Hasil Pencarian  ::  Simpan CSV :: Kembali

"

Latar belakang: Resistensi antibiotik merupakan masalah penting dan ancaman bagi kesehatan manusia di hampir seluruh negara. Dampak infeksi bakteri multidrug-resistant (MDR) berupa luaran pasien lebih buruk, biaya perawatan lebih besar, dan penggunaan antibiotik spektrum luas yang berpotensi meningkatkan prevalensi resistensi. Surveilans healthcare-associated infection (HAI) dan identifikasi faktor risiko diharapkan bisa menurunkan laju resistensi.

Tujuan: Menilai kekuatan pengaruh dari komorbiditas, riwayat pengobatan dengan antibiotik intravena 15 hari terakhir, tindakan bedah, penggunaan lebih dari 2 indwelling medical device, dan rawat inap lebih dari 7 hari terhadap terjadinya infeksi bakteri MDR pada pasien anak.

Metode: Penelitian retrospektif di Rumah Sakit Cipto Mangunkusumo Jakarta terhadap pasien berusia 1 bulan-18 tahun dengan pertumbuhan bakteri pada hasil kultur. Data diperoleh dari electronic health record yaitu data demografi, komorbid, riwayat terapi antibiotik, tindakan bedah, medical device, lama rawat inap, data mikrobiologi, dan luaran akhir perawatan.

Hasil: Proporsi bakteri MDR pada penelitian ini sebesar 76,3%. Analisis bivariat tidak menunjukkan adanya hubungan antara komorbiditas, riwayat terapi antibiotik, tindakan bedah, dan penggunaan lebih dari 2 indwelling medical device, dengan infeksi bakteri MDR pada pasien anak. Namun rawat inap lebih dari 7 hari akan meningkatkan risiko pasien anak mengalami infeksi bakteri MDR (OR 2,755; 95% IK 1,107-6,857; P = 0,036).

Simpulan: Pasien anak dengan rawat inap lebih dari 7 hari memiliki risiko hampir 2,7 kali lipat untuk mengalami infeksi bakteri MDR dibanding pasien anak dengan rawat inap 7 hari atau kurang.

---

Background: Antibiotic resistance is an important problem and threats to human health worldwide. Multidrug-resistant (MDR) bacteria infection is associated with poor outcome, higher treatment cost, and higher rate of broad spectrum antibiotic use which may lead to subsequent antibiotic resistance. Healthcare-associated infection surveillance and identification of risk factors can provide effort to control the development of antibiotic resistance.

Objective: Measure the strength of association between comorbidity, intravenous antibiotic use within the last 15 days, surgery procedure, use of more than two indwelling medical devices, and hospital stay more than 7 days, with MDR bacteria infection in pediatric patient.

Methods: Restrospective study in 1 month - 18 years old pediatric patient at Cipto Mangunkusumo Hospital Jakarta who had bacteria growth on microbiological culture. Demographic data, comorbid condition, history of antibiotic use, surgery, indwelling medical device use, length of hospital stay, microbiological data, and mortality were collected from the electronic health record.

Results: Rate of MDR bacteria infection in this study was 76,3%. Bivariate analysis showed no relationships between comorbidity, intravenous antibiotic use in prior 15 days, surgery, and use of more than two indwelling medical devices, with MDR bacteria infection. Pediatric patients with hospital stay longer than 7 days were more likely to have MDR bacteria infection (OR 2,755; CI 95% 1,107-6,857; P = 0,036) compared to those with hospital stay 7 days or less.

Conclusion: Hospital stay longer than 7 days increase risk pediatric patient to contract MDR bacteria infection by 2,7 fold.

