Drug Resistance Patterns of Bacterial Pathogens in Adult Pneumonia Patients in a Tertiary Care Hospital
Keywords:
Antimicrobial Resistance, Multidrug-resistant Bacteria, Extensively Drug-resistant Bacteria, PneumoniaAbstract
BackgroundPneumonia remains one of the leading causes of morbidity and mortality around the world, with a disproportionate burden in low- and middle-income countries such as Pakistan. Antimicrobial resistance (AMR), especially multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacteria, is becoming more common. This presents a serious obstacle to efficient therapeutic therapy and worsens patient consequences. ObjectiveTo determine the bacteriological profile, antimicrobial resistance patterns, and distribution of MDR and XDR pathogens among adult pneumonia patients, as well as to evaluate their clinical characteristics. MethodologyIn the present cross-sectional study, 385 respiratory specimens were collected from adult patients with pneumonia. Pathogens were isolated and identified using gram staining and culture by using different media such as MacConkey, blood agar, and chocolate agar. Biochemical tests were performed such catalase and coagulase for Staphylococcus spp, Oxidase test for P. aeruginosa and Indole, citrate Urease and TSI. ResultsIn the present study, 146 (37.9%) pneumonia patients needed intensive care management. The most affected age group was old age people (> 60) accounted for 169 (43.9%). Klebsiella pneumoniae 126 (32.7%) being the most commonly isolated pathogen, followed by Pseudomonas aeruginosa 104 (27%) and Acinetobacter baumannii 61 (15%). Biofilm formation was observed in 182 (47.3%) of the 385 bacterial isolates that were isolated from pneumonia patients. Conclusion Present study show that the most common etiological agents were Gram-negative organisms, specifically Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. These organisms also showed alarmingly high resistance rates to commonly prescribed antibiotics, such as ?-lactams, tetracyclines, fluoroquinolones, and third-generation cephalosporins.References
Ticona JH, Zaccone VM, McFarlane IM. Community-acquired pneumonia: A focused review. American journal of medical case reports. 2021;9(1):45.
Mussema A, Beyene G, Gudina EK, Alelign D, Mohammed T, Bawore SG, et al. 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.
Wan X, Miao R, Zhang N, Huang W, Wu Z, Wang H, et al. Global burden of antimicrobial resistance in lower respiratory infections in 2021: A systematic analysis. International Journal of Antimicrobial Agents. 2025;65(2):107431.
Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet. 2022;399(10325):629-55.
Cillóniz C, Dominedò C, Torres A. Multidrug resistant gram-negative bacteria in community-acquired pneumonia. Annual Update in Intensive Care and Emergency Medicine 2019. 2019:459-75.
Torres A, Cillniz C. Clinical management of bacterial pneumonia: Springer; 2015.
Eshwara VK, Mukhopadhyay C, Rello J. Community-acquired bacterial pneumonia in adults: An update. Indian Journal of Medical Research. 2020;151(4):287-302.
Henig O, Kaye KS. Bacterial pneumonia in older adults. Infectious disease clinics of North America. 2017;31(4):689.
Hanada S, Pirzadeh M, Carver KY, Deng JC. Respiratory viral infection-induced microbiome alterations and secondary bacterial pneumonia. Frontiers in immunology. 2018;9:2640.
Jean S-S, Chang Y-C, Lin W-C, Lee W-S, Hsueh P-R, Hsu C-W. Epidemiology, treatment, and prevention of nosocomial bacterial pneumonia. Journal of clinical medicine. 2020;9(1):275.
Pahal P, Rajasurya V, Sharma S. Typical bacterial pneumonia.[Updated 2023 Jul 31]. StatPearls [Internet] Treasure Island (FL): StatPearls Publishing. 2023.
Sharma R, Sandrock CE, Meehan J, Theriault N. Community-acquired bacterial pneumonia—changing epidemiology, resistance patterns, and newer antibiotics: spotlight on delafloxacin. Clinical drug investigation. 2020;40(10):947-60.
Feldman C, Anderson R. Pneumococcal virulence factors in community-acquired pneumonia. Current opinion in pulmonary medicine. 2020;26(3):222-31.
Mayanskiy N, Alyabieva N, Ponomarenko O, Lazareva A, Katosova L, Ivanenko A, et al. Serotypes and antibiotic resistance of non-invasive Streptococcus pneumoniae circulating in pediatric hospitals in Moscow, Russia. International journal of Infectious diseases. 2014;20:58-62.
Ashiq HT, Shaheen Z, Asiri S, Syed W, Khan MK, Khan IA, et al. Prevalence of bacterial infections, antimicrobial sensitivity, and resistance patterns in respiratory samples. Am J Transl Res. 2025;17(8):6542-55.
Karruli A, Massa A, Bertolino L, Andini R, Sansone P, Dongiovanni S, et al. Clinical Characteristics and Outcome of MDR/XDR Bacterial Infections in a Neuromuscular Semi-Intensive/Sub-Intensive Care Unit. Antibiotics. 2022;11(10):1411.
Wajid M, Naaz S, Jyothi L. Study of Bacterial Profile and Susceptibility Pattern of Lower Respiratory Tract Infections in a Tertiary Care Hospital. Journal of Evidence Based Medicine and Healthcare. 2020;7:1984-8.
Häder A, Köse-Vogel N, Schulz L, Mlynska L, Hornung F, Hagel S, et al. Respiratory Infections in the Aging Lung: Implications for Diagnosis, Therapy, and Prevention. Aging Dis. 2023;14(4):1091-104.
