Aims: This study was aimed to identify the risk factors for the acquisition of extended-spectrum beta-lactamase (ESBL)producing Escherichia coli and Klebsiella pneumoniae on non-ventilator hospital-acquired pneumonia (NV-HAP) patients in a tertiary care hospital in Indonesia. Methodology and results:A case-control study was performed between March 31, 2018, and August 31, 2019. Twenty-eight ESBL-producing E. coli and K. pneumoniae isolates and 28 susceptible strains of E. coli and K. pneumoniae obtained from NV-HAP patients were included in this study. Phenotypic screening for ESBL production was performed by the Vitek2 system and subsequently confirmed by double-disk synergy tests. The use of 3 rd generation cephalosporin as initial antibiotic therapy for more than three days was the significant risk factor for the acquisition of ESBL-producing E. coli and K. pneumoniae among NV-HAP patients (odds ratio [OR] 41.827; p=0.001). The length of stay of patients with NV-HAP acquiring the ESBL strains was longer than 10 days (OR 17.334; p=0.001). Conclusion, significance and impact of study: The use of 3 rd generation cephalosporin as the initial antibiotic for NV-HAP should be restricted to prevent the emergence of ESBL-producing strains. Infection prevention measures are required to control the acquisition of ESBL-producing E. coli and K. pneumoniae in NV-HAP patients.
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