{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T11:16:36Z","timestamp":1780917396040,"version":"3.54.1"},"reference-count":40,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Pneumonia is a common cause of hospitalization and a significant contributor to worldwide morbidity and mortality. Effective definitive antimicrobial therapy for pneumonia relies on accurate identification of bacterial pathogens and their resistance patterns. Therefore, this study aims to evaluate the distribution bacterial pathogens and their antimicrobial resistance patterns, as well as clinical factors associated with outcomes among hospitalized pneumonia patients. Methods: This retrospective cohort study was conducted at Dr. Hasan Sadikin General Hospital, Indonesia, and included adult patients hospitalized with pneumonia between January and December 2024. Clinical, demographic, microbiological, and outcome data were extracted from electronic medical records and the laboratory system. Bacterial distribution, antimicrobial patterns, and clinical outcomes were analyzed descriptively and compared across pneumonia types. Multivariable regression analyses were performed to identify factors associated with in-hospital mortality and length of hospital stay. Results: A total of 662 hospitalized pneumonia patients were included with Gram-negative bacteria (i.e., Klebsiella pneumonia, Acinetobacter baumannii, and Pseudomonas aeruginosa) identified as the most common pathogens. Carbapenem-resistant Acinetobacter baumannii (CR-Ab) and Klebsiella pneumoniae (CR-Kp) were the most frequently identified resistant pathogens, particularly in hospital-acquired (HAP) and ventilator-associated pneumonia (VAP). HAP and VAP were independently associated with higher in-hospital mortality and longer hospital stay compared to community-acquired pneumonia (CAP). In addition, CR-Ab and difficult-to-treat Pseudomonas aeruginosa (DTR-Psa) were associated with prolonged hospitalization. Conclusions: Type of pneumonia, bacterial pathogens and resistance patterns were associated with in-hospital mortality and length of hospital stay. These findings highlight the importance of ongoing microbiological surveillance, antimicrobial stewardship, and infection prevention strategies to optimize pneumonia management and clinical outcomes.<\/jats:p>","DOI":"10.3390\/antibiotics15060582","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T10:04:14Z","timestamp":1780913054000},"page":"582","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antimicrobial Resistance and Clinical Outcome Among Hospitalized Bacterial Pneumonia: A Retrospective Cohort Study in Indonesian Tertiary Hospital"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7182-386X","authenticated-orcid":false,"given":"Prayudi","family":"Santoso","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia"},{"name":"Department of Medicine, Dr. Hasan Sadikin General Hospital, Bandung 40161, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghyna Ravifa","family":"Muliandini","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saniya Dhafarina","family":"Izzati","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonya","family":"Alexandra","sequence":"additional","affiliation":[{"name":"Research Center for Care and Control of Infectious Disease (RC3ID), Universitas Padjadjaran, Bandung 40161, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iceu Dimas","family":"Kulsum","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia"},{"name":"Department of Medicine, Dr. Hasan Sadikin General Hospital, Bandung 40161, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9498-1791","authenticated-orcid":false,"given":"Basti","family":"Andriyoko","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia"},{"name":"Department of Supporting Medicine, Dr. Hasan Sadikin General Hospital, Bandung 40161, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2898-6719","authenticated-orcid":false,"given":"Adhi Kristianto","family":"Sugianli","sequence":"additional","affiliation":[{"name":"Research Center for Care and Control of Infectious Disease (RC3ID), Universitas Padjadjaran, Bandung 40161, Indonesia"},{"name":"Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia"},{"name":"Department of Supporting Medicine, Dr. Hasan Sadikin General Hospital, Bandung 40161, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2026, February 02). Ten Health Issues WHO Will Tackle This Year. Available online: https:\/\/www.who.int\/news-room\/spotlight\/ten-threats-to-global-health-in-2019."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"World Health Organization (2025). Global Antibiotic Resistance Surveillance Report 2025: WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS), World Health Organization. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240116337.","DOI":"10.2471\/B09585"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Global Burden of Disease Antimicrobial Resistance Collaborators (2024). Global burden of bacterial antimicrobial resistance 1990\u20132021: A systematic analysis with forecasts to 2050. Lancet, 404, 1199\u20131226.","DOI":"10.1016\/S0140-6736(24)01885-3"},{"key":"ref_4","unstructured":"Longo, D., Fauci, A., Kasper, D., Hauser, S., Jameson, J.L., Loscalzo, J., Holland, S., and Langford, C. (2025). Harrison\u2019s Principles of Internal Medicine, McGraw Hill. [22nd ed.]