Gurmeet Singh, Tonny Loho, Mira Yulianti, Dita Aditianingsih, Laila Fakhriyatuz Zakiyah, Sudirman Fakhruddin Masse, Muhammad Rizki Triono
{"title":"感染肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌的重症肺炎患者的抗生素耐药性相关因素和存活率分析:印度尼西亚雅加达的一项回顾性队列研究。","authors":"Gurmeet Singh, Tonny Loho, Mira Yulianti, Dita Aditianingsih, Laila Fakhriyatuz Zakiyah, Sudirman Fakhruddin Masse, Muhammad Rizki Triono","doi":"10.1177/20503121241264097","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance is one of the most significant challenges to global public health and the risk factors in severe pneumonia are constantly growing. Therefore, this study aimed to identify factors associated with antimicrobial resistance and conduct survival analysis of severe pneumonia patients with single and multiple pathogens in the National Referral Hospital, Jakarta, Indonesia.</p><p><strong>Methods: </strong>A retrospective method was used, and secondary data were collected from severe pneumonia patients admitted to the intensive care unit at Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia, from January 2016 to December 2022. Respiratory specimens were collected through bronchial washing. Furthermore, univariate and multivariate analyses were performed to analyze factors associated with antimicrobial resistance. Kaplan‒Meier survival curves were generated with the log-rank test to compare 30-day mortality between patients infected with single, dual, and multiple pathogens.</p><p><strong>Results: </strong>The results showed that a total of 333 patients from 415 enrolled were analyzed. <i>Klebsiella pneumoniae</i> (35.4%), <i>Acinetobacter baumannii</i> (29.3<i>%</i>), and <i>Pseudomonas aeruginosa</i> (15.4%) were the most frequently isolated Gram-negative pathogens. Factors associated with resistance to aminoglycoside, carbapenem, and quinolone were sepsis, cerebrovascular disease, and ventilator-associated pneumonia, as indicated by <i>p</i> < 0.05. In addition, the Kaplan-Meier curves showed that multiple pathogens influenced the survival rate of severe pneumonia patients (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>Sepsis, cerebrovascular disease, and ventilator-associated pneumonia were associated with antimicrobial resistance in severe pneumonia patients. The survival rate of patients infected with multiple pathogens was low. This suggests the importance of further awareness regarding empirical antibiotic stewardship and mortality assessment in severe pneumonia patients.</p>","PeriodicalId":21398,"journal":{"name":"SAGE Open Medicine","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11350540/pdf/","citationCount":"0","resultStr":"{\"title\":\"Factors associated with antibiotic resistance and survival analysis of severe pneumonia patients infected with <i>Klebsiella pneumoniae</i>, <i>Acinetobacter baumannii</i>, and <i>Pseudomonas aeruginosa</i>: A retrospective cohort study in Jakarta, Indonesia.\",\"authors\":\"Gurmeet Singh, Tonny Loho, Mira Yulianti, Dita Aditianingsih, Laila Fakhriyatuz Zakiyah, Sudirman Fakhruddin Masse, Muhammad Rizki Triono\",\"doi\":\"10.1177/20503121241264097\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Antimicrobial resistance is one of the most significant challenges to global public health and the risk factors in severe pneumonia are constantly growing. Therefore, this study aimed to identify factors associated with antimicrobial resistance and conduct survival analysis of severe pneumonia patients with single and multiple pathogens in the National Referral Hospital, Jakarta, Indonesia.</p><p><strong>Methods: </strong>A retrospective method was used, and secondary data were collected from severe pneumonia patients admitted to the intensive care unit at Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia, from January 2016 to December 2022. Respiratory specimens were collected through bronchial washing. Furthermore, univariate and multivariate analyses were performed to analyze factors associated with antimicrobial resistance. Kaplan‒Meier survival curves were generated with the log-rank test to compare 30-day mortality between patients infected with single, dual, and multiple pathogens.</p><p><strong>Results: </strong>The results showed that a total of 333 patients from 415 enrolled were analyzed. <i>Klebsiella pneumoniae</i> (35.4%), <i>Acinetobacter baumannii</i> (29.3<i>%</i>), and <i>Pseudomonas aeruginosa</i> (15.4%) were the most frequently isolated Gram-negative pathogens. Factors associated with resistance to aminoglycoside, carbapenem, and quinolone were sepsis, cerebrovascular disease, and ventilator-associated pneumonia, as indicated by <i>p</i> < 0.05. In addition, the Kaplan-Meier curves showed that multiple pathogens influenced the survival rate of severe pneumonia patients (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>Sepsis, cerebrovascular disease, and ventilator-associated pneumonia were associated with antimicrobial resistance in severe pneumonia patients. The survival rate of patients infected with multiple pathogens was low. This suggests the importance of further awareness regarding empirical antibiotic stewardship and mortality assessment in severe pneumonia patients.</p>\",\"PeriodicalId\":21398,\"journal\":{\"name\":\"SAGE Open Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-08-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11350540/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"SAGE Open Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/20503121241264097\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"SAGE Open Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/20503121241264097","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Factors associated with antibiotic resistance and survival analysis of severe pneumonia patients infected with Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa: A retrospective cohort study in Jakarta, Indonesia.
Background: Antimicrobial resistance is one of the most significant challenges to global public health and the risk factors in severe pneumonia are constantly growing. Therefore, this study aimed to identify factors associated with antimicrobial resistance and conduct survival analysis of severe pneumonia patients with single and multiple pathogens in the National Referral Hospital, Jakarta, Indonesia.
Methods: A retrospective method was used, and secondary data were collected from severe pneumonia patients admitted to the intensive care unit at Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia, from January 2016 to December 2022. Respiratory specimens were collected through bronchial washing. Furthermore, univariate and multivariate analyses were performed to analyze factors associated with antimicrobial resistance. Kaplan‒Meier survival curves were generated with the log-rank test to compare 30-day mortality between patients infected with single, dual, and multiple pathogens.
Results: The results showed that a total of 333 patients from 415 enrolled were analyzed. Klebsiella pneumoniae (35.4%), Acinetobacter baumannii (29.3%), and Pseudomonas aeruginosa (15.4%) were the most frequently isolated Gram-negative pathogens. Factors associated with resistance to aminoglycoside, carbapenem, and quinolone were sepsis, cerebrovascular disease, and ventilator-associated pneumonia, as indicated by p < 0.05. In addition, the Kaplan-Meier curves showed that multiple pathogens influenced the survival rate of severe pneumonia patients (p < 0.05).
Conclusions: Sepsis, cerebrovascular disease, and ventilator-associated pneumonia were associated with antimicrobial resistance in severe pneumonia patients. The survival rate of patients infected with multiple pathogens was low. This suggests the importance of further awareness regarding empirical antibiotic stewardship and mortality assessment in severe pneumonia patients.