Prince Sree Kumar Pius 1 , Anitha Alexis 2 , P. Suresh Kumar 3 , Manivel Ganesan
BACKGROUND Lower respiratory tract infections are quite common in the general population occurring with increased frequency in older individuals and younger children and those with chronic diseases or compromised immune function. Aetiologic diagnosis of the responsible pathogen is made by culture of respiratory tract secretions or by isolation of a compatible organism from blood (or pleural fluid) cultures. While a positive blood or pleural fluid culture definitely identifies the pathogen, an organism growing from a respiratory specimen is not as readily implicated as the aetiologic agent. Many organisms maybe normal flora or colonisers of the respiratory tract and not responsible for the clinical syndrome. As a result, there is considerable controversy about the diagnostic value of many respiratory specimens. A rationale approach to specimen collection and the interpretation of results must be used if clinically useful information is to be obtained. Lower respiratory tract infection- An acute illness (present for 21 days or less), usually with cough as the main symptom with at least one other lower respiratory tract symptom (sputum production, dyspnoea, wheeze or chest discomfort/pain) and no alternative explanation (e.g. sinusitis or asthma). Acute Bronchitis (AB)- An acute illness occurring in a patient without chronic lung disease with symptoms including cough, which may or may not be productive and associated with other symptoms or clinical signs that suggest LRTI and no alternative explanation (e.g. sinusitis or asthma). Influenza- An acute illness usually with fever together with the presence of one or more of headache, myalgia, cough or sore throat. Community-Acquired Pneumonia (CAP)- An acute illness with cough and at least one of new focal chest signs, fever >4 days or dyspnoea/tachypnoea and without other obvious cause, but supported by chest radiograph findings of lung shadowing that is likely to be new. In the elderly, the presence of chest radiograph shadowing accompanied by acute clinical illness (unspecified) without other obvious cause. Acute Exacerbation of COPD (AECOPD)- An event in the natural course of the disease characterised by a worsening of the patient’s baseline dyspnoea, cough and/or sputum beyond day-to-day variability sufficient to warrant a change in management. If chest radiograph shadowing consistent with infection is present, the patient is considered to have CAP. Acute Exacerbation of Bronchiectasis (AEBX)- In a patient with features suggestive of bronchiectasis, an event in the natural course of the disease characterised by a worsening in the patient’s baseline dyspnoea and/or cough and/or sputum beyond day-to-day variability sufficient to warrant a change in management. If chest radiograph shadowing, consistent with infection is present, the patient is considered to have CAP. MATERIALS AND METHODS Sputum is the thick mucus or phlegm that is expelled from the lower respiratory tract (bronchi and lungs) through coughing; it is not saliva or spit. Care must be taken in the sample collection process to ensure that the sample is from the lower airways and not from the upper respiratory tract. In this study, we collected 851samples from the patients in whom lower respiratory tract infections were suspected in a tertiary care centre- Kanyakumari district during the year January 2016-June 2016. RESULTS Sputum cultures were positive for 29% of the patients. Among these cultures, Klebsiella pneumonia (73%), Pseudomonas aeruginosa (19%), Staphylococcus aureus (4%) and others (Acinetobacter and Streptococcus pneumonia) (5%) were the common organisms found. Highest antimicrobial sensitivity amongst these pathogens was found with cefoperazone/sulbactam and amikacin. CONCLUSION Cefoperazone/sulbactam and amikacin were the highly sensitive systemic antibiotics while ciprofloxacin and co-trimoxazole were the sensitive oral antibiotics in our locality.
