Infection and Drug Resistance (Nov 2019)
Multidrug-Resistant Infections Among Hospitalized Adults With Community-Acquired Pneumonia In An Indonesian Tertiary Referral Hospital
Abstract
Abdul KR Purba,1–5 Purwantyastuti Ascobat,4 Armen Muchtar,4 Laksmi Wulandari,6 Alfian Nur Rosyid,6 Priyo Budi Purwono,7 Tjip S van der Werf,8 Alex W Friedrich,2 Maarten J Postma1,3,5,9 1Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 2Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 3Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo Hospital, Surabaya, Indonesia; 4Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; 5Unit of PharmacoTherapy, Epidemiology and -economics (PTE2), Department of Pharmacy, Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands; 6Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo Hospital, Surabaya, Indonesia; 7Department of Microbiology, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo Hospital, Surabaya, Indonesia; 8Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 9Department of Economics, Econometrics and Finance, Faculty of Economics & Business, University of Groningen, Groningen, The NetherlandsCorrespondence: Abdul KR PurbaUniversitair Medisch Centrum Groningen, Hanzeplein 1, Groningen 9700RB, The NetherlandsTel +31 697 52 411Email [email protected]: To evaluate the clinical and microbiological appearance among hospitalized pneumonia patients focusing on resistance and risk factors for mortality in a referral hospital.Patients and methods: The study was an observational retrospective study on patients with CAP from 2014 to 2016 at Dr Soetomo referral hospital of Surabaya, Indonesia. All positive cultures with antimicrobial susceptibility results from blood and respiratory specimens were included. Patients infected with drug-susceptible pathogens and MDR organisms were also assessed in terms of clinical characteristics, day-3 clinical improvement, and 14-day mortality.Results: Of 202 isolates, 181 possessed antimicrobial susceptibility data. S. pneumoniae was the most prevalent pathogen causing CAP (18.3%). Most patients were empirically treated with ceftriaxone (n=75; 41.4%). Among beta-lactam antibiotics, the susceptibility to the third-generation cephalosporins remained relatively high, between 67.4% and 82.3%, compared with the other beta-lactams such as amoxicillin/clavulanate and ampicillin/sulbactam (a sensitivity rate of 36.5% and 47.5, respectively). For carbapenem antibiotics, imipenem and meropenem susceptibility was 69.6% and 82.3% respectively. Approximately 22% of isolates were identified as MDR that showed significant differences in clinical outcomes of 14-day mortality rates (p<0.001). Notably, patients with day-3 improvement had a lower risk of mortality (OR= 0.06; 95% CI= 0.02–0.19).Conclusion: One-fifth of causative agents among hospitalized CAP cases were identified as MDR organisms. The pathogens of MDR and non-MDR CAP remain susceptible to the third-generation cephalosporins. Together with additional consideration of culture findings and Pneumonia Severity Index (PSI) assessment, a 3-day clinical assessment is essential to predict the prognosis of 14-day mortality.Keywords: gram-negative bacteria, pneumonia, microbial sensitivity tests, developing country, day-3 improvement
