Acinetobacter baumannii

On postoperative day POD+2, the recipient presented fever (38°C), hypotension and respiratory failure. Infiltrate in lower third of right lung. On the basis of the reported antibiogram from donor's BAL (results that later were shown to be wrong), meropenem was substituted for cefepime. POD 6+: Dehiscence of the surgical wound with purulent discharge. POD+9: BAL yielded carbapenemase-producing A.baumannii (CRAB)10^5 cfu/ml, sensitive only to polymixyn B and amikacin. Treatment was changed to polymyxin B for 19 days (from POD +10 from +29). On POD 49+, recurrence of pneumonia, BAL again positive for CRAB, treatment was re-started with polymyn B and inhaled amikacin. TBB showed concomitant CMV pneumonia, IV ganciclovir was started. On POD+61 immunossuppressive therapy with FK and azathioprine was stopped. Patient died on POD+65.