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Background and Objectives: Burkholderia cepacia is one of the multiple intrinsic resistant bacteria causing opportunistic infections. The study aimed to determine the distribution of B. cepacia isolates based on types of clinical specimen, hospital wards, and the patient's gender-age and to evaluate their antibiotic susceptibility. Materials and Methods: This study involved isolating, identifying, and testing antibiotic susceptibility of B. cepacia isolates recovered from clinical specimens of Dr. Zainoel Abidin general hospital (RSUDZA) Banda Aceh Indonesia during March 2019-March 2022. Results: In total, there were 3,622 Gram-negative bacterial isolates of 10,192 clinical specimens obtained during the study period and B. cepacia was positively detected in 127 isolates (1.24%). Most of the 127 isolates of B. cepacia were found in blood and sterile body fluid samples (55.11%) followed by urine and pus samples accounting for 23.62% and 13.37%, respectively. The internal medicine wards had the highest number of detected B. cepacia isolates at 28.3%. B. cepacia infections were more common in men (59.05%) and people over 45 years old (41.73%). The bacteria were highly sensitive to the antibiotic ceftazidime (92.7%). Conclusion: Culture examination of clinical specimens is not required for confirmed infections, despite being essential for appropriate antibiotic treatment. Implementing surveillance programs and judicious use of antibiotics can prevent bacterial transmission.
RESUMO
An accurate and timely identification of causative microorganisms as well as determination of their antibiotic susceptibility patterns will help in the selection of proper antibiotics and prevention of their misuse in pneumonia patients. The aim of this study was to determine the distribution and antibiotic susceptibility pattern of bacteria isolated from endotracheal aspirates of ventilator-assisted pneumonia patients in Indonesia. A retrospective cross-sectional study was conducted at Dr. Zainoel Abidin Hospital, a provincial reference hospital in Banda Aceh, Indonesia, from January to December 2021. Ventilator-assisted pneumonia patients aged ≥17 years treated in the hospital were considered eligible. Antibiotic susceptibility was valuated using Kirby-Bauer disc-diffusion followed with VITEK 2 Compact. We included 57 patients of which 73.7% males and 26.3% aged 56-65 years (represent the majority group of the patients). Each patient reported at least one comorbidity and the average duration of receiving mechanical ventilation was 8.68 days, and more than half (59.7%) of the patients had a poor clinical outcome (died). A total 57 bacteria isolates (consisting nine species) were recovered; 68.5% Gram-negative and 31.5% Gram-positive bacteria. Among 57 patients, Acinetobacter baumannii was the most frequent isolated Gram-negative bacteria (19.3%), followed by Klebsiella pneumoniae (17.5%), Pseudomonas aeruginosa (15.8%), and Achromobacter denitrificans (12.3%). A. baumannii exhibited <70% sensitivity to aminoglycoside and carbapenem antibiotics and 100% resistance to third-generation cephalosporins. The most abundant Gram-positive bacteria was Staphylococcus aureus (17.5%), followed by S. haemolyticus (10.5%) and S. epidermidis (3.5%). All S. aureus were sensitive to linezolid, tigecycline, vancomycin, and macrolide antibiotics (azithromycin, clarithromycin, clindamycin, and erythromycin), whereas 50% were sensitive to some beta-lactams. However, 50% of S. aureus were methicillin resistant S. aureus (MRSA). Given the magnitude of multi-drug resistance, an empiric antimicrobial therapy in particular to specific settings and implementation of antibiotic stewardship programs are crucial.
RESUMO
BACKGROUND: Empiric antibiotics are administered for pneumonia when the causative pathogens are unidentified. Pathogen-directed therapy is impeded by negative culture results and/or culture time lag. This circumstance necessitates a salvage method for pathogen identification, especially when antibiotic therapy has failed. Here, we aimed to preliminarily investigate the HIRA-TAN method in pneumonia with a progressive course despite prior empiric antibiotic therapy. METHODS: This prospective study was conducted for patients who were referred to Dr. Zainoel Abidin Hospital, Aceh, Indonesia, from December 2016 to January 2017, owing to pneumonia with a progressive course. Sputum or pleural effusion was subjected to culture and the HIRA-TAN assay. The HIRA-TAN identified the candidate causative pathogens based on the difference in the cycle threshold (Ct) between the targeted pathogen and the single-copy human gene. RESULTS: Patients (n=27) were predominantly males (22 patients, 81.5%), with a median age of 62 years. All patients had comorbid disease and were classified as hospital-acquired pneumonia (25 patients, 92.6%) with multilobar infiltrates (22 patients, 81.5%). Bacterial culture identified causative pathogen(s) in some (14 patients, 51.8%), whereas the HIRA-TAN identified pathogen(s) in most (23 patients, 85.2%). The rapid pathogen identification by the HIRA-TAN will provide valuable information in guiding pathogen-directed therapy. CONCLUSIONS: The result warrants a larger clinical trial to confirm the clinical efficacy of the HIRA-TAN in patients with progressive pneumonia despite previous antibiotic treatment.
