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"Latar belakang. Sepsis merupakan salah satu penyebab utama kematian pada pasien sakit kritis. Pada sepsis berat dan melanjut, akan terjadi ketidakseimbangan sitokin inflamasi dan anti-inflamasi. Berbagai penelitian telah mencoba mengungkapkan peran mikronutrien bagi sistem imun, di antaranya adalah zinc. Defisiensi zinc dapat menyebabkan gangguan sistem imun alamiah dan didapat. Namun, sejauh ini di Indonesia, belum terdapat studi yang meneliti interaksi antara defisiensi zinc dengan sistem imun terutama pada sepsis melanjut.Tujuan. Penelitian ini bertujuan untuk mengetahui: (1) profil kadar zinc serum, TNF-α, IL-10, IFN-γ, (2) hubungan antara kadar zinc serum dengan skor PELOD. (3) hubungan antara masing-masing kadar zinc serum, TNF-α, IL-10, IFN-γ dengan luaran sepsis melanjut, (4) korelasi antara kadar zinc serum dengan TNF-α, IL-10, IFN-γ dan rasio TNF-α/IL-10 pada sepsis melanjut.Metode. Penelitian potong lintang di Unit Perawatan Intensif (ICU) Anak RSCM, dengan subjek berusia 1 bulan?18 tahun. Pasien dengan diagnosis sepsis, berlangsung lebih dari 5 hari, memiliki skor PELOD ≥10, tanpa dugaan infeksi HIV, keganasan, dan tidak mendapat suplementasi zinc, dilakukan pemeriksaan kadar zinc serum, TNF-α, IL-10, dan IFN-γ. Dilakukan pemeriksaan kadar zinc serum pada populasi anak non-sepsis (dari pasien yang menjalani toleransi operasi elektif dengan diagnosis non-infeksi dan non-keganasan).Hasil. Sebanyak 23 dari 52 subjek dengan sepsis memenuhi kriteria penelitian. Seluruh subjek memiliki kadar zinc serum yang rendah (median 0,56 μg/dL; 0,06-3,39 μg/dL), berbeda bermakna dengan kelompok kontrol (median 31,13 μg/dL; 21,71-55,57 μg/dL) (p = 0,00). Median kadar TNF-α, IL-10, dan IFN-γ pada penelitian ini berturut-turut adalah 13,73 (1,53-43,59) pg/mL, 5,15 (0,86-52) pg/mL, dan 5,17 (0,16-36,10) pg/mL. Zinc serum tidak berhubungan dengan mortalitas (p=0,186), namun berkorelasi terbalik dengan skor PELOD (r=-0,489, p=0,018). Kadar TNF-α berkorelasi lurus dengan mortalitas sepsis (r=-0,42, p= 0,046), namun IL-10 dan IFN-γ tidak terbukti berhubungan dengan luaran sepsis. Kadar zinc serum cenderung berkorelasi negatif terhadap kadar TNF-α dan IFN-γ, namun tidak berkorelasi dengan kadar IL-10 dan rasio TNF-α/IL-10.Simpulan. Pada anak dengan sepsis melanjut terdapat penurunan kadar zinc serum yang berkorelasi dengan perburukan skor PELOD. Kadar zinc serum yang rendah cenderung berhubungan dengan peningkatan kadar TNF-α dan IFN-γ. Mortalitas pada sepsis melanjut berhubungan dengan peningkatan kadar TNF-α.

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Background. Sepsis is a major cause of mortality in critically ill patients. Imbalance of the inflammatory and antiinflammatory reactions will results in severe and prolonged sepsis. Many researches have showed the role of micronutrients, such as zinc, in immune system. Yet, no research in Indonesia studied the interaction between zinc deficiency and the immune system, particularly in prolonged sepsis.

Objectives. This study was designed to identify: (1) serum zinc, TNF-α, IL-10, and IFN-γ profile in prolonged sepsis, (2) the relationship between serum zinc level and PELOD score in prolonged sepsis, (3) the relationship between serum zinc, TNF-α, IL-10, and IFN-γ with sepsis outcome in prolonged sepsis, (4) the correlation between serum zinc level and TNF-α, IL-10, IFN-γ, TNF-α/IL-10 ratio in prolonged sepsis.

Method. All patients age between 1 month ? 18 years old, with PELOD score ≥10 on >5 days after sepsis onset, and without any immunosupressive underlying disease, admitted to the pediatric intensive care unit from June through November 2012, were eligible for enrollment. After consent, blood samples were collected and pooled for serum zinc, TNF-α, IL-10, and IFN-γ level analysis. A control group consist of pre-operative children were also enrolled to compare the serum zinc level.

