scholarly journals Risk factors of community acquired pneumonia among the elderly population: A study in a semi urban area

2021 ◽  
Vol 6 (2) ◽  
pp. 125-129
Author(s):  
Kunachgi Preeti Nagkumar ◽  
Ch Bhadra Reddy ◽  
M Hima Bindu ◽  
Chinthaparthi Mallikarjuna Reddy
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Blood Culture ◽  
Klebsiella Pneumoniae ◽  
The Elderly ◽  
Community Acquired Pneumonia ◽  
Sputum Culture ◽  
Ultra Sound ◽  
X Rays ◽  
Culture And Sensitivity

Pneumonia is defined as an infection and inflammation of the alveoli and the bronchioles. It is caused by microorganisms when the hosts’ defences are overcome by their virulence. Community Acquired Pneumonia affects people of all age groups, though the elderly is especially susceptible. This retrospective study was conducted on 56 patients above the age of 65 years who were admitted to our hospital for pneumonia. Demographic data of the patients such as age, sex, weight, temperature blood pressure etc. was taken. History of underlying disease, comorbidities, cardiopulmonary function was noted. Data on the laboratory investigations such as Complete Blood Picture, haemoglobin estimation, Blood glucose levels, Kidney function tests, liver function rests, electrolyte levels, CRP, D Dimer were noted. Details of chest X rays or Ultra sound, ABG analysis were also noted. Details of sputum culture and sensitivity and blood culture and sensitivity for the patients was also noted. the most common comorbidity was hypertension, followed by cerebrovascular diseases cardiopathy, COPD and diabetes. Klebsiella pneumoniae was isolated in 69.6%, Pseudomonas aeruginosa in 48.2%, Candida albicans in 51.8% and Acinetobacter baumanni in 44.6% cases in sputum culture and in blood culture Klebsiella pneumoniae was isolated in 16.1%) followed by Pseudomonas aeruginosa in 8.9% cases. Community acquired pneumonia contributes significantly to the health burden of the world especially causing severe morbidity and mortality among the elderly patients. For a better prognosis, it is important to diagnose and identify the risk factors so that the severity of the infection can be prevented.

scholarly journals Bronchoscopic Microbial Diagnosis in Non-Responding & Non-Resolving Pneumonia

2021 ◽  
Vol 35 (1) ◽  
pp. 12-15
Author(s):  
Muhammad Saqib
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Klebsiella Pneumoniae ◽  
Stenotrophomonas Maltophilia ◽  
The Elderly ◽  
Community Acquired Pneumonia ◽  
Microbiological Diagnosis ◽  
Sample Collection ◽  
Serious Illness ◽  
Bronchial Washing ◽  
Considerable Morbidity

Introduction: Pneumonia is a common and potentially serious illness associated with considerable morbidity and mortality, especially in the elderly and those with notable comorbidities. More than 100 microbes (bacteria, viruses, fungi, and parasites) can cause pneumonia. In hospitalized community-acquired pneumonia (CAP), 40% are non-responding CAP. The reliability of using bronchoscopic procedures when compared with sputum cultures, routinely processed bronchoscopic specimens demonstrate improved sensitivity. Aims & Objectives: Isolation of a responsible microbe causing respiratory infection in non-responding & non- resolving pneumonia. Place and duration of study: This Study was conducted at the Department of Pulmonology Shaikh Zayed Medical Complex, Lahore from 01-01-2018 to 31-12-2019. Material & Methods: Retrospective analysis of 109 bronchoscopic procedures conducted in patients with NonResponding & Non-Resolving Pneumonia with a fiberoptic bronchoscope over two years (01-01-2018 to 3112-2019). Results: One hundred nine (109) procedures were done in patients with non-responding and resolving Pneumonia. Bronchial washing microbiology yielded results in 71 (65.1%) patients. Pseudomonas aeruginosa was the most frequent organism and was isolated in 30 (42.3%) patients; Klebsiella pneumoniae was found in 23 (32.4%) patients. Other organisms included Staphylococcus aureus (22.5%), Acinetobacter baumanni (14.1%), Escherichia coli (11.3%), Streptococcus pneumoniae (11.3%), Stenotrophomonas maltophilia (4.2%), Haemophilus influenzae (2.8%), Enterococcus (1.4%) and Mycobacterium tuberculosis (4.2%). Conclusion: Pseudomonas aeruginosa and Klebsiella pneumoniae are the most common isolated organisms in patients with non-responding and non-resolving Pneumonia. Bronchoscopy is an extremely useful tool for sample collection among non-responding & non-resolving pneumonia and making the correct microbiological diagnosis.

