Study of Community-Acquired Bacterial Pneumonias Presenting to Tertiary Care Centre (original) (raw)
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Analysis of Etiology and Clinical Profile of Pneumonia
2020
Background: Community acquired pneumonia (CAP) is major cause of morbidity in adults. The presentation may be varied. Severity of the disease is seen to be more if co-morbid conditions are present, especially chronic lung disease. This study was done to analyze the etiology and clinical profile of community acquired pneumonia admitted in a tertiary hospital in Pakistan, to focus on treatment options and improve outcomes. Methods: Etiology and clinical profile of 100 patients of CAP was studied retrospectively from April 2016 to March 2017. Data regarding clinical features, physical examination, chest x-ray, sputum samples for smear microscopy and culture was collected in a preformed proforma and analyzed. Results: Mean age of patients was 51 years. Forty one patients had associated co-morbidity. None of the patients were vaccinated against influenza and pneumococcus. The duration of hospital stay was longer in patients with higher CURB-65 score. The commonest mode of presentation was cough (76) followed by fever (64). Etiology was determined in 24 patients, commonest being Streptococcus pneumonia which was most commonly sensitive to penicillin group of antibiotics followed by cephalosporines. The mortality rate was 1%. Two patients required care in Intensive care unit and 97 were discharged after improving. conclusion: Etiology of pneumonia could be identified in 24% of cases. Pneumococcus was found mostly sensitive to penicillins and cepahalosporines. Gram negative organisms were mostly sensitive to ciprofloxacin and aminoglycoside. None of the patients were vaccinated against H.influenza or S.pneumoniae. Higher CURB-65 score was associated with longer duration of hospital stay.
Medical Principles and Practice, 2005
moniae in 3 (2%), Staphylococcus aureus in 3 (2%), gramnegative enterobacteria in 5 (4%), Moraxella catarrhalis in 2 (2%), and viruses in 4 (3%). The yields from laboratory tests were 48% for paired serology, 20% from adequate sputum sample, and 3% from blood culture. Conclusion: Our study shows that a large percentage of mild CAP cases are admitted to hospitals in Kuwait. Atypical pathogens have a signifi cant role in the etiology of CAP. There is overtreatment of CAP with a combination treatment consisting mainly of third-generation chephalosporins and macrolides.
BACTERIOLOGICAL AND CLINICAL PROFILE OF COMMUNITY ACQUIRED PNEUMONIA IN A TERTIARY CARE HOSPITAL
Context: Community acquired pneumonia (CAP) is still a significant cause of morbidity and mortality throughout the world despite availability of potent antimicrobials. Aims: The objective of our study was to look into the bacteriological and clinical profile of CAP patients requiring admission in our tertiary care hospital in Kolkata, West-Bengal. Settings and Design: This was a prospective, observational, cross sectional study comprising of 128 patients admitted in chest ward with CAP. Methods and material: At the time of admission a detailed history and clinical examination, chest radiography, complete hemogram, glycemic status, renal and liver function tests were done in all patients. Sputum sample was collected for gram staining and bacteriological culture on blood agar and MacConkeys agar media. Two blood samples were sent for culture. Statistical analysis used: Predesigned and pretested schedule for collection of baseline informations. For statistical analysis multiple logistic regression were performed with SPSS programme version 16. Results: Our results showed that mean age was 42.13? 9.8yrs with male predominance (M:F 2.28:1). The commonest presenting symptom was cough, whereas the commonest clinical sign was tachypnea. Microorganism could be isolated in sputum culture in 75% of cases, but yield of blood culture was low(9%). The commonest microorganism isolated was Streptococcus Pneumonia in 41% cases followed by Pseudomonas in 11% cases. In diabetic patients, the commonest organism was Streptococcus Pneumonia (28%), but proportion of Klebsiella species was also high(16%). Conclusion: The present study showed that microorganisms can be isolated in significant number of cases of CAP in sputum culture, but the yield of blood culture is low. The microbiological pattern in samples may differ, but knowledge of distribution in certain geographical area is always helpful for initiation of empirical therapy to guide a favourable clinical response.
Thorax, 1996
Background -The purpose of this study was to assess the causes of communityacquired pneumonia in adult patients admitted to hospital. Methods -A prospective study was performed on 346 consecutive adult patients (54% men) of mean (SD) 49 3 (19.5) years (range 17-94) admitted to a university affiliated regional hospital in southern Israel with community-acquired pneumonia over a period of one year. Convalescent serum samples were obtained from 308 patients (89%). The aetiological diagnosis for community-acquired pneumonia was based on positive blood cultures and/or significant changes in antibody titres to Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, respiratory viruses, Coxiella burnetii, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella sp. Results -The aetiology of communityacquired pneumonia was identified in 279 patients (80.6%). The distribution of causal agents was as foliows: S pneumoniae, 148 patients (42-8%); M pneumoniae, 101 (29.2%); C pneumoniae, 62 (17-9%); Legionella sp, 56 (16.2%); respiratory viruses, 35 (10-1%); C burnetii, 20 (5.8%); H influenzae 19 (5 5%); and other causes, 21 patients (6-0%). In patients above the age of 55 years C pneumoniae was the second most frequent aetiological agent (25-5%). In 133 patients (38.4%) more than one causal agent was found. Conclusions -The causal agents for community-acquired pneumonia in Israel are different from those described in other parts of the world. In many of the patients more than one causal agent was found. In all these patients treatment should include a macrolide antibiotic, at least in the first stage of their illness.
