Clinical Outcome and In-vitro Microbiological Response of Bacterial Isolates to Commonly Prescribed Antibiotics among Hospitalized Patients with Community Acquired Pneumonia in Jimma University Specialized Hospital, Ethiopia

Abstract

Background: Initial antibiotic treatment for community acquired pneumonia (CAP) in Ethiopian settings is invariably empirical and further clinical decision making upon inadequate initial response is not evidence-based. A detailed knowledge of the local susceptibility pattern of the pathogens would ensure a more appropriate and evidencebased selection of the initial antibiotic(s). This study was conducted to assess the clinical outcome and in-vitro response of bacterial isolates to locally available and commonly prescribed antibiotics among hospitalized adults with community acquired pneumonia at JUSH.Materials and Methods: A prospective observational cohort study was conducted on sixty hospitalized patients. Clinical outcome including responding pneumonia, non-responding pneumonia, death, or progressive pneumonia was assessed using clinical parameters. In-vitro microbiological response of the bacterial isolates was determined to prescribed antibiotics (doxycycline, 30 µg and ceftriaxone, 30µg) using disk diffusion and Stock methods.Results: Of all patients with CAP (n=60) two species of potential bacterial causes of pneumonia were isolated; S. pneumoniae accounted for 19(57.6%) while S. aureus accounted 14 (41.7%). S. pneumoniae, 6 (31.6%) were resistant to doxycycline and 4 (21.1%) of the isolates were resistant to ceftriaxone. Half of the S. aureus isolates were susceptible to doxycycline while 3 (21.4%) were resistant to this antibiotic. Half, 50%, of S. aureus isolates were resistant to ceftriaxone. Clinically 25% of the participants had non-responding pneumonia, however, 45 (75%) had responding pneumonia to the combined therapy of doxycycline and ceftriaxone. The presence of co-morbid illness was associated with inadequate initial clinical outcome (p=0.03).Conclusion: S. pneumoniae was the common isolate and showed high resistance rate to both ceftriaxone and doxycycline. One fourth of the patients experienced non-responding pneumonia. The presence of co-morbid illnesses was significantly associated with inadequate initial clinical response.

Keywords: CAP; Microbiological response; Clinical outcome; Non-Responding pneumonia; Responding pneumonia