Factors Associated with Multidrug-Resistant Pathogens in Community-Acquired Pneumonia Patients Hospitalized in a Provincial Teaching Hospital in Indonesia

Background: Pneumonia has high rates of morbidity and mortality in Indonesia. Infections caused by multidrug-resistant (MDR) pathogens are not only found in patients with nosocomial pneumonia but are also reported in patients with community-acquired pneumonia (CAP). Only a few studies have analyzed the factors associated with MDR pathogenic infections, especially in developing countries such as Indonesia. Therefore, the identification of such factors can help to predict the infections caused by MDR pathogens in CAP patients. Objectives: This study aimed to determine factors associated with MDR pathogenic infections in CAP patients admitted to Hasan Sadikin General Hospital, Bandung, West Java Province, Indonesia. Methods: This is an observational analytic study which compared 85 patients with MDR pneumonia and 70 patients with pneumonia caused by non-MDR pathogens from March to May 2018. Sputum of all adults patient > 18 years old with CAP who had the Murray and Washington’s criteria was collected. In vitro test was performed based on the Kirby-Bauer method with Clinical and Laboratory Standards Institute (CLSI) 2018 protocols. This study was ethically approved by the Ethics Committee of the Hasan Sadikin Hospital. Results: One hundred and fifty five patients with positive sputum culture were investigated. Overall, 85 (54%) patients had MDR pathogens in their cultures. Klebsiella pneumoniae was the most common pathogen found in the CAP patients (37/155; 23.9%), while Acinetobacter baumannii accounted for the highest proportion of MDR pathogens (18/85; 21.2%). Multivariate logistic regression analysis showed that the immobilization status was the only associated factor for MDR pathogenic infections in CAP patients (adjusted prevalence ratio = 1.862 [1.432 - 2.420]; P < 0.001). Conclusions: This study highlighted the need for early risk assessment of infections caused by MDR pathogens, especially immobilization status in CAP patients. Also, the local pathogen pattern should be considered to prescribed antibiotics for CAP patients. The findings showed that antibiotics against MDR pathogens should be prescribed for CAP patients with immobilization.