Community acquired pneumonia in Port Harcourt Rivers State of Nigeria.

Abstract

BACKGROUND Community acquired pneumonia (CAP) is a major cause of death world wide. Knowledge of the likely pathogens and their sensitivity/resistance pattern can help in the choice of antibiotic therapy and improve outcome. OBJECTIVE To identify the seasonal variation; age and sex distribution; bacteriology; antimicrobial sensitivity pattern of isolates; haematological data; radiology and clinicaloutcome of community-acquired pneumonia (CAP) in adult patients admitted to hospital in Port Harcourt, Nigeria. DESIGN Prospective study. SETTING University of Port Harcourt Teaching Hospital, and Braithwaite Memorial Hospital, Port Harcourt, Rivers State. PATIENTS Adults admitted to the hospitals with CAP between 1 May 2002, and 30 April 2003. INTERVENTIONS A diagnostic strategy using regular collection of sputum samples for gram stain, bacteriological culture and chest radiography were done. Blood cultures were done in severe cases. Antibiotic sensitivity testing was done on the positive cultures. RESULTS During a 12 month period, 54 patients aged 16 to 82 years (mean 38.1 years) were evaluated. A total of 944 medical admissions were seen during the same period. This gives a prevalence rate of 5.7%. Twenty six classes of bacteria were isolated from the sputum of 23 patients (yield, 42.6%). Streptococcus pneumoniae, the most common pathogen, was isolated in nine cases (34.6%), followed by Klebsiella pneumoniae which was present in eight (30.8%). Other isolates included, Escherichia coli, four cases (15.4%), Pseudomonas aeruginosa, three cases (11.5%), and Staphylococcus aureus, two cases (7.7%). The commonest radiological pattern was lobar consolidation (49.9%) with no Distinct pattern associated with any conventional bacterial pathogen. The isolates showed good sensitivity to the newer and more expensive antibiotics (quinolines and cephalosporines) with marked resistance to the older and cheaper ones. However, clinical responses to benzyl penicillin and gentamycin were found to be good. Out of 54 patients evaluated, four (7.4%) died. CONCLUSION Streptococcus pneumoniae and Klebsiella were common aetiological organisms of CAP in Port Harcourt. Treatment of CAP with benzyl penicillin remains an appropriate first line choice in this environment while the more expensive quinolines and cephalosporines can be used as backups.