title: Are elderly end-stage renal disease patients more susceptible for drug resistant organisms in their sputum?
abstract: End stage renal disease (ESRD) patients are at risk for pneumonia in view of their impaired immune status. Similar empiric antibiotic regimens are used in elderly as well as young ESRD patients with respiratory tract infections. We conducted an observational, cross sectional study between June 2007 and June 2008 in 100 ESRD patients half being > 65 yrs. All patients had positive sputum culture and chest X-ray findings of pneumonia Streptococcus pneumoniae was the commonest in younger while Klebsiella pneumoniae in > 65 yrs old patients. Elderly patients had significant resistance to common antibiotics. Ceftrioxone was the most suitable antibiotic in the younger patients while a combination of piperacillin with gentamycin was the best choice in the geriatric age group. In conclusion, organisms cultured from sputum in ESRD patients with pneumonia were different in the ESRD patients of more than and less than 65 years of age as well as the drug susceptibility. We should probably redefine the management of pneumonia according to the sensitivities in our local populations to better treat these patients.
authors.affiliation: Department of General Medicine, Sri Ramachandra University, Chennai, Tamilnadu, India. drpssghanshyam@yahoo.co.in
authors.forename: Ghanshyam Palamaner Subash
authors.initials: GP
authors.lastname: Shantha
authors.forename: Anita A
authors.initials: AA
authors.lastname: Kumar
authors.forename: Anish George
authors.initials: AG
authors.lastname: Rajan
authors.forename: Kuilan Karai
authors.initials: KK
authors.lastname: Subramanian
authors.forename: Yadav
authors.initials: Y
authors.lastname: Srinivasan
authors.forename: Georgi
authors.initials: G
authors.lastname: Abraham
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007194:India; D007676:Kidney Failure, Chronic / Q000150:complications*; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy / Q000382:microbiology; D013183:Sputum / Q000382:microbiology*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents