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"Interactions of yeasts, moulds, and antifungal agents : how to detect resistance covers the available antifungal agents, how to perform in vitro testing and how those results should be interpreted for the most common fungal pathogens."

"Latar Belakang : Meropenem, salah satu antibiotik yang paling efektif terhadap bakteri gram negatif dan bakteri gram positif, dianggap sebagai pengobatan terakhir yang paling dapat diandalkan untuk infeksi bakteri. Penyebaran yang cepat dari resistensi meropenem, terutama diantara bakteri gram negatif, merupakan masalah kesehatan yang sangat penting. Berbagai faktor diketahui berhubungan dengan kejadian resistensi meropenem terhadap bakteri gram negatif, namun penelitian yang dilakukan pada pasien infeksi intra abdomen masih terbatas. Tujuan : Mengetahui faktor-faktor yang berhubungan dengan resistensi antibiotik meropenem terhadap bakteri gram negatif pada pasien infeksi intra-abdomen di RSCM tahun 2013-2017. Metode : Penelitian desain cross sectional dengan mengambil data dari rekam medis pasien infeksi intra abdomen pada rentang waktu tahun 2013-2017 sebanyak keseluruhan populasi terjangkau. Hasil : Tidak terdapat perbedaan bermakna secara statistik dari faktor-faktor yaitu, usia, jenis kelamin, penyakit yang menyertai, riwayat antibiotik, jumlah leukosit dan jumlah albumin yang berhubungan dengan resistensi meropenem terhadap bakteri gram negatif. Kesimpulan : Usia, jenis kelamin, penyakit yang menyertai, riwayat antibiotik, jumlah leukosit dan jumlah albumin bukan merupakan faktor yang berhubungan dengan resistensi meropenem terhadap bakteri gram negatif pada pasien infeksi intra abdomen. Penelitian lebih lanjut dibutuhkan untuk mengetahui pengaruh faktor-faktor lain yang berhubungan dengan resistensi meropenem terhadap bakteri gram negatif pada pasien infeksi intra abdomen.

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Background : Meropenem, one of the most effective antibiotics against gram-negative bacteria and gram-positive bacteria, is considered to be the most reliable last treatment for bacterial infections. The rapid spread of meropenem resistance, especially among gram negative bacteria, is a very important health problem. Various factors are known to be associated with the incidence of meropenem resistance to gram-negative bacteria, but studies conducted on patients with intra-abdominal infections are still limited.

Objectives : To determine the factors associated with meropenem resistance against gram-negative bacteria in patients with intra-abdominal infections at Cipto Mangunkusumo Hospital in the year of 2013-2017.

Methods : A cross sectional design study by taking data from medical records of intra-abdominal infection patients in the period of 2013-2017 as much as the entire affordable population.

Results : There were no statistically significant differences in factors, namely age, sex, accompanying disease, history of antibiotics, number of leucocyte and amount of albumin associated with meropenem resistance against gram-negative bacteria.

Conclusion : Age, sex, accompanying disease, history of antibiotics, number of leucocytes and amount of albumin are not factors associated with meropenem resistance against gram-negative bacteria in patients with intra-abdominal infections. Further research is needed to determine the effect of other factors related to meropenem resistance against gram-negative bacteria in patients with intra-abdominal infections. "

"This book, which is the translated version of a Swedish book, combines a general introduction of a variety of antibiotics with a more in-depth discussion of resistance. The focus on resistance in learning about antibiotics will help future scientists recognize the problem antibiotics resistance poses for medicinal and drug-related fields, and perhaps trigger more research and discoveries to fight antibiotic resistant strains. Current overviews of the topic are included, along with specific discussions on the individual mechanisms (betalactams, glycopeptides, aminoglycosides, etc) used in various antibacterial agents and explanations of how resistances to those develop. Methods for counteracting resistance development in bacteria are discussed as well."

