Hubungan Pola Kuman dan Pemilihan Antibiotika dengan Mortalitas pada Anak Pneumonia Berat di PICU RSPAL dr. Ramelan Surabaya

Sitti Radhiah; Tamam Jauhar; Angela Puspita; Onisdia Maria Geslin

doi:10.30649/

Authors

Sitti Radhiah University of Hang Tuah
Tamam Jauhar
Angela Puspita
Onisdia Maria Geslin

DOI:

https://doi.org/10.30649/

Keywords:

Severe pneumonia , Children, Bacterial patterns, Antibiotic, Mortality, PICU

Abstract

Background: In PICU, pneumonia remains a leading cause of morbidity and mortality. Identification of bacterial patterns and appropriate antibiotic selection are crucial in managing severe pneumonia; however, their association with mortality is not yet fully understood.

Objective: To determine the mortality rate, bacterial patterns, and the correlation between bacterial patterns and antibiotic selection with mortality in pediatric patients with severe pneumonia at the PICU of RSPAL dr. Ramelan Surabaya.

Method: This was an analytical observational study with a cross-sectional design. Data were obtained from the medical records of children aged 1 month to 18 years diagnosed with severe pneumonia at the PICU of RSPAL dr. Ramelan Surabaya.

Results: Twenty patients met the inclusion criteria, of whom 14 (70%) died and 6 (30%) survived. Gram-negative bacteria were the most frequently identified pathogens. Klebsiella pneumoniae was the most common isolate, followed by Acinetobacter baumannii, Burkholderia cepacia, Pseudomonas aeruginosa, and Enterobacter cloacae complex. Statistical analysis showed no significant association between bacterial patterns (p = 0.329) or antibiotic selection (p = 0.792) and mortality.

Conclusion: There is no significant association between bacterial patterns or antibiotic selection and mortality in children with severe pneumonia at the PICU of RSPAL dr. Ramelan Surabaya

References

1. Marcdante KJ, Kliegman RM. Nelson Essentials of Pediactrics, 8th ed. Philadelphia; 2019.

2. WHO. Pneumonia in children [Internet]. 2022 [cited 2025 Apr 29].

3. Kemenkes RI. Profil Kesehatan Indonesia 2022. Jakarta; 2023.

4. WHO. Pocket Book of Primary health care for children and adolescents: guidelines for health promotion, disease prevention and management from the newborn period to adolescence. 2022 [cited 2025 May 21];664–5.

5. Dean P, Florin TA. Factors Associated With Pneumonia Severity in Children: A Systematic Review. J Pediatric Infect Dis Soc. 2018 Dec 3;7(4):323–34.

6. Wong JJM, Abbas Q, Wang JQY, Xu W, Dang H, Phan PH, et al. Severe Pneumonia in PICU Admissions: The Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) Observational Cohort Study, 2020-2022. Pediatric Critical Care Medicine [Internet]. 2024 Nov 1 [cited 2025 May 21];25(11).

7. El-Nawawy A, Ramadan MAF, Antonios MAM, Arafa SAF, Hamza E. Bacteriologic profile and susceptibility pattern of mechanically ventilated paediatric patients with pneumonia. J Glob Antimicrob Resist [Internet]. 2019 Sep 1 [cited 2025 May 20];18:88–94.

8. Willems J, Hermans E, Schelstraete P, Depuydt P, De Cock P. Optimizing the Use of Antibiotic Agents in the Pediatric Intensive Care Unit: A Narrative Review. Vol. 23, Pediatric Drugs. Adis; 2021. p. 39–53.

9. Putra MFR. Pola Bakteri Dan Sensitivitas Antibiotik Pada Hasil Kultur Pasien Di Ruangan Intensive Care Unit Rsup Dr. M. Djamil Padang Tahun 2020. 2024 [cited 2025 Apr 29];3

10. Chen D, Cao L, Li W. Etiological and clinical characteristics of severe pneumonia in pediatric intensive care unit (PICU). BMC Pediatr [Internet]. 2023 Dec 1 [cited 2025 May 22];23(1):1–11.

11. Cicco M Di, Kantar A, Masini B, Nuzzi G, Ragazzo V, Peroni D. Structural And Functional Development In Airways Throughout Childhood: Children Are Not Small Adults [Internet]. 2020.

