Acinetobacter baumannii

Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Time to detection: 
2 days
Alerting signals, symptoms, evidence of occurrence: 
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.
Demonstration of imputability or root cause: 
Proven donor transmission of carbapenem-resistant Acinetobacter baumannii, which resulted in severe infectious complications after lung transplantation. Same strain in donor and recipient confirmed by RAPD (random amplification of random DNA) to a single genotype.
Imputability grade: 
3 Definite/Certain/Proven
Suggest references: 
Martins N, Martins IS, de Freitas WV, et al.Severe infection in a lung transplant recipient caused by donor-transmitted carbapenem-resistant Acinetobacter baumannii. Transpl Infect Dis. 2012 Jun;14(3):316-20.
Information from record 368 merged here (EP)