"

"Objektif: Infeksi terkait pelayanan kesehatan adalah salah satu kasus infeksi yang masih bertahan di dunia, terutama di negera berkembang seperti Indonesia. Kolonisasi bakteri resistan multi obat diperkirakan berkontribusi untuk infeksi tersebut. Maka dari itu, studi mengenai prevanlensi infeksi terkait pelayanan kesehatan pada rumah sakit primer di Indonesia dan asosiasinya kepada kolonisasi bakteri resisten multiobat adalah bermakna.Metode/Desain: Riset ini bersifat observasi analisis retrospektif cohort menggunakan hasil skrining mikrobiologi dan data sekunder dari rekam medis pasien di RSCM tahun 2022. Jumlah subjek adalah 100 dan dievaluasi menggunakan uji Chi-square. Uji Fisher Exact akan digunakan jika Chi-Square tidak dapat digunakan.Hasil: Uji Fisher Exact menunjukkan bahwa tidak ada perbedaan signifikan secara statistik (nilai p>0.05) antara asosiasi koloniasi bakteri resisten multiobat pada pasien rawat inap dan infeksi terkait pelayanan kesehatan pada RSCM tahun 2022.Kesimpulan: Prevalensi infeksi terkait pelayanan kesehatan pada pasien rawat inap RSCM tahun 2022 adalah 12%. Tidak ada asosiasi antara koloniasi bakteri resisten multiobat pada pasien rawat inap dan infeksi terkait pelayanan kesehatan pada RSCM tahun 2022.

---

Objectives: Healthcare-associated infection is one of the most persistent infectious cases in the world, especially in developing county such as Indonesia. The colonization of MDR bacteria is thought to contribute to such infection. Therefore, a study regarding the prevalence of healthcare associated infection in primary hospitals in Indonesia and its association with MDR bacteria colonization is valuable.

Methods/Design: This research is an observational analytic retrospective cohort study using the microbiological screening results and the secondary data from patients’ medical records in RSCM in 2022. The total subject sample is 100 and evaluated using the Chi-Square test. If the Chi-Square test value is not met, the Fisher Exact test will be used.

Results: The result of the Fisher Exact test showed an insignificant difference (p value>0.05) between the association of MDR bacteria colonization in patients on admission with healthcare-associated infections at RSCM.

Conclusion: The prevalence of healthcare-associated infections in patients admitted to RSCM in 2022 is 12%. The conclusion is there is no association between healthcare-associated infection and multidrug-resistant bacteria colonization in patients admitted to RSCM in 2022."

"ABSTRAKMultidrug-resistant tuberculosis (MDR-TB) adalah tuberkulosis yang disebabkan oleh galur Mtb yang resisten setidaknya terhadap rifampisin dan isoniazid (INH). Penelitian ini bertujuan menilai kemampuan AccuPower TB and MDR Real-Time PCR Kit sebagai metode alternatif dalam mendeteksi Mtb serta resistensi terhadap isoniazid dan rifampisin dibandingkan dengan metode kultur dan uji resistensi konvensional. Subjek penelitian terdiri dari 61 pasien tersangka MDR-TB. Sampel sputum dari semua subjek dilakukan pemeriksaan untuk Mtb dan resistensi terhadap INH dan rifampisin dengan Accupower TB and MDR Real-Time PCR Kit dan metode konvensional. 28 dari 52 pasien terdeteksi resisten terhadap INH dan rifampisin. 1 subjek terdeteksi hanya resisten terhadap INH. 1 subjek terdeteksi hanya resisten terhadap rifampisin. Sensitivitas dan PPV kit dalam mendeteksi Mtb diperoleh 98,1% dan 86,7%. Sensitivitas, spesifisitas, PPV, dan NPV kit dalam mendeteksi resistensi Mtb terhadap INH diperoleh 62,1%, 86,9%, 85,7%, dan 64,5%. Sensitivitas, spesifisitas, PPV, dan NPV kit dalam mendeteksi resistensi Mtb terhadap Rifampisin diperoleh 93,1%, 86,9%, 90% dan 90,9%. Accupower TB and MDR Real-Time PCR Kit dalam mendeteksi resistensi ganda Mtb terhadap INH dan Rifampisin (MDR-TB) memperoleh sensitivitas 53,8%, spesifisitas 57,1%, PPV 88,9%, dan NPV 64,7%. Kit ini cukup baik dalam mendeteksi Mtb dan resistensi terhadap rifampisin, tetapi kurang baik untuk mendeteksi resistensi terhadap INH. Deteksi adanya resistensi tunggal diperlukan, karena monoresistensi dapat berkembang menjadi multi-drug dan extended-drug resistant.

