Microbiology and outcomes in patients with pneumonia in an English Hospital
2014
Background Current guidelines for pneumonia recommend antibiotics targeting common etiologic agents i.e S.pneumoniae , M.pneumoniae, H.influenzae for community acquired infections but suggest consideration of resistant organisms in those with co-morbidities. Lack of risk assessment can lead to choice of inappropriate antibiotics leading to poor response and outcomes. We undertook a retrospective review of sputum microbiology and other data for patients admitted with pneumonia. Methods A retrospective audit of sputum culture, LOS and mortality was carried out at Milton Keynes Hospital from 01.07.12 to 30.06.13, in patients with pneumonia. Results Of 49 patients admitted, 29 were male and 20 female. Median age was 73 years (18-86) and mean LOS of 19.7 days (0-129). 15 had COPD, 3 had bronchiectasis, 4 had lung fibrosis, and 8 other chest diseases. Sputum culture was sent in 46 cases. 6 were negative. 16 patients (35%) grew P.aeruginosa (PA) and 10(22%) grew enterobacteriaceae (EB). 5(11%) grew H. influenzae (HI), 3(7%) grew S.pneumoniae (SP), 1(2%) S.aureus (SA) and 1(2%) grew M.catarrhalis (MC). 4(9%) had Stenotrophomonas maltophila(SM). Mean LOS was 39.5 days in those growing PA and 11.6 days in others. 17 out of 49(35%) patients died in hospital or within 28 days as against 7 out of 16(44%) with PA and 3 out of 4(75%) with SM Conclusion Aging and co-morbidity are likely causes of isolation of pseudomonas and other gram negative organisms not covered by standard first line antibiotics in our cohort, contributing to increased stay and mortality. Patients presenting with community acquired LRTI should have appropriate risk assessment for same, to guide antibiotic therapy, thus improving outcomes.
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