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"Penggunaan antibiotik yang tidak sesuai dapat meningkatkan laju mortalitas pada pasien sepsis. Sepsis masih manjadi penyebab kematian tersering di ruang perawatan intensif. Tujuan penelitian ini yaitu untuk mengevaluasi kesesuaian penggunaan antibiotik dengan luaran pasien sepsis, serta faktor-faktor yang mempengaruhinya di ruang perawatan Intensive Unit Care ICU . Penelitian ini merupakan penelitian deskriptif analitik dengan menggunakan metode cross-sectional yang dilakukan pada pasien sepsis di ICU Rumah Sakit Kanker Dharmais, Jakarta, Indonesia, selama bulan Februari sampai Mei 2017. Data dikumpulkan dari rekam medis pasien. Pasien dewasa dengan sepsis dan syok septik yang menerima antibiotik parenteral dimasukkan ke dalam kriteria inklusi. Pasien berusia kurang dari 18 tahun atau dengan lama rawat di ICU kurang dari 24 jam tidak disertakan dalam penelitian ini. Data dianalisis dengan menggunakan program SPSS Versi 23.0. Subjek penelitian yang diperoleh yaitu sebanyak 60 pasien. Hasil penelitian menemukan sebanyak 115 antibiotik diresepkan untuk pasien ini. Penggunaan antibiotik yang tidak sesuai berdasarkan pola kuman lokal sebanyak 45,22 . Pasien yang menerima rejimen antibiotik yang tidak sesuai berdasarkan rekomendasi pedoman Survival Sepsis Campaign SSC tahun 2016 yaitu sebanyak 33,33 dan terdapat 51,67 menerima dosis yang tidak sesuai berdasarkan rekomendasi Drug Information Handbook. Analisis bivariat menunjukkan bahwa ada hubungan yang signifikan antara ketidaktepatan pemberian dosis antibiotik dengan laju mortalitas p=0,034; p

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An inappropriate antibiotic usage can increase the mortality rate in sepsis patients. Sepsis still the most common cause of death in intensive unit care ICU . This study aims to evaluate the appropriateness of antibiotics use and the factors associated with outcome of sepsis patients in ICU. This study was an analityc descriptive study using cross sectional method for sepsis patients in the ICU of Dharmais Cancer Hospital, Jakarta, during February to May 2017. The data is collected from patient rsquo s medical record files. Inclusion criteria is an adult patients with sepsis and septic shock who received parenteral antibiotics. Patients less than 18 years of ages or with lenght of stay in ICU less than 24 hours were excluded. Then, it analyzed using the SPSS Version 23.0 software program. There are 60 patients act as study subjects. As result, 115 antimicrobial was prescribed for these patients. The inappropriate antibiotic usage reached 45,22 , based on local microbial pattern. Among 60 patients, 33.33 received inappropriate types of antibiotics regimens based on Survival Sepsis Campaign SSC guidelines and 51.67 received inappropriate doses based on Drug Information Handbook. Bivariat analysis showed that there was significant correlation between inappropriate doses of antibiotics and mortality p 0.034 p"

"Penggunaan antibiotik yang tinggi pada pasien sepsis dapat memicu penggunaan antibiotik yang tidak rasional. Upaya untuk memaksimalkan penggunaan antibiotik yang rasional merupakan salah satu tanggung jawab apoteker. Penelitian ini bertujuan untuk mengevaluasi kualitas dan kuantitas penggunaan antibiotik pada pasien sepsis di ruang rawat Intensive care unit (ICU) dengan metode Gyssens dan ATC/DDD dan mengevaluasi pengaruh intervensi apoteker dalam meningkatkan kualitas penggunaan antibiotik dan outcome terapi. Penelitian dilakukan secara prospektif selama periode Agustus-November 2018 dengan menggunakan rancangan studi pra eksperimen one grup pretest-posttest. Rekomendasi diberikan kepada penulis resep terhadap masalah ketidaktepatan penggunaan antibiotik yang ditemukan. Evaluasi kualitatif dengan metode Gyssens diperoleh hasil bahwa penggunaan antibiotik pada pasien sepsis yang rasional sebesar 85,09 % dan yang tidak rasional sebesar 14,91 %. Jenis antibiotik, jenis terapi antibiotik, jumlah antibiotik  dan lama penggunaan antibiotik berpengaruh terhadap kualitas penggunaan antibiotik. Intervensi meningkatkan ketepatan penggunaan antibiotik (0 % menjadi 64,71 %), menurunkan masalah pemilihan antibiotik (88,24 % menjadi 32,35 %), masalah lama pemberian antibiotik (5,88 % menjadi 0 %) dan masalah rute pemberian obat (5,88 % menjadi 0 %). Kualitas penggunaan antibiotik yang rasional dan yang tidak rasional berpengaruh terhadap hasil terapi. Kuantitas penggunaan antibiotik sebesar 63,84 DDD/patient-day dengan nilai terbesar pada antibiotik meropenem yaitu 32,91 DDD/patient-day.

