P0898 - Severe Necrotizing Pneumonia and Persistent Bacteremia in a Teenager with a History of Vaping

A 15-year-old previously healthy male with a history of vaping and electronic cigarette (e-cigarette) use was hospitalized due to worsening breathing difficulty and hypoxemia. He had tested positive for influenza B a few days earlier but his condition acutely worsened despite symptomatic management. During hospitalization, he required intensive care management of acute hypoxic respiratory failure secondary to a necrotizing pneumonia with bilevel positive airway pressure (BiPAP) support and broad-spectrum antimicrobial therapy. Sputum and blood cultures acquired on admission grew oxacillin-resistant Staphylococcus aureus (ORSA). Bacteremia persisted for 10 days only clearing after escalation of antibiotic therapy. Hospital course was complicated by drug induced acute kidney injury necessitating modification of antibiotic treatment. The patient was discharged following 22 days of hospitalization and completed a total of 46 days of antibiotic treatment. His physical examination normalized one month after discharge but he continued to experience dyspnea on moderate exertion. On review of his substance history, he acknowledged vaping flavored nicotine pods multiple times a day for 2 years prior to his hospitalization. E-cigarette or vaping product use-associated lung injury (EVALI) was first recognized in June 2019 and is a diagnosis of exclusion that describes chemically induced injuries to the lung parenchyma and upper respiratory tract. The working case definition of EVALI specifically excluded individuals with microbiologically confirmed infections, but there is mounting data that suggests a relationship between EVALI and infection exists. We propose that his frequent vaping increased his susceptibility to viral and bacterial infection through its cytotoxic effect on lung epithelial and immune cells. We also propose the possibility that his vaping and e-cigarette use increased the virulence of his ORSA infection, possibly through biofilm formation, invasiveness, and resistance to antimicrobial peptides, leading to a necrotizing pneumonia and persistent bacteremia. Therefore, clinicians should be aware that vaping and e-cigarette use may increase the risk for lung infection by impairing host defense mechanisms while also increasing bacterial virulence through its direct effects on bacterial cells. More studies are needed to confirm the correlation between EVALI and necrotizing bacterial pneumonia.