiratory support, and ensuring adequate nutrition and hydration.

Prognosis and Long-term Care
The prognosis for patients with infections caused by fully resistant AB bacteria can be quite serious. The mortality rate can be high, particularly in patients with significant comorbidities. The fact that your mother has not responded to multiple lines of antibiotic therapy is concerning.
- Long-term Respiratory Care: If your mother recovers from the acute infection, there may be a need for ongoing respiratory support, especially if her lung function remains compromised. This could involve home oxygen therapy or other forms of respiratory assistance.

- Monitoring and Follow-up: Continuous follow-up with her healthcare team will be necessary to monitor her recovery and manage any potential complications. Regular assessments of her lung function and overall health will be crucial.

Family Support
As family members, your support can be invaluable. Here are some ways you can help:
- Advocate for Care: Stay informed about her condition and treatment options. Don't hesitate to ask questions or seek second opinions if you feel it's necessary.

- Emotional Support: Being present for your mother during this challenging time can provide her with comfort and strength.

- Hygiene Practices: If she is discharged, ensure that proper hygiene practices are followed to prevent the spread of any resistant bacteria, especially if she is still a carrier.

Conclusion
In summary, while the situation is indeed serious with the identification of fully resistant AB bacteria, there are still treatment options available. The involvement of specialized care and a comprehensive approach to her treatment and recovery will be essential. It’s important to remain hopeful and proactive in seeking the best possible care for your mother.

Similar Q&A

Understanding Post-Pneumonia Complications: AB Bacterial Infection and Lung Fibrosis

Hello, Doctor: My grandfather was hospitalized recently due to pneumonia. Later, the medical staff noticed that he was experiencing severe shortness of breath and he was transferred to the intensive care unit for intubation and treatment. He has been receiving sedatives because h...

Dr. Shen Bochan reply Pulmonology
Hello! Regarding the question you raised, I recommend consulting your grandfather's attending physician, as a complete assessment cannot be conducted online. The treatment and recovery from critical illness cannot be summarized in a few words online. Based on your descriptio...

Flu and Pneumonia: Treatment Duration, Complications, and Concerns

Hello Doctor: My family member, a 46-year-old male, is experiencing a 40-degree fever due to influenza, along with pneumonia. After screening, there is evidence of pulmonary infiltration, and his white blood cell count has spiked to 18,000. He has been hospitalized for 6 days, an...

Dr. Jian Shuntian reply Pulmonology
Due to the complexity of the condition, a complete understanding may not be possible, and only simple questions can be addressed. Further discussions with the attending physician may be necessary. (1) The use of antibiotics is partially metabolized by the kidneys, depending on th...

Understanding Pneumonia Symptoms: What to Look For

Dear Sir/Madam, I would like to inquire about the symptoms of the currently prevalent pneumonia. I arrived in Taiwan from mainland China via Hong Kong on the 18th of this month. Currently, I have a cold and am experiencing alternating chills and hot flashes, but I do not have a ...

Dr. Ke Zhengchang reply Pulmonology
Currently, the predominant causes of pneumonia are mycoplasma and typical bacterial pneumonia, which can be effectively treated with erythromycin and traditional antibiotics. Severe pneumonia caused by the coronavirus or paramyxovirus, which is prevalent in mainland China and ass...

Understanding Treatment Options for Citrobacter Infection: What You Need to Know

I would like to ask the doctor, I previously had tests done at a medical laboratory, and it was found that I have a Campylobacter infection. The medical technologist told me that antibiotics would resolve it, but the cost of the antibiotics is about 3,000 New Taiwan Dollars. Due ...

Dr. Du Shixi reply Urology
Hello: If treatment is necessary, you should first perform a culture to determine which antibiotic is effective (as some bacteria may be resistant to certain antibiotics). However, you need to go to the hospital for the culture to confirm whether there is indeed an infection and ...