Yoshimatsu Y, Melgaard D, Westergren A, Skrubbeltrang C, Smithard DG. The diagnosis of aspiration pneumonia in older persons: a systematic review. European Geriatric Medicine. 2022;13(5):1071-80.
Iwai-Saito K, Shobugawa Y, Aida J, Kondo K. Frailty is associated with susceptibility and severity of pneumonia in older adults (A JAGES multilevel cross-sectional study). Scientific Reports. 2021;11(1):7966.
Nseir S, Martin-Loeches I, Povoa P, Metzelard M, Du Cheyron D, Lambiotte F, et al. Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort. Critical Care. 2021;25(1):177.
Hassan MM. Chronic Obstructive Pulmonary Disease Patients With Community-Acquired Pneumonia on Inhaled Corticosteroid Therapy: A Comprehensive Analysis of Risk Factors, Disease Burden, and Prevention Strategies. 2015.
Ahmad I. Awareness of diverse bacterial flora distribution causing pneumonia in Dir, Khyber Pakhtunkhwa, Pakistan. Journal of Entamology 2017.
Schurz H, Salie M, Tromp G, Hoal EG, Kinnear CJ, Möller M. The X chromosome and sex-specific effects in infectious disease susceptibility. Human genomics. 2019;13(1):2.
Venegas-Ramírez J, Mendoza-Cano O, Trujillo X, Huerta M, Ríos-Silva M, Lugo-Radillo A, et al. Sex differences in pneumonia risk during COVID-19 in Mexico. Scientific Reports. 2024;14(1):27962.
Harding AT, Heaton NS. The impact of estrogens and their receptors on immunity and inflammation during infection. Cancers. 2022;14(4):909.
Buja A, De Polo A, De Battisti E, Sperotto M, Baldovin T, Cocchio S, et al. The importance of sex as a risk factor for hospital readmissions due to pulmonary diseases. BMC Public Health. 2020;20(1):53.
Ohbe H, Sasabuchi Y, Yamana H, Matsui H, Yasunaga H. Intensive care unit versus high-dependency care unit for mechanically ventilated patients with pneumonia: a nationwide comparative effectiveness study. Lancet Reg Health West Pac. 2021;13:100185.
Mansoor F, Akhtar A, Sikandar I, Qadeer A, Ali Z, Kaleem B. WHAT FACTORS ON ADMISSION INFLUENCE ICU MORTALITY IN ADULT PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT WITH SEVERE PNEUMONIA? Adult Patients Admitted in ICU With Severe Pneumonia. Pakistan Armed Forces Medical Journal. 2016;66(4):548-52.
Iqbal N, Irfan M, Zubairi ABS, Awan S, Khan JA. Association of hypercapnia on admission with increased length of hospital stay and severity in patients admitted with community-acquired pneumonia: a prospective observational study from Pakistan. BMJ Open. 2017;7(6):e013924.
Incidence and outcomes of pneumonia related hospitalizations in individual with type 2 diabetes mellitus: https://doi.org/10.5281/zenodo.16925717. Pakistan Journal of Medical & Cardiological Review. 2025;4(3):1061-70.
Assefa M. Bacterial profile, antimicrobial susceptibility patterns, and associated factors of community-acquired pneumonia among adult patients in Gondar, Northwest Ethiopia: A cross-sectional study. PLoS Genet. 2022.
Baidya S, Sharma S, Mishra SK, Kattel HP, Parajuli K, Sherchand JB. Biofilm Formation by Pathogens Causing Ventilator-Associated Pneumonia at Intensive Care Units in a Tertiary Care Hospital: An Armor for Refuge. Biomed Res Int. 2021;2021:8817700.
Riwu KHP, Effendi MH, Rantam FA, Khairullah AR, Widodo A. A review: Virulence factors of Klebsiella pneumonia as emerging infection on the food chain. Vet World. 2022;15(9):2172-9.
Azra, Khan TA, Ul Haq I, Hinthong W, Campino S, Gohar A, et al. Antibiotic Susceptibility Patterns and Virulence Profiles of Classical and Hypervirulent Klebsiella pneumoniae Strains Isolated from Clinical Samples in Khyber Pakhtunkhwa, Pakistan. Pathogens. 2025;14(1):79.
Khan K, Ali H, Ullah R, Khalid T. Clinical, Epidemiological, and Microbiological Profile of Community-Acquired Pneumonia: A Cross-Sectional Study. Pakistan Journal of Chest Medicine. 2025;31(3):222 - 9.
Khursheed N, Adnan F, Khan MA, Hatif R. Regional insights on the prevalence and antimicrobial susceptibility pattern of carbapenem and colistin-resistant gram-negative bacteria: an observational cross-sectional study from Karachi, Pakistan. BMC Infectious Diseases. 2025;25(1):186.
Rizvi M, Khan N, Fatima A, Bushra R, Zehra A, Saeed F, et al. The Microbiological Characteristics and Genomic Surveillance of Carbapenem-Resistant Klebsiella pneumoniae Isolated from Clinical Samples. Microorganisms. 2025;13(7):1577.
Saeed DK, Farooqi J, Shakoor S, Hasan R. Antimicrobial resistance among GLASS priority pathogens from Pakistan: 2006–2018. BMC Infectious Diseases. 2021;21(1):1231.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Pakistan Journal of Chest Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
