Determination of the Dominant Bacterial Causal Agents of Pneumonia at the Komfo Anokye Teaching Hospital, Kumasi, Ghana

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Appropriate treatment of “typical” bacterial pneumonias depends on the knowledge of the likely aetiological agents in any community. Little is known about the aetiological pattern of “typical” bacterial pneumonias in our community. This study was undertaken at the Komfo Anokye Teaching Hospital to determine the dominant bacterial causal agent of “typical” bacterial pneumonia, the appropriate and affordable antibiotics for treatment and whether pneumonias in our community have any underlying predisposing diseases. One hundred and fifty (150) children aged five (5) years and less with clinical and radiological evidence of pneumonia attending the hospital for medical care were studied within a period of one year. Pleural aspirates, nasal swabs, and throat swabs were obtained from the study cases and investigated by microscopy and bacterial culture methods. The study population constituted of 84 (5 6%) males and 66 (44%) females. Forty-one percent (4 1%) of the pneumonia cases studied were due to bacteria, either as a single pathogen infection or in association with other bacteria. Seventy percent (70%) of the isolates were Gram-positive, while the remaining 30% were Gram-negative. Strep. pneumoniae was the dominant bacterial causal agent (36%), followed by Kleb. ppcurnoiiie, (25%), Staph. aureus (17%), Streptococcus viridans (13%), . E. coli (4%) and Staph. albus (2%). Strep. pneumoniae was isolated from children of all age groups. Kieb. pneumoniae, was the commonest bacterial species isolated from children aged two (2) years and less. Staph. aureus was found to be common in children aged between 24-36 months. Irrespective of the bacterial strain isolated, 87% of the isolates were found to be sensitive to erythromycin, 76% were found to be sensitive to gentamicin, 70% were sensitive to Co-trimoxazole and 70% of the isolates being sensitive to ampicillin and 67% to chioramphenicol. Erythrornycin was found to be the most effective of all the test antibiotics against Strep. pneurnoniae (MIC ≥ 0.03mg/l) and Staph. aureus (MIC 0.06mg/l). One hundred and nine (73%) of the children studied were found to be healthy before the onset of pneumonia, while 31 (21%) had measles before the pneumonia attack and 9 (6%) had Coryza before the onset of pneumonia. This study highlights the following findings: (i) Strep. pneumoniae is the dominant bacterial causal agent of “typical” bacterial pneumonia in children in our community. (ii) H. influenzae is not a bacterial causal agent of “typical” bacterial pneumonia in children in our community. (iii) Nasal swabs and throat swabs are of diagnostic value in the absence of pleural aspirates for the determination of the bacterial aetiology of pneumonia. (iv) Erythrornycin, gentamicin, co-trimoxazole, chioramphenicol and ampicillin can be used for blind therapy. (v) Underlying diseases can be said not to be predisposing factors for pneumonia in our community.
A thesis submitted to the Board of Postgraduate Studies, Kwame Nkrumah University of Science and Technology, Kumasi, in partial fulfilment of the requirement for the award of Master of Science Degree in Clinical Microbiology, 1999