Results. Twenty-three out of 52 patients with sepsis were enrolled. All subjects had a low serum zinc level (median 0,56 μg/dL; 0,06-3,39 μg/dL), significantly differ to control group (median 31,13 μg/dL; 21,71-55,57 μg/dL) (p = 0,00). The median level of TNF-α, IL-10, and IFN-γ in this research were 13,73 (1,53-43,59) pg/mL, 5,15 (0,86-52) pg/mL, and 5,17 (0,16-36,10) pg/mL. Serum zinc did not correlate to mortality (p = 0,186), but correlate to PELOD score (r = -0,489, p = 0,018). There were trends toward an increase in the TNF-alpha, IL-10 and IFN-gamma level in the non-survivor group compare to the survivors, but these trends were not significantly different, except for the TNF-alpha level (r = -0.42, p = 0.046). The serum zinc level tend to inversely correlate to TNF-α and IFN-γ level, but not to IL-10 level and TNF-α/IL-10 ratio.

Conclusion. In children with prolonged and severe sepsis, the decrease in serum zinc level is correlate to PELOD score deterioration and tend to correlate with the increase of TNF-α and IFN-γ level, adding a risk toward increase mortality."

"Sepsis merupakan kondisi yang sulit untuk didiagnosis. Definisi sepsis berdasarkan International Consensus Conference on Pediatric Sepsis 2005 terlalu sensitif dan tidak spesifik. Akibatnya sering terjadi underdiagnosed/overdiagnosis terhadap sepsis. Sampai saat ini tidak ada data tentang karakteristik pasien sepsis, kepatuhan diagnosis berdasarkan konsensus yang disepakati, dan luaran sepsis pasien di PICU. Penelitian ini bertujuan untuk mengetahui gambaran karakteristik sepsis di PICU RS dr. Cipto Mangunkusumo. Metode penelitian ini adalah deskriptif retrospektif dari data rekam medis pasien sepsis di PICU periode Januari 2012 sampai April 2016. Didapatkan 85 pasien yang didiagnosis dokter dengan sepsis, 7 pasien diantaranya tidak memenuhi kriteria konsensus. Hanya 1 pasien yang didiagnosis sepsis berat oleh dokter, sedangkan berdasarkan konsensus didapatkan 66 pasien sepsis berat. Infeksi respiratorik adalah penyakit primer penyebab sepsis di PICU (51,3%). Angka kejadian sepsis berat di PICU sebesar 85% dan syok septik 70%. Klebsiella pneumonia kuman gram negatif terbanyak penyebab sepsis (22%). Angka kematian sepsis sebesar 29%, pada sepsis berat 32% dan meningkat pada syok septik 37%. Penelitian ini menunjukkan kepatuhan diagnosis sepsis oleh dokter berdasarkan konsensus masih kurang. Diagnosis sepsis pasien di PICU berdasarkan kadar prokalsitonin yang meningkat.

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Sepsis is a condition that is difficult to diagnose. Definition of sepsis based on the International Consensus Conference on Pediatric Sepsis 2005 is too sensitive and not specific. As a result underdiagnosed/overdiagnosis often occurs in sepsis. Until now there are no data on the characteristics of sepsis patients, compliance to diagnosis based on consensus, and the outcome of sepsis patients in PICU. The aim of this study is to determine the characteristic features of sepsis in PICU of dr. Cipto Mangunkusumo hospital. The methods is descriptive retrospective study from medical records of sepsis patients in PICU from January 2012 until April 2016. There were 85 patients diagnosed with sepsis by physicians, 7 of them did not meet the criteria of consensus. Only one severe sepsis patients diagnosed by a doctor, but based on the consensus, there are 66 patients with severe sepsis. Respiratory infections are the primary cause of sepsis (51.3%). The incidence of severe sepsis in PICU is 85% and of septic shock is 70%. Klebsiella pneumonia, Gram negative bacteria, is the most common cause of sepsis (22%). Sepsis mortality rate is 29%, severe sepsis is 32% and increased in septic shock by 37%. This study describes compliance of diagnosis of sepsis by doctor based on consensus is still lacking. The diagnosis of sepsis patients in PICU based on increased levels of procalcitonin."

"Latar Belakang: Sepsis merupakan salah satu penyebab utama kematian di unit perawatan intensif. Dalam kasus infeksi, pemberian cairan intravena dan agen vasoaktif sangat direkomendasikan sebagai salah satu tatalaksana pasien sepsis. Namun, banyak studi yang belum dapat menunjukkan temuan positif sesuai dengan studi orisinil EGDT. Tujuan: Tujuan penelitian ini adalah mengetahui hubungan antara mortalitas pasien sepsis dengan waktu pemberian vasoaktif selama proses resusitasi cairan di Unit Perawatan Intensif Rumah Sakit Cipto Mangunkusumo. Metode: Studi ini menggunakan metode cohort retrospective dengan 188 subjek yang didapatkan melalui pemenuhan kriteria penelitian dari rekam medis pasien. Subjek dibagi menjadi dua kelompok, yaitu pasien sepsis yang mendapatkan terapi vasoaktif dalam enam jam pertama dan setelah enam jam. Hasil: Terdapat karateristik sosiodemografi dari subjek, antara lain jenis kelamin, usia, total cairan rerata, status transfusi, jenis cairan, jenis vasoaktif, penyakit penyerta, dan lama rawat di unit perawatan intensif. Dari hasil uji Chi-square didapatkan waktu pemberian vasoaktif terhadap mortalitas, bernilai P=0.282 dengan RR 1.060 95 CI 0.974-1.153. Diskusi: Hasil penelitian ini menunjukkan tidak adanya hubungan mortalitas dengan perbedaan waktu pemberian terapi vasoaktif tersebut.

