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Putri ND, Dickson BF, Adrizain R, Kartina L, Baker J, Sukarja D, Cathleen F, Husada D, Utomo MT, Yuniati T, Suginali AK, Harrison M, Sharland M, Williams PC. Epidemiology of sepsis in hospitalised neonates in Indonesia: high burden of multidrug-resistant infections reveals poor coverage provided by recommended antibiotic regimens. BMJ Glob Health 2025; 10:e016272. [PMID: 40204461 PMCID: PMC11987146 DOI: 10.1136/bmjgh-2024-016272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 02/12/2025] [Indexed: 04/11/2025] Open
Abstract
BACKGROUND Neonatal sepsis is a leading cause of child mortality, and this burden is rising secondary to increasing antimicrobial resistance worldwide. There are marked global disparities in the burden of antimicrobial resistance, with Southeast Asia identified as a region of particular concern. Indonesia is the world's fourth most populous country, with 4.2 million babies born each year. Despite this, there remains limited published data on the burden of neonatal sepsis and antimicrobial resistance in the country. METHODS We conducted a 2-year analysis of the epidemiology of neonatal sepsis across three high-burden clinical settings in Indonesia, alongside an antibiotic point prevalence prescribing survey. RESULTS Of 5439 blood cultures analysed, gram-negative bacteria predominated as causative pathogens for neonatal sepsis in Indonesia, with Klebsiella spp and Acinetobacter spp most common (prevalence 35% and 19%, respectively). Overall, the pathogens causing neonatal sepsis exhibit very low susceptibility to WHO-recommended antibiotic regimens for the treatment of neonatal sepsis, with only 25% coverage provided by aminopenicillins plus gentamicin (95% credible interval (CI) 22% to 29%) and 20% by third-generation cephalosporins (95% CI 17% to 23%). Almost half of all antibiotics prescribed to treat neonatal sepsis across the clinical settings included in our study were Watch and Reserve antibiotics. CONCLUSION Our multicentre study across three sites in Indonesia revealed neonatal sepsis is predominantly caused by Gram-negative pathogens, with very poor coverage provided by currently recommended empiric regimens. A high burden of multidrug-resistant pathogens drives empirical use of broad-spectrum antibiotics. There is an urgent need for new antibiotic regimens and infection prevention and control strategies to treat neonatal sepsis in regions with a high prevalence of multidrug-resistant infections.
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Affiliation(s)
| | - Benjamin Fr Dickson
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Institute of Infectious Diseases, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Riyadi Adrizain
- Department of Paediatric Infectious Diseases, Dr Hasan Sadikin Central General Hospital Bandung, Bandung, West Java, Indonesia
| | - Leny Kartina
- Department of Paediatric Infectious Diseases, Dr Soetomo Regional General Hospital, Surabaya, East Java, Indonesia
| | - Jannah Baker
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Dominicus Husada
- Department of Child Health, Dr Soetomo Regional General Hospital, Surabaya, East Java, Indonesia
| | - Martono T Utomo
- Dr Soetomo Regional General Hospital, Surabaya, East Java, Indonesia
| | - Tetty Yuniati
- Microbiology Department, Dr Hasan Sadikin Central General Hospital Bandung, Bandung, West Java, Indonesia
| | - Adhi K Suginali
- Microbiology Department, Dr Hasan Sadikin Central General Hospital Bandung, Bandung, West Java, Indonesia
| | - Michelle Harrison
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Institute of Infectious Diseases, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Sharland
- St George's University of London Institute for Infection and Immunity, London, London, UK
| | - Phoebe Cm Williams
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Institute of Infectious Diseases, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Childrens Hospital, Department of Infectious Diseases, University of New South Wales, Sydney, New South Wales, Australia
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Prastiyanto ME, Darmawati S, Daryono BS, Retnaningrum E. Examining the prevalence and antimicrobial resistance profiles of multidrug-resistant bacterial isolates in wound infections from Indonesian patients. NARRA J 2024; 4:e980. [PMID: 39280315 PMCID: PMC11394175 DOI: 10.52225/narra.v4i2.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 08/12/2024] [Indexed: 09/18/2024]
Abstract
The emergence of multidrug-resistant (MDR) infections in wounds is a significant public health issue. The aim of this study was to investigate the prevalence and antimicrobial resistance profiles of MDR bacterial isolates in wound infections. Through a cross-sectional study, 1,035 bacterial isolates were collected from wound infection patients at Tugurejo Hospital in Semarang, Indonesia, over a three-year period (from January 2020 to December 2022). Initial identification involved Gram staining and colony morphology assessment, followed by biochemical assays and antimicrobial susceptibility testing using the VITEK®2 Compact system. Gram-negative bacteria constituted the majority of isolates (60.77%, n=629). The predominant strains included were Staphylococcus spp. (30.92%, n=320), Escherichia coli (18.45%, n=191), and Klebsiella pneumoniae (13.04%, n=135). Notably, Gram-negative bacteria exhibited a significantly higher likelihood of MDR development compared to their Gram-positive counterparts (p<0.001), with Gram-negative bacteria having a 2.05 times higher probability of acquiring MDR. These findings underscore the urgent need for comprehensive surveillance of antimicrobial resistance patterns and the implementation of tailored antimicrobial stewardship programs to address the pressing public health challenge of MDR wound infections. Further research is warranted to elucidate the complex interplay of factors contributing to MDR development in wound infections, thereby informing targeted intervention strategies and improving patient outcomes.
