Clinical and microbiological profile of health care associated pneumonia in patients with chronic renal disease referred to a tertiary care hospital- a prospective study

Background: Healthcare associated pneumonia (HCAP) is a public health problem in the era of home care of chronic illness including chronic renal disease. They have greater burden of comorbidities, immune suppression and impaired mobility. Aim of the Study: To characterise the clinical, radiological and microbiological profile of health care associated pneumonia in chronic renal disease cases including its resistance pattern and outcome in the study population. Materials and Methods: This prospective study was conducted among patients with chronic kidney disease (CKD) who had been treated in multiple hospitals across Odisha. They were subjected to history taking, clinical examination, laboratory and radiological investigations. Sputum or endotracheal tube culture were sent for gram stain and aerobic culture. All the categorical parameters were compared using Fisher’s exact test. Continuous parameters were compared using independent t-test. All the statistical analysis was carried out using the software Stata 15.1. A p-value less than 0.05 was considered significant. Results: 58 patients with an underlying chronic kidney disease were included. 54 (93.1%%) patients survived while 4 (6.9%) died. The mean age, total leucocyte count and serum urea levels were higher among patients who died in comparison to the survivors (p= 0.95, 0.334 and 0.386 respectively). Klebsiella spp (12.07%), and Acinetobacter (8.6%) were most commonly isolated. Multi-drug resistance (MDR) and extensive drug resistance (XDR) were encountered among these organisms. Death was more commonly associated in patients ≥60yrs (p= 1), TLC ≥ 11000 cells/mm3 (p= 0.0091), serum creatinine ≥ 3mg/dl (p= 0.329) and radiological involvement of ≥ 3zones (p= 1). Conclusion: CKD is an important contributor in HCAP. Data from different institutions to corroborate our findings regarding antibiotic resistance pattern of the microbes in HCAP cases is recommended.