Clinical and epidemiological features of community-acquired pneumonia during an epidemic of respiratory viral infection

2021 ◽  
Vol 31 (4) ◽  
pp. 490-498
Author(s):  
N. I. Izmozherova ◽  
A. A. Popov ◽  
E. R. Prokopeva ◽  
A. A. Kuryndina ◽  
E. I. Gavrilova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Streptococcus Pneumoniae ◽  
Causative Agent ◽  
Community Acquired Pneumonia ◽  
Influenza Viruses ◽  
X Rays ◽  
Imaging Data ◽  
Cross Sectional ◽  
Epidemiological Features ◽  
Working Age

Community-acquired pneumonia (CAP) is one of the most common lower respiratory tract diseases. An increase in the CAP incidence has been reported to be associated with epidemics of acute respiratory viral infections (ARVI).Aim. Аssess clinical and epidemiological features of CAP in patients admitted to hospital during an ARVI epidemic.Methods. A cross-sectional study included 208 patient records. Medical history, physical examination, laboratory and imaging data were analyzed. CAP severity was assessed by CRB-65 scale and the systemic inflammatory response syndrome (SIRS) criteria.Results. Most CAP patients (75%) were of active working age; all presented signs of ARVI upon admission. Nasal mucosa diagnostic smears have revealed type A influenza viruses: H1N1 – 5 (83.3%) and H3N2 – 1 (16.7%) cases. 195 (93.8%) patients were not vaccinated against influenza. X-rays showed that unilateral (81.7%) and lobular pneumonia (55.8%) were the most common CAP types. 93.2% patients had nonsevere CAP, according to CRB-65. But 88 (42.3%) subjects qualified for SIRS upon admission. Concomitant conditions as risk factors of an adverse course of CAP were present in 89 patients (42.8%). Sputum analysis, if available, most frequently identified Streptococcus pneumoniae (23 cases or 38.9%) as a causative agent. Antibacterial drugs (ABD) used to treat CAP were ceftriaxone 206 (99%), macrolides 188 (90.4%), and fluoroquinolones 94 (45.2%). The initial antibacterial treatment regimens were: 186 (89.4%) prescriptions of ceftriaxone + macrolides, 16 (7.7%) prescriptions of ceftriaxone alone, and 6 (2.9%) prescriptions of levofloxacin. A switch between ABDs was reported in 78 (37.5%) cases, including 61 switches to fluoroquinolones. The median ABD administration duration was 10 (8 – 13) days.Conclusion. Most of the hospitalized CAP patients were of working age and not vaccinated against influenza. Streptococcus pneumoniae was the most common causative agent. PCR (polymerase chain reaction) smear analysis was performed only in 6 patients with ARVI, which does not allow us to assess the role of viruses and viral-bacterial associations in the etiology of CAP. In spite of non-severe CAP, all hospitalizations were justified, due to multiple risk factors of unfavorable prognosis of CAP and epidemiological factors. Most patients received a combination of generation 3 cephalosporins and macrolides as the initial therapy for CAP.

scholarly journals Clinical Presentation and Bacterial Etiology of Adult Community Acquired Pneumonia

