# Antimicrobial Resistance Patterns and Cumulative Antibiogram of Clinically Significant Bacteria From a Tertiary Hospital in Indonesia

## TL;DR

This study presents an antibiogram from an Indonesian hospital, showing high resistance in bacteria like Klebsiella and Acinetobacter, stressing the need for better antibiotic use.

## Contribution

The paper provides a detailed, stratified cumulative antibiogram from a tertiary hospital in Indonesia, highlighting local AMR patterns.

## Key findings

- Klebsiella pneumoniae showed high multidrug resistance, with low susceptibility to third-generation cephalosporins.
- Acinetobacter baumannii was only susceptible to amikacin and trimethoprim–sulfamethoxazole in respiratory and ICU isolates.
- Escherichia coli from urine remained largely susceptible to several antibiotics, including meropenem and amikacin.

## Abstract

Antimicrobial resistance (AMR) is a critical global health threat, with disproportionately high burdens in low‐ and middle‐income countries. In Indonesia, where antimicrobial stewardship initiatives are still developing, local antibiograms are scarce yet crucial to guide evidence‐based empirical therapy.

We conducted a retrospective descriptive study of cumulative antibiogram data from YARSI Hospital, a tertiary care academic hospital in Jakarta, Indonesia, covering January–December 2024. Analysis followed Clinical and Laboratory Standards Institute (CLSI) M39‐A4 guidelines and was restricted to the first clinical isolate per species, patient, and specimen type. Susceptibility data were stratified by Gram classification, specimen source, and care setting, with semester‐wise comparisons (January–June vs. July–December).

Among 1782 clinical specimens, Klebsiella pneumoniae predominated among Gram‐negative isolates, exhibiting high multidrug resistance with ≤ 20% susceptibility to third‐generation cephalosporins, particularly in blood and ICU samples. Acinetobacter baumannii, the leading respiratory and ICU isolate, retained susceptibility only to amikacin (15%) and trimethoprim–sulfamethoxazole (25%). Escherichia coli from urine remained susceptible to ceftazidime (78%), cefepime (81%), meropenem (95%), and amikacin (93%). Gram‐positive isolates, including Staphylococcus epidermidis and Enterococcus faecalis, were largely susceptible to vancomycin and linezolid, although frequent coagulase‐negative staphylococcal bacteremia suggested challenges in aseptic technique.

The persistence of multidrug‐resistant K. pneumoniae and A. baumannii highlights the urgent need for targeted antimicrobial stewardship in Indonesian tertiary hospitals. Routine, stratified antibiogram reporting is essential to guide empirical therapy, inform policy, and curb the progression of AMR.