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• W4387258210 abstract "SESSION TITLE: Chest Infections Case Report Posters 14 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Acinetobacter Baumannii is a gram-negative coccobacillus, aerobic, nonfermenting, non-fastidious, catalase-positive, oxidase-negative, nonmotile bacteria, with a tendency for acquiring resistance to broad-spectrum antibiotics including carbapenems [1]. We present a case of Carbapenem Resistant Acinetobacter baumannii (CRAB) pneumonia with a rare type of carbapenamase called New Delhi Metallo-B-lactamase (NDM) in a patient with no recent travel to the endemic regions or contact with known NDM CRAB pneumonia. CASE PRESENTATION: 75-year-old man with a history of hypertension, presented to the emergency department with 6-days of cough, fever, sore throat, and progressive shortness of breath. He was admitted to the Intensive Care Unit (ICU) for acute hypoxic respiratory failure secondary to COVID pneumonia and suspected superimposed bacterial pneumonia and was treated with broad spectrum antibiotics and dexamethasone. He was intubated for worsening hypoxia. On hospital day (HD) 4, he developed copious secretions; however, he was extubated. The sputum cultures showed light growth of New Delhi metallo-beta-lactamase-producing Acinetobacter baumannii (AB). Infectious disease recommended polymyxin B and minocycline on day 6. On HD7, patient developed upper gastrointestinal bleed, requiring intubation for airway protection. Patient then developed acute renal injury, therefore antibiotic therapy was discontinued on HD 11. Eventually patient was extubated and downgraded to the general medicine ward. However, patient became septic on HD 23, and was started on meropenem and vancomycin but upgraded to the ICU on HD 28. Sputum cultures showed moderate growth of CRAB and MRSA (Methicillin Resistant Staph Aureus), and he had to be intubated due to progressive hypoxia. Polymyxin B and minocycline were re-started for 10 days. Renal function tests worsened, requiring him to be started on dialysis. Patient was tracheotomized, and respiratory status improved, and he was weaned to trach collar. DISCUSSION: NDM CRAB infections are difficult to treat due to minimal availability of treatment options that are often nephrotoxic, as seen in this case. Per IDSA (Infectious Disease Society of America) guidelines, the preferred antibiotic regimen for NDM carbapenem-resistant Enterobacterales (CRE) except Acinetobacter baumannii, is ceftazidime-avibactam plus aztreonam, since their concurrent production of ESBL (extended spectrum beta lactamases) is neutralized by avibactam, allowing aztreonam to act against NDM CRE [2]. For moderate to severe CRAB infections, IDSA recommends combination therapy with meropenem, polymyxin B, ampicillin-sulbactam, and tetracyclines. Acinetobacter baumannii have ESBL coding plasmid genes (TEM and sulf-hydryl variable-SHV) and intrinsic chromosomal genes such as Beta lactamase Acinetobacter Derived Cephalosporinases (blaADC) which code for production of ampicillinase C (AmpC) beta lactamases that negate aztreonam activity, making the treatment of NDM CRAB difficult. CONCLUSIONS: Treatment of NDM CRAB could be an area for further research, for instance; the ongoing invitro studies that are increasing NDM CRAB's susceptibility to sulbactam (which inhibits cell wall synthesis by binding to penicillin binding protein (PBP) 1 and 3), by combining it with avibactam [3]. REFERENCE #1: Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: Emergence of a Successful Pathogen. Clinical Microbiology Reviews. 2008;21(3):538-582. doi:https://doi.org/10.1128/cmr.00058-07 REFERENCE #2: Jayol A, Nordmann P, Poirel L, Dubois V. Ceftazidime/avibactam alone or in combination with aztreonam against colistin-resistant and carbapenemase-producing Klebsiella pneumoniae. J Antimicrob Chemother. 2018 Feb 1;73(2):542-544. doi: 10.1093/jac/dkx393. PMID: 29165563. REFERENCE #3: Pasteran F, Cedano J, Baez M, et al. A New Twist: The Combination of Sulbactam/Avibactam Enhances Sulbactam Activity against Carbapenem-Resistant Acinetobacter baumannii (CRAB) Isolates. Antibiotics. 2021;10(5):577. doi:https://doi.org/10.3390/antibiotics10050577 DISCLOSURES: No relevant relationships by Maimoona Iftikhar Ali No relevant relationships by Karoll Cortez No relevant relationships by Siddartha Guru No relevant relationships by Vignesh Harish" @default.
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• W4387258210 date "2023-10-01" @default.
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• W4387258210 title "A RARE CASE: NEW DELHI METALLO-β-LACTAMASE CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII (NDM CRAB) PNEUMONIA" @default.
• W4387258210 doi "https://doi.org/10.1016/j.chest.2023.07.915" @default.
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