"During their storage, the traditional ready-to-eat food, such as sticky rice cake, are easily contaminated by spoilage pathogens. Hence, this study aims to evaluate the effect of Citrus hystrix extract in reducing spoilage pathogens in sticky rice cake during storage. The experimental sticky rice cake was prepared and formulated with Citrus hystrix extract at varied level of concentrations of 0.65%, 1.26% and 1.82% (w/w). Treated samples were stored at room temperature for 28 days and evaluated periodically for their microbial activity (total plate count), thiobarbituric acid reactive substances (TBARS), and sensory analysis. For its antifungal activity, the Citrus hystrix extract was also compared against Penicillium sp. and Aspergillus nidulans prior to formulation. Results exhibited a significant advantage of the added extracts to the sticky rice cake. All extract levels effectively eliminated the spoilage microorganism and significantly lowered the TBARS values. The physico-chemical properties of sticky rice cake including pH, water activity, and moisture content were equal among all the formulated samples and slightly different at 1.82% (w/w) extract level. Moreover, the addition of Citrus hystrix extract up to 1.82% did not affect the acceptability sensory attributes of the sticky rice cake as compared to the control which has no Citrus hystrix extracts (p > 0.05)."

"This book describes antibiotic resistance amongst pathogenic bacteria. It starts with an overview of the erosion of the efficacy of antibiotics by resistance and the decrease in the rate of replacement of redundant compounds. The origins of antibiotic resistance are then described. It is proposed that there is a large bacterial resistome which is a collection of all resistance genes and their precursors in both pathogenic and non-pathogenic bacteria. Ongoing resistance surveillance programs are also discussed, together with the perspective of a clinical microbiologist. The book then turns to specific themes such as the most serious area of resistance in pathogens, namely in Gram-negative organisms. The role of combinations of antibiotics in combating resistance emergence is discussed, particularly in the tuberculosis field, and then the importance of non-multiplying and persistent bacteria which are phenotypically resistant to antibiotics and prolong the duration of therapy of antibiotics which leads to poor compliance and resistance emergence. The role of anti-microbial compounds in textiles is covered, with its potential to exacerbate the spread of resistance. Then, efflux pumps are discussed. The final chapter describes the compounds which are in late stage clinical development, illustrating the paucity of the antibiotic pipeline, especially for Gram-negative bacteria."

"Latar Belakang: Dalam beberapa tahun terakhir, permasalahan yang sering muncul pada pneumonia komunitas adalah terkait timbulnya patogen penyebab yang bersifat resisten obat. Skor DRIP merupakan suatu model prediksi terhadap Patogen Resisten Obat (PRO) pada pneumonia komunitas. Skor DRIP memiliki akurasi prediksi patogen PRO yang lebih baik dibandingkan dengan beberapa alternatif skor lain termasuk kriteria HCAP. Belum adanya studi validasi terhadap penggunaan skor DRIP di Indonesia sehingga belum diketahui tingkat akurasi prediksi skor ini pada populasi, karakteristik pasien dan pola kuman di Indonesia terutama di RSUPN dr. Cipto Mangunkusumo Jakarta.Tujuan: Penelitian ini dilakukan untuk mengetahui performa skor DRIP sebagai instrumen dalam memprediksi infeksi akibat patogen PRO pada pneumonia komunitas di RSUPN dr. Cipto Mangunkusumo Jakarta.Metode: Suatu penelitian dengan menggunakan desain potong lintang. Subyek penelitian adalah pasien pneumonia komunitas yang dirawat di RS Cipto Mangunkusumo pada periode Januari 2019 hingga Juni 2020. Penelitian dilakukan dengan mengambil data rekam medis pasien pneumonia komunitas yang dirawat inap. Didefinisikan sebagai PRO apabila dari hasil kultur sputum didapatkan resisten terhadap antibiotik golongan β-laktam non pseudomonas (ceftriaxone, cefotaxime, ampicilin sulbaktam), Makrolid (azitromisin) dan fluorokuinolon respirasi (levofloxacin, moxifloxacin). Performa skor dianalisis dengan menentukan nilai kalibrasi dan diskriminasi menggunakan uji Hosmer-Lemeshow dan AUROC.Hasil: Sebanyak 254 subyek yang memenuhi kriteria pemilihan diikutkan dalam penelitian. Terbagi menjadi kelompok PRO 103 pasien (40,6%) dan non PRO 151 pasien (59,4%). Hasil analisis kalibrasi skor DRIP dengan uji Hosmer-Lemeshow didapatkan nilai p=0,001 (p<0,05). Sementara untuk analisis diskriminasi skor DRIP dari kurva ROC didapatkan nilai AUC 0,759 (IK95%;0,702-0,810). Pada skor ≥ 4, skor DRIP memiliki nilai sensitivitas 70,9%, spesifisitas 92,7%, nilai prediksi positif 86,9%, dan nilai prediksi negatif 82,3%.Simpulan: Skor DRIP memiliki performa yang baik untuk memprediksi infeksi akibat patogen PRO pada pneumonia komunitas.