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Background: Sepsis is the leading cause of death in intensive care unit. In case of infection, intravenous resuscitation and vasoactive agent are very recommended as one of the treatment for septic patient. However, many studies not yet able to show the positive findings in accordance with the EGDT original study.

Objectives: This study aims to find out the association between septic patient rsquo s mortality and the time of vasoactive administration during fluid resuscitation in Intensive Care Unit of Cipto Mangunkusumo Hospital.

Method: This is a cohort retrospective study with 188 subject which meet the criteria from medical record. The subjects are divided into two groups septic patients that are given vasoactive therapy within six hours and after six hours during fluid resuscitation.

Results: This study shows sociodemographic characteristics of the subjects, such as gender, age, total fluid average, transfusion status, type of fluid, type of vasoactive, comorbidities, and length of stay in ICU. Based on Chi Square test, relationship between mortality and timing of vasoactive administration, sequentially P 0.282 with RR 1.060 95 CI 0.974 1.153.

Discussion: No association between septic patient rsquo s mortality and time difference in administrating the vasoactive therapy. "

"Anak yang dirawat di ICU cenderung mengalami malnutrisi sejak masuk atau selama perawatan yang dapat memperberat penyakit dasar, memperpanjang lama rawat serta meningkatkan mortalitas. Baik underfeeding atapun overfeeding dapat terjadi di ICU Anak selama perawatan. Penelitian ini merupakan penelitian potong lintang, menggunakan data rekam medis. Selama 3 bulan penelitian. didapatkan 45 subjek penelitian. Dari 45 data pasien didapatkan 127 peresepan untuk menilai keseuaian peresepan dengan pemberian nutrisi pada pasien. Pemberian nutrisi pada pasien yang dirawat di ICU Anak merupakan hal yang sangat penting. Perlu perhitungan kebutuhan nutrisi yang cermat, pemberian nutrisi tepat yang sesuai kebutuhan pasien agar tidak terjadi malnutrisi yang lebih berat lagi.

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Children admitted to the Pediatric Intensive Care Unit (PICU) are at risk for poor and potentially worsening nutritional status, a factor that further increases comorbidities and complications, prolongs the hospital stay, increases cost and increases mortality. Both underfeeding and overfeeding are prevalent in PICU and may result in large energy imbalance. This was cross sectional study design, with 3 month consecutive sampling in PICU which met 45 patients as the subject and 127 prescription of nutrition. Nutrition support therapies in PICU is very important .Adequate nutrition therapy is essential to improve nutrition outcomes in critically ill children."

"ABSTRAK Latar belakangKematian akibat sepsis dan syok septik pada pasien rawatan Intensive Care Unit (ICU) yaitu 20-30%. Pemberian antibiotik empirik yang tepat merupakan salah satu langkah awal yang sangat penting. Amikasin merupakan salah satu antibiotik terpilih untuk tata laksana sepsis di ICU RSUPN dr. Cipto Mangunkusumo (RSCM). Saat ini belum pernah dilakukan penelitian mengenai ketercapaian kadar terapi amikasin dengan menggunakan dosis standar amikasin pada pasien sepsis dewasa di ICU RSCM, sehingga studi ini menjadi penelitian pertama di Indonesia.Penelitian ini bertujuan untuk mengetahui ketercapaian kadar amikasin optimal pada pasien ICU RSCM.MetodeData dikumpulkan secara potong lintang melalui observasi terhadap hasil pemeriksaan kadar plasma amikasin, pengukuran minimum inhibitory concentration (MIC) dan perhitungan rasio Cmax/MIC pada pasien sepsis di ICU RSCM periode Mei-September tahun 2015.Hasil penelitianProporsi pasien sepsis dengan kadar amikasin optimal ialah sebesar 57% (4/7). Kadar puncak amikasin yang dapat dicapai dengan dosis 1000 mg sekali sehari tanpa menghiraukan berat badan ialah median 86,4 (43,5-238) µg/mL. Pada penelitian ini ditemukan 87% pasien dengan kadar puncak amikasin di atas 64 µg/mL, meskipun amikasin 1000 mg tersebut lebih rendah dari dosis yang dianjurkan untuk sepsis (25 mg/kgBB). Sebagian besar (78,3 %) subyek pada kenyataannya menerima dosis 15-25 mg/kgBB, dengan pemberian 1000 mg amikasin tanpa memperhatikan berat badan. Bakteri yang banyak ditemukan dari hasil kultur pasien sepsis di ICU RSCM, yaitu K. pneumoniae, A. baumanii, P. aeruginosa dan E. coli. Rentang nilai MIC untuk patogen tersebut berturut-turut yaitu 0,75 - >256 µg/mL, 0,75 - >256 µg/mL, 1,5 - >256 µg/mL dan 0,75 - 16) µg/mL. Sebanyak 84% isolat K. pneumoniae masih sensitif terhadap amikasin, diikuti oleh 63% untuk A. baumanii, 47% P. aeruginosa dan 100% untuk E. coli.KesimpulanOptimalitas amikasin terhadap bakteri Gram negatif penyebab sepsis bergantung kadar puncak dan MIC bakteri. Kadar puncak plasma amikasin yang dicapai dengan dosis 1000 mg sekali sehari sangat bervariasi. Pemberian amikasin dengan dosis per kgBB dapat dipertimbangkan. Kepekaan beberapa bakteri Gram negatif terhadap amikasin mulai menurun dengan rentang MIC yang cukup lebar. Pengukuran ketercapaian kadar optimal dalam terapi definitif dapat dilakukan untuk meningkatkan keberhasilan terapi.ABSTRACT BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment.;BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment.;BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment."

