Prospective Study On Clinical Profile, Risk Factors, Microbiological Pattern, And Outcomes Of Hospital Acquired Pneumonia Among Patients Admitted To A Tertiary Care Hospital In Chandigarh, 2025

Abstract

Background: Hospital-acquired pneumonia(HAP) remains a significant cause of morbidity and mortality among hospitalized patients, particularly in developing countries such as India, where healthcare systems are challenged by resource constraints and high patient loads. HAP is defined as pneumonia occurring 48 hours or more after hospital admission and is considered one of the most serious nosocomial infections. Despite advancements in diagnostic modalities and therapeutic options, HAP continues to contribute substantially to prolonged hospital stays, increased healthcare costs, and elevated mortality rates. The problem is compounded by the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens, which complicate treatment and highlight the urgent need for targeted prevention and management strategies.

Materials and methods: The present study was conducted at a hospital in Chandigarh, India, over a period of six months, with the objective of evaluating the clinical profile, risk factors, microbiological spectrum, and outcomes of HAP among hospitalized patients. A total of 120 adult patients who developed pneumonia after 48 hours of hospitalization were included in this prospective observational study. Inclusion criteria were based on the Centers for Disease Control and Prevention definition of HAP. Patients with community- acquired pneumonia, ventilator-associated pneumonia at admission, or pre-existing pneumonia at the time of hospital admission were excluded. Data collection encompassed detailed clinical evaluation, recording of demographic details, comorbidities, risk factors, laboratory and radiological investigations, and microbiological profiling through sputum cultures and antibiotic sensitivity testing.

Results: The mean age of the study population was 54.3 years, with the highest prevalence noted in the 51–60 years age group. A male predominance was observed, with males constituting58.3% of the cases. Comorbidities were highly prevalent, with diabetes mellitus being the most common (40%), followed by chronic obstructive pulmonary disease (30%), chronic kidney disease (18.3%), and immunosuppressive therapy (10%). These comorbid conditions likely contributed to increased susceptibility  to HAP, aligning with findings from previous studies that emphasize the importance of underlying health status in the pathogenesis of hospital-acquired infections. Risk factors associated with HAP in this study included prolonged hospital stay exceeding seven days in 73.3% of patients, prior antibiotic use in 55% of patients, and the presence of invasive devices such as intravenous lines and urinary catheters in65% of cases.Additional risk factors included recent surgery and the use of proton pump inhibitors. These findings are consistent with global literature that identifies prolonged hospitalization and invasive interventions as significant contributors to the development of HAP.Clinically, fever was the most commonly reported symptom (93.3%), followed by cough with expectoration (75%), dyspnea (63.3%), and chest pain (20%). Auscultatory findings were present in90% of patients,underscoring the importance of thorough physical examination in early detection of HAP. Laboratory investigations revealed leukocytosis in 80% of cases, while biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) were elevated in the majority of patients, supporting their role in the diagnosis and monitoring of bacterial infections.

Radiological evaluation demonstrated unilateral infiltrates in 60% of cases, bilateral infiltrates in 40%, and pleural effusion in 15%. These findings are consistent with the radiological patterns described in previous studies and highlight the value of chest imaging in confirming clinical suspicions of HAP.

Microbiological profiling identified Acinetobacterbaumanniias the most frequentlyisolated pathogen, accounting for 35% of cases, followed by Klebsiellapneumoniae(21.7%), Pseudomonas aeruginosa(18.3%), and Escherichia coli (15%). Methicillin- resistant Staphylococcus aureus(MRSA) was identified in 6.7% of cases. Alarmingly, a high prevalence of multidrug-resistant and extensively drug-resistant strains was noted, consistent with globalconcerns regarding antimicrobialresistance in nosocomial infections.

Treatment outcomes revealed a clinical recovery rate of 76.7%. However, significant complications such as septicemia (15%) and acute respiratory distress syndrome (ARDS) (8.3%) were observed. The overall mortality rate was 6.7%, which is within the range reported in earlier studies. Multivariate logistic regression analysis identified prolonged hospitalstay, invasive device use,and prior antibiotic use as independent predictors of HAP. These findings reinforce the importance of infection control measures and judicious antibiotic use to mitigate the burden of HAP in hospitalized patients. vi

Conclusion: In conclusion, this study provides valuable insights into the epidemiology, risk factors, clinical presentation, microbiological spectrum, and outcomes of hospital-acquired pneumonia in a tertiary care setting in India. The findings emphasize the need for early identification of high-risk patients, adherence to infection prevention protocols, and the integration of local antibiograms to guide empirical therapy. Future research should focus on multicenter studies to validate these findings and explore the role of molecular diagnosticsandnoveltherapeuticinterventionsinimprovingpatientoutcomes.