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Background: In recent years, problems that often arise in community-acquired pneumonia are related to drug-resistant pathogens. The DRIP score is a predictive score model for Drug-Resistant Pathogens (DRP) in community-acquired pneumonia. It also has a better DRP pathogen prediction accuracy compared to other alternative scores including HCAP. There is no validation study on the use of the DRIP score in Indonesia, so the accuracy of this score prediction in the population, patient characteristics and germ patterns in Indonesia is not known, especially in RSUPN dr. Cipto Mangunkusumo Jakarta.

Objective: This study aims to determine the performance of the DRIP score as an instrument in predicting infection due to DRP pathogens in community-acquired pneumonia at Cipto Mangunkusumo Hospital Jakarta, Indonesia.

Methods: A study with cross-sectional design, on community-acquired pneumonia patients who were treated at Cipto Mangunkusumo Hospital in the period January 2019 to June 2020. Furthermore, this was conducted by reviewing medical records of inpatients. It is defined as DRP if the sputum culture results show resistance to non pseudomonas β-lactam antibiotics (ceftriaxone, cefotaxime, ampicillin-sulbactam), macrolides (azithromycin) and respiratory fluoroquinolones (levofloxacin, moxifloxacin). Score performance analyzed by determining the calibration and discrimination values using the Hosmer-Lemeshow and AUROC tests.

Results: 254 subjects who met the selection criteria were included in the study. It was divided into a PRO group of 103 patients (40.6%) and a non-PRO of 151 patients (59.4%). The results of the calibration analysis of the DRIP score with the Hosmer- Lemeshow test obtained a value of p=0.001 (p<0.05). Discrimination analysis from ROC curve got an AUC value of 0.759 (CI95%; 0.702-0.810). At a threshold ≥ 4 points, DRIP score demonstrated a sensitivity of 70,9%, a specificity of 92,7%, a positive predictive value of 86,9%, a negative predictive value of 82,3%.

Conclusions: The DRIP score have good performance to predict infections due to DRP pathogens in community-acquired pneumonia."

"Meningkatnya jumlah pasien lanjut usia dan pasien disfungsi imun berkontribusi terhadap tingginya beban infeksi jamur invasif di Indonesia. Keterbatasan informasi dan pedoman penggunaan antijamur sistemik di Indonesia menyebabkan penggunaannya berkaitan dengan masalah terkait obat (MTO). Di Indonesia, antijamur sistemik bentuk injeksi memiliki biaya yang tinggi dan ketersediaan yang terbatas. Penelitian cross-sectional ini bertujuan untuk mengevaluasi profil penggunaan dan MTO antijamur sistemik bentuk injeksi di RSUPN dr. Cipto Mangunkusumo Gedung A periode Januari-Desember tahun 2022. Pengambilan sampel menggunakan metode quota sampling pada data sekunder berupa rekam medis. Analisis MTO terhadap regimen pengobatan pasien difokuskan pada ketepatan dosis, ketepatan durasi, potensi interaksi obat, dan efek samping obat. Flukonazol merupakan antijamur sistemik bentuk injeksi yang paling sering digunakan (63,6%) dengan indikasi penggunaan empiris yang paling umum (41,1%). Kandidiasis merupakan jenis infeksi jamur invasif yang paling umum terjadi (26,2%) dengan median durasi pengobatan antijamur sistemik selama 9 (4-26) hari. Terdapat 45 pasien yang mengalami MTO. Termasuk dosis terlalu rendah sebanyak 4 (3,7%), durasi pengobatan terlalu singkat sebanyak 10 (9,3%), durasi pengobatan terlalu lama sebanyak 3 (2,8%), potensi interaksi obat sebanyak 19 (17,8%), dan efek samping obat sebanyak 18 (16,8%) pasien. Hasil uji Chi-square menunjukkan bahwa pasien dengan durasi pengobatan  >9 hari (p = 0,041) dan berusia >60 tahun (p = 0,005) lebih tinggi 2,438 dan 3,646 kali mengalami MTO antijamur sistemik bentuk injeksi. Temuan terkait efek samping obat dan interaksi obat memerlukan pemantauan oleh tenaga kesehatan dan implementasi protokol de-eskalasi antijamur untuk MTO terkait durasi dapat mengurangi biaya perawatan pasien di rumah sakit.

