Antimicrobial resistance constitutes a threat to global health, especially in lower-middle income countries (LMICs) including Indonesia. Intensive care units (ICUs) are high-risk areas for acquisition of resistant bacteria. Carbapenem class antibiotics are often used in this setting and carbapenem resistance has emerged. We here describe the epidemiology of carbapenem-non-susceptible Acinetobacter baumannii (CNAB), Klebsiella pneumoniae (CNKP) and Pseudomonas aeruginosa (CNPA) in two ICUs in the National Referral Hospital in Jakarta, Indonesia. After an initial baseline phase, an intervention to reduce the acquisition of resistant strains was applied using a set of inexpensive measures that were deemed feasible to implement in a low-resource ICU. We found the resistance genes blaOXA-23-like , blaOXA-24-like, in combination with OXA-23/OXA-58, OXA-23/NDM-1 genes in CNAB. In CNKP we demonstrated the presence of the blaNDM gene in all isolates. CNPA was mainly due to the presence of blaGES-5, blaVIM-2-8, and blaIMP-1-7-43 genes. These three species were endemic in the ICU with a few clones circulating among ICU patients and the environment. The multimodal intervention was essentially feasible and shown to be quite effective in these ICUs

antimicrobial resistance, carbapenem, A. baumannii, K. pneumoniae, P.aeruginosa, intensive care unit, Indonesia
H.A. Verbrugh (Henri) , J.A. Severin (Juliƫtte) , Dr. A. Karuniawati
Erasmus University Rotterdam
The studies described in this thesis were financially supported by DIKTI NESSO Scholarship from The Directorate General of Higher Education of Indonesia Ministry of Education and Culture of the Republic of Indonesia
978-94-6423-048-2
hdl.handle.net/1765/132401
For copyright reasons there is a partial embargo for this dissertation
Medical Microbiology

Saharman, Y.R. (2020, November 27). ICU-acquired Carbapenem-non-susceptible Bacilli in Indonesia Focus on: Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. Erasmus University Rotterdam. Retrieved from http://hdl.handle.net/1765/132401