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High use of antibiotics in sepsis patients can lead to irrational use of antibiotics. Pharmacist has responsibility to improve appropriate antibiotics usage. This study was proposed to evaluate quality and quantity of antibiotics usage in sepsis patients in the Intensive care unit (ICU) ward with the Gyssens and ATC/DDD methods and evaluate whether intervention of pharmacy can improve quality of antibiotics usage and therapy outcome. The study was conducted prospectively during the period August - November 2018 using pre experiment one grup pretest-posttest design. Recommendations were given to prescribers to solve the problems of inappropriate antibiotics usage. Qualitative evaluation using that about 85.09 % antibiotic prescriptions were appropriate, and 14.91 % were inappropriate. Type of antibiotics, type of antibiotic therapy, total and duration antibiotics used by patients have effect on quality and quantity antibiotics usage. Intervention of pharmacist improve appropriateness of antibiotics (0% to 64.71 %), decrease drug choice problems (88.24 % to 32.35 %), duration problems (5.88 % to 0 %) and route of administration problems (5.88 % to 0 %). Appropriate used of antibiotics had significant different effect to outcome therapy compare with inappropriate used of antibiotics. The quantity of antibiotic use is 63.84 DDD/patient-day with the greatest value on meropenem antibiotics is 32.91 DDD/patient-day."

"Ventilator-associated pneumonia VAP adalah infeksi paru yang muncul setelah lebih dari 48 jam pemakaian ventilator mekanik atau pemasangan intubasi endotrakeal. Insidensi VAP bervariasi antara 8 hingga 28 dan memiliki angka mortalitas sampai 50 . Hal ini tentu saja berhubungan dengan peningkatan resiko infeksi lain, peningkatan biaya rawat inap biaya kesehatan dan peningkatan lama rawat di ICU. Tujuan penelitian ini adalah mengevaluasi kualitas penggunaan antibiotik untuk pengobatan VAP di ruang ICU RS Kanker Dharmais dengan metode Gyssens dan mengevaluasi perbedaan outcome pasien dengan antibiotik rasional dan antibiotik tidak rasional. Penelitian deskriptif analitik dengan pendekatan prospektif ini dilaksanakan dari Februari sampai Mei 2017. Peneliti mengambil sampel dengan metode total sampling, sehingga mengikutsertakan seluruh pasien yang berada di ruang ICU dengan memberikan beberapa kriteria inklusi dan eksklusi kemudian dianalisis dengan metode Gyssens. Dari 159 pasien yang menggunakan ventilator ada 29 pasien 18,24 yang memenuhi kriteria VAP dan menjadi subyek penelitian ini. Antibiotik yang paling sering digunakan adalah meropenem dan kemudian diikuti dengan levofloxacin. Faktor yang mempengaruhi kualitas penggunaan antibiotik antara lain adalah jenis terapi, jumlah antibiotik yang digunakan oleh pasien dan lama perawatan pasien P

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Objectives This study aims to evaluate the quality of antibiotic use for VAP treatment in ICU Dharmais Cancer Hospital using Gyssens method, evaluate the different outcomes of antibiotic therapy that are rational and irrational according to the Gyssens method, and evaluating the distribution of rational category 0 and irrational category 1 5 antibiotic use. Methods This prospective study was carried out from February to May 2017 with descriptive analyses. Antibiotic uses were documented prospectively by a pharmacist and analyse by using Gyssens method. Pharmacist was used total sampling method, which is included all adult VAP patients in ICU. Results A total of 29 patients 18,24 were reviewed from 159 patients. The most dominant antibiotic use for VAP empiric treatment was meropenem and the most dominant antibiotic use for VAP definitive treatment was levofloxacin. Factors affecting the quality of antibiotic use include type of therapy, number of antibiotic used by patient and length of stay P"

"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."

