Correlation of Rationality Empiric Antibiotic with Clinical Outcome in Hospital Acquired Pneumonia Patients

Authors

  • Anisa Ellen Brilyani Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
  • Tri Murti Andayani Faculty of Pharmacy,Universitas Gadjah Mada, Yogyakarta, Indonesia
  • Dwi Endarti Faculty of Pharmacy, Universitas Gadjah Mada,Yogyakarta, Indonesia

DOI:

https://doi.org/10.30595/jhepr.v3i2.151

Abstract

Background: Irrational use of antibiotics causes high mortality rates from Hospital Acquired Pneumonia (HAP), resulting in the worsening of patients’ clinical outcomes. This study aims to determine the correlation between the rationality of empirical antibiotic use and the clinical outcomes of HAP patients.

Methods: The research was conducted using a retrospective cohort and consecutive sampling with a research sample of adult patients diagnosed with HAP at Gadjah Mada University Academic Hospital who were treated in the period January 2021- October 2023. HAP patients who received empiric antibiotics for less than 48 hours, had infections other than HAP, and cancer were excluded from this study. The rationality of antibiotics was assessed using a Gyssens’ flow diagram, the patients’ clinical outcomes were seen on days 2 to 3rd of empirical antibiotic use, and the chi-square test to see the correlation of antibiotic rationality with clinical outcomes.

Results: A total of 52.63% of patients received rational empirical antibiotics, and 47.37% received irrational empirical antibiotics. Clinical outcomes that did not improve often occurred in the rational group, specifically in 13 patients out of 40 patients. The results of the chi-square test showed that the rationality of empirical antibiotic use did not correlate with clinical outcomes in HAP patients at Gadjah Mada University Academic Hospital, with a p-value of 0.317.

Conclusion: The rationality of empirical antibiotic use does not have a significant relationship with clinical outcomes.

 

Keywords: Clinical Outcome, Empiric Antibiotics, Gyssens, Hospital-Acquired Pneumonia (HAP), Rationality.

References

Wells BG, Dipiro JT, Dipiro CV, S. T. Pharmacotherapy Handbook. vol. 9 (2015).

Warganegara, E. Pneumonia Nosokomial: Hospital-Acquired, Ventilator-Associated, dan Health Care-Associated. J. Kedokt. Unila 1, 612–618 (2017).

Kemenkes RI. Hasil Riset Kesehatan Dasar Tahun 2018. Kementrian Kesehat. RI 53, 1689–1699 (2018).

Khan, H. A., Baig, F. K. & Mehboob, R. Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pac. J. Trop. Biomed. 7, 478–482 (2017).

Kim, B. G. et al. Comprehensive risk assessment for hospital-acquired pneumonia: sociodemographic, clinical, and hospital environmental factors associated with the incidence of hospital-acquired pneumonia. BMC Pulm. Med. 22, 1–11 (2022).

Nurhayati, D. H., Setyoningrum, R. A., Utariani, A. & Dharmawati, I. Risk Factors for Mortality in Children with Hospital-Acquired Pneumonia in Dr. Soetomo General Hospital Surabaya. J. Respirasi 7, 46 (2021).

Jiao, J. et al. Risk factors for 3-month mortality in bedridden patients with hospital-acquired pneumonia: A multicentre prospective study. PLoS One 16, 1–10 (2021).

Chou, C. C. et al. Recommendations and guidelines for the treatment of pneumonia in Taiwan. J. Microbiol. Immunol. Infect. 52, 172–199 (2019).

Kalil, A. C. et al. 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. Clin. Infect. Dis. 63, e61–e111 (2016).

Savitri, A. A., Nuryastuti, T. & Puspitasari, I. Analisis Rasionalitas Penggunaan Antibiotik Empiris Dan Definitif Pada Terapi Pneumonia Dan Profil Antibiogram di Rumah Sakit Akademik Universitas Gadjah Mada. Maj. Farm. 18, (2022).

Apriliany, F., Olivia Umboro, R., Fitriya Ersalena, V. & Kunci, K. Rasionalitas antibiotik empiris pada pasien hospital acquired pneumonia (HAP) di RSUD provinsi NTB. Maj. Farm. dan Farmakol. 26, 26–31 (2022).

Modi, A. R. & Kovacs, C. S. Hospital-acquired and ventilator-associated pneumonia: Diagnosis, management, and prevention. Cleve. Clin. J. Med. 87, 633–639 (2020).

López-de-Andrés, A. et al. Gender differences in incidence and in-hospital outcomes of community-acquired, ventilator-associated and nonventilator hospital-acquired pneumonia in Spain. Int. J. Clin. Pract. 75, 0–1 (2021).

Gonçalves-Pereira, J., Mergulhão, P., Nunes, B. & Froes, F. Incidence and impact of hospital-acquired pneumonia: a Portuguese nationwide four-year study. J. Hosp. Infect. 112, 1–5 (2021).

Khadijah, S., Handayani, I. & Sennang, N. PREVALENCE AND CHARACTERISTIC MULTIDRUG RESISTANT ORGANISMS IN INTENSIVE CARE UNIT OF Dr. WAHIDIN SUDIROHUSODO HOSPITAL MAKASSAR. Indones. J. Clin. Pathol. Med. Lab. 25, 323–327 (2019).

Gyssens, I. C. Chapter 12 Audits for Monitoring the Quality of Antimicrobial Prescriptions. 197–198 (2005).

Gupta, N. et al. Nosocomial pneumonia: Search for an empiric and effective antibiotic regimen in high burden tertiary care centre. Drug Discov. Ther. 12, 97–100 (2018).

Blot, S. et al. Prevalence, risk factors, and mortality for ventilator-Associated pneumonia in middle-Aged, Old, and very old critically ill patients. Crit. Care Med. 42, 601–609 (2014).

Zekavat, S. M. et al. Elevated Blood Pressure Increases Pneumonia Risk: Epidemiological Association and Mendelian Randomization in the UK Biobank. Med 2, 137-148.e4 (2021).

PDPI. HAP-VAP PDPI 2018.

RSAUGM. Panduan Penggunaan Antimikroba RS Akademik UGM.

Cluxton, R. J. Book Review: Pharmacotherapy: A Pathophysiologic Approach, 6th Edition. Annals of Pharmacotherapy vol. 40 (2006).

Rahmawati, C., Nopitasari, B. L. & Safitri, N. P. Gambaran Biaya Langsung Medis Penyakit Pneumonia Dengan Terapi Ceftriaxone di Rawat Inap Rumah Sakit Umum Daerah X di NTB Tahun 2018. Lumbung Farm. J. Ilmu Kefarmasian 1, 20 (2020).

Mizgerd, J. P. Inflammation and Pneumonia: Why Are Some More Susceptible than Others? Clin. Chest Med. 39, 669–676 (2018).

Liu, J. W. et al. Randomized noninferiority trial of cefoperazone-sulbactam versus cefepime in the treatment of hospital-acquired and healthcare-associated pneumonia. Antimicrob. Agents Chemother. 63, 1–10 (2019).

Published

28.07.2025 — Updated on 28.07.2025

How to Cite

Brilyani, A. E., Andayani, T. M., & Endarti , D. (2025). Correlation of Rationality Empiric Antibiotic with Clinical Outcome in Hospital Acquired Pneumonia Patients. Journal of Health Economic and Policy Research (JHEPR), 3(2), 48–53. https://doi.org/10.30595/jhepr.v3i2.151

Most read articles by the same author(s)