Microbial aetiology of community-acquired pneumonia and its relation to severity
Thorax, 2011
Background The distribution of the microbial aetiology and mortality of community-acquired pneumonia (CAP) was investigated in relation to the clinical setting and severity scores (pneumonia severity index (PSI) and confusion, blood urea nitrogen, respiratory rate, blood pressure, age (CURB-65)). Methods 3523 patients with CAP were included (15% outpatients, 85% inpatients). The distribution of the microbial aetiology in relation to the clinical setting and severity scores (PSI, CURB-65) and the relative mortality of different aetiologies across the severity scores were analysed.
Non-Resolving Pneumonia Aetiology and Clinical Profile: A Prospective Study
Journal of Evolution of Medical and Dental Sciences, 2016
BACKGROUND Pneumonia is defined as the inflammation and consolidation of the lung tissue due to an infectious agent. In as many as half of cases, the pathogen remains unidentified which greatly hampers the evaluation of slowly resolving or non-resolving pneumonia. OBJECTIVE The main objective is to evaluate the aetiology and clinical profile of non-resolving pneumonia in a tertiary care center and to study the outcome of treatment of non-resolving pneumonia. DESIGN AND SETTING A prospective, observational study was carried out in the department of pulmonary medicine of a 700 bedded tertiary care teaching hospital, Kerala. MATERIALS AND METHODS The patients who were diagnosed as non-resolving pneumonia were included in the study. Various investigations were done on patients to identify the aetiology and clinical profile of their pneumonia which includes sputum gram stain, culture and sensitivity for bacterial infections, AFB culture, fungal culture, chest X-ray, CT thorax, fibrotic bronchoscopy (For selected patients only) and sputum cytology for malignant cells. STATISTICAL METHODS USED Descriptive statistical analysis was done with help of 'Graph pad prism'. RESULTS With good clinical interpretations and appropriate treatment, about 31.8% of patients had good clinical improvement and complete chest X-ray clearance after 2 months of follow up where as 36.2% of study subjects had good clinical improvement with incomplete chest X-ray clearance. Majority of this group includes patients who were put on anti-tubercular treatment based on careful interpretation of chest X-ray findings of tuberculosis, Mantoux test and sputum AFB culture results. This implies the importance of early diagnosis of treatable diseases like tuberculosis in our population. Out of the total cases 21.2% of patients had poor clinical outcome whereas 4.4% patients were grabbed by death. CONCLUSION Tuberculosis was the commonest cause of non-resolving pneumonia followed by Malignancy. An open mind towards this disease is required and specific investigations are to be made more available.
https://www.ijrrjournal.com/IJRR\_Vol.6\_Issue.6\_June2019/Abstract\_IJRR0014.html, 2019
Background: Pneumonia is one of the most important, serious and debilitating infectious diseases, accounting for a considerable number of hospital admissions with an increasing rate of serious complications. Aim: (i) To study the clinical profile of Community Acquired Pneumonia. (ii) To determine the various predisposing factors. (iii) To identify the most common pathogen causing Community Acquired Pneumonia in hospitalized patients in Aarupadai Veedu Medical College and Hospital, Puducherry (AVMC&H). Methods: 50 patients with Community acquired pneumonia (CAP) aged more than 18 years were enrolled in this cross sectional study. In all the patients' demographic data and detailed history were recorded followed by complete physical examination, Chest X-ray, blood culture, sputum culture and other investigation wherever applicable in a preformed proforma. The study was conducted between October 2015 to September 2017. Result: CAP was found predominantly in females (58%) and elderly age group > 50 years (52%). The most common predisposing factors associated with CAP are: type 2 diabetes mellitus (44%), systemic hypertension (28%), bronchial asthma (10%), chronic obstructive pulmonary disease (8%). The commonest mode of presentation was cough with expectoration (100%) followed by fever (80%). Crepitations (84%) were the most common clinical sign. Signs of possibly harmful systemic response were seen in 92% of study group. The commonest organism involved in causing community acquired pneumonia in this study is Streptococcus Pneumoniae (42%) followed by Klebsiella and Pseudomonas aeruginosa (20%). Lobar pneumonia was the commonest radiological presentation. Conclusion: Streptococcus pneumoniae is the most common pathogen responsible for CAP in this geographical area. Our observations will be useful to help the physicians to start rational empirical treatment for patients with CAP.