---

ABSTRACT

Multidrug-resistant tuberculosis (MDR-TB) is caused by mycobacterium that is resistant at least to rifampicin and isoniazid (INH). The aim of this study was to assess the performance of Accupower TB and MDR Real-Time PCR Kit compared to the conventional culture-based drug susceptibility test for Mycobacterium tuberculosis (Mtb). Subject was consisted of 61 patients who were suspected of MDR-TB. Sputum samples from the participants were tested for Mtb and INH and rifampicin resistance by Accupower TB and MDR Real-Time PCR Kit and conventional method. 28 of 52 patients were detected resistance to both INH and rifampicin. 1 subject was detected INH resistance only. 1 subject was detected rifampicin resistance only. Sensitivity and PPV of the kit to detect Mtb were 98,1% and 86,7%, respectively. Sensitivity, specificity, PPV, and NPV of the kit in detecting INH resistance were 62,1%, 86,9%, 85,7%, and 64,5%, respectively. Sensitivity, specificity, PPV, and NPV of the kit in detecting rifampicin resistance were 93,1%, 86,9%, 90%, and 90,9%, respectively. Sensitivity, specificity, PPV, and NPV of the kit in detecting INH and rifampicin resistance (MDR-TB) were 53,8%, 57,1%, 88,9%, and 64,7%, respectively. This kit was good enough to detect Mtb and Rifampisin resistance, but not good to detect INH resistance. Detection of single drug resistance is required as mono resistance might develop further to multi-drug and extended-drug resistant."

"Tuberkulosis multidrug resistant (TB MDR) merupakan penyakit infeksi yang terus mengalami peningkatan jumlah kasus setiap tahunnya. Indonesia menempati peringkat ke-delapan dari 27 negara dengan kasus TB MDR paling banyak di dunia (WHO, 2013). Pengobatan yang lebih kompleks dengan durasi yang lebih lama, menjadikan pasien TB MDR seringkali mengalami kegagalan konversi sputum. Kegagalan konversi sputum ini dipengaruhi oleh banyak faktor (multifaktorial). Penelitian ini bertujuan untuk mengetahui hubungan antara faktor demografi (usia dan jenis kelamin), riwayat merokok serta penyakit komorbid (diabetes melitus dan HIV/AIDS) terhadap kejadian gagal konversi sputum pasien TB MDR di RSUP Persahabatan Jakarta tahun 2014-2016. Penelitian ini tergolong penelitian potong lintang dengan data sekunder yang diperoleh dari 51 rekam medis di Poli TB MDR RSUP Persahabatan. Hasil penelitian ini menunjukkan prevalensi pasien TB MDR dengan gagal konversi sputum sebesar 5.6%. Hasil analisis univariat menunjukkan pasien TB MDR dengan gagal konversi sputum didominasi oleh laki-laki (62.7%); usia dewasa (80.4%); memiliki kebiasaan merokok (58.8%); tidak memiliki riwayat diabetes melitus (82.4%); dan tidak memiliki riwayat HIV/AIDS (100%). Hasil analisis bivariat menunjukkan hubungan yang tidak bermakna antara usia (p=0.084); jenis kelamin (p=0.421); kebiasaan merokok (p=0.550); riwayat diabetes melitus (p=0.799) dengan kegagalan konversi sputum pasien TB MDR. Dari hasil tersebut, dapat disimpulkan bahwa usia, jenis kelamin, riwayat merokok, diabetes melitus, dan HIV/AIDS tidak memiliki hubungan yang bermakna dengan kejadian gagal konversi sputum pasien TB MDR di RSUP Persahabatan Jakarta tahun 2014-2016.

---

Multidrug resistant tuberculosis (MDR TB) is an infectious disease that continues to increase in the number of cases every year. Indonesia is on 8th rank among 27 countries with the most cases of MDR TB in the world (WHO, 2013). More complex treatment with longer duration, makes MDR TB patients often have sputum conversion failure. This sputum conversion failure is influenced by many factors (multifactorial). The aim of this study is to determine the relationship between demographic factors (age and gender), smoking habit, comorbid diseases (diabetes mellitus and HIV/AIDS) with sputum conversion failure of MDR TB patients at RSUP Persahabatan Jakarta in 2014-2016. The design of this study is a cross-sectional study with secondary data obtained from 51 medical records in MDR TB Polyclinic at Persahabatan Hospital.