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Affiliation(s)
- Muhammad E Prastiyanto
- Doctoral Program, Faculty of Biology, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Medical Laboratory Technology, Faculty of Health and Nursing, Universitas Muhammadiyah Semarang, Semarang, Indonesia
| | - Sri Darmawati
- Department of Medical Laboratory Technology, Faculty of Health and Nursing, Universitas Muhammadiyah Semarang, Semarang, Indonesia
| | - Budi S Daryono
- Faculty of Biology, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Gach MW, Lazarus G, Simadibrata DM, Sinto R, Saharman YR, Limato R, Nelwan EJ, van Doorn HR, Karuniawati A, Hamers RL. Antimicrobial resistance among common bacterial pathogens in Indonesia: a systematic review. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 26:100414. [PMID: 38778837 PMCID: PMC11109028 DOI: 10.1016/j.lansea.2024.100414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024]
Abstract
Background The WHO Global Antimicrobial Resistance Surveillance System (GLASS) aims to describe antimicrobial resistance (AMR) patterns and trends in common bacterial pathogens, but data remain limited in many low and middle-income countries including Indonesia. Methods We systematically searched Embase, PubMed and Global Health Database and three Indonesian databases for original peer-reviewed articles in English and Indonesian, published between January 1, 2000 and May 25, 2023, that reported antimicrobial susceptibility for the 12 GLASS target pathogens from human samples. Pooled AMR prevalence estimates were calculated for relevant pathogen-antimicrobial combinations accounting for the sampling weights of the studies (PROSPERO: CRD42019155379). Findings Of 2182 search hits, we included 102 papers, comprising 19,517 bacterial isolates from hospitals (13,647) and communities (5870). In hospital settings, 21.6% of Klebsiella pneumoniae isolates, 18.3% of Escherichia coli isolates, 35.8% of Pseudomonas aeruginosa isolates and 70.7% of Acinetobacter baumannii isolates were carbapenem-resistant; 29.9% of Streptococcus pneumoniae isolates were penicillin-resistant; and 22.2% of Staphylococcus aureus isolates were methicillin-resistant. Hospital prevalence of carbapenem-resistant K. pneumoniae and E. coli, and penicillin-resistant S. pneumoniae increased over time. In communities, 28.3% of K. pneumoniae isolates and 15.7% of E. coli isolates were carbapenem-resistant, 23.9% of S. pneumoniae isolates were penicillin-resistant, and 11.1% of S. aureus isolates were methicillin-resistant. Data were limited for the other pathogens. Interpretation AMR prevalence estimates were high for critical gram-negative bacteria. However, data were insufficient to draw robust conclusions about the full contemporary AMR situation in Indonesia. Implementation of national AMR surveillance is a priority to address these gaps and inform context-specific interventions. Funding Wellcome Africa Asia Programme Vietnam.
