ANTIBIOTIC RESISTANCE REPORT FROM THE SURVEILLANCE OF INDONESIA NETWORK ON ANTIMICROBIAL RESISTANCE (SINAR) 2023

This study evaluated antimicrobial susceptibility in 70 hospitals across 15 Indonesian provinces (31% tertiary, 69% secondary). National antimicrobial resistance surveillance is essential for understanding resistance patterns and developing strategies to combat resistance. Testing followed CLSI guidelines using automated methods or the Kirby-Bauer method. Community and hospital isolates were not separated. A total of 54,688 isolates were collected: 40% from the lower respiratory tract (LRT), 30% from blood, 26% from urine, and 4% from sterile body fluids. Samples were mainly from non-ICU inpatients (57%), followed by ICU patients (25%), outpatients (12%), NICU (4%), and PICU (2%). The predominant bacteria in blood and LRT samples were Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Acinetobacter baumannii, and Pseudomonas aeruginosa, with Enterococcus faecalis replacing S. aureus in urine samples. Resistance to third-generation cephalosporins was higher in E. coli (66%) than in K. pneumoniae (52%), while carbapenem resistance (CR) was lower in E. coli (6%) compared to K. pneumoniae (17%). P. aeruginosa and A. baumannii showed 25% and 59% CR respectively. Methicillin-resistant Staphylococcus aureus (MRSA) was found in 34% of cases. 5% of E. faecalis isolated from urine were vancomycin-resistant. Multidrug-resistant bacteria were more common in tertiary hospitals, except for CR P. aeruginosa. E. coli with resistance to third-generation cephalosporins and carbapenems was most prevalent in LRT samples, while K. pneumoniae with similar resistance was more common in blood. The study reveals concerning antimicrobial resistance rates in Indonesia, highlighting the need to strengthen infection control programs and antimicrobial stewardship in hospitals.