2017 ◽  
Vol 34 (3) ◽  
pp. 128-134
Author(s):  
Md Abdus Salam ◽  
Md Robed Amin ◽  
Quazi Tarikul Islam
Keyword(s):  
Streptococcus Pneumoniae ◽  
Blood Culture ◽  
Mycoplasma Pneumoniae ◽  
Chlamydia Pneumoniae ◽  
Community Acquired Pneumonia ◽  
Sputum Culture ◽  
Gram Positive ◽  
Gram Negative ◽  
The Mean ◽  
Gram Positive Cocci

Introduction: Pneumonia is a worldwide, serious threat to health and an enormous socio-economic burden for health care system. According to recent WHO data, each year 3-4 million patients die from pneumonia. The clinical presentations and bacterial agents responsible for community acquired pneumonia (CAP) varies according to geography and culture.Methods: A cross sectional observational study conducted among the 53 consecutive patients with a clinical diagnosis of CAP in admitted patient in the department of Medicine, DMCH, during January 2010 to December 2010. Hematological measurements (TC of WBC, Hb%, ESR, platelet count), blood culture, chest X-ray P/A view, sputum for Gram staining and culture sensitivity, sputum for AFB, blood urea and random blood sugar were done in all cases. ELISA for IgM antibody of Mycoplasma pneumoniae and Chlamydia pneumoniae were done in sputum culture negative cases.Results: The mean (±SD) age was 38.9±17.3 years and Male female ratio was 3:1. Fever, chest pain and productive cough were the most common clinical features. The mean (±SD) respiratory rate was 23.0±2.8 /minute . COPD and DM were found in 17.0% and 5.7% of patients respectively . Blood culture was found positive in only 1.9% of the study patients. Gram positive Cocci 62.26%, Gram negative Bacilli 9.43%, mixed Gram positive cocci and Gram negative bacilli 11.32% and Gram negative Cocco Bacilli 1.9% were observed and in 15.03 % cases, no bacteria could be seen. Sputum culture revealed 53.8% streptococcus pneumoniae, 26.9% Klebsiella pneumonia as predominant organism. Mycoplasma pneumoniae and Chlamydia pneumoniae were found in 7.4% and 3.7% respectively by serological test. For Streptococcus pneumoniae, sensitive antibiotics were Amoxyclav and Levofloxacin. For Gram negative bacilli and coccobacilli, more sensitive antibiotics were Meropenem, Ceftriaxone, and Clarithromycin. The best sensitive drug were found meropenem. The mean (±SD) duration of hospital stay was 5.0±1.7 days with ranging from 3 to 10 days.Conclusion: Region based bacteroiological diagnosis of Cap is important for selecting the best and sensitive drugs for complete cure.J Bangladesh Coll Phys Surg 2016; 34(3): 128-134

scholarly journals Common Pathogens and Their Resistance to Antimicrobials in Community Acquired Pneumonia (CAP): A Single Center Study in Bangladesh

2020 ◽  
Vol 7 (12) ◽  
pp. 5144-5153
Author(s):  
Abu Kausar Mohammad ◽  
Morshed Nasir ◽  
Sujat Paul ◽  
Habibur Rahman ◽  
Kalam Abul ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Legionella Pneumophila ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Sputum Culture ◽  
College Hospital ◽  
Cross Sectional ◽  
Female Ratio ◽  
Sensitivity Pattern