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The rising population of elderly and immunocompromised patients contributes to Indonesia's high burden of invasive fungal infections. Limited information and guidelines on systemic antifungal agents in Indonesia contribute to drug-related problems (DRPs). Moreover, in Indonesia, injectable forms of systemic antifungals have high costs and limited availability. This cross-sectional study aims to assess the utilization profile and DRP of injectable systemic antifungal medicines at dr. Cipto Mangunkusumo Hospital Building A between January and December 2022. This study utilized quota sampling of secondary data from medical records. The DRP evaluation of patient treatment regimens focused on dosage accuracy, duration accuracy, possible drug interactions, and adverse drug events (ADE). Fluconazole was the most frequently administered intravenous antifungal drug (63,66%), with empirical therapy being the primary indication for treatment (41,1%). Candidiasis was the most prevalent invasive fungal infection (26,2%), and the median duration of intravenous antifungal treatment was 9 (4-26) days. A total of 45 patients experienced DRPs, encompassing dosage too low in 4 (3,7%), treatment duration too short in 10 (9,3%), treatment duration too long in 3 (2,8%), potential drug interactions in 19 (17,8%), and ADE occurring in 18 (16,8%) patients. Chi-square analysis indicated that patients with treatment duration >9 days and those >60 years of age were 2,438 and 3,646 times more likely to experience DRPs (p = 0,041 and p = 0,005, respectively). Findings concerning ADE and potential drug interactions require monitoring by healthcare providers, and antifungal de-escalation protocols for duration-associated DRPs help reduce hospitalization costs."

"Penyebaran mikroba yang resisten terhadap pengobatan merupakan tantangan kesehatan masyarakat yang menyeluruh, yang akan menurunkan efektivitas obat dan mengakibatkan tingginya angka kesakitan dan kematian serta bertambahnya biaya pengobatan. Pengawasan resistensi obat antimikrobial melalui laporan data tentang pola resistensi mikroba terhadap suatu antimikroba akan berguna untuk mencegah timbulnya resistensi. Pada studi ini akan dilaporkan tentang pola resistensi mikroba terhadap ceftriaxone dalam 4 tahun terakhir. Data yang dilaporkan ini berasal dari spesimen yang diperiksa di Laboratorium Mikrobiologi Klinik, Departemen Mikrobiologi FKUI dari tahun 2002 sampai dengan 2005. Spesies mikroba ditentukan melalui kultur dan uji identifikasi. Disc Diffussion Methods digunakan untuk uji sensitivitas ceftriaxone terhadap 14 bakteri Gram-negatif dan 7 bakteri Gram-positif. Hasilnya memperlihatkan, walaupun angka resistensi mikroba terhadap ceftriaxone meningkat dari tahun 2002 sampai 2005, tetapi secara umum masih kurang dari 50%. Angka resistensi yang rendah (< 3%) terlihat untuk Salmonella typhi, Salmonella paratyphi A, Shigella flexneri, Serratia marcescens, dan Streptococcus pneumoniae. Hasil ini dapat digunakan untuk menyusun pedoman penggunaan ceftriaxone di Indonesia.

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AbstractThe spread of drug resistant microbes is a global public health challenge which impairs the efficacy of antimicrobial agents and causes substantial increase in morbidity and mortality rates, including healthcare-associated costs. Monitoring of antimicrobial drug resistance from documented microbial epidemiology & resistance rate is useful in preventing the emergence of resistance. This study reports on the pattern of bacterial resistance against ceftriaxone in the past 4 years. The data were obtained from specimens examined in the Clinical Microbiology Laboratory, Department of Microbiology Faculty of Medicine, University of Indonesia from 2002 to 2005. Microbial species were determined from culture and identification tests. Disc diffusion method was used for sensitivity testing of ceftriaxone to 14 Gram-negative and 7 Gram-positive bacteria. Although resistance rates were increased from 2002 to 2005, resistance rates of ceftriaxone were found to be less than 50%. Low resistance rates (< 3%) were observed for Salmonella typhi, Salmonella paratyphi A, Shigella flexneri, Serratia marcescens, and Streptococcus pneumoniae. These results could be useful in developing guidelines on the use of ceftriaxone in Indonesia. "

