PREVALENCE OF MULTIDRUG-RESISTANT PATHOGENS IN PATIENTS WITH HOSPITAL-ACQUIRED PNEUMONIA IN A COUNTRY WHERE ANTIBIOTIC RESISTANCE IS INCREASING SERIOUSLY

Abstract

PURPOSE: we have recently been observing in our clinical setup an increase in multidrug resistant pathogens. We therefore conducted a study to measure the amount of antibiotic resistance. Study was conducted in a tertiary care centre in Karachi, Pakistan where antibiotics are available without doctor's prescription. METHODS: It was a prospective study which was conducted in chest ward, ICU and HDU of a tertiary care centre in our country. Results of microbiology cultures of sputum, bronchial wash, and tracheal aspirates were evaluated along with the patient's clinical condition, radiology and total leukocyte count. RESULTS: Of 121 patients 48 had hospital acquired pneumonia. Mortality rate was 21%. Prevalence was Acenitobacter 40%, Pseudomonas 17%, E.Colli 10%, Klebsiella 6%, Staphylococcus Aureus 8%, Enterococcus 2%, Morganella 2%, Super Added Infections noted in 20% patients and negative results in 12 patients. Patients showing response to First line group of antibiotics were 19%, Second line 27%, Third line 10% and Fourth line 44%. CONCLUSION: Concluding from above results we can highlight that pathogens causing hospital acquired pneumonia have a very high prevalence and marked resistance. The reason could be lack of standardization of antibiotics, poor hygienic conditions which could be related to hot humid weather conditions, improper use of antibiotics and over the counter availability. This requires that antibiotics should be available only on physician's prescription and proper strategies should be made for there standardization or we would end up with pathogens with no antibiotics available to treat them properly. CLINICAL IMPLICATIONS: we are worried about increasing amount of antibiotic resistance seen in our tertiary care setup in hospital acquired infections.we feel this could lead to a problem of global antibiotic resistance if necessary precautions are not put in place 1. antibiotics should not be freely available over the counter2. antibiotic standardization and efficacy should be regularly checked3. acenitobacter infection problem could be related to the weather and climatic conditions, more attention should be focused on eradication of this bug from respiratory HDU and ICU settings.