Antimicrobial resistance among WHO priority carbapenem-resistant pathogens in Indonesia: a bibliometric analysis and scoping review

Abstract

Purpose: Carbapenem-resistant organisms (CROs) designated as "Critical Priority" on the 2024 Bacterial Priority Pathogens List (BPPL) pose a major public health risk in Indonesia. However, the country's research focus and the precise epidemiological burden of these pathogens remain poorly understood. Methods: This study combined bibliometric analysis with a scoping review. Metadata were extracted from Scopus and PubMed (February 2026) using targeted Boolean queries. Bibliometric mapping was conducted in VOSviewer (v1.6.20), and the scoping review followed PRISMA-ScR guidelines and the PECO framework. The analysis focused on carbapenem-resistant Acinetobacter baumannii (CRAB), Pseudomonas aeruginosa (CRPA), and Enterobacterales (CRE) in Indonesian clinical settings. Results: Eleven studies were included from 31 identified records. Research output increased after 2019, with activity primarily centered in Jakarta and Surabaya, and a noticeable shift from phenotypic to molecular characterization after 2020. Key findings include a 50.5% resistance rate in CRAB and high rates of carbapenemase gene carriage in CRPA (69.7%) and K. pneumoniae (96.0%), with blaNDM identified as the predominant genotype. Clinically, CRAB infections were associated with significantly longer ICU stays and more than twice the hospitalization costs compared with susceptible cases. Conclusion: Carbapenem resistance among WHO critical priority pathogens in Indonesia is significant and genetically diverse, imposing a serious clinical and economic burden. Current research is largely concentrated in Java. To address this crisis, expanded national surveillance, decentralized research capabilities, and stronger infection prevention and control (IPC) programs are needed nationwide.