Diagnosis, Treatment and Outcome of Hospital Acquired Pneumonia among Medical Patients at Saint Paul's Hospital Millennium Medical College, Ethiopia April to July 2019

Abstract

Abstract Background: Hospital acquired pneumonia (HAP) is the second most important cause of nosocomial infection and accounts for high morbidity and mortality and a relevant economic burden on health care services and resources worldwide. In sub-Saharan countries including Ethiopia, there is limitation of most of the diagnostic modality used to diagnose HAP. One of the most underutilized diagnostic modality is chest x-ray. The study tries to assess the practice of diagnosis, treatments and outcome of the patient with HAP. The topic is barely studied in Ethiopia. Objective: To assess the diagnostic modalities utilized, antibiotic usage and the outcome of hospital acquired pneumonia. Methods: The study was conducted using a prospective cohort study design from March 2019 to July 2019 on diagnosis, treatment and outcome of HAP among medical patient admitted at Saint Paul medical ward and medical Intensive care unit. Data was collected from 60 patients with HAP. For data entry and analysis SPSS version 25 was used. Frequencies and percentages were used to express descriptive statistics. Results: Of 60 study participant, 39 (65.0%) were females and 32(53.3%) are from Oromia region. The median age was 35 years. Medical ward account 41(68.3%) of patient place of admission while medical intensive care unit account for 19(31.7%) of the patients. Acute kidney injury and chronic renal disease due to multiple cause were the most common underlying co morbidity in around 19(31.7%) of the patients. Diagnosis was made by radiologic confirmation in 25 (41.7%) while blood culture was requested in 21(35.0%) patients. Among the radiological confirmed patients lobar involvement is found in 13(52.0%) and multi-lobar in 12(48.0%) of patients. Only 3 blood cultures grew; Staphylococcous Aureus (Methcillin resistance Staphylococcus Aureus), Enterococcus Facecium and Acinetobacter Baumannii being the grown organisms. The mean duration of growth is 7 days. Complete blood count is requested in all patients for diagnosis and it turn out to be normal in 19(31.7), leucopenia in 7(11.7) and lecuocytosis in 34(56.7%) of patients. Chest CT scan in 3(5%) of patients, left sided pleural effusion in 3(5%) of patients and right sided pleural effusion with pleural fluid analysis result in II 1(1.7%) of patients were used as other diagnostic modality to reach at diagnosis. Ceftazidime and vancomycin combination antibiotics were used in 38(63.3%) of patients for treatment and 10 days being the commonest duration of antibiotic prescription in 37(61.7%) of patients. Of all patients 49(81.7%) of patient were alive and discharged home, 11(18.3%) of them were dead. Conclusion: HAP was found to be more prevalent among adult females. The majority of patients were admitted at medical ward with AKI/CKD as commonest medical co morbidity. Diagnosis by CBC is found to be the most common means of HAP diagnosis followed by radiological confirmation and lastly by blood culture. Lobar and multi lobar involvement on the CXR is the most common radiologic report. Blood culture demonstrated growth in only 12% of patients for whom blood culture is requested. Other diagnostic modalities like chest CT scan performed for possible diagnosis. The most common antibiotics being utilized are a combination of ceftazidime and vancomycin and it’s usually given for 10 days. Majority of the patients were alive and discharged home once their disease is addressed.