Two case reports of gastroendoscopy-associated Acinetobacter baumannii bacteremia

Table 1 Evidence-based literature review for gastroendoscopy-associated Acinetobacter bacteremia

Ref.	Country	Evaluation	Risk factors	Microbiology	Treatment	Outcome
Norfleet et al[3], 1981	United States	447 patients have been evaluated, of which 6% had bacteremia after upper gastrointestinal endoscopy	Upper gastrointestinal endoscopy	One case with Acinetobacter sp infection	NM	NM
Maulaz et al[4], 2003	Brazil	The bacteremia incidence in cirrhotic patients submitted to variceal ligation was 2.5%, showing no difference from the control groups	Endoscopic variceal ligation or esophagogastroduodenoscopy only	One case with Acinetobacter lwoffii infection	NM	One case with Acinetobacter lwoffii infection is survived
Oh et al[5], 2007	South Korea	A total of 364 patients who underwent PTC were included in the study	Cholangitis and bacteremia were associated with percutaneous transhepatic biliary drainage and tract dilation, catheter migration and blockage with tract maturation, and bile duct injury with PTC	NM	NM	NM
Lai et al[6], 2008	Taiwan	Case report	Endoscopic procedure	Initial, polymicrobes (Acinetobacter baumannii, Klebsiella pneumoniae and Enterococcus Faecalis), then became Acinetobacter genomic species 13TU at day 14	Ceftazidime and ampicillin-sulbactam, then intravenous gentamicin and ciprofloxacin (parenteral antibiotics for 4 wk) then followed by oral ciprofloxacin and trimethoprim-sulfamethoxazole (for another 13 d) , antibiotics used for 61 d in total	Survived
de la Tabla Ducasse et al[7], 2008	Spain	Case report	Post-endoscopic retrograde cholangiopancreatography	Acinetobacter ursingii infection	Cefotaxime	Survived

NM: Not mentioned; PTC: Percutaneous transhepatic cholangioscopy.

Table 2 Demographics and clinical presentations of 19 non-hospital-acquired Acinetobacter baumannii bacteremia patients

No.	Age (yr)	Sex	Chief complaint (d)	Previous admission	Initial diagnosis of infection	Underlying disease	Fever/shock	Route of entry1	Treatment (d)	Outcome
P1	67	F	RUQ pain (1)	0	Pancreatic abscess	CBD stone	Y/N	Biliary tract1	Cefazoline+gentamicin (5), imipenem-cilastatin (12), levofloxacin (8)	S
P2	76	F	Conscious disturbance (3)	3	Liver abscess	DM	Y/N	Biliary tract	Cefmetazole (3), imipenem-cilastatin (7), levofloxacin (7)	S
P3	79	M	SOB (7)	3	Pneumonia	Esophageal cancer	Y/N	Respiratory tract	Co-trimoxazole (4)	S
P4	40	F	SOB (3)	2	Sepsis	Breast cancer	Y/N	Primary2	Cefazoline+gentamicin (5), levofloxacin (7)	S
P5	74	M	Deafness (4)	0	Sepsis, sudden deafness	Nil	Y/N	Primary	Cefazoline + gentamicin (1)	S
P6	24	F	Fever, right flank pain (1)	2	Acute pyelonephritis	Pelvic cancer	Y/N	Urinary tract	ampicillin-sulbactam (7), co-trimoxazole (3)	S
P7	76	F	Chest pain (1)	0	Sepsis	AMI	N/Y	Primary	Cefmetazole (4), imipenem-cilastatin (7)	S
P8	80	F	SOB (1)	1	Urinary tract infection	Right renal stone	Y/N	Urinary tract	Cefazoline (5), amikacin (7)	S
P9	82	M	Hematuria (1)	1	Urinary tract infection	Old CVA	Y/N	Urinary tract	Nil	S
P10	1	M	Fever (1)	0	Neonetal infection	Nil	Y/N	Primary	Ampicillin (5)	S
P11	33	F	SOB (3)	1	Sepsis	Cholangiocarcinoma	Y/N	Primary3	Cefmetazole (1), imipenem-cilastatin (7)	S
P12	64	M	Abdominal pain (3)	2	Cholangitis	Liver cirrhosis, uremia, AF	N/Y	Biliary tract	Cefazoline (5), gentamicin (14)	E
P13	73	F	Epigastric pain (1)	0	Urosepsis	DM	Y/N	Urinary tract	Imipenem-cilastatin (14)	S
P14	70	M	RUQ pain (1)	2	Cholangitis	HCC, HCV	N/N	Biliary tract4	Cefamet (5), imipenem-cilastatin (9)	E
P15	79	M	Loss of consciousness (1)	1	Sepsis	DM	N/N	Primary	Cefazoline (7)	S
P16	79	F	Fever (1)	4	Lung abscess	DKA	Y/Y	Respiratory tract	Cefuroxime (2)	E
P17	80	M	Dysuria (7)	1	Urinary tract infection	DM, urethral stricture HBV	Y/N	Urinary tract	imipenem-cilastatin (14)	S
P18	51	F	Right limb weakness (2)	4	Pneumonia	Chf	N/N	Respiratory tract	Cefazoline (7), co-trimoxazole (7)	S
P19	80	F	Hematuria (3)	1	Urinary tract infection	Left hydronephrosis, right urethral stone	N/N	Urinary tract	Cefazoline (3), urotactin (11)	S

¹This patient is case one, and she had received the endoscopic papillotomy one day before the episode of Acinetobacter baumannii (A. baumannii) bacteremia;

²This patient had suspected hepatocellular carcinoma;

³This patient had received the percutaneous transhepatic cholangeal drainage three days before the episode of A. baumannii bacteremia, and the route of entry of A. baumannii could result from biliary tract. He was categorized to primary bacteremia due to lack of typical clinical symptoms and signs of biliary sepsis;

⁴This patient is case two, and she had received the endoscopic retrograde biliary drainage one day before the episode of A. baumannii bacteremia. RUQ pain: Right upper quadrant pain; SOB: Shortness of breath; AMI: Acute myocardial infarction; TIA: Transient ischemic attack; CBD: Common bile duct; DM: Diabetes mellitus; DKA: Diabetic ketoacidosis; CHF: Congestive heart failure; HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; HCV: Hepatitis C virus; AF: Atrial fibrillation; CVA: Cerebrovascular attack; co-trimoxazole: Sulfamethoxazole-trimethoprim; S: Survived; E: Expired; P: Patient number; F: Female; M: Male; Y: Yes; N: No.