Original Article

Bacterial etiology, antimicrobial resistance and factors associated with community acquired pneumonia among adult hospitalized patients in Southwest Ethiopia


Background and Objectives: Antibiotic resistance is a significant problem that restricts the options for treating bacterial pneumonia. This research aimed to determine the bacterial causes of pneumonia and antibiotic resistance among hospitalized patients in southwest Ethiopia.
Materials and Methods: We collected and analyzed 150 sputum samples from individuals with community-acquired pneumonia from April 1st to October 30th, 2019. Standard bacteriological procedures were used to identify the bacteria. Kirby Bauer's disk diffusion method was used to assess the bacteria's susceptibility patterns. Production of carbapenemase and extended-spectrum-lactamase were confirmed phenotypically. Odds ratios and the chi-square test were computed.
Results: On the whole, bacterial pathogens were verified in 50% of the sputum samples. The predominant bacterial isolates were Klebsiella species, followed by Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus pneumoniae. About 77.5% of isolates were multidrug resistant. Moreover, 40.5% and 10.8% of the isolates were ESBL and carbapenemase producers, respectively. Aging, tobacco smoking, previous history of pneumonia, heart disease, and chronic respiratory disease had association with sputum culture-positivity.
Conclusion: As a result, it is important to regularly monitor the bacterial etiologies and their patterns of resistance. Additionally, sociodemographic and clinical characteristics should all be taken into account while managing patients with pneumonia empirically in this context.

1. Eccles S, Pincus C, Higgins B, Woodhead M; Guideline Development Group. Diagnosis and management of community and hospital acquired pneumonia in adults: summary of NICE guidance. BMJ 2014; 349: g6722.
2. Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, et al. Guidelines for the management of adult lower respiratory tract infections--full version. Clin Microbiol Infect 2011; 17 Suppl 6(Suppl 6): E1-59.
3. Lanks CW, Musani AI, Hsia DW. Community-acquired Pneumonia and Hospital-acquired Pneumonia. Med Clin North Am 2019; 103: 487-501.
4. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 Suppl 2(Suppl 2): S27-72.
5. Heron M. Deaths: Leading Causes for 2015. Natl Vital Stat Rep 2017; 66: 1-76.
6. Cillóniz C, Polverino E, Ewig S, Aliberti S, Gabarrús A, Menéndez R, et al. Impact of age and comorbidity on cause and outcome in community-acquired pneumonia. Chest 2013; 144: 999-1007.
7. Torres A, Peetermans WE, Viegi G, Blasi F. Risk factors for community-acquired pneumonia in adults in Europe: a literature review. Thorax 2013; 68: 1057-1065.
8. Falguera M, Carratalá J, Ruiz-González A, García-Vidal C, Gázquez I, Dorca J, et al. Risk factors and outcome of community‐acquired pneumonia due to Gram‐negative bacilli. Respirology 2009; 14: 105-111.
9. Ouedraogo AS, Jean Pierre H, Bañuls AL, Ouédraogo R, Godreuil S. Emergence and spread of antibiotic resistance in West Africa: contributing factors and threat assessment. Med Sante Trop 2017; 27: 147-154.
10. Pavia AT. Viral infections of the lower respiratory tract: old viruses, new viruses, and the role of diagnosis. Clin Infect Dis 2011; 52 Suppl 4(Suppl 4): S284-289.
11. Beardsley JR, Williamson JC, Johnson JW, Ohl CA, Karchmer TB, Bowton DL. Using local microbiologic data to develop institution-specific guidelines for the treatment of hospital-acquired pneumonia. Chest 2006; 130: 787-793.
12. Goudarzi M, Navidinia M. Overview perspective of bacterial strategies of resistance to biocides and antibiotics. Arch Clin Infect Dis 2019; 14(2): e65744.
13. Temesgen D, Bereded F, Derbie A, Biadglegne F. Bacteriology of community acquired pneumonia in adult patients at Felege Hiwot Referral Hospital, Northwest Ethiopia: a cross-sectional study. Antimicrob Resist Infect Control 2019; 8: 101.
