title: Inadequate Empirical Antibiotic Therapy in Hospital Acquired Pneumonia.
abstract: BACKGROUND
  Inadequate empirical antibiotic therapy for HAP is a common phenomena and one of the indicators of the poor stewardship. This study intended to analyze the efficacy of empirical antibiotics in the light of microbiological data in HAP cases.
  
  
  METHODS
  Suspected cases of HAP were followed for clinico-bacterial evidence, antimicrobial resistance and pre and post culture antibiotic use. The study was taken from February,2014 to July 2014 in department of Microbiology and department of Respiratory medicine prospectively. Data was analyzed by Microsoft Office Excel 2007.
  
  
  RESULTS
  Out of 758 cases investigated, 77(10 %) cases were HAP, 65(84%) of them were culture positive and 48(74 %) were late in onset. In early onset cases, isolates were Acinetobacter 10(42%), Escherichia coli 5(21%), S.aureus 4(17%), Klebsiella 1(4%) and Pseudomonas 1(4%). From the late onset cases Acinetobacter 15(28%), Klebsiella 17(32%) and Pseudomonas 13(24%) were isolated. All Acinetobacter, 78% Klebsiella and 36% Pseudomonas isolates were multi drug resistant. Empirical therapies were inadequate in 12(70%) of early onset cases and 44(92%) of late onset type. Cephalosporins were used in 7(41%) of early onset infections but found to be adequate only in 2(12%) cases. Polymyxins were avoided empirically but after cultures were used in 9(19%) cases.
  
  
  CONCLUSIONS
  Empirical antibiotics were vastly inadequate, more frequently so in late onset infections. Use of cephalosporins empirically in early onset infections and avoiding empirical use of polymyxin antibiotics in late onset infections contributed largely to the findings. Inadequate empirical regimen is a real time feedback for a practitioner to update his knowledge on the local microbiological trends.
authors.affiliation: Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: S
authors.initials: S
authors.lastname: Dahal
authors.affiliation: Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: B P
authors.initials: BP
authors.lastname: Rijal
authors.affiliation: Department of Respiratory Medicine, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: K N
authors.initials: KN
authors.lastname: Yogi
authors.affiliation: Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: J B
authors.initials: JB
authors.lastname: Sherchand
authors.affiliation: Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: K
authors.initials: K
authors.lastname: Parajuli
authors.affiliation: Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: N
authors.initials: N
authors.lastname: Parajuli
authors.affiliation: Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: B M
authors.initials: BM
authors.lastname: Pokhrel
keywords: empirical therapy; hospital acquired pneumonia.