Prevalence and Incidence Antimicrobial Resistance of Patients Pneumonia in Indonesia: Systematic Review and Meta-analysis

A BSTRACT Introduction: Antimicrobial resistance (AMR) remains a threat in Indonesia. In this regard, AMR also poses a challenge in the management of pneumonia. This systematic review and meta-analysis aimed to evaluate the prevalence and AMR of pneumonia-causing microorganisms in Indonesia, with a focus on Gram-negative and Gram-positive bacteria. Methods: We searched five databases and screened 997 studies. After removing duplicates and irrelevant studies, eight studies (six retrospective and two cross-sectional) were included in the study. Data on bacterial prevalence and antibiotic resistance were extracted, and bias assessment was performed using the Newcastle–Ottawa Scale and Agency for Healthcare Research and Quality standards. Meta-analysis of proportion was carried out using R version 4.4 with the random-effect model. Results: The pooled prevalence of Gram-negative bacteria was higher than Gram-positive. Klebsiella pneumoniae had the highest prevalence of 0.21 (95% confidence interval [CI]: 0.16–0.27), followed by Acinetobacter baumannii 0.20 (95% CI: 0.13–0.26) and Pseudomonas aeruginosa 0.12 (95% CI: 0.09–0.15). Staphylococcus aureus and Streptococcus pneumoniae had the highest Gram-positive prevalence of 0.07 each. K . pneumoniae and A . baumannii exhibited high resistance to cephalosporins but retained sensitivity to carbapenems and amikacin. Conclusions: Gram-negative bacteria are prevalent among pneumonia patients in Indonesia, showing high resistance to cephalosporins. Further research and antimicrobial stewardship programs are needed to curb rising AMR rates.