14. Gebre AB, Begashaw TA, Ormago MD. Bacterial profile and drug susceptibility among adult patients with community acquired lower respiratory tract infection at tertiary hospital, Southern Ethiopia. BMC Infect Dis 2021; 21: 440.
15. Assefa M, Tigabu A, Belachew T, Tessema B. Bacterial profile, antimicrobial susceptibility patterns, and associated factors of community-acquired pneumonia among adult patients in Gondar, Northwest Ethiopia: A cross-sectional study. PLoS One 2022; 17(2): e0262956.
16. Dessie T, Jemal M, Maru M, Tiruneh M. Multiresistant bacterial pathogens causing bacterial pneumonia and analyses of potential risk factors from Northeast Ethiopia. Int J Microbiol 2021; 2021: 6680343.
17. Lee D-H, Kim S. Clinical analysis of sputum Gram stains and cultures to improve the quality of sputum cultures. Lab Med Qual Assur 2020; 42: 33-39.
18. Mussema A, Beyene G, Gashaw M. Bacterial isolates and antibacterial resistance patterns in a patient with acute exacerbation of chronic obstructive pulmonary disease in a tertiary teaching Hospital, Southwest Ethiopia. Can J Infect Dis Med Microbiol 2022; 2022: 9709253.
19. Rattani S, Farooqi J, Jabeen G, Chandio S, Kash Q, Khan A, et al. Evaluation of semi-quantitative compared to quantitative cultures of tracheal aspirates for the yield of culturable respiratory pathogens - a - cross-sectional study. BMC Pulm Med 2020; 20: 284.
20. Cheesbrough M (2006). District Laboratory Practice in Tropical Countries—Part 2. 2nd Edition, Cambridge University Press, New York.
21. CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 33th ed. Clinical and Laboratory Standards Institute. 2023. https://clsi.org/standards/products/microbiology/documents/m100/
22. Magiorakos A-P, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18: 268-281.
23. El-Sokkary RH, Ramadan RA, El-Shabrawy M, El-Korashi LA, Elhawary A, Embarak S, et al. Community acquired pneumonia among adult patients at an Egyptian university hospital: bacterial etiology, susceptibility profile and evaluation of the response to initial empiric antibiotic therapy. Infect Drug Resist 2018; 11: 2141-2150.
24. Iroezindu MO, Chima EI, Isiguzo GC, Mbata GC, Onyedum CC, Onyedibe KI, et al. Sputum bacteriology and antibiotic sensitivity patterns of community-acquired pneumonia in hospitalized adult patients in Nigeria: a 5-year multicentre retrospective study. Scand J Infect Dis 2014; 46: 875-887.
25. Amarasinghe N, Athavan M, Jayamanne D, Rajapakshe Y, Sadikeen A, Gunasekara K, et al. Bacterial profile and antibiotic susceptibility pattern of adult lower respiratory tract infections in Colombo, Sri Lanka. J Health Soc Sci 2018; 3: 27-36.
26. Lupisan S, Suzuki A, Macalalad N, Egos R, Sombrero L, Okamoto M, et al. Etiology and epidemiology of community-acquired pneumonia in adults requiring hospital admission: A prospective study in rural Central Philippines. Int J Infect Dis 2019; 80: 46-53.
27. Zhang Y, Shou S. Pathogens and drug-resistance of hospital-acquired pneumonia in an EICU in Tianjin, China. Int J Biochem Mol Biol 2021; 12: 49-54.
28. Hassanzadeh S, Khoramrooz SS, Mazloomirad F, Sharifi A, Roustaei N, Gholamnezhad M, et al. Bacterial profile and their antimicrobial resistance patterns among patients with community‑acquired pneumonia in southwestern Iran. Iran J Microbiol 2023; 15: 343-349.
29. Gupta S, Maheshwari V. Prevalence of ESBLs among Enterobacteriaceae and their antibiotic resistance pattern from various clinical samples. IntJ Curr Microbiol App Sci 2017; 6: 2620-2628.
