Excess mortality attributable to antimicrobial-resistant bacterial bloodstream infection at a tertiary-care hospital in Indonesia

Patricia M Tauran; Irawaty Djaharuddin; Uleng Bahrun; Asvin Nurulita; Sudirman Katu; Faisal Muchtar; Ninny Meutia Pelupessy; Raph L Hamers; Niholas P J Day; Mansyur Arif; Direk Limmathurotsakul

doi:10.1371/journal.pgph.0000830

Excess mortality attributable to antimicrobial-resistant bacterial bloodstream infection at a tertiary-care hospital in Indonesia

PLOS Glob Public Health. 2022 Jul 20;2(7):e0000830. doi: 10.1371/journal.pgph.0000830. eCollection 2022.

Authors

Patricia M Tauran¹, Irawaty Djaharuddin^{2

3}, Uleng Bahrun^{2

4}, Asvin Nurulita^{2

4}, Sudirman Katu^{2

5}, Faisal Muchtar^{2

6}, Ninny Meutia Pelupessy^{2

7}, Raph L Hamers^{8

9

10}, Niholas P J Day^{1

9}, Mansyur Arif^{2

4}, Direk Limmathurotsakul^{1

9

11}

Affiliations

¹ Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
² Dr. Wahidin Sudirohusodo Hospital, Makassar, South Sulawesi, Indonesia.
³ Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia.
⁴ Department of Clinical Pathology, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia.
⁵ Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia.
⁶ Department of Anesthesiology, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia.
⁷ Department of Pediatrics, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia.
⁸ Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.
⁹ Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
¹⁰ Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
¹¹ Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

Abstract

The burden of antimicrobial-resistant (AMR) infections in low and middle-income countries (LMICs) is largely unknown. Here, we evaluate attributable mortality of AMR infections in Indonesia. We used routine databases of the microbiology laboratory and hospital admission at Dr. Wahidin Sudirohusodo Hospital, a tertiary-care hospital in South Sulawesi from 2015 to 2018. Of 77,752 hospitalized patients, 8,341 (10.7%) had at least one blood culture taken. Among patients with bacteriologically confirmed bloodstream infections (BSI), the proportions of patients with AMR BSI were 78% (81/104) for third-generation cephalosporin-resistant (3GCR) Escherichia coli, 4% (4/104) for 3GCR plus carbapenem-resistant E. coli, 56% (96/171) for 3GCR Klebsiella pneumoniae, 25% (43/171) for 3GCR plus carbapenem-resistant K. pneumoniae, 51% (124/245) for methicillin-resistant Staphylococcus aureus, 48% (82/171) for carbapenem-resistant Acinetobacter spp., and 19% (13/68) for carbapenem-resistant Pseudomonas aeruginosa. Observed in-hospital mortality of patients with AMR BSI was 49.7% (220/443). Compared with patients with antimicrobial-susceptible BSI and adjusted for potential confounders, the excess mortality attributable to AMR BSI was -0.01 (95% CI: -15.4, 15.4) percentage points. Compared with patients without a BSI with a target pathogen and adjusted for potential confounders, the excess mortality attributable to AMR BSI was 29.7 (95%CI: 26.1, 33.2) percentage points. This suggests that if all the AMR BSI were replaced by no infection, 130 (95%CI: 114, 145) deaths among 443 patients with AMR BSI might have been prevented. In conclusion, the burden of AMR infections in Indonesian hospitals is likely high. Similar large-scale evaluations should be performed across LMICs to inform interventions to mitigate AMR-associated mortality.

Copyright: © 2022 Tauran et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

The study was funded by the Wellcome Trust (219651/Z/19/Z) to PT. For the purpose of Open Access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. The funders of the study had no role in study design, data collection and analysis, decision to publish, or writing of the report.