Factors Affecting Antibiotic Resistance Among Patients With Community Acquired Pneumonia In A Tertiary Care Hospital

Abstract

Background: Community Acquired Pneumonia (CAP) is a major health problem leading to significant morbidity and mortality worldwide. Bacteriological profile of CAP is different in different countries and changing with time within the same country. Bacterial resistance to antibiotics is also an increasing problem, which may cause infection that is difficult to treat.

Aims: To identify the factors affecting antibiotic resistance among indoor patients of NIDCH.

Materials & Methods: This cross sectional, observational study conducted at the Department of Respiratory Medicine in National Institute of Diseases of the Chest and Hospital from May 2019 to September 2020. Of 195 patients with CAP, 87 patients with positive sputum bacterial growth were enrolled in this study.

Results: A total number of 87 patients with community acquired pneumonia were selected and among them, majority patients were male 65(74.7%), male to female ratio was 2.9:1. The mean age was found 50.6±16.7 years with range from 18 to 85 years. Among the co morbidities diabetes mellitus was the highest 34(39.1%) followed by hypertension 23(26.4%), chronic obstructive pulmonary disease (COPD) 20(23.0%). Most frequent pathogens were Klebsiella pneumoniae 35(40.2%) followed by Streptococcus pneumoniae 15(17.2%), Pseudomonas aeruginosa 11(12.6%). In this study it was observed that multidrug-resistant pathogens was found 54(62.1%) with 95% CI 51.9 to 72.3%. In multivariate logistic regression analysis, previous antibiotic use, history of self medication and history of previous hospitalization were found to be independent predictors for multidrug resistance.

Conclusion: Gram negative bacteria are the main pathogenic bacteria in CAP. Identification of bacteriological profile and susceptibility pattern of pathogens could enable accurate diagnosis and treatment of CAP. The growing prevalence of multidrug resistant bacteria represents an important issue in choosing empiric antimicrobial management in hospitalized patients. The widespread antibiotic resistant microorganisms necessitate the implementation of antibiotic stewardship strategies, to ensure that antibiotics are used only when necessary and appropriate.

Chest Heart J. 2021; 45(1) : 31-39