Pneumonia is a worldwide, serious threat to health and an enormous socio-economic burden for health care system. Community-acquired pneumonia (CAP) is associated with a significant mortality and morbidity. Knowledge of predominant microbial patterns in CAP constitutes the basis for initial decisions about empirical antimicrobial treatment. The aim of this study was to identify the bacterial etiology of CAP in adult hospitalized patients and to see their antibiotic sensitivity pattern. It was a hospital based cross sectional observational study on 87 hospitalized patients diagnosed with CAP admitted in Medicine department of Chittagong Medical College Hospital (CMCH). Sputum for Gram staining, Z N staining, culture sensitivity, blood culture and sensitivity and PCR for Legionella pneumophila, Mycoplasma pneumoniae, Chlamydophila pneumonia and Streptococcus pneumonia were done. Patients were followed up for in-hospital outcome and 30-day mortality. The mean (±SD) age was 49.59±16.97 years and male female ratio was 1.56:1. Sputum culture, blood culture and PCR were positive in 60.9%, 1.1% and 4.6% of the samples respectively. Klebsiella pneumoniae was identified in the sputum culture of the majority of the patients (39.1%), followed by Pseudomonas aeruginosa (10.3%), Staphylococcus aureus and Escherichia coli (5.7%). The only one sample which was positive in blood culture and it was Staphylococcus aureus. Streptococcus pneumoniae was identified in all the 4 PCR positive cases. The highly sensitive drugs were meropenem, levofloxacin and amikacin. In hospital mortality and 30-day mortality was 6.9% and 16.1% respectively. Gram-negative bacteria pre-dominate in the bacteriologic profile of CAP using conventional sputum and blood culture. There is need for further conventional serologic tests for atypical and viral pathogens in all patients admitted with CAP.

scholarly journals Bacterial Etiology and Antibiotic Sensitivity Pattern of Community Acquired Pneumonia in Diabetic Patients: Experience in a Tertiary Care Hospital in Bangladesh

2017 ◽  
Vol 7 (2) ◽  
pp. 101-105
Author(s):  
Jamal Uddin Ahmed ◽  
Mohammad Delwar Hossain ◽  
Muhammad Abdur Rahim ◽  
Farhana Afroz ◽  
AKM Musa
Keyword(s):  
Staphylococcus Aureus ◽  
Klebsiella Pneumoniae ◽  
Antibiotic Sensitivity ◽  
Community Acquired Pneumonia ◽  
Sputum Culture ◽  
Diabetic Patients ◽  
Care Hospital ◽  
E Coli ◽  
Sensitivity Pattern ◽  
Pseudomonas Species

Background: Diabetes mellitus (DM) is an immunosuppressive condition and uncontrolled diabetes is associated with increased susceptibility to various infections like pneumonia. Community acquired pneumonia (CAP) in diabetic patients is often caused by more virulent or atypical organisms and associated with increased resistance to conventional antibiotics. The aims of this study were to identify the bacterial etiology of CAP in patients with DM and to see their antibiotic sensitivity pattern.Methods: This was a cross-sectional, observational study conducted in the Department of Internal Medicine & Pulmonology of BIRDEM General Hospital, Dhaka, Bangladesh, from January 2013 to December 2015. A total of 120 hospitalized diabetic patients diagnosed with CAP and with a positive sputum culture growth of any bacteria were included in the study.Results: Majority (67%) of the patients were male. Mean age of the patients was - 55.69 ±10.5 years. Mean duration of diabetes was - 7.35 ±1.3 years. Mean HbA1c was - 8.6 ±1.89%. Sputum for culture showed that out of 120 (100%) patients, Klebsiella pneumoniae was detected in 53 (44.2%) patients, Staphylococcus aureus in 18 (15.0%), Pseudomonas species in 16 (13.3%) patients, Acinetobacter in 10 (8.3%), Escherichia coli in 9 (7.5%) patients and 14 (11.7%) patients had growth of other organisms. Sensitivity pattern of different bacterial growth in sputum to commonly used antibiotics like ceftriaxone, ciprofloxacin, amikacin and imipenem were as follows – Klebsiella (19%, 47%, 74%, 96% respectively), Staph aureus (11%, 33%, 78%, 67% respectively), Pseudomonas (19%, 75%, 81%, 88% respectively), Acinetobacter (0%, 0%, 20%, 50% respectively), E. coli (22%, 22%, 100%, 100% respectively). All (100%) of the Pseudomonas and Acinetobacter were sensitive to colistin. Most of the growth of all the bacteria (Klebsiella 94%, Staphylococcus 78%, Pseudomonas 81%, Acinetobacter 100%, E. coli 100%) occurred in patients with poor glycemic control (HbA1c ? 7.0%).Conclusion: This study results suggest that CAP in diabetic patients are more frequently due to Klebsiella pneumoniae, Staphylococcus aureus and Pseudomonas species and mostly they are less sensitive to commonly used antibiotics like ceftriaxone and ciprofloxacin. So, whenever possible, treatment of CAP should be guided by sputum culture and sensitivity test and for empirical treatment of CAP in diabetic patients, alternative antibiotics like imipenem and amikacin should be considered.Birdem Med J 2017; 7(2): 101-105

