Factors Associated with Multidrug-Resistant Pathogens in Community-Acquired Pneumonia Patients Hospitalized in a Provincial Teaching Hospital in Indonesia (original) (raw)
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Infection and Drug Resistance, 2019
ObjectivesTo evaluate the clinical and microbiological appearance among hospitalized pneumonia patients focusing on resistance and risk factors for mortality in a referral hospital.Patients and methodsThe 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.ResultsOf 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).ConclusionOne-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.
Infection and Drug Resistance, 2019
Objectives: 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 14day 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.
Acta medica Indonesiana, 2021
BACKGROUND The emergence of drug-resistant pathogens (DRP) in recent years possibly contributes to the common problems associated with community-acquired pneumonia. However, to predict the risk of the ailment, the DRIP score is mainly applied, although no validation study has been reported in Indonesia. Therefore, the score prediction accuracy in the population, patient characteristics and germ patterns appears indefinite, particularly for Cipto Mangunkusumo Hospital, Jakarta. The purpose of this study is to determine the DRIP performance as an instrument in predicting infections due to drug-resistant pathogens (DRP) in community-acquired pneumonia at Cipto Mangunkusumo Hospital. METHODS This research employed a cross-sectional design, where the subjects were community-acquired pneumonia patients treated between January 2019 and June 2020. In addition, adequate medical records of the participants were obtained. The condition is defined as DRP when the sputum culture results show res...
2022
Background: Patients hospitalized in the intensive care unit (ICU) have a higher susceptibility to infections. Respiratory infections are the most common nosocomial infections. Rising antibiotic resistance due to indiscriminate use of antibiotics and poor adherence to standard precaution in healthcare facilities compounds the problem. The main aim of this study is to assess microbial patterns and antibiotic resistance from bronchoalveolar lavage specimens in severe pneumonia patients. Methods: This retrospective study was conducted in an Indonesian tertiary care hospital from January 2016-December 2020. Written and verbal informed consent was obtained prior to bronchoscopy procedures. Patients were enrolled if they had severe community-acquired pneumonia (CAP) according to American Thoracic Society (ATS)/Infectious Disease Society of America (IDSA) criteria, had high-risk hospital-acquired pneumonia (HAP), late-onset ventilator-associated pneumonia (VAP), or pneumonia caused by Coronavirus disease (COVID-19). Respiratory specimens via bronchoscopy were inoculated on general semi-sloid thioglycolate media. Testing for antibiotic susceptibility was done using the disk diffusion method. Results: Two hundred and one patients' data were analyzed. The majority of patients were males (65,17%) and above 60 years of age. The most common type of pneumonia was CAP (39,3%). Neurologic/cerebrovascular disease was the most common comorbidity (35,32%). Acinetobacter baumannii was the most frequently isolated microorganism. Ampicillin/sulbactam and amikacin were found to yield lower microbial resistance. Conclusion: Combination of ampicillin/sulbactam and amikacin appeared effective as initial empirical therapy in severe pneumonia patients. Further studies are needed to evaluate the feasibility and effectiveness of this combined therapy.
Research Square, 2020
Pneumonia is a worldwide, serious threat to health and an enormous socio-economic burden for health care system. Community-acquired pneumonia (CAP) is associated with a signicant mortality and morbidity. Knowledge of predominant microbial patterns in CAP constitutes the basis for initial decisions about empirical antimicrobial treatment. The aim of this study was to identify the bacterial etiology of CAP in adult hospitalized patients and to see their antibiotic sensitivity pattern as well as to observe their clinical prole and short term outcome. It was a hospital based prospective observational study. A total of 87 hospitalized patients diagnosed with CAP were enrolled consecutively from the medicine ward of Chittagong Medical College Hospital (CMCH). Sputum for Gram staining, Z N staining, culture sensitivity, blood culture and sensitivity and PCR for Legionella pneumophila, Mycoplasma pneumoniae, Chlamydophila pneumonia and Streptococcus pneumonia were done. Patients were foll...
Advances in Medicine
Background. Pneumonia is still a major global problem with high morbidity and mortality. The increasing number of pneumonia cases caused by bacteria, especially multidrug-resistant pathogens, increasing age of the population, patients with chronic disease (comorbid), and inappropriate antimicrobial therapy at initial administration make the treatment become less effective. These issues finally contribute to higher morbidity and mortality in cases of hospitalized pneumonia patients. Therefore, it is crucial to know the microbial pattern and select the therapy according to local antimicrobial sensitivity patterns. Method. A cross-sectional study was conducted for hospitalized pneumonia patients between January 2015 and December 2016 in Indonesia National Referral Infectious Disease Hospital. Data were collected from medical records to show patient characteristics, antimicrobial treatment data, culture examination, and bacterial sensitivity. Results. A total of 99 pneumonia patients re...
Community-Acquired Pneumonia in Indonesia
2015
Ucapan terima kasih / Dankwooord (Acknowledgement) Curiculum vitae List of publication PhD portofolio Introduction and outline of the thesis 11 Chapter 1 Introduction and outline of the thesis 12 13 12 | Introduction and outline of the thesis INTRODUCTION Community-acquired pneumonia (CAP) remains a significant cause of morbidity, mortality, and an economic burden [1]. In low-to middle-income countries, it is one of the most important causes of death and loss of years of life [2,3]. Of the 15 million deaths reported for the year 2004 in Southeast Asian countries (as defined by WHO), 1.5 million (10 %) were due to respiratory infections, mostly lower respiratory tract infections, including 0.5 million deaths due to tuberculosis. Likewise, these infections were responsible for over 40/440 million disability adjusted life years lost in this area of the world [3]. Knowledge about the epidemiology, etiology and pathogenesis of CAP is essential for patient management in order to achieve the optimum patients' outcomes [4]. As antibiotic therapy is one of the cornerstones in the management of patients with infections including CAP, the quality of care, in particular the quality of the use of antibiotics, is also crucial in the management of CAP cases [5]. Although host factors such as age and gender, and severity of disease on presentation, are the most important determinants of outcome of CAP, patients with CAP also need to be identified and empirically treated at an early stage of their illness since delay in the timely instigation of appropriate empirical antimicrobial therapy for CAP has been independently associated with poor patient outcomes [6]. CAP is often caused by pathogens that have colonized the upper airways prior to causing lower respiratory disease. This has been proven for Streptococcus pneumoniae. Therefore, the commensal microflora of the upper respiratory tract, especially the nasopharyngeal space needs to be studied in detail. Indonesia is the world's fourth most populous country, with a population of close to 250 million inhabitants. In Indonesia, CAP ranks the first as the cause of mortality in children [7] and the sixth in adults [8]. However, there are still very few data available with regard to CAP in Indonesia. Data are lacking on the etiology, antimicrobial management, and supportive patient care, leading to difficulties in controlling this disease, and, consequently, to a potentially enhanced burden from this disease. Also, the normal nasopharyngeal microflora of Indonesian inhabitants has received little attention so far. These are in sharp contrast to the many experiences with this disease and with nasoparyngael carriage reported from western countries, and even from some countries neighbouring Indonesia [9-11]. Consequently, the management of CAP patients in Indonesia has been, so far, based on experience gained elsewhere and presented in international guidelines [8] without evaluation of their appropriateness for the Indonesian setting. There is also, to our knowledge, no proper evaluation of the outcomes of patients with CAP in this country. Introduction and outline of the thesis 14 | Introduction and outline of the thesis Central Java province, Indonesia, is presented. The etiological diagnosis was determined based on a comprehensive range of diagnostic laboratory tests and interpretation of these test results by integrative panel discussions involving clinicians, radiologists, and clinical microbiologists. One of the implicated pathogenic species, Leptospira spp., is discussed separately in chapter 4. Part III: Characteristic differences between isolates from colonized and infected individuals Pneumonia, especially bacterial pneumonia, is usually preceded by colonization of the upper respiratory tract by potential lower respiratory pathogens. A population-based survey of nasopharyngeal carriage of Streptococcus pneumoniae, Klebsiella pneumoniae, and other Gram-negative bacilli among healthy individuals is described in chapter 5 and chapter 6. The risk factors for carriage of these potential pathogens are analyzed. The heterogeneity among isolates from the major bacterial Gram-negative respiratory pathogen, i.e. K. pneumoniae, isolated from healthy and infected individuals is presented in chapter 7. Part IV: Management of community-acquired pneumonia in Indonesia Chapter 8 describes the development of a set of quality indicators for the assessment of the medical management of CAP patients in the Indonesian setting. Part V: Discussion The main findings of the studies in this thesis are discussed and suggestions for further research regarding the management of CAP in Indonesia are given in chapter 9 and summarized in chapter 10.
2019
Pneumonia still remains as a significant cause of mortality due to the virulence factors of the causative microorganism. The causative microorganism profile of pneumonia differs from one region to another. This study aimed to identify the etiology of pneumonia and bacterial sensitivity pattern to antibiotics. A cross-sectional study was conducted based on reports of bacteria isolates from the ward of Teaching Hospital, from May to October 2018. Microbiological isolates were collected from sputum patient. Identification of all causative microorganisms was performed by standard microbiologic methods. Susceptibility testing was performed using disk diffusion method. Among 47 patient, the subject was dominated by a male (51%) with mean age was 57±2.22. Streptococcus pneumoniae was the most common causative agent (28%) followed by Candida sp. (21%), Pseudomonas aeruginosa (8.8%), Klebsiella pneumoniae (8.8%) and Streptococcus viridans(8.8%). S pneumonia was sensitive to Levofloxacin (81.25%); Ceftriaxone (62.5%); and Ampicillin (75%). Cefoperazone was the only antibiotics showed high effectiveness against P. aeruginosa (83.3%) and K. pneumoniae (100%). Antibiotics susceptibility pattern surveillance should be done periodically.
Individualizing Risk of Multidrug-Resistant Pathogens in Community-Onset Pneumonia
PloS one, 2015
The diffusion of multidrug-resistant (MDR) bacteria has created the need to identify risk factors for acquiring resistant pathogens in patients living in the community. To analyze clinical features of patients with community-onset pneumonia due to MDR pathogens, to evaluate performance of existing scoring tools and to develop a bedside risk score for an early identification of these patients in the Emergency Department. This was an open, observational, prospective study of consecutive patients with pneumonia, coming from the community, from January 2011 to January 2013. The new score was validated on an external cohort of 929 patients with pneumonia admitted in internal medicine departments participating at a multicenter prospective study in Spain. A total of 900 patients were included in the study. The final logistic regression model consisted of four variables: 1) one risk factor for HCAP, 2) bilateral pulmonary infiltration, 3) the presence of pleural effusion, and 4) the severit...