Pneumonia Panel Precision: Evaluating Antibiotic Utilization in a Retrospective Study

INTRODUCTION: Pneumonia remains a leading cause of morbidity and mortality worldwide, often necessitating antibiotic therapy. This study evaluates the potential overuse of antibiotics in pneumonia cases diagnosed with the pneumonia panel test, aiming to enhance antimicrobial stewardship and improve treatment outcomes. OBJECTIVES: This study aims to investigate the potential overuse of antibiotics in the treatment of pneumonia, as diagnosed by the pneumonia panel test. MATERIALS AND METHODS: This retrospective observational study reviewed 224 patient records at a tertiary care centre in Kerala. Patients aged >18 years with pneumonia per ATS/IDSA guidelines were included. Exclusions encompassed non-infectious lung diseases, bronchial exam contraindications, and incomplete records. Data were entered in Excel and analysed using SPSS software version 26. RESULTS: The study analyzed 224 patients with a male predominance (59.8%) and a mean age of 62 years (±16), ranging from 23 to 88 years. Among the patients, 67.4% had community-acquired pneumonia. Respiratory samples were predominantly bronchoalveolar lavage (55.4%) and sputum (44.6%), with 69.2% testing positive for bacteria, and 99.3% of these identified as typical bacteria. Acinetobacter baumannii (29%) and Klebsiella pneumoniae (24.5%) were the most common organisms. Additionally, 48.7% of samples tested positive for carbapenemase-producing genes, highlighting significant antibiotic resistance. The most prevalent enzymes were NDM (28.6%), VIM (10.7%), and OXA-48 (23.7%). The high prevalence of these enzymes indicates a significant burden of MDR pathogens, which can complicate treatment options and lead to more difficult-to-treat infections. Post-film array, meropenem (35.7%) and polymyxin B/colistin (24.1%) were the most frequently administered antibiotics. Respiratory culture showed bacterial growth in 59.4% of bacteria-positive samples, with a statistically significant P-value of 0.000. Among 109 patients with the genotype, 32 (29.4%) tested positive for carbapenemase production, compared to 5 of 115 patients without the genotype (4.3%). The results were statistically significant (p=0.000, Chi-Square=25.34), highlighting a strong link between the presence of carbapenemase genes and carbapenemase production. Polymyxin B/Colistin administration showed no significant association with carbapenem sensitivity (P=0.6, Chi-Square=0.561), despite the majority of patients having carbapenem-resistant strains (89.7%). These findings underscore the high prevalence of multidrug-resistant organisms and the importance of genotypic and rapid diagnostic methods in managing antibiotic resistance in pneumonia patients. DISCUSSIONS/CONCLUSIONS: In conclusion, both the study by Jinru Gong et al. and the current research underscore the critical importance of rapid diagnostic tools in tailoring antibiotic therapy for pneumonia. By pinpointing specific resistance markers such as NDM, IMP, and other AMR genes, these studies highlight the potential of molecular diagnostics to minimize antibiotic overuse, bolster antimicrobial stewardship, and enhance treatment outcomes. This, in turn, contributes significantly to the global effort against antimicrobial resistance. Future research involving larger datasets is essential to further validate these findings and refine diagnostic strategies for improved clinical outcomes.