ADEQUACY OF EMPIRICAL TREATMENT PROTOCOLS OF HOSPITAL ACQUIRED PNEUMONIA

Objective: This study was conducted with the objective of analyzing the efficacy of empirical antibiotics in the light of microbiological data in Hospital acquired pneumonia. Methods: This cross-sectional study was conducted from August to December 2019 in department of Microbiology and department of Respiratory medicine prospectively. Suspected cases of Hospital acquired pneumonia were followed for clinico-bacterial evidence, antimicrobial resistance and pre and post culture antibiotic use. Results: A total of 758 cases were investigated, of which 77(10 %) cases were HAP, 65(84%) of them were culture positive and 48(74 %) were late in onset. In early onset cases, isolates were Acinetobacter 10(42%), Escherichia coli 5(21%), S.aureus 4(17%), Klebsiella 1(4%) and Pseudomonas 1(4%). From the late onset cases Acinetobacter 15(28%), Klebsiella 17(32%) and Pseudomonas 13(24%) were isolated. All Acinetobacter, 78% Klebsiella and 36% Pseudomonas isolates were multi drug resistant. Empirical therapies were inadequate in 12(70%) of early onset cases and 44(92%) of late onset type. Cephalosporins were used in 7(41%) of early onset infections but found to be adequate only in 2(12%) cases. Polymyxins were avoided empirically but after cultures were used in 9(19%) cases. Conclusion: The use of empirical antibiotics was found majorly inadequate and unneeded. Use of cephalosporins empirically in early onset infections and avoiding empirical use of polymyxin antibiotics in late onset infections contributed largely to the findings. Inadequate empirical regimen is a real time feedback for a practitioner to update his knowledge on the local microbiological trends. Keywords: empirical therapy; hospital acquired pneumonia