PURPOSE: To identify the causative bacteria, antibiotic sensitivity and antibiotic resistance of lower respiratory tract infections in upper Egypt.
METHODS: A multicentre prospective study was performed for 2 years.Sampling was done for all patients including, sputum and /or bronchoalveolar lavage (BAL)for gram stain and culture, and serum sample for serology. The validated sputum as well as BAL samples were cultured on three bacteriological media (Nutrient, Chocolate and MaConkey,s agar plates) . The colonies were processed for identification of micro-organisms by Automated Walkaway Microscan 96.Pneumoslide IgM kit (Vircell-slide) was used for detection of atypical pathogens through the use of serological indirect Fluorescent Antibody method.
RESULTS: The predominant isolates in 360 patients with CAP were streptococcus pneumoniae(36%), , chlamydia pneumoniae (18%) ,mycoplasma pneumoniae (11%) and Klebsiella (10%). A higher sensitivity was recorded for Moxifloxacin ,Levofloxacin,Macrolides, and Cefipime. A higher rate of resistance was recorded for amoxicillin-clavulinic acid, ampicillin-sulbactem, , lincomycin, clinadamycin, tetracyclines, first or second generations cephalosporins and aminoglycosides. The predominant isolates in 318 patients with HAP were Klebsiella pneumoniae (20%), MRSA (20%)and Pseudomonas Aerogonasa (15%). A higher sensitivity was recorded for Ciprofloxacin,Linezolid ,Levofloxacin,Vancomycin, ,Amikacin and Cefipime. A higher rate of resistance was recorded for amoxicillin-clavulinic acid, ampicillin-sulbactem, , lincomycin, clinadamycin, tetracyclines, first ,second or third generations cephalosporins and Gentamicin. The predominant isolates in 376 patients with acute exacerbation of COPD were Heamophilus Influnza (32%) ,streptococcus pneumoniae(30%), Moraxella catarrhalis (14%), Klebsiella pneumoniae (10%) and chlamydia pneumoniae (7%).A higher sensitivity was recorded for Moxifloxacin ,Levofloxacin,Macrolides, and Cefipime. A higher rate of resistance was recorded for tetracyclines, first or second generations cephalosporins and gentamicin.
CONCLUSION: The most predominant bacteria for CAP in upper Egypt are streptoccus pneumoniae and atypical organisms,while, that for HAP are gram negative bacteria and MRSA.For acute exacerbation of COPD,haemophilus influnzae is commonest responsible organism.
CLINICAL IMPLICATIONS: Respiratory quinolones,cefipime and linezolide are the most efficient antibiotics in treatment of lower bacterial respiratory tract infections in our locality.
DISCLOSURE: Gamal Agmy, No Financial Disclosure Information; No Product/Research Disclosure Information