No abstract

Background: Despite the availability of potent new antimicrobial agents and vaccines, Community Acquired Pneumonia (CAP) remains a common and serious illness .The microbial etiologies and their resistant patterns vary widely. Frequent, irrational and unnecessary use of antibiotics, changes in environment, changes in lifestyle and increased mobility of the people have contributed to changes in the patterns of microbial profiles and their resistant patterns in the Community. Unfortunately, there have been very few studies done regarding etiology of CAP, prevalence of causative organisms and their resistance pattern in Nepal. Thus it was quite crucial to detect them in our context Methods & Materials: A descriptive cross-sectional study conducted over a period of six months (March 2011-August 2011) at Bacteriology laboratory of Tribhuvan University and Teaching Hospial (TUTH) among 600 clinically diagnosed CAP patients visiting TUTH-OPD. Sputum samples that met the acceptance criteria of ASM were further processed according to the standard methodology.Results: Bacterial etiologies could be identified only in 25.5% of cases of CAP. Haemophilus influenzae (26.9%), Streptococcus pneumoniae (20.0%) and Pseudomonas aeruginosa (19.4%) were the commonest bacterial etiologies, Twenty-six percent of H. influenzae isolates were MDR The prevalence of MDR bacteria in CAP patients was 41.25%. Among gram-negative bacterial isolates, the highest number of MDR was seen in Pseudomonas aeruginosa, followed by Klebsiella pneumoniae, E. coli and Acinetobacter spp.The prevalence of ESBL, AmpC and MBL producing gramnegative bacteria were 10.1% (more common among Klebsiella pneumoniae (16.6%), 5.8% and 4.3% (more common among Acinetobacter spp(14.29%) respectively.Conclusion: Different bacteria are responsible for CAP in our setting. MDR, ESBL, MBL and AmpC producing bacterial strains are present in our Community also. Thus it has demanded to take special care during treatment of patients with community acquired infections also and also sought for other similar type of extensive studies on large number of community isolates to characterize their genetic relatedness and resistant patterns so that appropriate measures can be applied.