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.