4.

Profile of Hospital-Acquired Pneumonia in Indonesia

Pneumonia, an infection of thein respiratory tract, is divided by two major groups based on the epidemiology of the diseases: community-acquired (CAP) pneumonia (CAP) and hospital-acquired pneumonia (HAP). The later is said to have a higher risk of death (30%-70% risk of death) than CAP. In ventilator-using patients, the risk of having HAP increases by 10-folded compared to patients those who do not use ventilators. HAP is divided by two groups based on the onset: early onset HAP and late onset HAP. Early onset HAP occurs in patients who has been hospitalised for less than 4 days, while late onset HAP frequently presents in patients who has been hospitalised for 4 days or more. Each of which these category is caused by unique pathogens.

Pattern of Pathogens pathogens There are a lot of microbes that can be the source of pneumonia infection. Some microbes tend to infect particular individuals in different classes of ages, risk factors, and places. Take, for example, MethicillinResistant Staphylococcus aureus (MRSA). It is commonly found in patients with prolonged use of corticosteroid or antibiotics, patients with chronic lung disease, and patients with mechanical ventilation for more thanover 5 days. Thus, these microbes, as well as some other negative Gram pathogens, eg Acinetobacter sp., P. aeruginosa, MRSA, and Klebsiella sp., commonly cause late onset HAP. In particular specific care units (such as ICU, NICU, and ICCU,) P. aeruginosa, Pseudomonas sp., and Klebsiella sp. are the dominant predisposing microbes that responsible forcause HAP. Moreover, there are some patterns of bacteria based on the ages of the patients (particularly in children), as described below: Specific Age < 20 days 3 weeks 3 months 4 months 4 years 5 years 15 years Patterns of Microbes Streptococcus Group B, Lysteria monocytogenes, negative Gram enteric bacteria S. pneumonia, Chlamydia, Respiratory Sincytial Virus (RSV) RSV, S. pneumoniae, Mycoplasma, Haemophilus Mycoplasma pneumoniae, S. pneumoniae, Chlamydia

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Diagnostic test Diagnostic The diagnostic approach for pneumonia is sputum analysis, primarily to identify the gram classification of the pathogen. Furthermore, by culturing the sample sputum sample, physicians can beare able to know the exact species, and to detect the microbes sensitivity against antimicrobial agents. By thoseUsing these data, physicians can determine specific therapy for each patient. The result of sputum analysis depends on the technique physicians using while they taking the sample sputum. Some bacteriaes, for instance P.aeruginosa and S. Aureusaureus, are commonly found in the oral cavity. Thus, if the sample is that of saliva instead the real sputum secreted by the bronchi, the result can be a false positive for those bacteria. To avoid this error, sample sputum sample should be well collected and well analysed.

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Therapy and rResistance The principle of the initial therapy is to administer appropriate empiric therapy to the patient. It should be an important note, because inappropriate empiric therapy can lead to another disease. Afterwards, when the laboratory result is available, one can consider specific therapy based on the species of bacteria. In some conditions, physicians must also think about coexisting disease as one factor that can influence the result of therapy. Each antimicrobial agent gives different results, depends on the resistance pattern. Take, fFor instance, the antimicrobial agents used in regular ward is are different with the agent used inthan the ones used in ICU, where since the pathogens are more resistant. In regular wards, Piperacilin-Tazobactam (TZP) and Cefoperazone-Sulbactam (CSL) are still sensitive against pathogenic microbes. In the other hand, Iminepem can be given for patients in ICU to eradicate the more resistant pathogen microbes swhich are more resistant.

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Reviewed from a lecture given by Prof. dr. Amin Soebandrio, Ph.D, Sp.MK(K) in 6th National Symposium of Indonesia Antimicrobials Resistance Watch