Microbiological and resistance profile in patients admitted to intensive care units with community acquired pneumonia in the city of Medellin, Colombia, in 2015

Introduction Community-acquired pneumonia (CAP) is a health problem with significant morbidity and mortality. Knowing its magnitude can help establish corrective measures using the guidelines and institutional protocols to ensure proper care. There are insufficient data on patients with CAP admitted to intensive care unit (ICU) in this country. Objective To describe the origins and resistance profile of bacterial pathogens isolated from patients diagnosed with CAP admitted to the intensive care unit (ICU). Methods A multicentre, retrospective, observational, and descriptive study of the diagnosis in patients with CAP in whom a sample was taken either from spontaneous sputum, a tracheal aspirate, bronchoalveolar lavage, pleural fluid, or a pharyngeal swab in the first 72 h of admission to four intensive care units in the city of Medellín during 2015. Results The study included 127 patients with a median age of 68 years. 80% with some comorbidity. The large majority (71.7%) of patients underwent a microbiological study, of which 46.2% reported isolation. A total of 45 isolated microorganisms were identified, in 42 patients: 22% Staphylococcus aureus, more than half resistant to methicillin; 15.5% Mycobacterium tuberculosis and 15.5% Klebsiella pneumoniae. Nearly 97% started more than one antibiotic, beta-lactam plus macrolide in 84%. In 34.4% of cases the empirical antibacterial management was not correct according to the antibiogram. According to the ATS criteria, 12.6% of patients did not require admission to ICU. Mechanical ventilation was required in 59.8%, with a general mortality of 39.3%. Conclusions A microbiology study was not performed on 28.3%.The most common pathogen was Staphylococcus aureus, of which 60% were methicillin resistant. The initial empirical treatment of patients with bacterial isolation was partially adequate ICU admission, with a mortality rate of one in three patients.