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LETTERS TO EDITOR
Year : 2017  |  Volume : 34  |  Issue : 5  |  Page : 491-492  

Clinicomicrobiological study of community-acquired pneumonia


1 Final MBBS Student, Kasturba Medical College, Mangalore, Karnataka, India
2 Department of Microbiology, Kasturba Medical College, Mangalore, Karnataka, India

Date of Web Publication31-Aug-2017

Correspondence Address:
Sevitha Bhat
Department of Microbiology, Kasturba Medical College, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/lungindia.lungindia_89_17

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How to cite this article:
Prasad P, Bhat S. Clinicomicrobiological study of community-acquired pneumonia. Lung India 2017;34:491-2

How to cite this URL:
Prasad P, Bhat S. Clinicomicrobiological study of community-acquired pneumonia. Lung India [serial online] 2017 [cited 2019 Dec 16];34:491-2. Available from: http://www.lungindia.com/text.asp?2017/34/5/491/213846



Sir,

Community-acquired pneumonia (CAP) remains as an infectious cause of mortality and morbidity globally. The common etiological agents of CAP are Klebsiella pneumoniae, Haemophilus influenzae, Streptococcus pneumoniae, and Pseudomonas aeruginosa.[1] Pneumonia is reported more in older patients and those with comorbidities, such as chronic liver, cardiac, lung and/or renal diseases, metabolic disorders such as diabetes mellitus, chronic alcoholism, malignancies, absence of spleen (asplenia), immune-compromising conditions or the use of immune-suppressing drugs, exposure to radiation or chemotherapy, and administration of antimicrobials, within the previous 3 months. In India, the incidence of CAP is 4 million cases/year with 20% requiring hospitalization. The mortality rate of CAP patients in outpatient settings is 1%–5%, and in Intensive Care Unit, it is 25%.[1],[2]

CAP is treated using either monotherapy or combination therapy. Doxycycline and respiratory quinolones are preferred as single agents. Combination therapy includes ceftriaxone plus doxycycline or azithromycin.[3]

Antibiotic resistance is on rise among the respiratory pathogens. The incidence of β-lactamase production has been reported in 20%–35% of the isolates of H. influenzae. Macrolide resistance has been reported as 5% while previous studies have reported a low prevalence rate of 0.15% resistance to fluoroquinolones.[4]

The present study was undertaken to study the pattern of antibiotic resistance in respiratory isolates and the associated risk factors of CAP. A cross-sectional study was carried out in the tertiary care center. A total of 165 patients of the age 16 years and above with clinical suspicion of CAP were included in the study. Respiratory tract specimen, bronchoalveolar lavage samples, and sputum samples with the growth of bacterial pathogens were included in the study. The samples were plated on chocolate agar and blood agar and MacConkey agar and incubated at 37°C overnight, and any bacterial growth was identified by the standard biochemical reactions and the antibiotic sensitivity done by modified Kirby-Bauer disk diffusion method.

The mean age of the patients was found to be 58 years. A total of 104 (63.6%) were male and 61 (36%) female. After the treatment course was completed, 124 were successfully cured, 4 patients died, and 37 developed reinfection (within the next 60 days). The common bacterial pathogens found to be responsible for CAP in our study were K. pneumoniae (29.09%), H. influenzae (4.8%), Pseudomonas spp.(18.18%), and S. pneumoniae (13.33%).

The culture positivity rate in our study was 48%. The remaining culture negative cases who presented to our hospital could be due to prior antibiotic administration, atypical bacterial pathogens, or viruses. The patients in this study presented with fever (93%), cough with sputum (94%), and chest pain (60%). The risk factors of CAP in our study were diabetes mellitus, alcohol/tobacco use, bronchiectasis, cancer patients, and elderly, similar to previous reports.[5] The antibiotics effective against S. pneumoniae were amoxiclav, levofloxacin with around 20% resistance. The antibiotics against H. influenzae were cefuroxime, azithromycin, and amoxiclav with 6%, 13%, and 23% resistance, respectively. The antibiotics effective against K. pneumoniae, Pseudomonas spp. were carbapenems, piperacillin-tazobactam, and cefoperazone-sulbactam, with their resistance percentages being relatively less at 16.6%, 39.5%, and 42%, respectively.

Acknowledgment

The study has received ICMR-STS grant: 2016. The authors are grateful to Manipal University for all the support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Shah BA, Singh G, Naik MA, Dhobi GN. Bacteriological and clinical profile of community acquired pneumonia in hospitalized patients. Lung India 2010;27:54-7.  Back to cited text no. 1
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2.
American Thoracic Society. Guidelines for the initial management of adults with community-acquired pneumonia: Diagnosis, assessment of severity, and initial antimicrobial therapy. Am J Respir Crit Care Med 2001;163:1730-54.  Back to cited text no. 2
[PUBMED]    
3.
Martinez FJ. Monotherapy versus dual therapy for community-acquired pneumonia in hospitalized patients. Clin Infect Dis 2004;38 Suppl 4:S328-40.  Back to cited text no. 3
[PUBMED]    
4.
Chawla K, Mukhopadhay C, Majumdar M, Bairy I. Bacteriological profile and their antibiogram from cases of acute exacerbations of chronic obstructive pulmonary disease: A hospital based study. J Clin Diagn Res 2008;2:612-6.  Back to cited text no. 4
    




 

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