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Affiliation(s)
- Michael W. Gach
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Gilbert Lazarus
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Daniel Martin Simadibrata
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Robert Sinto
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Internal Medicine, Division of Tropical Medicine and Infectious Diseases, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Yulia Rosa Saharman
- Department of Clinical Microbiology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ralalicia Limato
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Erni J. Nelwan
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Internal Medicine, Division of Tropical Medicine and Infectious Diseases, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - H. Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Anis Karuniawati
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Clinical Microbiology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Raph L. Hamers
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Adnyana IMDM, Utomo B, Eljatin DS, Sudaryati NLG. One Health approach and zoonotic diseases in Indonesia: Urgency of implementation and challenges. NARRA J 2023; 3:e257. [PMID: 38455621 PMCID: PMC10919696 DOI: 10.52225/narra.v3i3.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/16/2023] [Indexed: 03/09/2024]
Abstract
The urgency of implementing the One Health approach to overcome zoonotic diseases cannot be overstated. By recognizing the interconnectedness of human health, animal health, and the environment, we can effectively prevent and respond to emerging infectious disease threats. This review article provides information on the importance of generating research on zoonotic diseases, especially in Indonesia, where research is still relatively scarce. The Indonesian government has taken steps to implement the One Health by establishing the One Health Coordinating Unit and the National Zoonosis Committee; however, implementation has not been optimal. The urgency and challenges are focused on critical implementation aspects in the community. The urgency of implementing One Health includes that Indonesia has experienced several outbreaks of zoonotic diseases; high environmental degradation; and the antimicrobial resistance issue in Indonesia has increased. The challenges faced in implementing One Health are overcoming fragmentation due to incohesive communication between important sectors, securing funding and resource investment, aligning policies to eliminate regulation barriers, capacity building to increase awareness and professionals, and addressing critical socioeconomic factors. By prioritizing implementing the One Health approach and addressing existing challenges, Indonesia can build a more resilient and integrated system to protect the well-being of all species, protect ecosystems, and prevent the devastating effects of zoonotic diseases on global health. In this review, we present the urgency of One Health implementation and its challenges comprehensively.
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Affiliation(s)
- I MDM. Adnyana
- Department of Tropical Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Biology, Faculty of Information, Technology and Science, Universitas Hindu Indonesia, Denpasar, Indonesia
| | - Budi Utomo
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Dwinka S. Eljatin
- Department of Medicine, Faculty of Medicine and Health, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
| | - Ni LG. Sudaryati
- Department of Biology, Faculty of Information, Technology and Science, Universitas Hindu Indonesia, Denpasar, Indonesia
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Srisuphan V, Klaytong P, Rangsiwutisak C, Tuamsuwan K, Boonyarit P, Limmathurotsakul D. Local and timely antimicrobial resistance data for local and national actions: the early implementation of an automated tool for data analysis at local hospital level in Thailand. JAC Antimicrob Resist 2023; 5:dlad088. [PMID: 37457885 PMCID: PMC10349292 DOI: 10.1093/jacamr/dlad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/26/2023] [Indexed: 07/18/2023] Open
Abstract
Background In low- and middle-income countries (LMICs), hospitals can rarely utilize their own antimicrobial resistance (AMR) data in a timely manner. Objectives To evaluate the utility of local AMR data generated by an automated tool in the real-world setting. Methods From 16 December 2022 to 10 January 2023, on behalf of the Health Administration Division, Ministry of Public Health (MoPH) Thailand, we trained 26 public tertiary-care and secondary-care hospitals to utilize the AutoMated tool for Antimicrobial resistance Surveillance System (AMASS) with their own microbiology and hospital admission data files via two online meetings, one face-to-face meeting and online support. All meetings were recorded on video, and feedback was analysed. Results Twenty-five hospitals successfully generated and shared the AMR reports with the MoPH by 28 February 2023. In 2022, the median frequency of hospital-origin bloodstream infections (BSIs) caused by carbapenem-resistant Escherichia coli (CREC) was 129 (range 0-1204), by carbapenem-resistant Klebsiella pneumoniae (CRKP) was 1306 (range 0-5432) and by carbapenem-resistant Acinetobacter baumannii (CRAB) was 4472 (range 1460-11 968) per 100 000 patients tested for hospital-origin BSI. The median number of all-cause in-hospital deaths with hospital-origin AMR BSI caused by CREC was 1 (range 0-18), by CRKP was 10 (range 0-77) and by CRAB was 56 (range 7-148). Participating hospitals found that the data obtained could be used to support their antimicrobial stewardship and infection prevention control programmes. Conclusions Local and timely AMR data are crucial for local and national actions. MoPH Thailand is inviting all 127 public tertiary-care and secondary-care hospitals to utilize the AMASS. Using any appropriate analytical software or tools, all hospitals in LMICs that have electronic data records should analyse and utilize their data for immediate actions.
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Affiliation(s)
- Voranadda Srisuphan
- Health Administration Division, The Office of Permanent Secretary, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Preeyarach Klaytong
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Chalida Rangsiwutisak
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Kritiya Tuamsuwan
- Health Administration Division, The Office of Permanent Secretary, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Phairam Boonyarit
- Health Administration Division, The Office of Permanent Secretary, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Direk Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford OX3 7LG, UK
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
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