"Latar belakang : Pembedahan abdomen secara laparotomi menyebabkan penurunan kadar albumin. Kadar albumin di bawah 3,00 g/dL berperan dalam terjadinya mortalitas dan morbiditas pasca-operasi.Tujuan: Mengetahui hubungan antara kadar albumin pre-operasi dan pasca-operasi terhadap luaran klinis pasca-operasi laparotomi.Metode : Penelitian ini dengan desain kohort retrospektif menggunakan data rekam medis Departemen Ilmu Kesehatan Anak tahun 2015-2017. Total sampling pada pasien pasca-laparotomi di PICU dengan rentang usia 1 bulan hingga 18 tahun, dikelompokan ke dalam dua kategori, yaitu: albumin ≤ 3,0 g/dL dan > 3,00 g/dL. Subyek diambil data luaran klinis pasca-operasi seperti sepsis pasca-operasi, infeksi luka operasi, dehisens, relaparotomi, dan lama rawat di PICU.Hasil : Dua ratus satu subyek pasca-laparotomi diikutsertakan dalam penelitian ini. Kadar albumin pre-operasi ≤ 3,0 g/dL meningkatkan risiko terjadinya sepsis pasca-operasi (RR 3,40(95%IK: 1,54-7,51), relaparotomi (RR 3,84(95%IK: 1,28-11,49), dan lama rawat PICU 2 kali lebih lama daripada normoalbuminemia. Kadar albumin pasca-operasi ≤ 3,0 g/dL meningkatkan risiko terjadinya sepsis pasca-operasi (RR 2,55(95%IK: 1,40-4,63) dan lama rawat PICU 1 hari lebih lama daripada normoalbuminemia. Mortalitas pada kelompok hipoalbuminemia sebesar 19,2% dengan RR 3,44(95%IK: 1,07-11,07).Simpulan : Hipoalbuminemia pre-operatif atau pasca-operatif meningkatkan risiko kejadian sepsis pasca-operatif. Hipoalbuminemia pre-operatif atau pasca-operatif tidak berhubungan dengan infeksi luka operasi. Hipoalbuminemia pre-operatif atau pasca-operatif tidak berhubungan dengan risiko kejadian dehisens. Hipoalbuminemia pre-operatif meningkatkan risiko untuk menjalani relaparotomi. Hipoalbuminemia pre-operatif atau pasca-operatif memperpanjang lama rawat di PICU. Hipoalbuminemia pre-operatif meningkatkan angka mortalitas.

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Backgrounds : Laparotomy abdominal surgery decreasing serum albumin. Serum albumin concentration below 3,00 g/dL associated with postoperative morbidity and mortality.

Aim: To determine the relationship between serum albumin (preoperative and postoperative) and postoperative clinical course.

Methods : Retrospesctive observational study in pediatric patients undergoing laparotomy and hospitalized in Pediatric Intensive Care Unit during January 2015- December 2017. Post-laparotomy patients over the age range 1 month to 18 years, classified according to serum albumin concentration: ≤ 3,0 g/dL and > 3,00 g/dL. Postoperative outcome measured by postoperative sepsis, surgical site infection, dehiscence, relaparotomy, PICU length of stay, and mortality.

Results : Two hundred and one subjects undergone laparotomy participated. Preoperative serum albumin ≤ 3,0 g/dL increase risk of postoperative sepsis (RR 3,40 (95%CI: 1,54-7,51)), relaparotomy (RR 3,84 (95%CI: 1,28-11,49)), and twice longer in Pediatric Intensive Care Unit length of stay. Postoperative albumin ≤ 3,0 g/dL increase risk of postoperative sepsis (RR 2,55(95%CI: 1,40-4,63)) and Pediatric Intensive Care Unit length of stay. Mortality rate in hypoalbuminemic group is 19,2% with RR 3,44(95%CI: 1,07-11,07).

