Abstract:

Background: During the pre-COVID- 19 era common pathogens associated with community-acquired pneumonia (CAP) included: Streptococcus pneumoniae, pneumoniae, Legionella pneumophila and Klebsiella pneumoniae; whereas Pseudomonas aeruginosa and Staphylococcus aureus were the pathogens frequently associated with Hospital-acquired pneumonia (HAP). Due to the ongoing COVID-19 pandemic, there have been reports in different parts of the world on the change in patterns of the bacterial pathogens causing both CAP & HAP, this change may affect the efficacy of the existing guidelines on management of bacterial pneumonia.

Objective: This study aimed at determining the prevalence and patterns of bacterial pneumonia among adult patients who presented with signs and symptoms of lower respiratory tract infections (LRTIs) in Mwanza, Tanzania during the ongoing COVID-19 pandemic.

Methodology: This study was a laboratory-based cross-sectional study that analyzed data collected from July 2021 to July 2022 at Bugando Medical Centre, Nyamagana district hospital and Sengerema district hospital in Mwanza, Tanzania. Demographic and clinical data were collected using standardized data extraction tools. Sputum culture was done followed by identification of isolates and antibiotic susceptibility testing.

Results: A total of 286 patients with signs and symptoms of pneumonia were enrolled in this study. More than half of the patients were female 150 (52.4%). The median age was 40 (IQR 29-60) years. A total of 98 (34.3%) sputum samples were positive for pathogenic bacteria. Majority of the isolates were gram-negative bacteria 61.2% (60/98). The predominant isolates were Klebsiella spp. 38.8% (38/98) and S.pyogenes 21.4% (21/98). Gram negative bacteria showed high proportions of resistance against ciprofloxacin 60.0% (36/60), trimethoprim-sulfamethoxazole 68.3% (41/60), ceftriaxone 58.3% (35/60) and ceftazidime 58.3% (35/60).

Conclusion: One third of the patients with signs and symptoms of LRTIS had laboratory confirmed bacterial pneumonia with the predominance of multi-drug resistant gram negative bacteria. The observed high proportions of resistance among gram negative bacteria against third generation cephalosporins and ciprofloxacin which are in the watch category of the WHO’s AWaRe classification calls for continuous AMR surveillance so as to obtain data that can guide empiric antibiotic treatment.