RESUMO
PURPOSE: To describe meropenem empirical use, susceptibility trend, and associated factors for acquired nonsusceptibility in P. aeruginosa in the intensive care unit. PATIENTS AND METHODS: This study was conducted in the intensive and high care unit of a tertiary care hospital in Indonesia to evaluate empirical meropenem bolus administration protocol. All patients admitted during the 3 year study period from January 2018 through January 2021 with culture-confirmed P. aeruginosa infection were included in the study. Primary data were collected from hospital database electronic medical record and series of local biannual report of microorganism susceptibility pattern. RESULTS: The data suggested that there was increasing trend in meropenem nonsusceptibility and multidrug-resistance rates. A total of 135 patients with various primary diagnoses and comorbidities were studied. P. aeruginosa isolates were mostly (73.4%) obtained from sputum specimen. Empirical meropenem therapy was administrated in 24.4% of patients with standard- and high-dose as indicated. Nonsusceptibility was acquired in 37% patients who mostly received empirical therapy. Multivariable analysis revealed protocol being evaluated as a statistically significant risk factor for nonsusceptibility in P. aeruginosa (PR = 30.65; p <0.001). CONCLUSION: Empirical meropenem administration protocol in this study was an independent determinant of nonsusceptibility acquisition in P. aeruginosa. These findings proved that empirical therapeutic strategy modification is indispensable and routine evaluation practice should be promulgated.
RESUMO
A recent modeling study estimated that there could be as many as 20,000 human melioidosis cases per year in Indonesia, with around 10,000 potential deaths annually. Nonetheless, the true burden of melioidosis in Indonesia is still unknown. The Indonesia Melioidosis Network was formed during the first melioidosis workshop in 2017. Here, we reviewed 101 melioidosis cases (99 human and two animal cases) previously reported and described an additional 45 human melioidosis cases. All 146 culture-confirmed cases were found in Sumatra (n = 15), Java (n = 104), Kalimantan (n = 15), Sulawesi (n = 11) and Nusa Tenggara (n = 1). Misidentification of Burkholderia pseudomallei was not uncommon, and most cases were only recently identified. We also evaluated clinical manifestations and outcome of recent culture-confirmed cases between 2012 and 2017 (n = 42). Overall, 15 (36%) cases were children (age <15 years) and 27 (64%) were adults (age ≥15 years). The overall mortality was 43% (18/42). We conducted a survey and found that 57% (327/548) of healthcare workers had never heard of melioidosis. In conclusion, melioidosis is endemic throughout Indonesia and associated with high mortality. We propose that top priorities are increasing awareness of melioidosis amongst all healthcare workers, increasing the use of bacterial culture, and ensuring accurate identification of B. pseudomalleiand diagnosis of melioidosis.