Conclusions : Preoperative and postoperative hypoalbuminemia increase risk of postoperative sepsis. Preoperative and postoperative hypoalbuminemia not associated with risk of surgical site infection and wound dehiscense. Preoperative hypoalbuminemia increase risk of relaparotomy. Preoperative and postoperative albumin concentration inversely related with Pediatric Intensive Care Unit length of stay. Preoperative hypoalbuminemia increase mortality rate."

"Latar belakang : Definisi sepsis tahun 2016 adalah disfungsi organ yang mengancam kehidupan akibat disregulasi imun terhadap infeksi. Skor PELOD 2 digunakan untuk mengetahui disfungsi organ pada anak dengan sakit kritis.Tujuan : Mengetahui validitas skor PELOD 2 pada disfungsi organ yang mengancam kehidupan pada sepsis dan titik potong optimal skor PELOD 2 terhadap luaran terutama mortalitas.Metode : Penelitian dilaksanakan dari Januari sampai April 2017 di ruang intensif RSUPN Cipto Mangukusumo. Pengambilan subjek dengan consecutive sampling dan penilaian skor PELOD 2 dilakukan pada 24 jam pertama. Subjek dipantau untuk mengetahui luaran.Hasil : Diperoleh 52 subjek yang memenuhi kriteria. Nilai diskriminasi skor PELOD 2 adalah 0,85 IK 95 0,745-0,965, kalibrasi dengan Hosmer and Lemeshow test 69,2 p.

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Background . In 2016, a new definition of sepsis has been created that is a presence of life threatening organ dysfunction cause by a dysregulated host response to infection. PELOD 2 score is stated can be used to discover organ dysfunction in critical ill child.

Objective To discover validity PELOD 2 score to know life threatening organ dysfunction and cut off point of toward outcome of sepsis pediatric patient.

Methods This cross sectional study was conducted from January to April 2017 in Intensive Care Unit ICU of RSUPN Cipto Mangunkusumo. The selection of subject through consecutive sampling and evaluation of PELOD 2 score were performed in the first 24 hours. Subjects were monitored to know the outcome.

Results There were 52 subjects that fulfilled the criteria. Discrimination value of PELOD 2 score was 0.85 95 CI 0.745 0.965 and calibration which was tested by using Hosmer and Lemeshow test 69.2 p."

"ABSTRAKLatar belakang: Sepsis merupakan masalah kesehatan penting yang dapat menyebabkan insidens kematian sampai 50% pada pasien dengan sepsis berat. Antibiotik aminoglikosidaterutama amikasin semakin banyak digunakan untuk mengobati infeksi kuman Gram negatif pada pasien sepsis di ICU, meskipun penggunaan obat tersebut pada dosisterapi dapat meningkatkan risiko kerusakan ginjal sekitar 10-25%. Pemantauan kadar lembah amikasin serta biomarker dini diperlukan untuk mencegah kerusakan ginjal pada pasien sepsis yang dirawat di ICU. Penelitian ini dilakukan untuk mengetahui hubungan kadar lembah amikasin pada pasien ICU dewasa yang dirawat di Rumah Sakit Cipto Mangunkusumo yang diberikan amikasin 1000 mg/hari denganpeningkatan kadar KIM-1 normalisasi dalam urin yang merupakan biomarker dini nefrotoksisitas.Metode:Penelitian ini merupakan penelitian pendahuluan yang dilakukan pada 12 pasien sepsis dewasa yang dirawat di ICU RSCM dan diberikan amikasin 1000 mg/hari pada bulan Mei-September 2015. Kadar lembah amikasin dosis ketiga dihubungkan dengan peningkatan kadar KIM-1 normalisasi yang diukur melalui urin 24 jam setelah pemberian amikasin dosis pertama/kedua dan dosis ketiga.Hasil:Dari 12 subyek penelitian, didapatkan 3 subyek penelitian dengan kadar lembah amikasin di atas 10 g/mL, sedangkan 9 subyek penelitian kadar lembahnya ada dalam batas aman (di bawah 10 g/mL). Delapan dari 12 subyek penelitian (66,7%) mengalami peningkatan kadar KIM-1 normalisasi dalam urin hari ketiga dibandingkan hari pertama. Tidak ada hubungan antara kadar lembah amikasin dengan peningkatan kadar KIM-1 normalisasi dalam urin (p=0,16; r=0,43).Kesimpulan:Pasien sepsis yang mendapat amikasin 1000 mg/hari di ICU RSCM selama 3 hari memperlihatkan kadar lembah amikasin plasma dalam batas aman untuk ginjal.

