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KMID : 0941820120220020181
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Korean Journal of Clinical Pharmacy
2012 Volume.22 No. 2 p.181 ~ p.186
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Treatment of Multidrug-Resistant Acinetobacter baumannii Pneumonia after Glucocorticoids Administration for Interstitial Lung Disease: A Case Report
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Kim Hea-Sook
Shin Hyun-Taek
Kim Hyun-Ah
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Abstract
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Objective: To report a fatal case of Multidrug-resistant Acinetobacter baumannii (MDR-AB) in a patient with interstitial lung disease (ILD) on high-dose glucocorticoids.
Case Summary: A 66-year-old man with a history of coniosis was transferred to the hospital with progressive cough and sputum production. This patient has been diagnosed with pneumonia and ILD on admission, requires antimicrobial therapy and systemic immunosuppressants. He received high dose of methylprednisolone and cyclophosphamide for ILD as well as ceftriaxone and azithromycin for pneumonia. On day 7 in the intensive care units (ICUs), patient had fever and leukocytosis, thus antimicrobials were switched to piperacillin. After 13 days in the ICU, Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus (MRSA) were isolated on transtracheal aspirate (TTA) and meropenem was initiated. However, it was revealed a multidrug-resistant Acinetobacter baumannii (MDR-AB) species, resistant to carbapenem. Patient was administered colistin but expired due to septic shock on day 84.
Discussion: Systemic immunosuppressive therapy can result in infections that may compromise patient’s survival. MDR-AB has emerged as a serious cause of nosocomial infections in immunocompromised patients. MDR-AB is resistant to most standard antimicrobials and therapeutic options are limited.
Conclusion: We report our recent experience with a fatal MDR-AB pneumonia in a patient with ILD, who had to be treated with high dose glucocorticoids and immunosuppressnts.
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KEYWORD
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Multidrug-Resistant Acinetobacter baumannii (MDR-AB), pneumonia, immunosuppression
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