FARMACIA, 2020, Vol. 68, 3 512 https://doi.org/10.31925/farmacia.2020.3.17 ORIGINAL ARTICLE ANTIBIOTIC RESISTANCE IN COMMUNITY-ACQUIRED PNEUMONIA. A ROMANIAN PERSPECTIVE IONUȚ EMILIAN BLEJAN 1# , CAMELIA CRISTINA DIACONU 2# , ANDREEA LETIȚIA ARSENE 1 , DENISA IOANA UDEANU 1# , MANUELA GHICA 1 *, DOINA DRĂGĂNESCU 1 , GEORGE TRAIAN ALEXANDRU BURCEA DRAGOMIROIU 1 , MIHAELA RĂDULESCU 3 , HELENA C. MALTEZOU 4 , ARISTIDES M. TSATSAKIS 5 , MARIA PAPASAVVA 6 , NIKOLAOS DRAKOULIS 6 , DANIELA ELENA POPA 1 1 “Carol Davila” University of Medicine and Pharmacy, Faculty of Pharmacy, Bucharest, Romania 2 “Carol Davila” University of Medicine and Pharmacy, Clinical Emergency Hospital of Bucharest, Romania 3 University of Economic Studies, Bucharest, Romania 4 National Public Health Organization, 15123, Athens, Greece 5 University of Crete, Medical School, Department of Toxicology and Forensic Sciences, 74100, Rethymno, Greece 6 Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15771, Zografou, Greece *corresponding author: manuela.ghica@umfcd.ro # Authors with equal contribution. Manuscript received: August 2019 Abstract Community-acquired pneumonia (CAP) is one of the most common communicable diseases with a high mortality rate worldwide. Treatment is administered empirically based on clinical symptoms and the most commonly incriminated microorganisms in lower respiratory infections responsible for CAP. This study aimed to identify microorganisms responsible for CAP in patients hospitalized in an Emergency Hospital in Bucharest, Romania; to assess the impact of patients’ comorbidities and age on the survival level and to establish the degree of antimicrobial resistance of the most important isolated species. A total of 170 patients diagnosed with CAP from December 2017 through December 2018 were studied. Statistical analyses were performed considering the following data: survival rate, comorbidities, initiated pharmacotherapy, antibiogram results in case of refractory treatments. The overall survival rate was 36% among patients. Cardiovascular disease was incriminated as the highest risk factor. Concerning refractory antibiotic treatment, the microbiological results revealed that the most common bacterial strains detected were Klebsiella sp., Acinetobacter baumanii, S. aureus, E. coli and Pseudomonas, with high multiple antibiotic resistance (MAR) index. The results point out a real concern for patients with refractory CAP due to high antimicrobial resistance to the administered antibiotics in Romania. Rezumat Pneumonia comunitară (PC) este una dintre cele mai frecvente boli transmisibile cu o rată mare de mortalitate la nivel mondial. Tratamentul este administrat empiric pe baza simptomelor clinice și a microorganismelor cel mai frecvent incriminate în infecțiile respiratorii inferioare responsabile de PC. Acest studiu a urmărit identificarea microorganismelor responsabile de PC la pacienții internați într-un spital de urgență din București, România; pentru a evalua impactul comorbidităților și vârstei pacienților asupra nivelului de supraviețuire și a stabili gradul de rezistență antimicrobiană a celor mai importante specii izolate. Au fost studiați 170 de pacienți diagnosticați cu PC din decembrie 2017 până în decembrie 2018. Analizele statistice au fost efectuate ținând cont de următoarele date: rata de supraviețuire, comorbiditățile, farmacoterapia inițiată, rezultatul antibiogramei în cazul tratamentelor refractare. Rata de supraviețuire globală a fost de 36% în rândul pacienților. Boala cardiovasculară a fost incriminată drept cel mai mare factor de risc. În ceea ce privește tratamentul cu antibiotice refractare, rezultatele microbiologice au relevat că cele mai frecvente tulpini bacteriene detecta te au fost Klebsiella sp., Acinetobacter baumanii, S. aureus, E. coli și Pseudomonas, cu un indice MAR (multiple antibiotic resistance) ridicat. Rezultatele subliniază importanța particulară a pneumoniei refractare datorită rezistenței antimicrobiene la antibioticele administrate în România. Keywords: community-acquired pneumonia; antibiotic resistance; multiple antibiotic resistance index Introduction Community-acquired pneumonia (CAP) is an acute infection of the lower respiratory tract with a high mortality rate worldwide. The diagnosis of community- acquired pneumonia can be established in patients without any contact with hospitals or other health care settings over a 3 months period before hospitalization [1, 2].