Validation of a Prediction Score for Drug-resistant Microorganisms in Community-Acquired Pneumonia

Pneumonia is a common illness accounting for majority of hospitalizations worldwide with significant mortality and morbidity. Antimicrobial therapy, being the main stay of treatment, the choices of antibiotics depends on the nature of the etiologic agents and the host factors. The current study was aimed to identify the bacterial & fungal etiologic agents of Community Acquired Pneumonia (CAP) in Immunocompromised (IC) patients, with their antimicrobial resistant pattern and to analyze the associated immunocompromised states. Various respiratory samples from study group of 75 immunocompromised patients with features of pneumonia were collected, processed and the isolates were identified with their antimicrobial susceptibility& resistance pattern according to CLSI guidelines. The results were analyzed statistically. Diabetes mellitus is the most common immunocompromised state (48%) associated with CAP. Monomicrobial and polymicrobial infection rates were 80.36% and 19.64% respectively. Gram negative pathogens and fungal pathogens were identified in 60% and 25.37% of culture positive cases respectively. Diabetes mellitus is commonly found in association with polymicrobial infection (19.44%) and fungal infection (16.66%). Drug resistant strains comprise about 75% of MRSA strains, 72.72 % of ESBL producers and 3.44% of Amp C producers. As the number of elderly people with associated IC state is on rise, with change in the pattern of microbial etiologic agents causing CAP, a prior knowledge of the host and microbial factors will help in formulating empirical antimicrobial therapy and proper treatment thereby curbing the spread of infections by drug resistant pathogens and the associated morbidity and mortality.

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Primary lung abscess due to multidrug-resistant Klebsiella pneumoniae

BMJ Case Reports ◽

10.1136/bcr-2021-244759 ◽

2021 ◽

Vol 14 (9) ◽

pp. e244759

Author(s):

Mascarenhas Chrystle ◽

Acharya Vishak ◽

Kamath Sindhu ◽

Mendonca Jane

Keyword(s):

Klebsiella Pneumoniae ◽

Unusual Case ◽

Early Recognition ◽

Multidrug Resistant ◽

Community Acquired Pneumonia ◽

Lung Abscess ◽

Drug Resistant ◽

Management Guidelines ◽

History Of

Primary lung abscess as a complication of necrotising community-acquired pneumonia due to multidrug-resistant (MDR) Klebsiella pneumoniae is rare. A 63-year-old man with a medical history of type 2 diabetes mellitus and chronic kidney disease was diagnosed with lung abscess due to MDR Klebsiella pneumoniae, a rare organism as a causative agent for community-acquired pneumonia. This unusual case revealed therapeutic challenges faced owing to factors such as drug-resistant pathogen, longer duration of antibiotics required for lung abscess and the chronic kidney status of the patient limiting the dosage of antibiotics. The clinical nuggets discussed in this case might pave the way in the future for management guidelines to be formulated in optimising the selection and duration of therapy for lung abscesses with MDR aetiology and in early recognition of this rare but dreaded entity.

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Clinical characteristics of patients with pneumonia caused by Klebsiella pneumoniae in Taiwan and prevalence of antimicrobial-resistant and hypervirulent strains: a retrospective study

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-019-0660-x ◽

2020 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Chih-Han Juan ◽

Shih-Yu Fang ◽

Chia-Hsin Chou ◽

Tsung-Ying Tsai ◽

Yi-Tsung Lin

Keyword(s):

Retrospective Study ◽

Klebsiella Pneumoniae ◽

Clinical Characteristics ◽

Community Acquired Pneumonia ◽

Drug Resistant ◽

Hospital Acquired Pneumonia ◽

Resistant Strains ◽

Healthcare Associated ◽

Drug Resistant Strains ◽

Hospital Acquired

Abstract Background We aimed to compare the clinical characteristics of patients with community-acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP), and hospital-acquired pneumonia (HAP) caused by Klebsiella pneumoniae and analyze the antimicrobial resistance and proportion of hypervirluent strains of the microbial isolates. Methods We conducted a retrospective study on patients with pneumonia caused by K. pneumoniae at the Taipei Veterans General Hospital in Taiwan between January 2014 and December 2016. To analyze the clinical characteristics of these patients, data was extracted from their medical records. K. pneumoniae strains were subjected to antimicrobial susceptibility testing, capsular genotyping and detection of the rmpA and rmpA2 genes to identify hypervirulent strains. Results We identified 276 patients with pneumonia caused by K. pneumoniae, of which 68 (24.6%), 74 (26.8%), and 134 (48.6%) presented with CAP, HCAP, and HAP, respectively. The 28-day mortality was highest in the HAP group (39.6%), followed by the HCAP (29.7%) and CAP (27.9%) groups. The HAP group also featured the highest proportion of multi-drug resistant strains (49.3%), followed by the HCAP (36.5%) and CAP groups (10.3%), while the CAP group had the highest proportion of hypervirulent strains (79.4%), followed by the HCAP (55.4%) and HAP groups (41.0%). Conclusion Pneumonia caused by K. pneumoniae was associated with a high mortality. Importantly, multi-drug resistant strains were also detected in patients with CAP. Hypervirulent strains were prevalent in all 3 groups of pneumonia patients, even in those with HAP.

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