The results of this study showed the prevalence of MDR TB patients with sputum conversion failure is 5.6%. The results of univariate analysis showed that MDR TB patients with sputum conversion failure were dominated by men (62.7%); adult age (80.4%); have a smoking habit (58.8%); have no history of diabetes mellitus (82.4%); and have no history of HIV/AIDS (100%). The results of bivariate analysis showed an insignificant relationship between age (p=0.084); gender (p=0.421); smoking habits (p=0.550); history of diabetes mellitus (p=0.799) with sputum conversion failure of MDR TB patients. From these results, it can be concluded that age, gender, smoking habit, diabetes mellitus, and HIV/AIDS do not have significant relationships with sputum conversion failure of MDR TB patients at RSUP Persahabatan Jakarta in 2014-2016."

"[ABSTRAKLatar Belakang: Pengobatan TB MDR memiliki hasil yang buruk dengan keberhasilan hanya 48% di dunia. Salah satu indikator keberhasilan pengobatan adalah konversi dini. Identifikasi faktor yang mempengaruhi konversi merupakan hal yang penting. Metode: Penelitian ini dilakukan secara kohort retrospektif dengan menggunakan rekam medik pasien TB MDR di RSUP Persahabatan Jakarta yang berobat selama bulan Agustus 2009 - Desember 2013.Hasil: Dari 436 pasien terdapat 248 pasien laki-laki (56.6%). Sebanyak 256 pasien (58,7%) mengalami konversi biakan dalam dua bulan pengobatan. Nilai tengah waktu konversi adalah 44 hari. Faktor yang memperlambat lama konversi adalah jenis kelamin perempuan (aHR 0,808; [95%CI 0,659-0,991]), IMT pasien kurang (0,792; [0,637-0,983]), ditemukan gambaran kavitas pada foto toraks (0,781;[0,634-0,961]), bacterial load 2+ (0,617;[0,439-0,869]), bacterial load 3+ (0,701;[0,501-0,979]), riwayat pengobatan OAT sebelumnya dengan lini kedua (0,597;[0,415-0,858]), jumlah resisten obat > 2 OAT (0,614;[0,429-0,879]), kelompok pasien Pre XDR dan TB XDR (0,486;[0,305-0,776]), dan jumlah limfosit rendah (0,681;[0,524-0,885]).Kesimpulan: Jenis kelamin perempuan, IMT kurang, gambaran kavitas pada foto toraks, tingginya bacterial load, riwayat pengobatan OAT sebelumnya dengan lini kedua, jumlah resisten obat > 2 OAT, kelompok pasien Pre XDR dan TB XDR serta limpositopenia berhubungan dengan lamanya konversi pada pasien TB MDR.