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ABSTRACT

Background: Sepsis is a common caused of mortality which may account for up to 50% death rate in patients with severe sepsis. Aminoglycoside antibiotics, especially amikacin, are the most commonly used antibiotics in the septic patients with Gram-negative bacterial infections, despite these drugs may induce nephrotoxicity in 10-25%

patients. Hence, it is essential to monitor amikacin trough plasma concentration and to detect nephrotoxicity as early as possible. The aim of this study is to find out the correlation between amikacin trough plasma concentration with normalized KIM-1 concentration in the urine as a sensitive and specific biomarker.

Methods:

This is a pilot study conducted in 12 septic patients treated with amikacin 1000 mg/day from May, 2015 to September, 2015. The correlation between amikacin

trough plasma concentrations measured at the third doses with the elevation of urine normalized KIM-1 concentrations measured at the first/second and the third doses were evaluated.

Results:

We observed 3 patients with amikacin trough plasma concentration above the safe level (>10 g/mL), while 9 patients had amikacin concentrations within the safe

plasma level (<10 g/mL). Furthermore, we observed 8 out of 12 patients with higher normalized KIM-1 concentrations measured at third doses compared to normalized KIM-1 concentrations measured at first/second doses. There was no correlation between amikacin trough concentration with elevated urine normalized KIM-1

concentration (p=0,16; r=0,43).

Conclusion:

Septic patients treated with amikacin 1000 mg/day hospitalized in ICU RSCM for 3 days have amikacin safe trough plasma concentration."

"Latar belakang: Sepsis neonatal masih menjadi masalah besar di negara berkembang seperti Indonesia. Penggunaan antibiotik pada sepsis neonatal penting untuk eleminasi kuman penyebab. Untuk meningkatkan pemakaian yang bijak dan mengurangi potensi terjadi resistensi terhadap antibiotik, penggunaannya perlu selalu dievaluasi. Evaluasi penggunaan antibiotik dan antimikroba lain khususnya pada sepsis neonatal belum banyak dilakukan. Penelitian ini bertujuan melakukan kajian kualitatif dan kuantitatif peresepan antibiotik dan antimikroba lainnya pada pasien sepsis neonatal yang dirawat di Neonatal Intensive Care Unit NICU RSCM pada periode September 2014-Desember 2015. Ketepatan penggunaan antibiotik dievaluasi berdasarkan alur Gyssen, kuantitas penggunaan antibiotik dihitung berdasarkan Defined Daily Dose, kesesuaian pemilihan jenis antibiotik empiris dengan hasil kultur darah juga dievaluasi. Metode: Penelitian ini bersifat observasional deskriptif dengan rancangan potong lintang menggunakan data retrospektif. Analisis dilakukan terhadap 192 kasus sepsis neonatal yang terdiri dari dua kelompok: berat lahir normal 96 pasien dan berat lahir rendah 96 pasien. Hasil: Dari 192 pasien dengan diagnosis sepsis neonatorum 96 pasien berat lahir normal, dan 96 pasien berat lahir rendah didapatkan 4763 peresepan antimikroba 4408 antibiotik dan 355 antimikroba lainnya . Tiga rejimen antibiotik yang paling banyak digunakan pada kelompok neonatal berat lahir normal dan neonatal berat lahir rendah berturut-turut adalah kombinasi ampisilin - sulbaktam dan gentamisin 42,1 dan 35,3 , yang merupakan antibiotik lini pertama untuk diagnosis klinis sepsis neonatorum, disusul oleh piperasilin - tazobaktam dan amikasin lini ke dua, 26,0 dan 29,6 dan meropenem lini ke tiga, 15,5 dan 12,8 . Ketepatan penggunaan antibiotik Gyssens kategori I mencapai 90,35 pada bayi berat lahir normal dan 88,11 pada neonatal dengan berat lahir rendah. Ketidaktepatan penggunaan antibiotik sebagian besar tergolong dalam Gyssen kategori V tidak tepat indikasi . Terdapat 12 jenis antibiotik yang diresepkan dengan total nilai DDD/100 bed-days sebesar 79,72 untuk kelompok berat lahir normal dan 66,807 untuk kelompok berat lahir rendah. Nilai DDD /100 bed-days terbesar adalah ampisilin sulbaktam 40,60 untuk kelompok berat lahir normal dan 39,10 untuk kelompok berat lahir rendah, disusul oleh meropenem 13,72 untuk kelompok berat lahir normal dan 12,86 untuk kelompok berat lahir rendah , dan piperasilin tazobaktam 10,40 untuk kelompok berat lahir normal dan 16,05 untuk kelompok berat lahir rendah . Di antara antimikroba lain, yang terbanyak digunakan adalah nistatin 1,19 DDD/100 bed-days untuk kelompok berat lahir rendah , dan mikafungin 0,19 DDD/100 bed-days untuk kelompok berat lahir normal dan 0,15 DDD/100 bed-days untuk kelompok berat lahir rendah , yang digunakan sesuai indikasi profilaksis antijamur pada pasien sepsis neonatal. Dari 192 sampel darah yang dikultur, yang berhasil tumbuh 27 sampel 14,06 dengan bakteri terbanyak Acinetobacter baumanii. Uji resistensi memperlihatkan 37 bakteri yang tumbuh resisten terhadap semua rejimen antibiotik empiris lini I, II, dan III untuk terapi sepsis neonatal yang tercantum di Pedoman Penggunaan Antibiotik Divisi Neonatologi Departemen Ilmu Kesehatan Anak RSCM 2015. Kesimpulan: Ketepatan penggunaan antibiotik pada pasien sepsis neonatal di Neonatal Intensive Care Unit RSUPN Cipto Mangunkusumo cukup baik khususnya pada kelompok neonatal berat lahir normal. Tiga rejimen antibiotik dengan persentase penggunaan terbanyak sesuai dengan antibiotik lini I, II dan III pada Pedoman Penggunaan Antibiotik Divisi Neonatologi Departemen Ilmu Kesehatan Anak RSCM 2015. Didapatkan 37 kasus resistensi terhadap antibiotik lini I, II dan III tersebut. Kuantitas penggunaan antibiotik di NICU RSCM tahun 2015 secara total relatif lebih rendah dibandingkan dengan di Belanda pada tahun 2005 rata-rata 221,26 DDD/100 bed days dan di Polandia pada tahun 2013 352,17 DDD/100 bed days.