"Bedah merupakan salah satu prosedur medis yang dilakukan secara manual dan menyebabkan banyak perlukaan dan berisiko tinggi menyebabkan infeksi Adanya infeksi harus ditangani dengan antibiotika empiris yang tepat dan rasional. Penelitian ini dilakukan untuk memperoleh data penggunaan antibiotika empiris pada pasien pascabedah di Ruang ICU RSAL Dr Mintohardjo selama periode 2012 2013 dan melakukan evaluasi kerasionalannya dilihat dari ketepatan pasien ketepatan indikasi ketepatan obat ketepatan dosis dan interaksi obat. Penelitian dilakukan dengan pengambilan data penggunaan antibiotik empiris dari rekam medis pasien pascabedah dengan metode retrospektif dengan desain cross sectional. Pengambilan sampel penelitian dilakukan dengan tekniktotal sampling. Populasi penelitian berjumlah 299 pasien dan 35 pasien diterima sebagai sampel penelitian. Pada penilaian terhadap jumlah pasien pascabedah terdapat 100 pasien mendapatkan terapi antibiotik tepat dengan kondisi pasien 11 43 pasien mendapatkan antibiotik sesuai indikasi 0 pasien mendapatkan antibiotik tepat obat 85 71 pasien sudah mendapatkan dosis yang tepat dan 51 43 pasien tidak mengalami interaksi obat. Sehingga dapat disimpulkan pengobatan antibiotik empiris pada pasien pascabedah di RSAL Dr Mintohardjo tidak rasional.

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Surgery is a manual medical procedure which causes many wounds and has a high infection risk Patient who has infection must be given antibiotic immediatelyand rationally. The aim of this study was to collect empiric antibiotics usage data in Intensive Care Unit of Naval Hospital Dr Mintohardjo 2012 2013 and to evaluate rationality of the administration through the appropriate patient appropriate indication appropriate drug appropriate dose and drugs interaction. This retrospective cross sectional study was done by collecting empiric antibiotics usage data from medical record of postoperative patients on 2012 2013 using total sampling. Population of study included 299 patients and 35 patients were accepted as samples of study. Appropriate assessment based on number of postoperative patients showed 100 appropriate patient 11 43 appropriate indication 0 appropriate drug 85 71 appropriate dose and 31 43 no drugs interaction. It was concluded that empirical antibiotic treatment in postoperative patients in Naval Hospital Dr Mintohardjo were irrational."

"Penggunaan antibiotik yang tidak rasional dapat menyebabkan sulitnya penanganan penyakit infeksi karena dengan meningkatnya penggunaan antibiotik yang tidak rasional, tingkat resistensi kuman terhadap antibiotik akan terus meningkat. Salah satu penyakit infeksi yang mempunyai prevalensi tinggi di Indonesia adalah SIRS, yang mencakup sepertiga dari pasien yang dirawat di ICU. SIRS (Systemic Inflammatory Response Syndrome) merupakan respons klinis terhadap rangsangan spesifik dan nonspesifik, yang disebabkan oleh faktor infeksi maupun non-infeksi. SIRS yang terjadi akibat infeksi perlu diberikan terapi antibiotik yang rasional. Penelitian ini dilakukan untuk mengetahui pola penggunaan antibiotik pada pasien SIRS di Ruang ICU RSAL Dr. Mintohardjo dan melakukan evaluasi kerasionalannya dilihat dari ketepatan pasien, ketepatan indikasi, ketepatan obat, ketepatan dosis, dan tanpa interaksi obat. Penelitian ini merupakan studi survey yang dilakukan dengan cara pengambilan data penggunaan antibiotik dari rekam medis pada periode 2012-2013 secara retrospektif dengan desain cross-sectional dan pengambilan sampel dengan teknik total sampling. Populasi penelitian bejumlah 148 pasien dan 35 pasien diterima sebagai sampel penelitian dengan total administrasi antibiotik sebanyak 91 kali dengan rincian sebagai berikut, antibiotik tunggal sebanyak 8 kali dan kombinasi 62 kali. Antibiotik yang paling sering digunakan adalah meropenem, sedangkan antibiotik yang paling sering dikombinasi adalah meropenem+metronidazol. Penggunaan antibiotik yang memenuhi kriteria tepat pasien sebanyak 100,00%, tepat indikasi 22.86%, tepat obat 2.86%, tepat dosis 74.29% dan tanpa interaksi obat 31.43%. Hasil secara keseluruhan pemberian antibiotik empiris pada pasien penderita SIRS dinilai tidak ada yang memenuhi kriteria rasional.