."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1093\/cid\/ciw353","article-title":"Management of Adults with Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society","volume":"63","author":"Kalil","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","article-title":"Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America","volume":"200","author":"Metlay","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1806","DOI":"10.1093\/cid\/cix647","article-title":"Adults Hospitalized with Pneumonia in the United States: Incidence, Epidemiology, and Mortality","volume":"65","author":"Ramirez","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1080\/14760584.2023.2261785","article-title":"Clinical, economic, and humanistic burden of community acquired pneumonia in Europe: A systematic literature review","volume":"22","author":"Tsoumani","year":"2023","journal-title":"Expert Rev. Vaccines"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/j.ajic.2017.09.005","article-title":"The epidemiology of nonventilator hospital-acquired pneumonia in the United States","volume":"46","author":"Giuliano","year":"2018","journal-title":"Am. J. Infect. Control"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.ajic.2019.08.023","article-title":"International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module","volume":"48","author":"Rosenthal","year":"2020","journal-title":"Am. J. Infect. Control"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1093\/cid\/ciy543","article-title":"A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology","volume":"68","author":"Bonell","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","unstructured":"(2025, November 25). Indonesian Health Survey 2023 in Numbers. Available online: https:\/\/www.badankebijakan.kemkes.go.id\/ski-2023-dalam-angka\/."},{"key":"ref_13","first-page":"169","article-title":"The Risk Factors of Multidrug-Resistant Organisms in Hospitalized Patients with Community-Acquired Pneumonia in Dr. Soetomo Hospital Surabaya, Indonesia","volume":"53","author":"Soedarsono","year":"2021","journal-title":"Acta Med. Indones."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"de Brabander, J., Nelwan, E.J., Limato, R., Alamanda, M., Mudia, M., Tjoa, E., Mauleti, I.Y., Mayasari, M., Firmansyah, I., and Jayati, T.M. (2026). Aetiology and Antibiotic Susceptibility of Common Bacterial Infections in Hospitalised Patients: A 2019 Multisite Cross-Sectional Survey in Jakarta, Indonesia. Trop. Med. Int. Health, early view.","DOI":"10.1111\/tmi.70162"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e25910","DOI":"10.5152\/eurasianjmed.2025.25910","article-title":"Comparison of Length of Treatment and Comorbidities in Older and Adult Hospitalized Patients with Bacterial Community-Acquired Pneumonia","volume":"57","author":"Fachri","year":"2025","journal-title":"Eurasian J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e1314","DOI":"10.52225\/narra.v5i2.1649","article-title":"Mortality and associated factors among community-acquired pneumonia patients: A cross-sectional study in a provincial referral hospital in Indonesia","volume":"5","author":"Rosdiana","year":"2025","journal-title":"Narra J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E3463","DOI":"10.1073\/pnas.1717295115","article-title":"Global increase and geographic convergence in antibiotic consumption between 2000 and 2015","volume":"115","author":"Klein","year":"2018","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.cmi.2020.12.018","article-title":"Antibiotic prescribing in patients with COVID-19: Rapid review and meta-analysis","volume":"27","author":"Langford","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_19","unstructured":"World Health Organization (2024). WHO Bacterial Priority Pathogens List, 2024: Bacterial Pathogens of Public Health Importance to Guide Research, Development and Strategies to Prevent and Control Antimicrobial Resistance, World Health Organization."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1016\/S1473-3099(24)00176-2","article-title":"Global, regional, and national incidence and mortality burden of non-COVID-19 lower respiratory infections and aetiologies, 1990\u20132021: A systematic analysis from the Global Burden of Disease Study 2021","volume":"24","author":"Bender","year":"2024","journal-title":"Lancet Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1007\/s10096-020-04046-9","article-title":"Clinical and microbiological characteristics of adults with hospital-acquired pneumonia: A 10-year prospective observational study in China","volume":"40","author":"Yin","year":"2021","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3455948","DOI":"10.1155\/2022\/3455948","article-title":"Antimicrobial Sensitivity Pattern from Hospitalized Pneumonia Patients in National Referral Infectious Disease Hospital in Indonesia","volume":"2022","author":"Sitompul","year":"2022","journal-title":"Adv. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1093\/cid\/ciad556","article-title":"Clinical Outcomes and Bacterial Characteristics of Carbapenem-resistant Acinetobacter baumannii Among Patients from Different Global Regions","volume":"78","author":"Wang","year":"2024","journal-title":"Clin. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"351","DOI":"10.2147\/IDR.S492299","article-title":"Etiology of Hospital-Acquired Pneumonia (HAP) and Ventilator-Associated Pneumonia (VAP) in Tertiary-Care Hospitals in Thailand: A Multicenter, Retrospective Cohort Study","volume":"18","author":"Rongrungruang","year":"2025","journal-title":"Infect. Drug Resist."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e149","DOI":"10.52225\/narra.v3i1.149","article-title":"Distribution and antibacterial susceptibility pattern of isolated bacteria from endotracheal aspirates among ventilator-assisted pneumonia patients in Indonesia","volume":"3","author":"Andayani","year":"2023","journal-title":"Narra J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s13054-021-03493-w","article-title":"Epidemiology and microbiology of ventilator-associated pneumonia in COVID-19 patients: A multicenter retrospective study in 188 patients in an un-inundated French region","volume":"25","author":"Blonz","year":"2021","journal-title":"Crit. Care"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S146","DOI":"10.1093\/cid\/ciy686","article-title":"Microbial Etiology and Prognostic Factors of Ventilator-associated Pneumonia: A Multicenter Retrospective Study in Shanghai","volume":"67","author":"Huang","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"800","DOI":"10.3904\/kjim.2021.348","article-title":"Microbiologic pattern and clinical outcome of non-ICU-acquired pneumonia: Korean HAP registry analysis","volume":"37","author":"Jang","year":"2022","journal-title":"Korean J. Intern. Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Reyes, L.F., Torres, A., Olivella-Gomez, J., Ibanez-Prada, E.D., Nseir, S., Ranzani, O.T., Povoa, P., Diaz, E., Schultz, M.J., and Rodriguez, A.H. (2025). Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections: An ENIRRI Analysis. Antibiotics, 14.","DOI":"10.3390\/antibiotics14020127"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"13","DOI":"10.4103\/jgid.jgid_33_18","article-title":"Factors Associated with Mortality in Immunocompetent Patients with Hospital-acquired Pneumonia","volume":"11","author":"Sangmuang","year":"2019","journal-title":"J. Glob. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-024-02621-1","article-title":"Predictors of mortality in severe pneumonia patients: A systematic review and meta-analysis","volume":"13","author":"Xie","year":"2024","journal-title":"Syst. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Feng, J.Y., Fang, W.F., Wu, C.L., Yu, C.J., Lin, M.C., Ku, S.C., Chen, Y.C., Chen, C.W., Tu, C.Y., and Su, W.J. (2012). Concomitant pulmonary tuberculosis in hospitalized healthcare-associated pneumonia in a tuberculosis endemic area: A multi-center retrospective study. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0036832"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Miron, M., Blaj, M., Ristescu, A.I., Iosep, G., Avadanei, A.N., Iosep, D.G., Crisan-Dabija, R., Ciocan, A., Pertea, M., and Manciuc, C.D. (2024). Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia: A Literature Review. Microorganisms, 12.","DOI":"10.3390\/microorganisms12010213"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"92","DOI":"10.12688\/f1000research.129080.1","article-title":"Hospital-acquired and ventilator-associated pneumonia caused by multidrug-resistant Gram-negative pathogens: Understanding epidemiology, resistance patterns, and implications with COVID-19","volume":"12","year":"2023","journal-title":"F1000Research"},{"key":"ref_35","unstructured":"Alam, A. (2025). Portofolio Inovasi Program Pengendalian Resistansi Antimikroba: Aplikasi SIMANTAP, RSUP Dr. Hasan Sadikin Bandung."},{"key":"ref_36","unstructured":"Badan Pusat Statistik Provinsi Jawa Barat (2025, November 21). Proyeksi Penduduk Kabupaten\/Kota Provinsi Jawa Barat Hasil Sensus Penduduk 2020. Available online: https:\/\/jabar.bps.go.id\/id\/statistics-table\/2\/OTIwIzI=\/proyeksi-penduduk-kabupaten-kota-provinsi-jawa-barat-hasil-sensus-penduduk-2020--ribu-jiwa-.html."},{"key":"ref_37","unstructured":"World Health Organization (2025). Global Tuberculosis Report 2025, World Health Organization."},{"key":"ref_38","unstructured":"Clinical and Laboratory Standards Institute (2024). Performance Standards for Antimicrobial Susceptibility Testing, Clinical and Laboratory Standards Institute. [34th ed.]."},{"key":"ref_39","first-page":"1469","article-title":"Antimicrobial resistance in uropathogens and appropriateness of empirical treatment: A population-based surveillance study in Indonesia","volume":"72","author":"Sugianli","year":"2017","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Tamma, P.D., Heil, E.L., Justo, J.A., Mathers, A.J., Satlin, M.J., and Bonomo, R.A. (2024). Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections. Clin. Infect. Dis., ciae403.","DOI":"10.1093\/cid\/ciae403"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/6\/582\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T10:53:54Z","timestamp":1780916034000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/6\/582"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,8]]},"references-count":40,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["antibiotics15060582"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics15060582","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,8]]}}}