A Study of Community Acquired Pneumonia in Elderly Diabetics Admitted To a Rural Hospital in South India
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2018, Vol 6, Issue 3
Abstract
Abstract: This study aimed to find any difference in the clinical presentation, causative organisms, antimicrobial susceptibility pattern of the isolated bacteria and short term outcome in elderly diabetic and elderly non-diabetic patients admitted with community acquired pneumonia (CAP). In this prospective observational study, 45 elderly diabetic and 45 elderly non-diabetic hospitalized patients with CAP were enrolled. Base line demographic data, detailed clinical and laboratory examination were done. Microbiological examinations of sputum samples were conducted. Immediate outcome was assessed in all patients. Frequency of atypical presentation, pleural effusion with multilobar infiltration and CURB-65 score were significantly higher in elderly diabetics. Renal impairment in the form of raised BUN (50.36±18.40mg/dl) was more in diabetics when compared to non diabetics (16.02±4.80) which was statistically significant (P=0.002361). More than one bacteria (polymicrobial) growth, 48.8% was seen in culture of sputum from elderly diabetics with CAP, whereas Streptococcus pneumoniae 48.8% was the most common culture isolate from sputum in elderly non Diabetics with CAP. Streptococcus pneumoniae (42.2%), Klebsiella pneumoniae (35.5%), Staphylococcus aureus (13.3%), E. coli (17.7%) and Pseudomonas aeruginosa (15.5%) and Acinetobacter (6.6%) were frequently isolated from sputum of elderly diabetics with CAP. Isolates of streptococcus, Staphylococcus, pseudomonas, Escherichia coli, Acinetobacter from diabetic patients with CAP were resistant to Co-Amoxyclav (100%), Levofloxacin (100%), Clarithromycin (100%).Significantly higher mortality rate 48.8% is seen in Elderly Diabetics with CAP, while only 6.6% is the mortality among Elderly Non Diabetics with CAP. P=0.003. Elderly diabetic patients with CAP have frequent atypical presentations; higher CURB-65 score, increased pulmonary complications and mortality. Infections are caused by more than one organism in majority of elderly diabetic males. Drug resistance to commonly used first line drugs for CAP is significantly high in elderly DM patients than NDM patients. In conclusion elderly DM patients with CAP require intensive monitoring and selection of appropriate therapeutic regimen based on anti-microbial drug susceptibility testing.
Authors and Affiliations
Dr. Pennuru Sujanapriya, Dr. Uma M Anandkumar, Dr. Vishweshwara Reddy YJ
Keywords
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