Critically ill COVID-19 pneumonia is one of the main causes of extubation failure and mortality. Understanding clinical characteristics, laboratory profiles and bronchoalveolar lavage fluid (BALF) ...

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.

Introduction: in critically ill patients, there is a defect in host defense mechanism resulting in increased susceptibility to bacterial and fungal infection. The pattern of organisms causing infections varies between different countries and hospitals; therefore it is important that every hospital generates antibiograms to guide healthcare professionals during treatment with optimal choice of antibiotics. Our study aimed to described the pattern of fungal and bacterial pathogen in patients with high risk for invasive fungal disease (IFD). Methods: An observational study was conducted in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, within March-September 2015. Specimens were taken from blood, sputum, endotracheal aspiration, bronchoalveolar lavage (BAL), urine, pus and drainage fluid/surgical tissue specimen on 5th-7th day of hospitalization. Samples were cultured onto suitable culture media and bacterial isolates were identified using standard biochemical methods. Results: Bacteria and Candida sp. were isolated from 153 patients. C. tropicalis (44.31%) was the commonest fungal isolated. Incidence of gram-negative bacteria was higher than gram-positive bacteria. Klebsiella pneumonia was the most common gram-negative bacteria isolated, where as Enterococcus faecalis for gram-positive bacteria. Conclusion: Critically ill patients were vulnerable to contracted fungal and bacterial pathogen. Candida non-albicans and Gram-negative bacteria were the most common pathogen detected among critically ill patients with high risk for IFD.