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All Journal Indonesian Journal Health Science and Medicine Academia Open
Rasool Chaloob Hulyal
Department of Pharmacology and Toxicology, College of Pharmacy, University of Basrah
Health Professions Medicine & Pharmacology Public Health Veterinary

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Empirical vs. Evidence-Based: Evaluating the Alignment of Initial Antibiotic Therapy with Local Antibiogram Data Rasool Chaloob Hulyal
Academia Open Vol. 11 No. 1 (2026): June
Publisher : Universitas Muhammadiyah Sidoarjo

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21070/acopen.11.2026.13937

Abstract

General Background: Antimicrobial resistance represents a major global health challenge requiring alignment of empiric antibiotic therapy with local susceptibility data. Specific Background: In clinical practice, variability persists between empiric prescribing and antibiogram-based expectations despite stewardship recommendations. Knowledge Gap: Real-world evidence on the degree of concordance and its association with clinical outcomes in hospital settings remains limited. Aims: This study evaluated concordance between initial empiric antibiotic therapy and local antibiogram data and examined outcomes associated with discordant therapy. Results: Among 512 patients, overall concordance was 64.8%, while 35.2% received discordant therapy. Concordance was highest in urinary tract infections (76.2%) and lowest in pneumonia (52.9%), and was reduced in intensive care settings (54.8%) compared with medical wards (71.3%). Gram-negative pathogens predominated, with Escherichia coli (37.7%) and Klebsiella pneumoniae (22.5%) most frequent. Independent predictors of resistance included prior antibiotic exposure, hospital-acquired infection, and intensive care admission. Discordant therapy was associated with longer hospitalization (11 vs 7 days) and higher antibiotic escalation rates (46% vs 18%), with a non-significant increase in mortality. Novelty: This study integrates antibiogram concordance analysis with clinical outcomes and identifies healthcare-associated predictors within a single cohort. Implications: Strengthening integration of local antibiograms into empiric prescribing pathways may support optimized antibiotic use and address antimicrobial resistance. Highlights:• One-Third of Initial Treatments Did Not Match Susceptibility Expectations.• Critical Care and Respiratory Cases Showed Lowest Alignment Rates.• Mismatch Linked to Longer Stays and Higher Treatment Escalation. Keywords: Antimicrobial Resistance, Empiric Antibiotic Therapy, Antibiogram, Antimicrobial Stewardship, Clinical Outcomes.
Gram-Negative Challenges: Assessing the Decline in Carbapenem Sensitivity Among Klebsiella Pneumoniae Isolates Rasool Chaloob Hulyal
Indonesian Journal on Health Science and Medicine Vol. 3 No. 1 (2026): July
Publisher : Universitas Muhammadiyah Sidoarjo

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21070/ijhsm.v3i1.439

Abstract

General Background: Antimicrobial resistance represents a critical global health challenge, particularly among Gram-negative pathogens such as Klebsiella pneumoniae. Specific Background: Carbapenems have served as last-resort therapies for multidrug-resistant infections; however, increasing resistance among K. pneumoniae threatens their clinical utility. Knowledge Gap: Longitudinal epidemiological evidence describing temporal susceptibility trends and associated clinical factors remains underexplored. Aims: This study evaluates temporal changes in carbapenem susceptibility among K. pneumoniae clinical isolates using cumulative antibiogram surveillance. Results: A retrospective analysis of 512 isolates (July 2024–September 2025) demonstrated a marked decline in susceptibility to imipenem (92% to 78%) and meropenem (93% to 82%), with significant reductions between early and late periods (p < 0.05; p < 0.01). Resistance rates increased alongside higher prevalence of carbapenemase-producing strains and MDR/XDR phenotypes. Epidemiological patterns shifted from mixed community–hospital distribution to predominantly nosocomial transmission, particularly in intensive care units, with associations to mechanical ventilation, prolonged hospitalization, invasive devices, and prior broad-spectrum antibiotic exposure. Temporal clustering indicated outbreak-like dynamics in critical care settings. Novelty: This study provides longitudinal antibiogram-based evidence linking declining carbapenem susceptibility with ICU-centered transmission and resistance clustering. Implications: Findings underscore the need for strengthened antimicrobial stewardship, continuous surveillance, and targeted infection control strategies to mitigate hospital-driven dissemination of resistant K. pneumoniae. Highlights:• Progressive reduction in carbapenem sensitivity observed over 15 months• Resistance patterns concentrated within critical care environments• Transmission dynamics shifted toward hospital-dominated infection sources Keywords: Klebsiella Pneumoniae, Antimicrobial Resistance, Carbapenem Resistance, Nosocomial Transmission, Antibiogram Surveillance
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