Community-acquired pneumonia-causing bacteria and antibiotic resistance rate among Syrian patients

Antimicrobial resistance poses a critical global health concern, particularly in developing countries like Syria, and is responsible for the increased rates of infection and mortality associated with community-acquired pneumonia (CAP).

This cross-sectional study determined the prevalence of bacteria that cause CAP and the rate of antibiotic resistance in a sample of patients who attended the Chest Department of Ibn Al-Nafis Hospital in Damascus, Syria from September 2022 to March 2023.

Almost three-quarters of the 100 CAP cases were caused by 3 agents: Streptococcus pneumonia (41%), Staphylococcus aureus (16%), and Klebsiella sp. (14%). The study showed high resistance of bacteria to the usually recommended antibiotics, which presents a significant challenge in treating these infections. Specifically, in this sample, Gram-negative bacteria had a higher antibiotic resistance rate than Gram-positive bacteria. Gram-negative bacteria showed the highest resistance against nitrofurantoin, cefazolin, and cefoxitin (100%, 91.7%, and 91.3%, respectively). Gram-positive bacteria exhibited the highest resistance against erythromycin, cefoxitin, and oxacillin (91.37%, 91.22%, and 87.71%, respectively). Resistance to the commonly recommended amoxicillin, and amoxicillin + clavulanic acid, was higher than 80%, while the tested Gram-positive bacteria showed high sensitivity to other recommended options such as cefotaxime (71%) and ceftriaxone (81%).

These findings underscore the importance of being able to adapt the general World Health Organization recommendations according to local evidence. It is crucial to emphasize the need for continuous local monitoring, functioning and well-equipped laboratories, and well-trained specialists in infectious diseases in hospitals to be able to make these decisions.