"Latar Belakang: Infeksi intraabdomen komplikata (IIAK) memiliki prevalensi tinggi dan angka mortalitas tinggi. Berdasarkan panduan di Indonesia, IIAK diberikan terapi empiris kombinasi aminoglikosida dan metronidazole. Resistensi antibiotik di Indonesia semakin meningkat setiap tahunnya. Resistensi antibiotik dipengaruhi oleh usia, komorbiditas, dan keparahan penyakit. Belum ada penelitian mengenai resistensi antibiotik terhadap terapi empiris amikasin pada infeksi intraabdomen komplikata, termasuk faktor-faktor yang memengaruhinya.Metode: Desain penelitian potong lintang dengan teknik pengambilan data secara retrospektif pada 44 pasien infeksi intraabdomen komplikata yang membutuhkan laparotomi darurat dari rekam medis Kelompok Staf Medis Bedah RSCM tahun 2019-2023. Analisis perbandingan faktor-faktor yang memengaruhi resistensi antibiotik dilakukan dengan chi-square dan regresi logistik. Semua hasil uji statistik dianggap bermakna jika nilai p<0,05.Hasil: Sebanyak 44 subjek diinklusi dan didapatkan 13 subjek (29,5%) mengalami resistensi terhadap amikasin. Keempat faktor yang diteliti tidak memiliki hubungan bermakna dengan resistensi antibiotik amikasin pada pasien infeksi intraabdomen komplikasi, yaitu usia (OR 1,98; IK95% 0,41-9,53), obesitas (OR 1,98; IK95% 0,41-9,53), diabetes melitus (OR 0,88; IK95% 0,06-13,29), dan sepsis (OR 1,38; IK95% 0,27-7,04). Hal tersebut dapat disebabkan oleh sedikitnya jumlah subjek pada penelitian ini.Kesimpulan: Prevalensi resistensi antibiotik empiris amikasin pada pasien infeksi intraabdomen komplikasi adalah 29,5%. Faktor-faktor, seperti usia, obesitas, diabetes melitus, dan sepsis tidak memiliki hubungan bermaksa dengan kejadian resistensi antibiotik amikasin pada infeksi intraabdomen komplikata di RSCM pada tahun 2019-2023.

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Background: Complicated intra-abdominal infection (CIAIs) has a high prevalence and high mortality rate. Based on Indonesian guidelines, CIAIs is given empirical therapy with a combination of aminoglycosides and metronidazole. Antibiotic resistance in Indonesia is increasing every year. Antibiotic resistance is influenced by age, comorbidities, and disease severity. There has been no research on antibiotic resistance to empirical amikacin therapy in complicated intra-abdominal infections, including the factors that influence it.

Methods: A cross-sectional study design with retrospective data collection techniques on 44 patients with complicated intra-abdominal infections requiring emergency laparotomy from the medical records of the RSCM Surgical Medical Staff Group in 2019-2023. Comparative analysis of factors affecting antibiotic resistance was performed by chi-square and logistic regression. All statistical test results were considered significant if the p value was <0.05.

Results: A total of 44 subjects were included and 13 subjects (29.5%) experienced resistance to amikacin. The four factors studied did not have a significant relationship with amikacin antibiotic resistance in patients with complicated intra-abdominal infections, namely age (OR 1.98; 95% CI 0.41-9.53), obesity (OR 1.98; 95% CI 0.41-9.53), diabetes mellitus (OR 0.88; 95% CI 0.06-13.29), and sepsis (OR 1.38; 95% CI 0.27-7.04). This could be due to the small number of subjects in this study.

Conclusion: The prevalence of empirical antibiotic resistance of amikacin in patients with complicated intra-abdominal infections is 29,5%. Age, obesity, diabetes mellitus, and sepsis do not have a statistically significant relationship with the incidence of amikacin antibiotic resistance in complicated intra-abdominal infections at RSCM in 2019-2023."