SPUTUM BACTERIOLOGY AND ANTIBIOTIC SENSITIVITY PATTERN OF COMMUNITY ACQUIRED PNEUMONIA IN A TERTIARY CARE HOSPITAL

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SPUTUM BACTERIOLOGY AND ANTIBIOTIC SENSITIVITY

PATTERN OF COMMUNITY ACQUIRED PNEUMONIA IN A

TERTIARY CARE HOSPITAL

Arya S.*1, Ayswarya K. P.2, Shilpa Thampi3, Dr. Binu Raj C.4 and Sareena A.5

India.

ABSTRACT

Community Acquired Pneumonia (CAP) is defined as an acute infection of the pulmonary parenchyma in a patient who has acquired the infection in the community, as distinguished from hospital acquired (nosocomial) pneumonia (HAP).[6,7] The study is conducted to analyse the sputum bacteriology and antibiotic sensitivity pattern in patients having community acquired pneumonia. When the culture report is obtained, the treatment has to be changed according to the isolated organism. Methods: A Prospective observational study was conducted among patients admitted to the pulmonology, paediatrics and general medicine department of a teritiary care hospital. Patients who met the inclusion criteria were enrolled. Informed consent forms were

taken from every patient after the procedure is being explained. The individual bacterial isolates and their sensitivity pattern to various antibiotics were also recorded. The result was later analysed, documented and then presented. Result: About 54.08% of cultures were positive for pathogenic bacteria. Among the pathogenic bacterial growth there are, 5 types of bacterial strain, out of which 3 were Gram negative bacteria 60% and 2 were gram positive bacteria 40%. The most common pathogenic bacteria isolated in sputum culture was Klebsiella pneumoniae followed by Staphylococcus aureus, Streptococcus pneumonia, Pseudomonas aeruginosa, Haemophilus influenza.

KEYWORDS: CAP, pneumonia, sputum culture, Gram positive, gram negative.

INTRODUCTION

Community Acquired Pneumonia (CAP) is defined as an acute infection of the pulmonary parenchyma in a patient who has acquired the infection in the community, as distinguished

from hospital acquired (nosocomial) pneumonia (HAP).[1,2]

*Corresponding Author Arya S.

India.

Article Received on 13 Oct. 2019,

Revised on 03 Nov. 2019, Accepted on 24 Nov. 2019

DOI: 10.20959/wjpr201913-16356

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It is a common and potentially serious illness. It is associated with considerable morbidity and mortality, particularly in older patients and those with significant co-morbidities.[7]

As per Infections Disease Society of America (IDSA) defines CAP as an acute infection of the pulmonary parenchyma that is associated with at least some symptoms of acute infection, accompanied by the presence of an acute infiltrate on a chest radiograph or auscultatory finding consistent with pneumonia in a patients not hospitalized or residing in a long term care facility more than 14 days before onset of symptoms.[8]

CAP associated with various factors such as viruses, bacteria, and fungi. The most community acquired infection are due to Streptococcus pneumoniae, Staphylococcus aureus, less commonly atypical organisms (chlamydia pneumoniae, mycoplasma pneumoniae).[14] Community Acquired Pneumonia results from secondary bacteraemia from a distant source, such as Escheria coli urinary tract infection or bacteraemia. Viruses such as Influenza, Adena virus, Rhino virus, Respirator syncytical virus (RSV) and fungi such as Aspergillus spp, Candida spp, Coccidioides immitis.[15,16]

METHODOLOGY

A prospective observational study was conducted among 98 patients admitted to the various department such as pulmonology, general medicine and paediatric department. A data entry form was used to obtain relevant information from case notes and direct interview. Informed consent form is signed and received from study population. Samples are enrolled according to the inclusion and exclusion criteria. Data collected including socio demographic parameters, medical and medication history, sputum culture and sensitivity results from the total population. The reports are analysed, documented and then presented.

RESULT

Out of 98 patients with community acquired pneumonia, 64(65.3%) were males and 34 (34.7%) were females. The age group of the patient included in the present study range from 5-80 years. Out of 98 patients maximum number belonged to the age group of 60-79(32.6%). In our study, out of 98 patients 70(71.4%) were current smokers, 24((24.5%) patients were ex- smokers and 4(4.1%) were non-smokers.