---

ABSTRACTIntroduction: Treatment for MDR-TB has a poor outcomes, success rate was only 48% worldwide. One indicator of treatment success is early culture conversion. Identification of potential factors associated with culture conversion are important.Methods: A cohort rectrospective study using medical records of MDR-TB patients of Persahabatan Hospital during August 2009 until December 2013. Data were analyzed using multivariate analysis.Results : Of a total 436 patients, there are 248 patients (56.6%) were males. Two hundred fifty six patients (58,7%) had sputum culture conversion at two months. The median time to culture conversion was 44 days. The factors for longer sputum culture conversion were female (aHR 0,808; [95%CI 0,659-0,991]), underweight patients (0,792; [0,637-0,983]), cavitaty on chest radiograph (0,781;[0,634-0,961]), bacterial load 2+ (0,617;[0,439-0,869]), bacterial load 3+ (0,701;[0,501-0,979]), previous TB treatment with second line drugs (0,597;[0,415-0,858]), resistance to more 2 TB drugs (0,614;[0,429-0,879]), pre XDR and XDR-TB (0,486;[0,305-0,776]), and lower lymphocites count (0,681;[0,524-0,885]).Conclusion: Female, underweight patients, cavitaty, high bacterial load, previous TB treatment with second line drugs, resistance to more 2 TB drugs, resistance to rifampicine, isoniazid and other second line drugs, and lower lymphocites count were associated with longer time culture conversion in MDR-TB patients.;Introduction: Treatment for MDR-TB has a poor outcomes, success rate was only 48% worldwide. One indicator of treatment success is early culture conversion. Identification of potential factors associated with culture conversion are important.Methods: A cohort rectrospective study using medical records of MDR-TB patients of Persahabatan Hospital during August 2009 until December 2013. Data were analyzed using multivariate analysis.Results : Of a total 436 patients, there are 248 patients (56.6%) were males. Two hundred fifty six patients (58,7%) had sputum culture conversion at two months. The median time to culture conversion was 44 days. The factors for longer sputum culture conversion were female (aHR 0,808; [95%CI 0,659-0,991]), underweight patients (0,792; [0,637-0,983]), cavitaty on chest radiograph (0,781;[0,634-0,961]), bacterial load 2+ (0,617;[0,439-0,869]), bacterial load 3+ (0,701;[0,501-0,979]), previous TB treatment with second line drugs (0,597;[0,415-0,858]), resistance to more 2 TB drugs (0,614;[0,429-0,879]), pre XDR and XDR-TB (0,486;[0,305-0,776]), and lower lymphocites count (0,681;[0,524-0,885]).Conclusion: Female, underweight patients, cavitaty, high bacterial load, previous TB treatment with second line drugs, resistance to more 2 TB drugs, resistance to rifampicine, isoniazid and other second line drugs, and lower lymphocites count were associated with longer time culture conversion in MDR-TB patients., Introduction: Treatment for MDR-TB has a poor outcomes, success rate was only 48% worldwide. One indicator of treatment success is early culture conversion. Identification of potential factors associated with culture conversion are important.Methods: A cohort rectrospective study using medical records of MDR-TB patients of Persahabatan Hospital during August 2009 until December 2013. Data were analyzed using multivariate analysis.Results : Of a total 436 patients, there are 248 patients (56.6%) were males. Two hundred fifty six patients (58,7%) had sputum culture conversion at two months. The median time to culture conversion was 44 days. The factors for longer sputum culture conversion were female (aHR 0,808; [95%CI 0,659-0,991]), underweight patients (0,792; [0,637-0,983]), cavitaty on chest radiograph (0,781;[0,634-0,961]), bacterial load 2+ (0,617;[0,439-0,869]), bacterial load 3+ (0,701;[0,501-0,979]), previous TB treatment with second line drugs (0,597;[0,415-0,858]), resistance to more 2 TB drugs (0,614;[0,429-0,879]), pre XDR and XDR-TB (0,486;[0,305-0,776]), and lower lymphocites count (0,681;[0,524-0,885]).Conclusion: Female, underweight patients, cavitaty, high bacterial load, previous TB treatment with second line drugs, resistance to more 2 TB drugs, resistance to rifampicine, isoniazid and other second line drugs, and lower lymphocites count were associated with longer time culture conversion in MDR-TB patients.]"

"ABSTRAKLatar belakang dan tujuan: Gangguan elektrolit merupakan salah satu efek samping yang spaling sering ditemukan pada pasien tuberkulosis multidrug-resistant TB MDR yang mendapatkan obat anti tuberkulosis OAT mengandung obat suntik lini kedua. Tujuan penelitian ini adalah untuk mengetahui proporsi gangguan elektrolit pada pasien yang mendapatkan OAT suntik lini kedua serta faktor-faktor yang berhubungan dengan gangguan tersebut.Metode: Penelitian ini merupakan penelitian potong lintang, retrospektif, berbasis rekam medis pada pasien TB MDR di RSUP Persahabatan selama pengobatan fase intensif dari Juli 2015-Juni 2016 dan mendapatkan OAT dengan regimen kanamisin ataukapreomisin, pirazinamid, etambutol, levofloksacin,sikloserin dan etionamid. Hasil: Sebanyak 121 pasien ikut pada penelitian ini. Gangguan elektrolit didapatkan pada 114 pasien 94,2. Rerata waktu terjadinya gangguan elektrolit setelah pengobatan adalah 2,0 bulan. Hipokalemia merupakan jenis gangguan elektrolit yang paling banyak ditemukan 57,9. Hipokalemia berhubungan dengan jenis kelamin dan jenis OAT suntik yang digunakan. Insidens hipokalemia lebih banyak ditemukan pada pasien perempuan 72 dibandingkan dengan laki-laki 47,9 dengan OR 2,8 KI 95 : 1,3-6,1 dan pada pasien yang mendapatkan kapreomisin 68,5 dibandingkan yang mendapatkan kanamisin 49,2 dengan OR 2,2 KI 95 : 1,1-4,7 . Hasil ini bermakna secara statistik. Faktor usia, status gizi, diabetes melitus, gangguan fungsi ginjal dan infeksi HIV tidak berhubungan dengan hipokalemia pada penelitian ini. Kesimpulan: Hipokalemia merupakan gangguan elektrolit yang paling sering terjadi pada pasien TB MDR yang mendapatkan OAT MDR mengandung obat suntik lini kedua. Jenis kelamin perempuan dan kapreomisin merupakan faktor risiko terjadinya hipokalemia namun diperlukan penelitian lebih lanjut untuk mengidentifikasi faktor risiko lainnya yang dapat mempengaruhi kejadian hipokalemia pada pasin TB MDR.

