title: Sputum bacteriology and antibiotic sensitivity patterns of community-acquired pneumonia in hospitalized adult patients in Nigeria: a 5-year multicentre retrospective study.
abstract: BACKGROUND
  A clear knowledge of the pathogens responsible for community-acquired pneumonia (CAP) in a given region and their antibiotic sensitivity patterns is necessary for optimal treatment. We determined the common bacterial pathogens causing CAP in Nigeria and further reviewed their antibiotic senstivity patterns with a view to providing recommendations to improve antibiotic management of CAP.
  
  
  METHODS
  Case notes of all adult patients who were 18 years or more admitted to four major tertiary hospitals in South East Nigeria with a diagnosis of CAP between 2008 and 2012 were retrospectively studied. To be eligible, patients were required to have sputum culture and sensitivity results available. Socio-demographic, clinical, pre-admission and in-hospital treatment data were also obtained.
  
  
  RESULTS
  Of 400 patients with a radiologically confirmed diagnosis of CAP, 232 fulfilled the study criteria; 122 (52.6%) were women and the mean age was 50.6 ± 18.8 years. Aetiological agents were identified from sputum in 189 (81.5%) patients. Streptococcus pneumoniae (n = 90, 47.6%) was the most frequent isolate followed by Klebsiella pneumoniae (n = 62, 32.8%), Staphylococcus aureus (n = 24, 12.7%) and Streptococcus pyogenes (n = 13, 6.9%). The pathogens were most sensitive to levofloxacin (77%), ceftazidime (75.5%) and ofloxacin (55.8%). The susceptibility of the isolates to antibiotics most frequently presecribed for empirical therapy was low (co-amoxiclav, 47.6%; ciprofloxacin, 45.9% and ceftriaxone, 47.6%) and this was associated with higher mortality and/or longer duration of hospital stay in survivors.
  
  
  CONCLUSIONS
  Strep. pneumoniae and K. pneumoniae were the most common causes of CAP. The pathogens were most sensitive to levofloxacin and ceftazidime. We suggest that these antibiotics should increasingly be considered as superior options for empirical treatment of CAP in Nigeria.
authors.affiliation: From the Department of Medicine, College of Medicine, University of Nigeria Enugu Campus , Nigeria.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Iroezindu
authors.forename: Emmanuel I
authors.initials: EI
authors.lastname: Chima
authors.forename: Godsent C
authors.initials: GC
authors.lastname: Isiguzo
authors.forename: Godwin C
authors.initials: GC
authors.lastname: Mbata
authors.forename: Cajetan C
authors.initials: CC
authors.lastname: Onyedum
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Onyedibe
authors.forename: Leo E
authors.initials: LE
authors.lastname: Okoli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D013291:Streptococcus / Q000187:drug effects / Q000302:isolation & purification*; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Aetiology; antibiotic sensitivity; bacterial; community-acquired pneumonia; sputum