Bacterial etiology of pneumonia and acute cerbations of chronic obstructive pulmonary disease at Assiut Unversity Hospital with special refern to carbapenemase

ABSTRACT

To assess the bacterial etiology of patients hospitalized for pneumonia and acute exacerbations of chronic obstructive pulmonary disease [AECOPD] and for screening and detection of carbapenemases in Enterobacteriaceae. From November 2006 to February 2008, this study was carried out in Assiut University Hospitals. A total of 29lpatients diagnosed as pneumonia and AECOPD [189 pneumonic patients and 102 AECOPD patients] were included in this study. Blood for serology and sputum for culture were obtained from all patients. Serological examination was carried out for detection of atypical bacterial pathogens, using Pneumobact kits [VERCELL Co., Ltd., GRANADA, SPAIN]. Antimicrobial susceptibility testing performed by using the disc diffusion method. Carbapenemase production in Enterobacteriaceae was determined using disc diffusion method, MICs were determined by an agar dilution technique, imipenem EDTA double discs synergy test and Modfled-Hodge test [confirmatory test]. One hundred and eighty six microorganisms were identified in 165 of pneumonic patients and 98 microorganisms were identified in 93 of AECOPD patients. No organisms could be detected in 24 patients suffering from pneumonia and 9 patients suffering from AECOPD by different cultures or serological techniques. Kiebsiella Pneumoniae was the most common implicated pathogen in patients with pneumonia [34.9% of isolates] and in AECOPD [37.8% of isolates]. In the present study; 55.6% of S. aureus isolates were resistant to methicillin in CAP patients and 61.5% of S. aureus isolates were resistant to methicillin in nosocomial pneumonia [NP] patients. Carbapenemases were detected in 23.86% and 28.5 7% of Enterobacteriaceae of patients with pneumonia and AECOPD respectively. Pneumonia and AECOPD represents a current problem in Assiut University Hospitals. Carbapenemases are among the most important emerging groups of enzymes responsible for antimicrobial resistance. Modified-Hodge test is easy, simple and specific tests for detection of Carbapenemases production