" Microbiology and Outcomes of Community Acquired Pneumonia "
Background: Community acquired pneumonia (CAP) is an acute illness acquired in the community with symptoms suggestive of lower respiratory tract infection (LRTI) together with the presence of a chest radiography of intrapulmonary shadowing which is likely to be new and has no clear alternative cause. Objective: To study the microbiology and different aetiologies of community acquired pneumonia (CAP), the complications associated with community acquired pneumonia, and the treatment outcomes. Methods: Cross sectional, prospective studydone at the Institute of Internal Medicine, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai from October 2016 to May 2017. 50 patients admitted with a clinical diagnosis of pneumonia were evaluated and non-infectious causes were excluded. Clinical data was collated and analysed. Results: Total of 50 patients were included in our study. Sputum staining showed gram positive organisms in 25 cases (50%), gram negative organisms in 12 cases (24%), mixed growth in 1 case (2%) and no organism in 12 cases (24%). Culture of the sputum yielded Streptococcus (most common), Staphylococcus, Klebsiella, Pseudomonas, E. coli, mixed growth or no organism. Involvement was unilateral in 92% and bilateral in 8% of cases. Complications included pleural effusion, lung abscess, circulatory failure and jaundice. 82% of patients were cured completely, 14% had a partial response to treatment, and 4% of patients died despite therapy.
Science Journal of Clinical Medicine, 2014
Background: Community-acquired pneumonia (CAP) is major causes of morbidity and mortality. The etiology of CAP varies by geographic region; knowing the etiology might help for the management of the case in case of emergency and to guide treatment. So, in resource limited countries it is wise to identify the most common pathogens of CAP. The objective of this study was to determine bacterial etiology of CAP among adult patients visiting Arba Minch Hospital. Methods: A cross sectional study was conducted in Arba Minch Hospital, Southern Ethiopia from March 01 to June 01, 2013. Data was collected from adult patients with CAP visiting Arba Minch Hospital using face to face interviews, observation using checklist and laboratory examinations. Sputum specimens were collected and microbiological investigations were performed using standard procedures. Data was processed and analyzed with SPSS version16.0 and Excel 2007. Results: Out of 170 cases, only 68 (40%) were culture positive. One pathogen was demonstrated in 63 (92.6%) patients and 6 (7.4%) had mixed infection. The common isolates of single bacterial pathogens from sputum specimens were S. pneumoniae 20 (11.8%), S. aureus 15 (8.8%), P. aeruginosa 10 (5.8%), K. pneumoniae 8 (4.7%), E. coli 4 (2.4%), H. influenzae 4 (2.4%), P. mirabilis 1 (0.6%), and P. vulgaris 1 (0.6%). The commonest mixed bacterial isolate was K. pneumoniae and P. aeruginosa 2(1.2%). Conclusion: In this study, common bacteria isolated were S. pneumoniae, S. aureus and gram negative bacteria. Significant numbers of Gram negative bacteria were isolated which may indicate a shift of infection trend to Gram negative bacteria. Hence, periodic monitoring of etiologic agents with their drug resistant pattern is essential for better management of CAP and treatment strategies.
Bacterial etiology in acute hospitalized chronic obstructive pulmonary disease exacerbations
The European Research Journal, 2016
Objectives. The most common cause of acute COPD exacerbation (AECOPD) is the respiratory tract infections. We sought to determine the bacteriological etiology of hospitalized acute exacerbations of COPD requiring hospitalization in consecutive two years. Methods. We aimed to determine the bacteriological etiology underlying in patients whom admitted to Uludag University Faculty of Medicine, Department of Pulmonary Medicine and hospitalized with AECOPD in the last two years. Medical records of the study participants were screened retrospectively and sociodemographic characteristics, routine laboratory tests and sputum culture results were analyzed. Results. A total of 242 patients hospitalized for AECOPD were enrolled. Of these 86.4% (n=209) were male. The mean age of the group was 66.6±11 years old. Sputum cultures were available in the 45 % (n=109) of the study group. The most frequent bacteria isolated from the sputum cultures of the study group were Pseudomonas aeruginosa, Streptococcus pneumonia, Haemophilus influenzae and Acinetobacter baumanii. Length of stay was longer in patients with the A. baumanii isolate than the rest of the group (p=0.024). Length of stay in hospital was independently associated with in-hospital mortality (OR: 1.37, 95% CI: 1.05-1.78). Isolation of A. baumanii and/or Staphylococcus aureus in sputum culture were identified as independent risk factors for prolonged length of stay in-hospital (b=0.26, p=0.008; b=15.40, p=0.003). Conclusions. Our study shows that P. aeruginosa, S. pneumonia, H. influenzae are common sputum isolates in AECOPD patients requiring hospitalization. Isolation of A. baumanii and/or S. aureus in sputum culture is associated with prolonged length of stay in hospital, which is an independent risk factor for in-hospital mortality.