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Community Acquired Pneumonia in Bangladesh: Sensitivity Pattern, Clinical Courses and Outcome of a Cross Sectional Population

Background: Pneumonia acquired outside the hospital by an immune-competent individual is defined as community acquired pneumonia (CAP). It is to be distinguished, on the basis of a wider spectrum of pathogens, from nosocomial pneumonia from pneumonia in an immune-compromised host. Community-acquired pneumonia is associated with a significant mortality and morbidity. Etiology of CAP varies geographically and the understanding of local epidemiology plays an important role in decision making for empirical treatment before test results are available. Primary decisions about empirical antimicrobial treatment required knowledge of predominant microbial patterns and their sensitivities. 
Objectives: The aim of this study was to identify the bacterial etiology of CAP, their sensitivity towards empirical therapy and to observe the clinical course as well as short term outcome in hospitalized adult patients. 
Methodology: It was one year-long observational prospective study on 87 patients diagnosed with CAP admitted in Chattogram Medical College Hospital, second largest tertiary care hospital during August 2018 to July 2019. Sputum for Gram and Z-N staining, culture and sensitivity, blood for culture, sensitivity and PCR for Streptococcus pneumonia, Mycoplasma pneumoniae, Legionella pneumophila and Chlamydophila pneumonia were done. Patients were followed up for in-hospital outcome and 30-day mortality. 
Results: The mean age was 49.59 years and male - female ratio was 1.56: 1. Fever, chest pain and cough were the most common clinical findings. Klebsiella pneumoniae was identified (39.1%) in the majority of the patients, followed by Pseudomonas aeruginosa (10.3%), Staphylococcus aureus and Escherichia coli (5.7%). Staphylococcus aureus was positive in blood culture of one patient. Four samples were positive in PCR and identified Streptococcus pneumoniae. The sensitivity to meropenem, levofloxacin and amikacin was highest. The mean duration of hospital stay was 6.34 ± 2.37 days along with in-hospital mortality and 30-day mortality was 6.9% and 16.1% respectively. 
Conclusion: The bacteriologic profile of community acquired pneumonia revealed Gram-negative bacteria as pre-dominant organism by conventional sputum and blood culture. But need for further serologic tests for atypical and viral pathogens and development of institutional antibiogram to facilitate the choice for empirical therapy is required.