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Kalita D, Sarma RK, Sharma KR, Deka S. High proportion of drug-resistant isolates in adult community-acquired pneumonia from Northeast India: A hospital-based study. Lung India 2021; 38:460-465. [PMID: 34472525 PMCID: PMC8509170 DOI: 10.4103/lungindia.lungindia_978_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Empirical antibiotic therapy is the mainstay of management of adult community-acquired pneumonia (CAP) globally. Knowledge of prevalent pathogen (bacterial) profile and drug susceptibility pattern is very essential for appropriate management of CAP cases, which again calls for regular update of pathogen profile in a given locality. This study was to identify the bacterial etiology of CAP cases and their antibiotic susceptibility pattern. Methods: This cross-sectional study was done on adult CAP patients from medicine, respiratory medicine, and intensive care unit area in our tertiary care hospital between May 1, 2015, and October 30, 2016. Subjects were enrolled continuously, and expectorated sputum, bronchoalveolar lavage fluid, and blood culture were performed. Urine antigen test was done for Streptococcus pneumoniae and Legionella pneumophila. Three types of ELISA (IgM, IgG, and IgA) were performed for atypical agents (Mycoplasma, Chlamydia, and Legionella) of CAP. Isolates obtained from culture of Sputum/BAL/Blood were further processed for antibiotic susceptibility testing - by disc diffusion as well as E-test method (latter for MIC i.e. minimum inhibitory concentration, determination). Results: About 574 subjects were included, and in 266 (46.3%) cases, bacterial pathogen could be detected. Klebsiella pneumoniae (33.6%) and S. pneumoniae (32.9%) were the predominant agents identified. Atypical agents (Mycoplasma, Legionella, and Chlamydia) were at 15.1%. A high proportion of pneumococci isolates were multidrug resistant (52.6%). Resistance to beta-lactams, macrolide, and other agents was on the higher side, but fluoroquinolones were found to be less resistant (15.8%–21.1%). Extended-spectrum beta-lactamase (among Klebsiella isolates) and methicillin-resistant Staphylococcus aureus were also detected. Conclusion: A moderate-to-high degree of drug-resistant in adult CAP was evident, which is detrimental in effective empirical management of such cases. Urgent implementation of antibiotic stewardship scheme is the need of the hour.
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Affiliation(s)
- Deepjyoti Kalita
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand; Department of Microbiology, Gauhati Medical College, Guwahati, Assam, India
| | - Ridip Kumar Sarma
- Department of Microbiology, Gauhati Medical College, Guwahati, Assam, India
| | | | - Sangeeta Deka
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Delic S, Mijac V, Gajic I, Kekic D, Ranin L, Jegorovic B, Culic D, Cirkovic V, Siljic M, Stanojevic M, Paragi M, Markovic M, Opavski N. A Laboratory-Based Surveillance Study of Invasive Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae Diseases in a Serbian Pediatric Population-Implications for Vaccination. Diagnostics (Basel) 2021; 11:diagnostics11061059. [PMID: 34207530 PMCID: PMC8228891 DOI: 10.3390/diagnostics11061059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/29/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to present the epidemiology of invasive diseases caused by Neisseria meningitidis and Streptococcus pneumoniae in the pre-vaccine period, and Haemophilus influenzae in the post-vaccine period in a pediatric population from Serbia. Among the meningococci, serogroup B dominated (83%), followed by serogroup C (11.3%). High antigenic diversity was found, with fine type P1.5-1,10-4 being the most frequent. Moderate susceptibility to penicillin was common (55%). Within pneumococci, serotypes 19F, 14, 6B, 6A, 18C, 23F, 3, and 7F prevailed, while 19A was rare (3.6%). The coverages of PCV10 and PCV13 were 68% and 84%, respectively. Major sequence types were ST320, ST15, ST273, ST271, and ST81. Non-susceptibility to penicillin (66.7%), cefotaxime (37%), and macrolides (55%) was predominantly detected in vaccine-related serotypes. Among the 11 invasive H. influenzae isolates collected, there were six Hib, three non-type b, and two non-typeable strains (ntHi) that were antibiotic susceptible. These results imply a potential benefit of future Men-B vaccine implementations. For pneumococci, as PCV10 was recently introduced, a significant reduction of morbidity and antibiotic resistance might be expected. The efficiency of Hib vaccination is evident, but a shift towards non-type b and ntHi strains may be anticipated.
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Affiliation(s)
- Snezana Delic
- Centre for Microbiology, National Reference Laboratory for Meningococcus and Haemophilus, Institute of Public Health, 25101 Sombor, Serbia; (S.D.); (D.C.)
| | - Vera Mijac
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia; (I.G.); (D.K.); (L.R.); (V.C.); (M.S.); (M.S.); (M.M.); (N.O.)
- National Reference Laboratory for Streptococci, Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia
- Correspondence:
| | - Ina Gajic
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia; (I.G.); (D.K.); (L.R.); (V.C.); (M.S.); (M.S.); (M.M.); (N.O.)
- National Reference Laboratory for Streptococci, Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia
| | - Dusan Kekic
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia; (I.G.); (D.K.); (L.R.); (V.C.); (M.S.); (M.S.); (M.M.); (N.O.)
- National Reference Laboratory for Streptococci, Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia
| | - Lazar Ranin
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia; (I.G.); (D.K.); (L.R.); (V.C.); (M.S.); (M.S.); (M.M.); (N.O.)
- National Reference Laboratory for Streptococci, Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia
| | - Boris Jegorovic
- Clinical Centre of Serbia, University Hospital for Infectious and Tropical Diseases, 11000 Belgrade, Serbia;
| | - Davor Culic
- Centre for Microbiology, National Reference Laboratory for Meningococcus and Haemophilus, Institute of Public Health, 25101 Sombor, Serbia; (S.D.); (D.C.)
| | - Valentina Cirkovic
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia; (I.G.); (D.K.); (L.R.); (V.C.); (M.S.); (M.S.); (M.M.); (N.O.)
| | - Marina Siljic
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia; (I.G.); (D.K.); (L.R.); (V.C.); (M.S.); (M.S.); (M.M.); (N.O.)
| | - Maja Stanojevic
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia; (I.G.); (D.K.); (L.R.); (V.C.); (M.S.); (M.S.); (M.M.); (N.O.)
| | - Metka Paragi
- National Laboratory of Health Environment and Food, Department for Public Health Microbiology, 1000 Ljubljana, Slovenia;
| | - Milos Markovic
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia; (I.G.); (D.K.); (L.R.); (V.C.); (M.S.); (M.S.); (M.M.); (N.O.)
| | - Natasa Opavski
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia; (I.G.); (D.K.); (L.R.); (V.C.); (M.S.); (M.S.); (M.M.); (N.O.)
- National Reference Laboratory for Streptococci, Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia
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