PDF(Pubmed)
Abstract：
BACKGROUND: Community-acquired Acinetobacter pneumonia (CAAP) typically presents with rapid progression to fulminant disease and is complicated by high mortality. Australian epidemiological studies are few.
METHODS: 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.
RESULTS: 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%.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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%.
CONCLUSIONS: 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.
摘要：
背景：社区获得性不动杆菌肺炎（CAAP）通常表现为快速进展为暴发性疾病，并且并发高死亡率。澳大利亚的流行病学研究很少。
方法：我们对北昆士兰州20年（2000-2019年）的CAAP菌血症病例进行了回顾性研究。病例是根据微生物，临床,和射线照相参数。获得了患者人口统计学数据，随着微生物，抗生素,死亡率和气候数据。
结果：共28例CAAP。男性19人(67.9%)，23名(82.1%)是澳大利亚土著居民，平均年龄为45.9岁。大多数表现为中度至重度肺炎（25/28（89.3％））。此外，90%的病例有两种或两种以上的危险因素。CAAP的最大危险因素是酒精过量和烟草使用。严重程度无统计学差异，在干季和湿季疾病之间观察到ICU入院或死亡。旱季疾病占病例的35.7%。总死亡率为28.6%。早期使用美罗培南或庆大霉素可降低死亡率，无论其严重程度如何（死亡率为17.6%）。非靶向抗生素治疗与44.4%的死亡率无显著差异相关。
结论：早期使用靶向抗生素可以降低高死亡率。社区获得性肺炎抗生素治疗的选择应基于严重程度，危险因素和临床怀疑CAAP而不是季节性。
方法：我们对北昆士兰州20年（2000-2019年）的CAAP菌血症病例进行了回顾性研究。病例是根据微生物，临床,和射线照相参数。获得了患者人口统计学数据，随着微生物，抗生素,死亡率和气候数据。
结果：共28例CAAP。男性19人(67.9%)，23名(82.1%)是澳大利亚土著居民，平均年龄为45.9岁。大多数表现为中度至重度肺炎（25/28（89.3％））。此外，90%的病例有两种或两种以上的危险因素。CAAP的最大危险因素是酒精过量和烟草使用。严重程度无统计学差异，在干季和湿季疾病之间观察到ICU入院或死亡。旱季疾病占病例的35.7%。总死亡率为28.6%。早期使用美罗培南或庆大霉素可降低死亡率，无论其严重程度如何（死亡率为17.6%）。非靶向抗生素治疗与44.4%的死亡率无显著差异相关。
结论：早期使用靶向抗生素可以降低高死亡率。社区获得性肺炎抗生素治疗的选择应基于严重程度，危险因素和临床怀疑CAAP而不是季节性。
