Risk Factors Predicting Developing of Multi-Drug-Resistant Pathogens in Hospitalised Patients with Pneumonia Coming from Community

Abstract

Community-acquired pneumonia(CAP) is a common serious illness that is associated with considerable costs, morbidity, and mortality and despite the widely use of prevention options( vaccination at the high risk groups)the annual incidence of CAP requiring hospitalization remains high.One of common findings in hospitalised patients with CAP is multi-drug-resistant pathogens(MDR) which is associated with considerable costs , longer in-hospital /ICU stay and treatment .Objective:The aim of this study was to evaluate the risk factors predicting developing MDR pathogens in hospitalised patients with CAP.Methods:We have examined 123 patients with CAP treating in pulmonary medicine department of medical university from January 2017 to February 2019.All patients have been investigated by chest radiography(in selected patients CT scan of lungs), and sputum , blood culture, endotracheal aspirate (in intubated patients).Data on admission and during hospitalization were collected.Results:Etiologic diagnosis of has been evaluated in 78 of 123(63.4%) patients with CAP.Most common finding pathogen was Streptococcus Pneumoniae-in 25 of 78 patients(32.1%),second pathogen most commonly causing CAP was Heamophilus Influenzae -in 12(15.4%).MDR pathogens were evaluated in 32(41,0%) patients and most common MDR pathogen was Pseudomonas aerigunosa-in 16(20.5%),following MRSA -in 10(12.8%),Escherichia coli-in 4(5.1%),and Klebsiella pneumoniae-in 2(2.6%).In patients group with MDR pathogens causing CAP severe sepsis/septic shock at the time of hospital admission was higher compared to non-MDR pathogen associated CAP .94],CI 95%;p<0.005).Acute respiratory distress syndrome(ARDS) at the time of hospital admission was common finding among patients with MDR pathogen causing CAP ],CI 95%;p<0.003).Previously hospitalisation to ICU department with antibiotic overuse was occur commonly in patients with MDR causing pneumonia( OR 7.9[2.67-12.42],CI 95%;p=0.0001) and chronic respiratory diseases such as chronic obstructive pulmonary disease with frequent exacerbations requiring use of antibiotics and bronchiectasis were common risk factors for MDR pathogens in CAP patients(p=0.005).MDR pathogen causing C AP was associated with highest rate of ICU admission(p<0.002),longer inhospital/ICU stay(p=0.003) and common need to mechanical ventilation ventilation(p<0.001).Conclusions:Our study shown increased incidence of MDR pathogen causing CAP which is associated with longer hospital/ICU stay, common ICU admission, and common need to mechanical ventilation of patients. Early recognition and identification of risk factors predicting of developing MDR causing CAP may be useful for modifying and correcting them, and by this way reducing the events associated with hospitalised patients with pneumonia coming from community