Abstract
Respiratory tract infection due to Gram positive bacteria is a common cause of morbidity and mortality worldwide. This study of one year duration was carried out to determine the antibiotic resistance pattern of Gram-positive bacteria from patients with lower respiratory tract infection visiting Kathmandu University Hospital. A total of 1,556 respiratory samples including sputum and endotracheal aspirates were processed following standard guidelines. Antibiotic resistance pattern was determined following Clinical Laboratory Standard Institute guidelines. Gram positive bacteria from total sample were 6.6%. Out of them 86.4% were Streptococcus pneumoniae and 13.6% were Staphylococcus aureus. Majority of S. pneumoniae, 53.9% were resistant to azithromycin, followed by cotrimoxazole 40.4%, ciprofloxacin 13.5% and Ceftriaxone 1.1% but all isolates were sensitive to penicillin. A total of 92.9% S. aureus were methicillin and Ciprofloxacin resistant, 64.3% were resistant to cotrimoxazole and 28.6% resistant to amikacin but all strains were sensitive to linezolid. Majority of multidrug resistant Staphylococcus were detected among patients of age more than 60 years. A total of 77.8% patients had lower respiratory tract infection with acute exacerbation of chronic obstructive pulmonary disease. Majority of diabetic patients had multidrug resistant organism. 70.69% patients of age above 60 had multidrug resistant isolates. Multidrug-resistant Gram positive bacteria were observed in respiratory samples. For effective management of lower respiratory tract infections detailed microbiological diagnosis and susceptibility testing is required.
Highlights
Acute lower respiratory tract infection is defined as evidence of acute infection and symptoms/signs of respiratory illness at the time of admission
Identification of the bacteria was done by Gram staining smears made from culture plates and for identification of S. pneumoniae, alphahemolytic colonies consistent with S. pneumoniae was examined along with optochin sensitivity and solubility in 10% bile following standard procedures.[6]
This study revealed Gram positive bacterial isolates from lower respiratory tract infection and determined antibiotic resistance pattern and multidrug resistance
Summary
Acute lower respiratory tract infection is defined as evidence of acute infection (reported fever, documented temperature >38.0oC, elevated age-specific white blood cell count or abnormal differential) and symptoms/signs of respiratory illness (abnormal breath sounds, tachypnea based on documented respiratory rate, cough, sputum production, hemoptysis, chest pain or dyspnea) at the time of admission. Among Gram positive bacterial strains, Methicillin resistant Staphylococcus aureus (MRSA) producing bacterial strains and drug resistant S. pneumoniae are common ones.[5] These bacterial isolates causing LRTI is associated with risk factors and has modified therapeutic approach. Risk factors such immunocompromised status may be a major factor which is responsible for some of the cases of multidrug resistant (MDR) bacterial respiratory infections. Almost three quarters of all antibiotic consumptions are for respiratory tract infections.[5]
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