Risk Factors for Antibiotic Resistance and Survival Analysis of Severe Pneumonia Patients Infected with Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa : A Retrospective Cohort Study

Abstract Background : One of the most important challenges to global public health is antimicrobial resistance. The risk factors for antimicrobial resistant in severe pneumonia are constantly growing. This study aimed to identify risk factors forantimicrobial resistance and conduct a survival analysis of severe pneumonia patients with single and multiple pathogen. Methods : This retrospective study collected secondary data from severe pneumonia patients admitted to the intensive care unit (ICU) at Cipto Mangunkusumo Indonesia National Referral Hospital from January 2016 to December 2022. Respiratory specimens were collected via bronchial washing. Univariate and multivariate analysis was performed to analyze risk factors for antimicrobial resistance. Kaplan‒Meier survival curves were generated with the log-rank test to compare 30-day mortality between patients infected with single and multiple pathogen. Results : A total of 333 patients from 415 patients enrolled in this study were analyzed. Klebsiella pneumoniae (29%), Acinetobacter baumannii (24 % ) and Pseudomonas aeruginosa (12%) were the most frequently isolated pathogens. Risk factors for resistance to aminoglycoside, carbapenem, and quinolone are sepsis, cerebrovascular disease and ventilator-associated-pneumonia (VAP) ( P <0.05). The Kaplan-Meier curves revealed that multiple pathogen influenced the survival rate of severe pneumonia patients ( P <0.05). Conclusions : Sepsis, cerebrovascular disease, and VAP were associated with antimicrobial resistance in severe pneumonia patients. The survival rate of severe pneumonia patients infected with multiple pathogen is low. This suggests the importance of further awarness of empirical antibiotic stewardship and mortality assessment in severe pneumonia patients.