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Background: Neonatal sepsis is still a major problem in developing countries like Indonesia. The use of antibiotics in neonatal sepsis is important for the elimination of the causative microorganism. To improve the prudent use and to reduce the potential of antibiotic resistance, antimicroial use should always be evaluated. Evaluation of antibiotics and other antimicrobials use, especially in neonatal sepsis has not been done frequntly. The purposes of this study were to conduct qualitative and quantitative study of prescribing antibiotics and other antimicrobial in neonatal sepsis patients who were treated in the Neonatal Intensive Care Unit NICU RSCM in the period of September 2014 December 2015. The accuracy of the use of antibiotics was evaluated based on the Gyssen methods, the quantity of antibiotic use was calculated based on Defined Daily Dose, the compatibility of selection of empirical antibiotics with blood culture results was also evaluated.

Methods: This research was a descriptive observational study with cross sectional design using retrospective data. The analysis is performed on 192 cases of neonatal sepsis consisting of two groups with normal birth weight 96 patients and with low birth weight 96 patients.

Results: Based on 192 patients with neonatal sepsis diagnosis 96 patients with normal birth weight, and 96 patients with low birth weight , 4763 antimicrobial prescriptions 4408 antibiotics and 355 other antimicrobials were obtained. The three most widely use empiric regimens of antibiotics in the neonatal group of normal birth weight and low birth weight neonatal were combination of ampicillin sulbactam and gentamicin 42.1 and 35.3 , which was the first line antibiotic for clinical diagnosis of neonatal sepsis, followed by piperacillin tazobactam and amikacin second line, 26.0 and 29.6 and meropenem third line, 15.5 and 12.8. The accuracy of antibiotics use Gyssens category I is 90.35 in normal birth weight neonates and 88.11 in low birth weight neonates. The inaccuracy of antibiotic use is largely classified as Gyssen category V no indication. There were 12 types of antibiotics which prescribed with a total DDD 100 bed days value of 79.72 for the normal birth weight group and 66.807 for the low birth weight group. The largest DDD 100 bed days values were ampicillin sulbactam 40.60 for normal birth weight group and 39.10 for low birth weight group, followed by meropenem 13.72 for normal birth weight group and 12.86 for birth weight group Low, and piperacillin tazobactam 10.40 for normal birth weight group and 16.05 for low birth weight group. Among other antimicrobials, the most widely used is Nystatin 1.19 DDD 100 bed days for groups of low birth weight , and micafungin 0.19 DDD 100 bed days for a normal birth weight group and 0.15 DDD 100 bed days for low birth weight group , which were used as indicated by antifungal prophylaxis for neonatal sepsis patients. Of 192 cultured blood samples, 27 samples 14.06 were successfully grown with most bacteria Acinetobacter baumanii. 37 of bacteria were obtained resistant to all first line, second line and third line empiric antibiotic regimen for the treatment of neonatal sepsis which listed Guidelines for the Use of Antibiotics Division of Neonatology Department of Pediatrics RSCM, 2015.

