Community acquired pneumonia among adult patients at an Egyptian university hospital: bacterial etiology, susceptibility profile and evaluation of the response to initial empiric antibiotic therapy

• Published in: Infection and drug resistance 2018-01, Vol.11, p.2141-2150
• Main Authors: El-Sokkary, Rehab H, Ramadan, Raghdaa A, El-Shabrawy, Mohamed, El-Korashi, Lobna A, Elhawary, Abeer, Embarak, Sameh, Tash, Rehab M Elsaid, Elantouny, Neveen G
• Format: Article
• Language: English
• Subjects: Adults; Antibacterial agents; antibiotic stewardship; Antibiotics; Antimicrobial agents; atypical bacteria; Azithromycin; Bacteria; Beta lactamases; Carbapenems; Cefepime; Chronic obstructive pulmonary disease; Community; Community-acquired infections; Drug therapy; empirical therapy; Etiology; Etiology (Medicine); Failure; Hospital patients; Hospitals; Imipenem; Immunology; infection control; Infectious diseases; Intensive care; Klebsiella pneumoniae; Lactams; Lung diseases; Medical prognosis; Medicine; Methicillin; Microbial drug resistance; Mortality; Moxifloxacin; Multidrug resistance; Original Research; Oxacillin; Pathogenic microorganisms; Patients; Phenotypes; Pneumonia; Pseudomonas aeruginosa; respiratory infection; Staphylococcus infections; Statistical sampling; Streptococcus infections; Streptococcus pneumoniae; Sulbactam; Systematic review; Tazobactam; Testing; β-Lactam antibiotics
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/idr.s182777

Effective empirical antibiotic therapy for community acquired pneumonia (CAP), based on frequently updated data about the pattern of bacterial distribution and their antimicrobial susceptibilities, is mandatory. To identify the bacterial etiology of CAP in adults and their antibiotic susceptibility patterns and to evaluate the response to initial empirical antibiotic therapy in an Egyptian university hospital. A cross-sectional hospital-based study. CAP cases were selected by systemic random sampling from those admitted to the chest department. All were evaluated at admission and 4 days after starting empiric therapy. Typical bacteria were isolated, identified and tested for their antibiotic susceptibility. An indirect IF assay was used to diagnose atypical bacteria. Clinical response to initial empiric antibiotic therapy was clinically, laboratory and radiologically evaluated. Two hundred and seventy CAP patients were included. Bacteria represented 50.4% of them. was the most prevalent bacterium (10.37%) followed by and (7.78% each). Overall, 76.2% of isolates showed a multidrug resistant phenotype: 82.61% (19/23) , 89.66 % (26/29) , 65.22% (15/23) , 87.50% (7/8) and 81.25 % (13/16) . Broad spectrum β-lactams, especially carbapenems, and moxifloxacin showed in vitro efficacy on most of the tested isolates. Forty-three cases (15.9%) were nonresponders, 37 (86%) of them showed bacterial etiology. The highest rate of nonresponsiveness (30.43%) was observed in cases receiving antipseudomonal/antipneumococcal β-lactam plus a fluoroquinolone for suspected infection. Multidrug resistance in bacteria causing CAP and high frequency of isolation of hospital pathogens are prominent features of this study. Azithromycin containing regimens were associated with the lowest rates of nonresponsiveness. Development and implementation of an antibiotic stewardship program are highly recommended for CAP management.