---

ABSTRACT<>br>Background: Electrolyte imbalance is one of the adverse reactions mostly found in patients with multidrugs resistant tuberculosis MDR TB who treated by injectable agent. The aim of this study is to know the proportion of electrolyte imbalance in MDR TB patients receiving second line injection of antituberculosis drugs and the contributing factors. Methods: This study is a cross sectional, retrospective, medical record based study among MDR TB patients in Persahabatan Hospital during intensive phase from July 2015 to June 2016 who received intensive phase treatment consist of kanamycin or capreomycin, pirazinamid, ethambutol, levofloxacin, cycloserine and ethionamide.Results One hundred and twenty one patients were included in this study. The proportion of electrolyte imbalance was found in 114 patients 94.2. The mean duration of therapy at the time incidence of electrolyte imbalance was 2.0 months. Hypokalemia 57,9 were the most electrolyte imbalance frequently found. Hypokalemia was associated with gender and type of antituberculosis injection drugs. The incidence of hypokalemia significantly high among female 72.0 patients than male 47.9 with OR 2.8 CI 95 1.3 6.1 and also in patients receiving capreomysin 68.5 than kanamycin 49.2 with OR 2.2 CI 95 1.1 4.7. Age, nutrition status, diabetes melitus, renal disfunction and HIV have no association with hypokalemiain our study. Conclusion: Hypokalemia was the most frequent electrolyte imbalance found among patient receiving MDR antituberculosis regimen. Female gender and capreomycin injection using were associated with the incidence of hypokalemia. However, more clinical researchs are needed to identify other risk factors contributing of hypokalemia state in MDR TB patients."

"Latar Belakang: Terdapat peningkatan angka kejadian sepsis pada populasi pediatrik. Bakteri batang Gram negatif merupakan mikroorganisme penyebab terbanyak sepsis pada pediatrik. Studi dari berbagai negara melaporkan terdapat peningkatan angka resistansi bakteri batang Gram negatif namun laporan dari negara berpenghasilan rendah seperti Indonesia masih kurang. Penelitian ini melakukan pemeriksaan fenotipik dan genotipik untuk mengetahui prevalensi bakteri batang Gram negatif resistan multiobat pada pasien pediatrik dengan diagnosis sepsis di RSUPN dr. Cipto Mangunkusumo pada tahun 2020.Metode: Studi cross-sectional ini dilakukan Februari hingga Oktober 2020 dengan subjek penelitian pasien pediatrik dengan diagnosis kerja sepsis yang dirawat di RSUPN dr. Cipto Mangunkusumo tahun 2020 yang memenuhi kriteria inklusi dan eksklusi. Masing-masing subjek dilakukan pengambilan spesimen darah 2 lokasi. Organisme diidentifikasi dan uji kepekaan dengan mesin VITEK-2 dan pemeriksaan molekular dengan Hybridspot-12. Data rekam medis pasien dikumpulkan untuk mencari faktor yang memengaruhi sepsis akibat bakteri batang Gram negatif resistan multiobat.Hasil Penelitian: Didapatkan 94 spesimen darah dari 47 subjek penelitian dengan prevalensi bakteri batang Gram negatif resistan multiobat sebesar 14,9% (7/47). Patogen Gram negatif yang ditemukan adalah Klebsiella pneumonia sebesar 12,8% (6/47) dan Enterobacter cloaceae 2,13% (1/47). Studi ini mendeteksi gen ESBL yang terdiri dari 13 CTX-M dan 8 SHV serta gen karbapenemase yang terdiri dari 12 NDM dan 1 GES. Dari delapan faktor yang dianalisis bivariat didapatkan lama hari rawat sebelum pengambilan spesimen (p= 0,02) dan asal ruang perawatan pasien (p= 0,04) sebagai faktor yang berhubungan dengan infeksi bakteri batang Gram negatif resistan multiobat.Kesimpulan: Pada studi ini, bakteri batang Gram negatif resistan multiobat merupakan patogen penyebab sepsis terbanyak pada pediatrik. Program pengendalian infeksi dan pengendalian resistansi antibiotik perlu digalakkan untuk membatasi transmisi dan kejadian mikroba resistan multiobat.