scholarly journals Common Pathogens and Their Resistance to Antimicrobials in Community Acquired Pneumonia (CAP): A Single Center Study in Bangladesh

2020 ◽  
Author(s):  
Kausar MA ◽  
Nasir M ◽  
Paul S ◽  
Rahman MH ◽  
Kalam A ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Legionella Pneumophila ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Sputum Culture ◽  
College Hospital ◽  
Female Ratio ◽  
Sensitivity Pattern ◽  
The Mean

Abstract Pneumonia is a worldwide, serious threat to health and an enormous socio-economic burden for health care system. Community-acquired pneumonia (CAP) is associated with a significant mortality and morbidity. Knowledge of predominant microbial patterns in CAP constitutes the basis for initial decisions about empirical antimicrobial treatment. The aim of this study was to identify the bacterial etiology of CAP in adult hospitalized patients and to see their antibiotic sensitivity pattern as well as to observe their clinical profile and short term outcome. It was a hospital based prospective observational study. A total of 87 hospitalized patients diagnosed with CAP were enrolled consecutively from the medicine ward of Chittagong Medical College Hospital (CMCH). Sputum for Gram staining, Z N staining, culture sensitivity, blood culture and sensitivity and PCR for Legionella pneumophila, Mycoplasma pneumoniae, Chlamydophila pneumonia and Streptococcus pneumonia were done. Patients were followed up for in-hospital outcome and 30-day mortality. The mean (±SD) age was 49.59±16.97 years and male female ratio was 1.56:1. Fever, chest pain and cough were the most common clinical features. Sputum culture, blood culture and PCR were positive in 60.9%, 1.1% and 4.6% of the samples respectively. Klebsiella pneumoniae was identified in the sputum culture of the majority of the patients (39.1%), followed by Pseudomonas aeruginosa (10.3%), Staphylococcus aureus and Escherichia coli (5.7%). The only one sample which was positive in blood culture and it was Staphylococcus aureus. Streptococcus pneumoniae was identified in all the 4 PCR positive cases. The highly sensitive drugs were meropenem, levofloxacin and amikacin. The mean (±SD) duration of hospital stay was 6.34±2.37. In hospital mortality and 30-day mortality was 6.9% and 16.1% respectively. Gram-negative bacteria pre-dominate in the bacteriologic profile of CAP using conventional sputum and blood culture. There is need for further conventional serologic tests for atypical and viral pathogens in all patients admitted with CAP.

scholarly journals 1301. Risk Factors for Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa in Community Acquired Pneumonia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S738-S739
Author(s):  
Maya Bell ◽  
Courtney Veltri ◽  
Evelina Kolychev ◽  
Leila S Hojat
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Risk Factor ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Academic Medical Center ◽  
Community Acquired Pneumonia ◽  
Methicillin Resistant ◽  
Independent Risk Factors ◽  
The Impact