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The irrationality of antibiotics usage can lead to difficulty in handling infectious diseases. This occurs due to the increased of antibiotics usage that are not rational will rising the level of resistance of germs to antibiotics. One of the diseases that have a high prevalence of infection in Indonesia is SIRS, which covers one-third of the patients treated in the ICU. SIRS (Systemic Inflammatory Response Syndrome) is a clinical response to specific and nonspecific insult, which are caused by infectious or non-infectious. SIRS caused by infection should be given a rational empirical antibiotic therapy. This study was conducted to determine the pattern of antibiotic usage in patients with SIRS in ICU Naval Hospital Dr. Mintohardjo and evaluation of the accuracy of precision patient, an indication of accuracy, precision medicine, precision dosing, and no drug interactions.

The study is a survey study done by collecting data from medical records of antibiotic usage in 2012-2013 with a retrospective methods, cross-sectional design and sampling with a total sampling technique. Population of study included 148 patients and 35 patients were accepted as samples of study. The study showed that the administration of antibiotics were given 91 times with the following details, a single antibiotic were given 8 times and the combination of antibiotic were given 62 times. The antibiotics most commonly used are meropenem, while most antibiotics are often combined meropenem + metronidazole. Patientd that giben empirical antibitocs with following criteria like right patients as much as 100.00%, 22.86% precise indications, 2.86% right drug, the right dose 74.29% and 31.43% with no drug interactions. There is no rationality in empirical antibiotics usage for patient with SIRS in Naval Hospital Dr. Mintohardjo."

"Perawat di unit perawatan intensif memiliki beban kerja yang tinggi, yang dapat menjadi sumber stres kerja bagi perawat ICU. Penelitian deskriptif ini bertujuan untuk mengidentifikasi tingkat stres kerja yang dialami perawat di ICU RS. Kanker Dharmais. Sampel pada penelitian ini adalah total populasi yaitu sebanyak 33 responden. Penelitian ini menunjukkan bahwa 22 orang (66.7%) perawat di ruang ICU mengalami tingkat stres kerja sedang. Peneliti merekomendasikan untuk dilakukan penelitian lanjutan tentang faktor-faktor stres kerja atau hubungan karakteristik responden dengan tingkat stres kerja. Penelitian ini bermanfaat sebagai sumber masukan untuk strategi menurunkan stres kerja atau manajemen stres pada perawat di ICU.

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Nurses in the intensive care unit have a high workload, which can lead a work stress for them. This descriptive study aims to identify the level of work stress of nurses in ICU Dharmais Cancer Hospital. Data were collected from total sampling of 33 nurses. Study showed that 22 (66.7%) nurses in the ICU had moderate work stress levels. Some recommendation of this study were proposed that future research could be identify factors related to work stress level. The result of this study would be beneficial to develop the stress management among ICU nurses."

"Upaya untuk memaksimalkan penggunaan antibiotik yang rasional merupakan salah satu tanggung jawab penting dari pelayanan farmasi. Penggunaan obat dikatakan rasional jika obat yang digunakan sesuai indikasi, kondisi pasien dan pemilihan obat yang tepat terkait jenis, sediaan, dosis, rute, waktu dan lama pemberian, mempertimbangkan manfaat dan resiko dari obat yang digunakan. Penggunaan antibiotik yang tidak tepat dapat menyebabkan pengobatan lebih mahal, efek samping lebih toksik, meluasnya resistensi dan timbulnya kejadian superinfeksi yang sulit diobati. Setelah melakukan pemantauan terapi obat pada pasien di ruang ICU RSUP Fatmawati, kesimpulan yang didapat: Pengobatan yang diterima oleh Nn. TRA sudah sesuai dengan indikasi penyakit, yaitu abses submandibularis, dengan frekuensi pengobatan dan dosis antibiotik juga dinilai sudah tepat. Pada Ny. AAH, didapatkan adanya obat yang tidak sesuai indikasi, yaitu tigecycline dan penggunaan meropenem serta levofloxacin juga tidak tepat dosis dan tidak tepat frekuensi pemakaian. Sepanjang penggunaan tigecycline, kondisi pasien justru memburuk hingga kemudian dinyatakan meninggal pada tanggal 11 April 2022 akibat gagal ventilasi dan sepsis pneumonia. Penggunaan tigecycline kemungkinan tidak efektif. Perhitungan DDD/100 patient-days, meropenem memiliki nilai DDD tertinggi,  kemudian disusul oleh amikasin, levofloxacin, metronidazole, dan tigecycline secara berurutan. Pada perhitungan DU 90 %, meropenem, amikacin, dan levofloxacin termasuk dalam segmen tersebut. Antibiotik yang memiliki nilai DDD/100 patient-days yang tinggi dan termasuk dalam segmen 90 % perlu diawasi penggunaannya dengan baik karena penggunaan yang tinggi dapat meningkatkan resiko terjadinya resisten antibiotik.

