Abstract

Background: Knowledge about the etiology and management of community-acquired pneumonia (CAP) in Indonesia is lacking. Methods: Hospital-based and a population-based cohort studies were carried out during 2007-2011 in Semarang, Indonesia. Results: Among 148 consecutive CAP patents admitted to hospital, influenza virus (18%), Klebsiella pneumoniae (14%), and Streptococcus pneumoniae (13%) were the commonest etiologies. Mixed infection occured in 28%. Bacteria presented wild type antibiotic susceptibility profiles. The mortality (rate: 30%) was associated with disease severity (P<0.001), and with failure to establish an etiological diagnosis (P=0.027). Among a cohort of 496 healthy volunteers nasopharyngeal carriage of K. pneumoniae, other Gram-negative bacilli, and S. pneumoniae was 11%, 19%, and 27%, respectively. K. pneumoniae carriage in adults (15%) was higher than in children (7%, P=.004), and strains from adults were more virulent. Carriage of S. pneumoniae among children (43%) was higher compared to adults (11%, P<.001). Capsular typing revealed that current 13-valent conjugate vaccine covers only 45% of these strains. Determinants of K. pneumoniae and other GNB carriage were poor food and water hygiene. To evaluate the quality of management of patients with CAP , we applied a Delphi method to derive six indicators that are feasible and valid for the Indonesian setting. Conclusions: The etiology of CAP and nasopharyngeal colonization in Indonesia differ from that of Western countries requiring adaptation of diagnosis, empiric treatments and prevention. Further multicenter studies are needed to delineate the full etiologic spectrum of CAP and to generate, implement and audit guidelines tailored for CAP management in Indonesia.

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H.A. Verbrugh (Henri) , P.J. van den Broek (Peterhans)
Erasmus University Rotterdam
The printing of this thesis was financially supported by Erasmus University Rotterdam, The Netherlands
hdl.handle.net/1765/77997
Erasmus MC: University Medical Center Rotterdam

Farida, H. (2015, April 22). Community-Acquired Pneumonia in Indonesia. Retrieved from http://hdl.handle.net/1765/77997