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Abdul Khairul Rizki Purba,1– 4 Christian F Luz,2 Riyanti R Wulandari,5 Ieneke van der Gun,2 Jan-Willem Dik,2 Alex W Friedrich,2 Maarten J Postma1,3,4,6 1Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 2University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, the Netherlands; 3Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; 4Unit of Pharmacotherapy, -Epidemiology and -Economics (PTE2), Department of Pharmacy, Faculty of Science and Engineering, University of Groningen, Groningen, the Netherlands; 5Department of Pharmacy, Dinas Kesehatan Kota Surabaya, Surabaya, Indonesia; 6Department of Economics, Econometrics and Finance, Faculty of Economics & Business, University of Groningen, Groningen, the NetherlandsCorrespondence: Abdul Khairul Rizki PurbaUniversitair Medisch Centrum Groningen, Hanzeplein 1, Groningen 9700RB, the Netherlands, Tel +62 81230019201Email khairul_purba@fk.unair.ac.idObjective: This study aimed to evaluate the impacts of deep surgical site infections (dSSIs) regarding hospital readmissions, prolonged length of stay (LoS), and estimated costs.Patients and Methods: We designed and applied a matched case–control observational study using the electronic health records at the University Medical Center Groningen in the Netherlands. We compared patients with dSSI and non-SSI, matched on the basis of having similar procedures. A prevailing topology of surgeries categorized as clean, clean-contaminated, contaminated, and dirty was applied.Results: Out of a total of 12,285 patients, 393 dSSI were identified as cases, and 2864 patients without SSIs were selected as controls. A total of 343 dSSI patients (87%) and 2307 (81%) controls required hospital readmissions. The median LoS was 7 days (P25-P75: 2.5– 14.5) for dSSI patients and 5 days (P25-P75: 1– 9) for controls (p-value: < 0.001). The estimated mean cost per hospital admission was € 9,016 (SE± 343) for dSSI patients and € 5,409 (SE± 120) for controls (p< 0.001). Independent variables associated with dSSI were patient’s age ≥ 65 years (OR: 1.334; 95% CI: 1.036– 1.720), the use of prophylactic antibiotics (OR: 0.424; 95% CI: 0.344– 0.537), and neoplasms (OR: 2.050; 95% CI: 1.473– 2.854).Conclusion: dSSI is associated with increased costs, prolonged LoS, and increased readmission rates. Elevated risks were seen for elderly patients and those with neoplasms. Additionally, a protective effect of prophylactic antibiotics was found.Keywords: surgical wound infection, prophylactic antibiotic, patient admission, economic evaluation, cost

Abdul KR Purba,1–5 Purwantyastuti Ascobat,4 Armen Muchtar,4 Laksmi Wulandari,6 Alfian Nur Rosyid,6 Priyo Budi Purwono,7 Tjip S van der Werf,8 Alex W Friedrich,2 Maarten J Postma1,3,5,9 1Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 2Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 3Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo Hospital, Surabaya, Indonesia; 4Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; 5Unit of PharmacoTherapy, Epidemiology and -economics (PTE2), Department of Pharmacy, Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands; 6Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo Hospital, Surabaya, Indonesia; 7Department of Microbiology, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo Hospital, Surabaya, Indonesia; 8Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 9Department of Economics, Econometrics and Finance, Faculty of Economics & Business, University of Groningen, Groningen, The NetherlandsCorrespondence: Abdul KR PurbaUniversitair Medisch Centrum Groningen, Hanzeplein 1, Groningen 9700RB, The NetherlandsTel +31 697 52 411Email khairul_purba@fk.unair.ac.idObjectives: To evaluate the clinical and microbiological appearance among hospitalized pneumonia patients focusing on resistance and risk factors for mortality in a referral hospital.Patients and methods: The study was an observational retrospective study on patients with CAP from 2014 to 2016 at Dr Soetomo referral hospital of Surabaya, Indonesia. All positive cultures with antimicrobial susceptibility results from blood and respiratory specimens were included. Patients infected with drug-susceptible pathogens and MDR organisms were also assessed in terms of clinical characteristics, day-3 clinical improvement, and 14-day mortality.Results: Of 202 isolates, 181 possessed antimicrobial susceptibility data. S. pneumoniae was the most prevalent pathogen causing CAP (18.3%). Most patients were empirically treated with ceftriaxone (n=75; 41.4%). Among beta-lactam antibiotics, the susceptibility to the third-generation cephalosporins remained relatively high, between 67.4% and 82.3%, compared with the other beta-lactams such as amoxicillin/clavulanate and ampicillin/sulbactam (a sensitivity rate of 36.5% and 47.5, respectively). For carbapenem antibiotics, imipenem and meropenem susceptibility was 69.6% and 82.3% respectively. Approximately 22% of isolates were identified as MDR that showed significant differences in clinical outcomes of 14-day mortality rates (p

Erik Bathoorn,1 Feikje Groenhof,2 Ron Hendrix,1,3 Thys van der Molen,2,4 Bhanu Sinha,1 Huib AM Kerstjens,5 Alex W Friedrich,1 Janwillem WH Kocks2,4 1Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 2Department of Primary Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 3Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 4Department of Medical Microbiology, Certe – Laboratory for Infectious Diseases, Groningen, the Netherlands; 5GRIAC Research Institute, Groningen, University of Groningen, University Medical Center Groningen, the Netherlands Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are generally treated with optimization of bronchodilation therapy and a course of oral corticosteroids, mostly without antibiotics. The Dutch guidelines recommend prudent use of antibiotics, with amoxicillin or doxycycline as first choice. Here we evaluate adherence to these guidelines with regard to antibiotic prescription in AECOPD in primary care and the use of sputum cultures. Methods: We retrospectively analyzed a longitudinal cohort of patients in three primary care practices in the north-eastern region of the Netherlands from 2009 to 2013 (n=36,172 subjects) participating in the Registration Network Groningen. Antibiotics prescribed for AECOPD -10/+28 days from the start date of corticosteroid courses were evaluated. In addition, we assessed regional data on the susceptibility of respiratory pathogens from COPD patients. Results: We identified 1,297 patients with COPD. Of these, 616 experienced one or more exacerbations, resulting in a total of 1,558 exacerbations, for which 1,594 antibiotic courses were prescribed. The recommended antibiotics doxycycline and amoxicillin accounted for 56% of the prescribed antibiotics overall and for 35% in subsequent antibiotic courses. The alternative choices were not based on culture results because only in 67 AECOPD events (2.9%) sputum samples were taken. Regional data including 3,638 sputum samples showed that pathogens relevant in AECOPD were detected in 19% of cultures. Conclusion: Our study shows that guidelines regarding the prescription of antibiotics are poorly followed, particularly in recurrent exacerbations. Sputum cultures were performed in a small minority of cases. Performing sputum diagnostics in patients with early treatment failure or a repeated exacerbation when antibiotic treatment is started may further rationalize antibiotic treatment. Keywords: COPD, exacerbation, antimicrobial stewardship, bacteria, sputum cultures