12. Ripoll JG, Guo W, Andersen KJ, Baker SE, Wiggins CC, Shepherd JRA, et al. Sex differences in paediatric airway anatomy. Exp Physiol. 2020 Apr 1;105(4):721–31.

13. Schurz H, Salie M, Tromp G, Hoal EG, Kinnear CJ, Möller M. The X chromosome and sex-specific effects in infectious disease susceptibility. Vol. 13, Human genomics. NLM (Medline); 2019. p. 2.

14. Hadisuwarno W, Setyoningrum RA, Umiastuti P. Host factors related to pneumonia in children under 5 years of age. Paediatrica Indonesiana Original Article VOLUME. 55(5).

15. Nguyen TKP, Tran TH, Roberts CL, Graham SM, Marais BJ. Child pneumonia – focus on the Western Pacific Region. Vol. 21, Paediatric Respiratory Reviews. W.B. Saunders Ltd; 2017. p. 102–10.

16. Sutriana VN, Sitaresmi MN, Wahab A. Risk factors for childhood pneumonia: a case-control study in a high prevalence area in Indonesia. Clin Exp Pediatr [Internet]. 2021 [cited 2025 May 20];64(11):588–95.

17. Pirker AL, Vogl T. Development of systemic and mucosal immune responses against gut microbiota in early life and implications for the onset of allergies. Vol. 5, Frontiers in Allergy. Frontiers Media SA; 2024.

18. Schuez-Havupalo L, Toivonen L, Karppinen S, Kaljonen A, Peltola V. Daycare attendance and respiratory tract infections: A prospective birth cohort study. BMJ Open. 2017 Sep 1;7(9).

19. Meliyanti A, Rusmawatiningtyas D, Makrufardi F, Arguni E. Factors associated with mortality in pediatric pneumonia patients supported with mechanical ventilation in developing country. Heliyon. 2021 May 1;7(5).

20. Cao L, Ji Z, Zhang P, Wang J. Epidemiology and mortality predictors for severe childhood community-acquired pneumonia in ICUs: A retrospective observational study. Front Pediatr. 2023 Apr 18;11.

21. Ergul AB, Cetin S, Ay Altintop Y, Bozdemir SE, Ozcan A, Altug U, et al. Evaluation of Microorganisms Causing Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit. Eurasian Journal of Medicine. 2017;49(2):87–91.

22. Chisti MJ, Harris JB, Carroll RW, Shahunja KM, Shahid ASMSB, Moschovis PP, et al. Antibiotic-Resistant Bacteremia in Young Children Hospitalized with Pneumonia in Bangladesh Is Associated with a High Mortality Rate. Open Forum Infect Dis. 2021 Jul 1;8(7).

23. Li Q, Cheng J, Wu Y, Wang Z, Luo S, Li Y, et al. Effects of delayed antibiotic therapy on outcomes in children with streptococcus pneumoniae sepsis. Antimicrob Agents Chemother. 2019;63(9).

24. Abeja CJ, Niyonzima V, Byagamy JP, Obua C. Antibiotic prescription rationality and associated in-patient treatment outcomes in children under-five with severe pneumonia at Bwizibwera health center IV, Mbarara District, South-Western Uganda. Pneumonia. 2022 Dec;14(1).

25. Nadia A, Bihar S, Syarani F. Hubungan Antara Pola Kuman dengan Mortalitas pada Pasien Pneumonia di IPI RS. HAM Medan. Public Health and Safety International Journal. 2025;5(1):2715–5854.

26. Tekam A, Ramteke S, Randa R. Risk factors associated with mortality in children with severe pneumonia. Int J Contemp Pediatrics [Internet]. 2023 Jun 5 [cited 2025 May 23];10(7):1013–8.

27. Ao XX. The epidemiology of hospital death following pediatric severe community acquired pneumonia. Ital J Pediatr. 2021 Dec 1;47(1).

28. Valentania V, Somasetia DH, Hilmanto D, Setiabudi D, Melinda H, Nataprawira N. Modified PIRO (predisposition, insult, response, organ dysfunction) severity score as a predictor for mortality of children with pneumonia in Hasan Sadikin Hospital, Bandung, Indonesia.

29. Williams DJ, Zhu Y, Grijalva CG, Self WH, Harrell FE, Reed C, et al. Predicting severe pneumonia outcomes in children. Pediatrics. 2016 Oct 1;138(4).