社區型鮑氏不動桿菌感染之肺炎－個案報告
 
林家弘¹　湯書亞¹　湯先秦^1,2

 

一位60歲男性除草工人，本身有高血壓及高血脂等慢性病，有規律追蹤與服藥，因發燒一天伴隨寒顫、咳嗽有痰等症狀，前來家庭醫學科門診求診，經門診症狀治療後離院，當晚症狀加劇，伴隨喘及胸悶，返回急診診斷為敗血性休克，胸部電腦斷層發現嚴重肺炎，隨即入住加護病房治療，血液細菌培養發現兩套皆分離出鮑氏不動桿菌(Acinetobacter baumannii)，予以抗生素治療，住院期間歷經氣管內插管、呼吸機輔助呼吸以及連續性腎臟替代療法，個案症狀改善並於兩個月後出院。
鮑氏不動桿菌為常見且重要的院內感染病原體，社區型鮑氏不動桿菌感染之肺炎在亞太平洋地區如台灣較為罕見，但臨床病程進展快速，通常伴隨多重器官衰竭及高死亡率，需要依賴早期診斷及早期抗生素治療。藉此病例及近年文獻回顧，整理鮑氏不動桿菌社區型肺炎之流行病學、危險因子、診斷與治療。
（台灣家醫誌2021; 31: 142-148）DOI: 10.3966/168232812021063102007
 
關鍵詞：鮑氏不動桿菌、鮑氏不動桿菌社區型肺炎
 

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¹戴德森醫療財團法人嘉義基督教醫院家庭醫學科、²職業醫學中心
受理日期：109年5月7日 修改日期：109年8月3日 同意刊登：109年10月19日
通訊作者：湯先秦　　　 通訊地址：嘉義市東區忠孝路539號 戴德森醫療財團法人嘉義基督教醫院職業醫學中心

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Community-acquired Acinetobacter Baumannii Pneumonia:
A Case Report
 
Chia-Hong Lin¹, Shu-Ya Tang¹ and Hsien-Chin Tang^1,2

 
A 60-year-old male weeding worker has underlying disease of hypertension and dyslipidemia with regular follow-up. He visited our family medicine outpatient clinic one day due to fever accompanied by chills and cough with scanty sputum. Symptomatic treatment was given then. The patient, however, came to our emergency department after the occurrence of chest tightness and shortness of breath later. Septic shock with respiratory failure was diagnosed, and chest CT scan found diffuse lobar pneumonia. During the hospital course in intensive care unit, Acinetobacter baumannii was isolated from both two of his blood culture sets. With antibiotic treatment, endotracheal intubation, ventilator use, and continuous renal replacement therapy, his symptoms improved within one month to enable his discharge with a stable condition.
A. baumannii is a common pathogen of nosocomial infection, but it is a rare and serious cause of community-acquired infection in an Asia-Pacific region like Taiwan. Usually presenting with severe and sudden onset of pneumonia and leading to multi-organ failure and high mortality rate, community-acquired A. baumannii pneumonia needs early diagnosis and appropriate initial antibiotic therapy. Through this review, we discussed the epidemiology, risk factors and further clinical characteristics of community-acquired A. baumannii pneumonia.
(Taiwan J Fam Med 2021; 31: 142-148) DOI: 10.3966/168232812021063102007
 
Key words: Acinetobacter baumannii, community-acquired A. baumannii pneumonia
 

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¹Departments of Family Medicine and ²Occupational Medical Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
Received: May 7, 2020; Revised: August 3, 2020; Accepted: October 19, 2020.