---

Background: There is an increasing incidence of sepsis in the pediatric population. Gram-negative rods are the most common cause of pediatric sepsis. Studies from various countries report an increase in the resistance rate of Gram-negative rods but reports from low-income countries such as Indonesia are still lacking. This study carried out phenotypic and genotypic examinations to determine the prevalence of multidrug-resistant Gram-negative bacteria in pediatric patients with a diagnosis of sepsis at RSUPN dr. Cipto Mangunkusumo in 2020.

Method: This cross-sectional study was conducted from February to October 2020. Each subject took blood specimens at 2 locations. Organisms were identified and susceptibility assayed with the VITEK-2 machine and molecular assay with Hybridspot-12. Data from pediatric patients with a working diagnosis of sepsis who met the inclusion and exclusion criteria were assessed for factors that influence sepsis due to multidrug-resistant Gram-negative bacteria.

Results: Among 47 patients, 94 blood specimens were obtained. Prevalence of multidrug-resistant Gram-negative bacteria was 14.9% (7/47). The pathogen found were Klebsiella pneumonia by 12.8% (6/47) and Enterobacter cloacae 2,13% (1/47). This study detected an ESBL genes consisting of 13 CTX-M and 8 SHV and carbapenemase genes consisting of 12 NDM and 1 GES. Of the eight factors analyzed, the length of hospitalization before specimen collection (p = 0.02) and the patient’s ward (p = 0.04) were factors associated with multidrug-resistant Gram-negative bacterial infection.

Conclusion: In this study, multidrug-resistant Gram-negative rods were the most common pathogen causing sepsis in pediatrics. Infection control and antibiotic resistance control programs need to be promoted to limit the transmission and development of multidrug-resistant organisms."

"ABSTRAKUpaya pengendalian TB-MDR telah dilakukan, namun hasil akhir pengobatan pasien TB-MDR masih menjadi permasalahan terkini yang perlu diselesaikan. Di Indonesia, terjadi penurunan success rate pasien TB RO sejak lima tahun terakhir, yaitu kisaran 68-46, sedangkan hasil pengobatan buruk lebih fluktuatif dan masih tinggi yaitu kisaran 28-47. Penelitian ini menggunakan desain kohort retrospektif yang bertujuan untuk mengetahui gambaran dan faktor yang berhubungan dengan hasil pengobatan pasien TB-MDR di Indonesia. Data yang digunakan adalah data pasien TB-MDR yang berusia 15 tahun yangmemulai pengobatan antara Januari 2013-Desember 2015 dan teregister dalam e-TB Manager. Didapatkan 1.683 kasus dengan 49,7 pasien sembuh, 2,7 lengkap, 14,1 meninggal, 4,4 gagal, dan 29,1 loss to follow up.Analisis bivariat dilakukan untuk mengidentifikasi faktor yang berhubungandenganhasil pengobatan buruk kematian, gagal, atau loss to follow up. Faktor risiko terhadap hasil pengobatan buruk adalah usia 45 tahun RR 1.32; 95 CI 1.20-1.46, resistansi OAT lini 1 RR 34.1; 95 CI 8.24-141.0, resistansi OAT lini 1 lini 2 dan/atau florokuinolon RR 32; 95 CI 7.9-134.0, kavitas paru RR 1.21; 95 CI 1.00-1.44, interval inisiasi pengobatan >30 hari RR 1.11; 95 CI 1.00-1.24, dan tempat tinggal di desa RR 1.15; 95 CI 1.02-1.30. Sedangkan faktor protektor terhadap hasil pengobatan buruk adalah paduan standar RR 0.73; 95 CI 0.59-0.91.