Abstract Background The 2019 American Thoracic Society and Infectious Diseases Society of America Community-Acquired Pneumonia (CAP) guidelines concluded that the major risk factors for methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PsA) include prior isolation of these organisms and previous hospitalization with IV antibiotic use within 90 days. However, the guidelines recognized that results may vary by region and recommended local validation of risk factors. The primary objective of this study was to determine which potential risk factors are associated with MRSA and Pseudomonas aeruginosa in CAP in our institution. This study also evaluated appropriateness of antibiotics used for empiric CAP therapy. Methods This was a single-center, retrospective cohort study performed in an urban academic medical center in Cleveland, OH. Adults hospitalized for CAP who had a respiratory culture performed between January 2016 and September 2020 were included. Patients were randomized in a 1:1:1 ratio into MRSA, PsA, and non-resistant CAP (NR-CAP) groups. Patients with bacterial co-infections or resistant pathogens other than MRSA or PsA were excluded. Results The study included 111 patients with 37 patients in each group. The median age was 61 years (IQR 52-70), and 58.6% of patients were male. There were no independent risk factors for MRSA (Table 1). Independent risk factors for PsA included prior isolation and enteral feeding (Table 2). MRSA risk factors as defined by the 2019 CAP guidelines were found in 48.6% of patients with MRSA CAP (Figure 1). Guideline-defined PsA risk factors were found in 56.8% of patients with PsA CAP (Figure 2). In NR-CAP, 62.2% received empiric MRSA coverage while only 27% had a guideline-defined risk factor; PsA coverage was administered in 78.4% of NR-CAP patients, but risk factors were found in only 24.3% of this cohort. MRSA and P. aeruginosa Risk Factor Analyses Empiric MRSA and P. aeruginosa Coverage and Guideline-Defined Risk Factors Conclusion Our findings were consistent with the risk factors identified in the 2019 CAP guidelines, but additional risk factors may be present in our patient population. Empiric coverage for MRSA and PsA was disproportionately high relative to the rate of recovery. This study encourages local validation of risk factors; however, further analyses are needed to determine the impact on empiric therapy. Disclosures All Authors: No reported disclosures

scholarly journals Prognostic role of time to positivity of blood culture in children with Pseudomonas aeruginosa bacteremia.

2020 ◽  
Author(s):  
huiting xu ◽  
Jie Cheng ◽  
Qinghong Yu ◽  
Qingyuan Li ◽  
Qian Yi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Pseudomonas Aeruginosa ◽  
Blood Culture ◽  
Hospital Mortality ◽  
Time To Positivity ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Independent Risk Factors

Abstract Background: Pseudomonas aeruginosa (P. aeruginosa) is a major Gram-negative pathogen, which has been reported to result in high mortality. We aim to investigate the prognostic value and optimum cut-off point of time-to-positivity (TTP) of blood culture in children with P. aeruginosa bacteremia.Methods: From August 2014 to November 2018, we enrolled the inpatients with P. aeruginosa bacteremia in a 1500-bed tertiary teaching hospital in Chongqing, China retrospectively. Receiver operating characteristic (ROC) analysis was used to determine the optimum cut-off point of TTP, and logistic regression were employed to explore the risk factors for in-hospital mortality and septic shock.Results: Totally, 52 children with P. aeruginosa bacteremia were enrolled. The standard cut-off point of TTP was18 hours. Early TTP (≤18 hours) group patients had remarkably higher in-hospital mortality (42.9% vs 9.7%, P=0.014), higher incidence of septic shock (52.4% vs12.9%, P=0.06), higher Pitt bacteremia scores [3.00 (1.00-5.00) vs 1.00 (1.00-4.00), P=0.046] and more intensive care unit admission (61.9% vs 22.6%, P=0.008) when compared with late TTP (>18 hours) groups. Multivariate analysis indicated TTP ≤18 h, Pitt bacteremia scores ≥4 were the independent risk factors for in-hospital mortality (OR 5.88, 95%CI 1.21-21.96, P=0.035; OR 4.95, 95%CI 1.26-27.50, P=0.024; respectively). The independent risk factors for septic shock were as follows: TTP ≤18h, Pitt bacteremia scores ≥4 and hypoalbuminemia (OR 6.30, 95%CI 1.18-33.77, P=0.032; OR 8.15, 95%CI 1.15-42.43, P=0.014; OR 6.46, 95% CI 1.19-33.19 P=0.031; respectively).Conclusions: Early TTP (≤18 hours) appeared to be associated with worse outcomes for P. aeruginosa bacteremia children.Trial registration: Retrospectively registered. File No. (2019)304

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