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Efforts to maximize the rational use of antibiotics is one of the important responsibilities of pharmaceutical services. The use of drugs is said to be rational if the drugs used are according to the indications, the patient's condition and the selection of the right drug regarding type, preparation, dose, route, time and duration of administration, considering the benefits and risks of the drug used. Inappropriate use of antibiotics can cause more expensive treatment, more toxic side effects, widespread resistance and the emergence of superinfections that are difficult to treat. After monitoring drug therapy on patients in the ICU at Fatmawati Hospital, the conclusion was obtained: The treatment received by Ms. TRA is in accordance with the indications of the disease, namely submandibular abscess, with the frequency of treatment and dosage of antibiotics also considered to be appropriate. To Mrs. AAH, it was found that there were drugs that were not according to indications, namely tigecycline and the use of meropenem and levofloxacin, which also included incorrect doses and incorrect frequency of use. Throughout the use of tigecycline, the patient's condition worsened until he was declared dead on April 11 2022 due to ventilation failure and pneumonia sepsis. The use of tigecycline may not be effective. Calculating DDD/100 patient-days, meropenem has the highest DDD value, followed by amikacin, levofloxacin, metronidazole, and tigecycline in sequence. In the 90% DU calculation, meropenem, amikacin, and levofloxacin are included in this segment. Antibiotics that have a high DDD/100 patient-days value and are included in the 90% segment need to be monitored carefully because high use can increase the risk of antibiotic resistance."

"Pasien kanker memiliki risiko tinggi berkembangnya komplikasi akibat infeksi selama penanganan penyakit dan proses pengobatan. Antibiotik sebagai obat yang digunakan dalam penanganan infeksi harus diberikan secara rasional untuk mencegah kejadian resistensi. Penelitian ini bertujuan untuk mengevaluasi penggunaan antibiotik pada pasien kanker di Rumah Sakit Kanker Dharmais periode bulan Januari-Juni 2017. Penelitian ini merupakan penelitian deskriptif dengan desain studi cross-sectional. Pengambilan data dilakukan secara retrospektif dari data resep pasien dengan teknik total sampling. Sampel dalam penelitian ini adalah resep pasien kanker 18-59 tahun yang menjalani rawat inap di Rumah Sakit Kanker Dharmais pada periode bulan Januari-Juni 2017. Penelitian dilakukan terhadap 2179 resep pasien yang memenuhi kriteria inklusi.Hasil penelitian menunjukkan bahwa antibiotik yang paling sering digunakan pada periode penelitian ini berasal dari golongan sefalosporin dengan jenis sefiksim. Total kuantitas penggunaan antibiotik dalam satuan DDD dan DDD/100 pasien/hari adalah 53069,23 dan 182,72. Kuantitas antibiotik terbesar yang dinyatakan dalam satuan DDD dan DDD/100 pasien/hari adalah levofloksasin dengan nilai 10660 dan 36,70. Ada sebanyak 12 jenis antibiotik yang menyusun segmen DU90 pada periode penelitian ini yaitu levofloksasin, seftriakson, meropenem, sefiksim, siprofloksasin, isoniazid, seftazidim, etambutol, metronidazol, sefotaksim, sefepim, dan rifampisin. Oleh sebab itu dapat disimpulkan bahwa penurunan kuantitas dan peningkatan kualitas penggunaan antibiotik dapat menurunkan kejadian resistensi.