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Bronchiectasis, Pneumonia, Bronchiolitis were found to be predominant factors for causing CAP.

Proportion of Organism Isolated

The sputum samples of 98 patients were subjected to culture study .Out of which 52(53.06%) were positive for pathogenic bacteria and 46(46.9%) were negative for pathogenic bacteria.

Table 1: Proportion of Organism Isolated.

Variables Frequency Percentage

Non-Bacteria 45 45.9

Bacteria 53 54.08

Organism Isolated In Cap

Among the pathogenic bacterial growth, there are 5 types of bacterial strain, out of which 3 were Gram-negative bacteria (60%) and 2 were Gram-positive bacteria (40%).

Organism Number Percentage (%)

Gram-Negative bacteria 3 60% Gram-Positive bacteria 2 40%

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Specific Organism Isolated In Cap

The most common pathogenic bacteria isolated in sputum culture was Klebsiella pneumonia 20(37.7%), followed by Staphylococcus aureus 13(24.5%), Streptococcus pneumoniae was isolated in 11cases (20.7%). Other common organism isolated were Haemophilus influenzae in 3 cases, Pseudomonas aeruginosa were isolated in 6 cases.

Organism Specific Antibiotic Sensitivity Pattern in Cap

Table: Antibiotic sensitivity pattern of Gram Positive Organism. Antibiotic S.aureus S.pneumoniae

Amikacin 69.23% 9.09%

Gentamicin 69.23% 0

Cotrimoxazole 92.3% 36.36%

Linezolid 30.76 54.54%

Tetracycline 46.15% 0

Levofloxacin 0 81.81%

Erythromycin 0 18.18%

Vancomycin 38.46% 89.9%

Azithromycin 0 9.09%

Clindamycin 0 36.36%

Penicillin 0 18.18%

Rifampicin 7.69% 0

Ceftriaxone 0 90.9%

Cefazolin 61.53% 9.09%

Table: Antibiotic Sensitivity Pattern of Gram-Negative Organisms in CAP. Antibiotic K.pneumoniae H.influenzae P.aeruginosa

Amikacin 90% 0 66.6%

Gentamicin 90% 0 83.3%

Ciprofloxacin 80% 32.3% 66.6%

Cotrimoxazole 50% 65.6% 0

Ceftriaxone 25% 33.3% 0

Meropenem 85% 98% 50%

Imepenem 45% 64.6% 0

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Cefazolin 10% 0 0

Cefoperazone 20% 0 16.6%

Cefuroxime 10% 66.6% 0

Ampicillin 10% 0 16.6%

Piperacillin+Tazobactam 5% 0 100%

Chloramphenicol 0 100% 0

Tetracycline 0 62.6% 0

Amoxiclav 0 0 66.6%

Percentage of Sensitivity of Organisms

Organisms Antibiotics % Sensitivity

K. Pneumoniae Amikacin, Gentamicin 90% P. Aeroginosa Piperacillin+ Tazobactam 100% H. Infuenza Chloramphenicol 100%

S. Aureus Cotrimoxazole 92.3%

S. Pneumoniae Ceftriazone 90.9%

Organism Specific Antibiotic Resistantance Pattern In Cap Antibiotic resistance pattern of Gram-positive organisms

Antibiotic S.aureus S.pneumoniae

Amikacin 7.69% 0

Gentamicin 7.69% 0

Ciprofloxacin 69.23% 0 Cotrimoxazole 0 36.36% Erythromycin 76.92% 54.5%

Vancomycin 23.07% 0

Penicillin 53.84% 45.4%

Clindamycin 0 36.3%

Amoxiclav 0 54.5%

Organism Specific Antibiotic Resistantance Pattern In Cap Antibiotic Resistance Pattern of Gram-Negative Organisms.

Antibiotic K.pneumoniae H.influenzae P.aeruginosa

Amikacin 5% 0 33.3%

Gentamicin 5% 0 16.6%

Ciprofloxacin 10% 0 33.3%

Cotrimoxazole 25% 33.3% 0

Ceftriazone 30% 0 0

Meropenem 0 0 38.3%

Cefepime 0 30.3% 16.6%

Cefazolin 50% 0 0

Cefuroxime 40% 0 0

Clindamycin 15% 0 0

Ampicillin 45% 0 0

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Percentage of Resistance In Organisms.

