Antimicrobial Resistance and Bacterial Trends in Lower Respiratory Tract Infections Among Hospitalized Patients in Astana and Shymkent, Kazakhstan, 2018-2024

Abstract

Background: Lower respiratory tract infections (LRTIs) represent one of the most common infectious diseases globally, contributing to acute morbidity and mortality among hospitalized patients. This study analyzed the distribution of bacterial pathogens and antimicrobial (AMR) trends among hospitalized patients with LRTIS in Astana and Shymkent, Kazakhstan, between 2022 and 2024. Methods: A population-based retrospective study of hospitalized patients with Lower respiratory tract infections (LRTIs) during 2022 -2024 was analysed using microbiological data to identify the prevalence of bacterial pathogens, resistance patterns, and demographic features. The International Classification of Diseases, 10th Revision (ICD-10), was used to retrieve data on lower respiratory tract infections from J12-J22. Descriptive analysis, AAPC, and chi-square tests were used. Results: a total of 2,098 hospitalized patients with LRTIs were analyzed in both cities: Shymkent, n=1,819 (86.7%); Astana, n=279 (13.3%). The predominant pathogen isolates were Gram-negative bacteria (43.61%) followed by Gram-positive bacteria (39.08%), and fungi (17.30%). The most frequent isolates were Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus mitis, Acinetobacter baumannii, and Candida albicans. High levels of antimicrobial resistance were noticed with more than 50% resistance to commonly used antibiotics like ampicillin, gentamicin, and azithromycin. The highest proportion of infections was observed in elderly patients aged 60 years and older, indicating vulnerability in this group. There were also substantial geographic differences, with Shymkent having a much higher burden of cases than Astana. Conclusion: the growing challenge of antimicrobial resistance and the limited effectiveness of empirical therapies in hospitals. This highlights the need to implement and enhance antimicrobial stewardship programs, infection prevention and control procedures, and local and national surveillance to promote evidence-based interventions and policymaking in Kazakhstan.