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Cancer patients has a high risk of developing complications from infection during disease management and treatment processes. Antibiotics as drugs used in the treatment of infections should be given rationally to prevent the occurrence of resistance. This study was conducted to evaluate the use of antibiotics in cancer patients in Dharmais Cancer Hospital during the period of January June 2017. This research was a descriptive study with cross sectional study design. Data retrieval was done retrospectively from patients rsquo recipe data with total sampling technique. Samples in this study were recipes of cancer patients 18 59 years old who underwent inpatient at Dharmais Cancer Hospital in January June 2017. This study was conducted on 2179 recipe of patients who met the inclusion criteria.The results showed that the most commonly used antibiotics during this period of study came from the cephalosporin group with the cefixime type. The total quantity of antibiotic used expressed in DDD and DDD 100 patients day was 53069,23 and 182,72. The largest quantity of antibiotics used expressed in units of DDD and DDD 100 patients day were levofloxacin with value 10660 and 36,70. There were 12 types of antibiotics that made up the DU90 segment in this study period, which were levofloxacin, ceftriaxone, meropenem, cefixime, ciprofloxacin, isoniazid, ceftazidime, ethambutol, metronidazole, cefotaxime, cefepime, and rifampicin. Therefore it can be concluded that the decrease in quantity and increase the quality of antibiotic used can decrease the incidence of resistance."

"Infeksi Saluran Pernapasan Akut (ISPA) termasuk penyakit yang menyebabkan kematian tertinggi pada anak, terutama di negara berkembang seperti Indonesia. Penelitian ini bertujuan untuk mengidentifikasi masalah terkait obat (MTO) pada pasien ISPA anak berdasarkan parameter MTO dari Cipolle, Strand, Morley, meliputi ketepatan pemilihan obat yaitu terapi obat tambahan dan terapi obat kurang, ketepatan indikasi, kesesuaian dosis terdiri dari dosis berlebih dan dosis kurang, serta kemungkinan reaksi yang tidak diinginkan (ROTD) berupa interaksi obat. Desain penelitian menggunakan metode cross-sectional bersifat deskriptif dengan pengambilan data retrospektif. Sampel pada penelitian ini meliputi resep pasienpasien di Poli MTBS (Manajemen Terpadu Balita Sakit) Puskesmas Kecamatan Tebet pada periode Juli – Desember 2018, dengan teknik pengambilan data total sampling. Sampel yang diperoleh sejumlah 179 lembar resep pasien dengan total 498 peresepan obat. Hasil penelitian MTO pada pasien ISPA anak untuk masing – masing parameter antara lain ketidaktepatan pemilihan obat (9,5%), ketidaktepatan indikasi (12,8%), ketidaksesuaian dosis (79,9%), dan potensi interaksi obat (0,6%). Berdasarkan hasil penelitian ini, dapat disimpulkan bahwa tingginya kejadian MTO pada pasien ISPA anak menyebabkan perlu dilakukan perbaikan peresepan obat dan pemantauan penggunaan obat untuk meminimalisasi kejadian MTO dan mengaplikasikan penggunaan obat yang rasional.

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Acute Respiratory Tract Infection (ARTI) were common to cause the highest death rate in children, especially in growing countries such as Indonesia. The aim of the research is to identify DRPs in ARTI paediatric based on DRPs classification by Cipolle, Strand, Morley, that were being categorized as unnecessary drug therapy, need additional therapy, ineffective drug, dosage adjustments such as too low or too high,  and adverse drug reaction which is drug interaction. The design of the study was cross-sectional with a retrospective method and descriptive study. The sample of the study was the overall prescription to URTI (Upper Respiratory Tract Infection) patient in Puskesmas Kecamatan Tebet Period July – December 2018 that fulfilled all the inclusion criteria, using total sampling method. Total sample that was analysed from 179 sheets of prescription with total prescription of 498 prescription. The result of the research based on each parameter: inaccurate drug selection (9.5%), inaccurate indication (12.8%), mismatched dose (79.9%), and drug interaction (0.6%). To conclude, DRPs in ARTI paediatric were in a high risk condition so the health facilities needed to improve their prescription, monitor and manage each therapy, also to do a routine prescription assessment to minimize the condition and to achieve a rational drug usage."