Case History/Examination:
Acinetobacter baumannii is an aerobic gram-negative bacillus and nosocomial pathogen that predominantly affects individuals in the intensive care unit. We present a case of a patient without any known medical problems or recent hospitalizations presenting withAcinetobacter baumannii bacteremia and a concomitant spontaneous fungal peritonitis in the setting of newly diagnosed cirrhosis.
Our patient had no known medical history other than alcohol abuse. The patient developed hepatic encephalopathy and subsequent aspiration pneumonia resulting in Acinetobacter baumannii bacteremia from pneumonia. Acinetobacter baumannii is especially known for its multidrug resistance (MDR). This case was further complicated by concomitant fungal peritonitis. Cirrhotic patients can have cirrhosis-associated immune dysfunction (CAID), leading to an immunosuppressed state. Furthermore, cirrhotic have physiologic changes such as a chronic vasodilatory state with hyperdynamic circulation and alterations in thermoregulation, that may independently make patients more susceptible and mask underlying sepsis. Therefore, identification of sepsis can be intrinsically challenging in the cirrhotic patient. Early and broad anti-microbial coverage has been a well proven way to improve mortality and lead to better clinical outcomes for critically ill patients, but the question arises, are there times where cirrhotic patients may need even broader coverage? Our case report explores these challenges and presents questions requiring further research in this patient population.