Organisms Antibiotic Resistance (%) K.pneumoniae Cefazolin 50 P.aeruoginosa Meropenem 33.3 H.infuenza Cotrimoxazole 33.3 S.aureus Erythromycin 76.9 S.pneumoniae Amoxiclav 54.5

Prescription Pattern of Cap

Class of Antibiotic Percentage (%)

Penicillin 52.5%

Macrolide 43.5%

Tetracycline 4.1%

Cephalosporin 41.2% Fluroquinolone 34.1% Aminoglycoside 2.2%

ANTIBIOGRAM OF CAP

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Antibiogram (Sensitivity) of Gram Positive organisms

Empirical antibiotic selection based on sensitivity and resistance pattern

Choice of drug before getting culture report Choice of drug after getting culture report

For gram positive isolates

Streptococcus pneumoniae 1st choice – Ceftriaxone, Cefazolin 2nd choice – Vancomycin

Staphylococcus aureus 1st choice – Cotrimoxazole 2nd choice – Gentamicin, Amikacin

For gram negative isolates

Klebsiella pneumoniae

1st choice – Amikacin, Gentamicin. 2nd choice – Ciprofloxacin.

Pseudomonas aeruginosa

1st Choice – Piperacillin +Tazobactam 2nd Choice – Gentamicin

Haemophilus influenzae

1st Choice – Chloramphenicol 2nd Choice - Meropenem

Give most appropriate sensitive drug based on culture report

In the current study, the majority of the patients are male (65.3%) and females were about (34.7%). This indicate a greater prevalence of CAP in males than in females. This is highly correlated with the study conducted by Felixgutierrez, 2006 entitled “The influence of age and gender on the population based incidence of Community acquired pneumonia caused by different microbial pathogen”, where male shows the higher prevalence than the females.

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Francisco Arancibia (2002) the study entitled” Community Acquired Pneumonia Due to Gram- negative bacteria and Pseudomonas aeruginosa” stated that in our setting, in every 10th patient

with CAP, an aetiology due to GNB has to be considered. Patients with probable aspiration, previous hospitalization or antimicrobial treatment and pulmonary comorbidity especially prone to GNB.

To obtain high susceptibilities to antimicrobial agents, we tested the susceptibilities of the isolated bacterial strains to major groups of antibiotics that have effect against both gram- negative and gram-positive bacteria.

In our study, The most common organism isolated was Klebsiella pneumonia 20(37.7%), followed by Staphylococcus aureus 13(24.5%), Streptococcus pneumoniae 11(20.7%), Haemophilus influenzae 3(5.6%), Pseudomonas aeruginosa 6(11.3%). The study conducted by Prashasti Prasad and Sevitha Bhatt entitled “Clinicomicrobiological study of Community acquired pneumonia” stated that community acquired pneumonia remains as an infectious

cause of mortality and morbidity globally. The common etiological agents of CAP are Klebsiella pneumoniae, Haemophilus influenzae, Streptococcus pneumoniae, Pseudomonas aeruginosa. While” Etiology of community acquired pneumonia in 254 hospitalized children

conducted by Jvuven (2000) stated that 62% of the patients had viral infection, 53% bacterial infection and 30% had evidence of concomitant viral bacterial infection. Streptococcus pneumonia (37%), Respiratory syncytial virus(29%), and rhinovirus (24%) were the most common agents associated with CAP.

CONCLUSION

In this prospective observational study we analysed the bacteriological profile of the patients with Community Acquired Pneumonia. Bacterial infection in CAP was seen more in the age group of 60-72 years.

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DECLARATION

ACKNOWLEDGEMENT

We would like to thank gratefully and sincerely Prof. (Dr). M K Unnkrishanan and Dr. Binu Raj for the keen interest, timely help and valuable suggestion from the very beginning till the completion of the study.

Ethic Approval and Consent To Participitate

All participants provided written informed consent and the study was given ethical approval from the Institutional Ethic Committee (IEC/IRB No: NCP/ IEC/2017/No:082).

COMPETING INTEREST

The authors declare that they have no competing interest, financial or otherwise.

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Figure

Table 1: Proportion of Organism Isolated.

Table 1:

Proportion of Organism Isolated. p.3

References

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