Appropriateness of antimicrobial administration and antibiogram in the treatment of pneumonia patients at a tertiary hospital in Indonesia

Background: Globally, pneumonia stands for the most substantial reason for patients to be given antimicrobial therapy. The increasing number of multidrug resistance bacteria and mortality of pneumonia may caused by inappropriate given empirical antimicrobial therapy. The empirical antimicrobial therapy for pneumonia patients in Indonesia were cephalosporins and fluoroquinolones. The aims of our study were to demonstrate appropriate empirical antimicrobial in pneumonia patients given by clinician, and to demonstrate the antibiogram of pneumonia patients. Methods and materials: This retrospective study, observed 1064 patients data collected from the medical records, which were consulted to antimicrobial stewardship program (ASP) team at Haji Adam Malik Hospital, Medan, Indonesia, during January 1, 2018–December 31, 2018. All patients diagnosed with pneumonia and had blood or sputum culture were included, while patients with incomplete data, double data, did not receive empirical antimicrobial, and culture was not obtained from blood or sputum were excluded. Empirical antimicrobial therapy was defined as the given antimicrobial therapy that was intended to treat a suspected bacterial infection before the culture result was obtained, while appropriate was defined when culture results from blood or sputum specimens were sensitive to the given empirical antimicrobial therapy. The results were summarized as percentages and frequency distribution. Data was analyzed using SPSS version 17.0. Results: A total of 105 pneumonia patients with positive blood or sputum culture were analyzed. Blood culture was performed in 73 patients (37%), only 29 (39.7%) were positive. Sputum culture was performed in 87 patients (44.1%), of these 76 (87.3%) were positive. The most frequent empirical antimicrobial group used by clinicians were third-generation cephalosporins (46.6%), Aminoglycosides (15.2%) and Fluoroquinolones (13.1%). The use of appropriate antimicrobial therapy was 31%. The most common microorganism was gram-negative (83.5%) such as Klebsiella species (24.34%), Acinetobacter species (21.4%), E.coli (13.8%). The most sensitive antimicrobial to underlying microorganisms were amikacin (80.2%), meropenem (67.7%) and tigecycline (62.5%) for gram-negative bacteria. Conclusion: The given of appropriate empirical antimicrobial therapy for pneumonia patients are still low. Empirical antimicrobial therapy guideline for pneumonia must use local antibiogram patterns.