Author(s): Ramakrishna Rachakonda1, Revathi Mogilappa2
Patients attending the Pulmonology OPD with symptoms of cough with expectoration of more than 10 days with pulmonary shadows suggestive of pneumonia were included in our study. Patients’ positive for AFB in the sputum and symptoms suggestive of tuberculosis were excluded.
MATERIALS AND METHODS
156 patients diagnosed to have pneumonia were included in the study. Patients having a history of cough with expectoration and fever for 10 days or more were subjected to clinical, radiological and sputum examination. Patients in whom tuberculosis was excluded by clinical, radiological and sputum examination and having associated shadows in the chest x-ray above 20 years of age were taken into the study and subjected to thorough clinical examination, haematological and biochemical examination. Sputum was sent for Gram stain and culture and sensitivity. Sensitivity pattern of the organisms isolated were studied.
85% of patients belong to 40 years and above age group. 73.12% of these patients are males and rest are females. 54% of the patients presented as bronchopneumonia by Radiology. Bilateral lesions present in 55% of patients followed by right-sided lesions in 26% and left-sided lesions in 19%. Cough, expectoration, fever and chest pain were the common symptoms and nearly all the patients had symptoms. Increased white cell count at the time of admission correlated with increased duration of hospital stay and is statistically significant (the p-value is <0.00001). Active and passive smoking is associated with pneumonia and the value is statistically significant (p<0.00001). Presence of comorbidities is associated with increased hospital stay and the value is statistically significant (p<0.00001). Individual comorbidities are not associated with increased prevalence of pneumonia. Presence of comorbidities compared to absence of comorbidities showed a statistically significant correlation (p value <0.00001). 48% of the patients were diagnosed as having gram-positive cocci and nearly 15% gram-negative bacilli. 5.12% had mixed organisms and 28% had normal Gram stain study. 3.20% patients had fungal elements in Gram stain study. 127 out of 156 patients were positive for bacterial pathogens by culture. Commonest organism isolated was Streptococcus pneumonia in 32.69% followed by Staph aureus in 18.59%, Klebsiella in 8.97%, Pseudomonas in 5.76%, Haemophilus influenza in 4.48%, mixed pathogens in 8.97% and Citrobacter in 1.92%. No organism was isolated by culture in 18.58%. Streptococcus pneumonia and Haemophilus influenzae organisms isolated in these patients were sensitive to routine drugs in all these patients. Nearly, 10% of Staphylococci, 7% of Klebsiella and 22% Pseudomonas organisms are found resistant to the routine drugs. Tazobactam-Piperacillin resistance was seen in both Klebsiella and Pseudomonas species and both were sensitive to meropenem.
Community acquired pneumonia occurs in the older age group among the adult population. Smoking has a significant correlation with development of pneumonia. Predominant number of patients are male. Bilateral and bronchopneumonia pattern is the commonest presentation. Comorbidities and initial white blood cell concentration enhance the duration of hospital stay and the values are statistically significant. Commonest organism isolated is Streptococcus pneumonia followed by Staphylococcus aureus, Klebsiella, Haemophilus and Pseudomonas. Staphylococci, Klebsiella and Pseudomonas species showed resistance. Tazobactam + Piperacillin resistance is seen among Klebsiella and Pseudomonas species isolated in our centre.