Bacterial Profile and Antimicrobial Susceptibility Pattern in Community-acquired Pneumonia patient at General Hospital, Indonesia

Culture and local antimicrobial susceptibility testing need to be carried out periodically, and special attention needs to be received from hospitals to reduce resistance levels and better manage community-acquired pneumonia (CAP). This study aims to determine the etiological profile of CAP in adult inpatients and antimicrobial susceptibility patterns at the Dr. Sardjito General Hospital, Yogyakarta, Indonesia. A prospective cohort study was conducted in the non-VIP adult ward at Dr. Sardjito General Hospital, from September 2022 to May 2023. There were 222 adult patients diagnosed with CAP as a sample based on the criteria. From 222 CAP patients, culture results were obtained as much 236 isolates of pathogenic bacteria which were suspected to be the clinical cause of CAP, with details of 208 patients each producing one strain of pathogenic bacteria (n=208 isolates), and 14 patients each producing two strains of pathogenic bacteria (n=28 isolates). All collected sputum samples were analyzed using the VITEK-2 instrument to identify bacteria and antimicrobial susceptibility results were interpreted based on Clinic and Laboratory Standards Institute (CLSI), sensitive if ≥70%, moderate if 40-69%, or resistant if <40%. The Gram-positive pathogens that cause CAP are Coagulase-negative Staphylococci, Enterococcus faecalis/ faecium, Kocuria kristinae, Streptococcus sp., Staphylococcus epidermidis, Staphylococcus aureus, and Streptococcus mitis. The Gram-negative pathogens that cause CAP are Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter cloacae, Escherichia coli, Stenotrophomonas maltophilia, and Serratia marcescens. Gram-positive organisms were dominated by coagulase-negative Staphylococci which was susceptible to gentamicin, linezolid, quinupristin/dalfopristin, tigecycline, and vancomycin (75-100%), Enterococcus faecalis/faecium which was susceptible to penicillin, fluoroquinolone, carbapenem, vancomycin, and linezolid (71.4-100%), and Streptococcus sp. which was susceptible to penicillin, cephalosporin, chloramphenicol, macrolide, imipenem, fluoroquinolone, and tigecycline (75-100%). Gram-negative organisms are dominated by Klebsiella pneumoniae which is susceptible to aminoglycosides, second and fourth-generation cephalosporins, colistin, and tigecycline (73.2-100%), Acinetobacter baumannii which is susceptible to amikacin, colistin, and tigecycline (71.4-100%), and Pseudomonas aeruginosa which is susceptible to aminoglycosides, third-generation cephalosporins, colistin, fluoroquinolones, carbapenems, and penicillins (75-100%).