Conclusions: The appropiate use of antibiotics in neonatal sepsis patients in the Neonatal Intensive Care Unit RSUPN Cipto Mangunkusumo is good, especially in the normal birth weight neonatal group. Three antibiotic regimens with the highest percentage of use in accordance with first line, second line and third line antibiotics of the Guidelines for the Use of Antibiotics Division of Neonatology Department of Pediatrics RSCM 2015. It is obtained 37 of cases of all antibiotic empiric resistance. The quantity of antibiotic use in the NICU RSCM 2015 in total is relatively lower than Neonatal Centres in Netherlands in 2005 average of 221.26 DDD 100 bed days and in Poland in 2013 352.17 DDD 100 bed days. "

"ABSTRAKLatar Belakang. Terdapat gangguan sistem imun pada sepsis. Fase awal ditandaidengan hiperinflamasi, sedangkan fase lanjut ditandai dengan imunosupresi.Kematian kumulatif lebih banyak pada fase lanjut. Saat ini belum terdapatpenelitian yang secara khusus meneliti faktor prognostik mortalitas sepsis faselanjut dan mengembangkan model prediksi mortalitasnya.Tujuan. Mengetahui faktor prognostik mortalitas sepsis berat fase lanjut di ICUdan mengembangkan sistem skor untuk memprediksi mortalitas.Metode. Penelitian kohort retrospektif dilakukan pada pasien dewasa yangmengalami sepsis berat di ICU RSCM pada periode Oktober 2011 – November2012 dan masih bertahan setelah > 72 jam diagnosis sepsis ditegakkan di ICU.Tujuh faktor prognostik diidentifikasi saat diagnosis sepsis berat ditegakkan diICU. Prediktor independen diidentifikasi dengan analisis Cox’s proportionalhazard. Prediktor yang bermakna secara statistik dikuantifikasi dalam modelprediksi. Kalibrasi model dinilai dengan uji Hosmer-Lemeshow dan kemampuandiskriminasi dinilai dari area under curve (AUC) dari receiver operating curve.Hasil. Subjek penelitian terdiri atas 220 pasien. Mortalitas 28 hari sepsis beratfase lanjut adalah 40%. Faktor prognostik yang bermakna adalah alasan masukICU (medis (HR 2,75; IK95%:1,56-4,84), pembedahan emergensi (HR 1,96;IK95%:0,99 – 3,90), indeks komorbiditas Charlson > 2 (HR 2,07; IK95%:1,32-3,23), dan skor MSOFA > 4 (HR 2,84; IK95%:1,54-5,24). Model prediksimemiliki kemampuan diskriminasi yang baik (AUC 0,844) dan kalibrasi yangbaik (uji Hosmer-Lemeshow p 0,674). Berdasarkan model tersebut risikomortalitas dapat dibagi menjadi rendah (skor 0, mortalitas 5,4%), sedang (skor 1 –2,5, mortalitas 20,6%), dan tinggi (skor > 2,5, mortalitas 73,6%).Simpulan. Alasan masuk medis dan pembedahan emergensi, indeks komorbiditasCharlson > 2, dan skor MSOFA > 4 merupakan faktor prognostik mortalitassepsis berat fase lanjut di ICU RSCM. Sebuah model telah dikembangkan untukmemprediksi dan mengklasifikasikan risiko mortalitas.

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ABSTRACTBackground. Immune system derrangement occurs during the course of sepsis,characterized by hyperinflamation in early phase and hypoinflamation andimmunosupression in late phase. The number of patient die during late phase islarger than early phase. Until now, there is no study specifically addressingprognostic factors of mortality from late sepsis and developing a mortalityprediction model.Aim. To determine prognostic factors of mortality from late phase of severesepsis in ICU and to develop scoring system to predict mortality.Method. A retrospective cohort study was conducted to identify prognosticfactors associated with mortality. Adult patients admitted to ICU duringNovember 2011 until October 2012 who developed severe sepsis and still alivefor minimum 72 hours were included in this study. Seven predefined prognosticfactors were indentified at the onset of severe sepsis in ICU. Cox’s proportionalhazard ratio was used to identify independent prognostic factors. Eachindependent factors was quantified to develop a prediction model. Calibration ofthe model was tested by Hosmer-Lemeshow, and its discrimination ability wascalculated from area under receiver operating curve.Result. Subjects consist of 220 patients. Twenty eight-day mortality was 40%.Significant prognostic factors indentified were admission source (medical (HR2.75; CI95%: 1.56 – 4.84), emergency surgery (HR 1.96; CI95%:0.99 – 3.90),Charlson comorbidity index > 2(HR 2.07; CI95%:1.32 – 3.23), and MSOFA score> 4 (HR 2.84; CI95% : 1.54 – 5.24). Prediction model developed has gooddiscrimination ability (AUC 0.844) and good calibration (Hosmer-Lemeshow testp 0.674). Based on the model mortality risk can be classified as low (score 0,mortality 5.4%), moderate (score 1 – 2.5, mortality 20.6%), and high (score > 2.5,mortality 73.6%).Conclusion. Medical and emergency surgery admission, Charlson comorbidityindex > 2, and MSOFA score > 4 were prognostic factors of mortality from latephase of severe sepsis in ICU at Dr.Cipto Mangunkusumo general hospital. Amodel has been developed to predict and classify mortality risk."