30. Gashaw M, Berhane M, Bekele S, Kibru G, Teshager L, Yilma Y, et al. Emergence of high drug resistant bacterial isolates from patients with health care associated infections at Jimma University medical center: a cross sectional study. Antimicrob Resist Infect Control 2018; 7: 138.
31. Teklu DS, Negeri AA, Legese MH, Bedada TL, Woldemariam HK, Tullu KD. Extended-spectrum beta-lactamase production and multi-drug resistance among Enterobacteriaceae isolated in Addis Ababa, Ethiopia. Antimicrob Resist Infect Control 2019; 8: 39.
32. Ibrahim Y, Sani Y, Saleh Q, Saleh A, Hakeem G. Phenotypic Detection of extended spectrum beta lactamase and carbapenemase co-producing clinical isolates from two tertiary Hospitals in Kano, North West Nigeria. Ethiop J Health Sci 2017; 27: 3-10.
33. Nepal R, Shrestha B, Joshi DM, Joshi RD, Shrestha S, Singh A. Antibiotic susceptibility pattern of Gram-negative isolates of lower respiratory tract infection. J Nepal Health Res Counc 2018; 16: 22-26.
34. Acharya VK, Padyana M, B U, R A, Acharya PR, Juneja DJ. Microbiological profile and drug sensitivity pattern among community acquired Pneumonia patients in tertiary care centre in Mangalore, Coastal Karnataka, India. J Clin Diagn Res 2014; 8: MC04-6.
35. Erku DA, Mekuria AB, Belachew SA. Inappropriate use of antibiotics among communities of Gondar town, Ethiopia: a threat to the development of antimicrobial resistance. Antimicrob Resist Infect Control 2017; 6: 112.
36. Reta A, Bitew Kifilie A, Mengist A. Bacterial infections and their antibiotic resistance pattern in ethiopia: a systematic review. Adv Prev Med 2019; 2019: 4380309.
37. Cilloniz C, Martin-Loeches I, Garcia-Vidal C, San Jose A, Torres A. Microbial etiology of pneumonia: epidemiology, diagnosis and resistance patterns. Int J Mol Sci 2016; 17: 2120.
38. Kolditz M, Tesch F, Mocke L, Höffken G, Ewig S, Schmitt J. Burden and risk factors of ambulatory or hospitalized CAP: A population based cohort study. Respir Med 2016; 121: 32-38.
39. Prina E, Ranzani OT, Polverino E, Cillóniz C, Ferrer M, Fernandez L, et al. Risk factors associated with potentially antibiotic-resistant pathogens in community-acquired pneumonia. Ann Am Thorac Soc 2015; 12: 153-160.
40. Cillóniz C, Liapikou A, Ceccato A, Torres A. Risk factors for community-acquired pneumonia in adults. Minerva Pneumol 2017; 56: 206-216.
41. Yanagi S, Tsubouchi H, Miura A, Matsuo A, Matsumoto N, nakazato M. The impacts of cellular Senescence in elderly Pneumonia and in age-related lung Diseases that increase the risk of respiratory infections. Int J Mol Sci 2017; 18: 503.
42. Klare B, Kubini R, Ewig S. Risk factors for pneumonia in patients with cardiovascular diseases. Pneumologie 2002; 56: 781-788.
43. Arancibia F, Bauer TT, Ewig S, Mensa J, Gonzalez J, Niederman MS, et al. Community-acquired Pneumonia due to Gram-negative bacteria and Pseudomonas aeruginosa: incidence, risk, and prognosis. Arch Intern Med 2002; 162: 1849-1858.
IssueVol 15 No 4 (2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijm.v15i4.13503
Pneumonia; Bacterial; Etiology; Antimicrobial drug resistance; Hospitalized; Ethiopia

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Mussema A, Beyene G, Gudina E, Alelign D, Mohammed T, Bawore S, Mohammed Seid A, Tadesse W, Gashaw M. Bacterial etiology, antimicrobial resistance and factors associated with community acquired pneumonia among adult hospitalized patients in Southwest Ethiopia. Iran J Microbiol. 2023;15(4):492-502.