---

ABSTRACTEfforts to control MDR TB have been done, but treatment outcome of MDR TB patients remains a current issue that needs to be resolved. In Indonesia, success rate was declining in the last five years, from 68 46 , whereas poor treatment results are more fluctuate and still high at 28 47. This cohort retrospective study was conducted to analyze the characteristics and factors influencing treatment outcomes of MDR TB patients in Indonesia. This research was use data from e TB Manager and included all MDR TB patients who were ge 15 years and starting treatment between January 2013 and December 2015. Overall, 1.683 MDR TB patientswere included,49.7 recovered, 2.7 complete treatment, 14.1 died, 4.4 treatment failure, and 29.1 loss to follow up. A bivariate analysis was used to identify risk factors for poor treatment outcomes, which were defined as death, treatment failure, or loss to follow up. The risk factors for poor treatment outcome were age above 45 years RR 1.32, 95 CI 1.20 1.46, patients who are resistant first lines TB drugs RR 34.1 95 CI 8.24 141.0 and first lines TB drugs 2nd lines injection and or fluoroquinolone RR 32 95 CI 7.9 134.0, lung cavity RR 1.21, 95 CI 1.00 1.44, treatment initiation interval 30 days RR 1.11 95 CI 1.00 1.24, and residence in rural areas RR 1.15 95 CI 1.02 1.30. While the protector factor for poor treatment outcome is standardized regimen RR 0.73 95 CI 0.59 0.91."

"Latar Belakang: Infeksi HAP oleh bakteri multidrug-resistant (MDR) menyebabkan mortalitas yang tinggi, lama rawat yang memanjang dan biaya perawatan yang tinggi. Karena itu perlu diketahui gambaran faktor risiko terjadinya infeksi bakteri MDR pada pasien HAP. Tujuan: Mengetahui gambaran faktor risiko terjadinya infeksi bakteri MDR pada pasien HAP di RSUPN Cipto Mangunkusumo. Metode: Penelitian dengan desain Kohort retrospektif menggunakan rekam medik pasien HAP yang memiliki hasil kultur sputum di RSUPN Cipto Mangunkusumo tahun 2015-2016 dengan metode total sampling. Pasien HAP diklasifikasikan menjadi terinfeksi bakteri MDR dan terinfeksi bakteri bukan MDR berdasarkan kategori resistensi isolat yang paling resisten pada sputum yang pertama kali didiagnosis MDR. Evaluasi gambaran faktor risiko dilakukan kepada semua subjek. Seluruh analisis dilakukan menggunakan program Microsoft Excel. Hasil: Proporsi HAP selama tahun 2015 dan 2016 berturut-turut adalah 6,12 dan 6,15/1000 admisi. Proporsi pasien HAP yang terinfeksi bakteri MDR selama tahun 2015 dan 2016 berturut-turut adalah 95% dan 82,1%. Gambaran proporsi faktor risiko infeksi bakteri MDR pada pasien HAP RSUPN Cipto Mangunkusumo tahun 2015-2016 mulai dari yang paling tinggi ke yang paling rendah berturut-turut adalah riwayat pemakaian antibiotik 90 hari sebelum diagnosis (100%), albumin <2.5 g/dL (100%), Charlson Comorbidity index≥3 (95,9%), usia> 60 (95,2%), lama rawat> 5 hari (92,5%), riwayat pemasangan NGT (92,1%), riwayat perawatan ICU/HCU sebelumnya (81,8%) dan penggunaan steroid setara prednison>10 mg/hari atau ekivalen selama>14 hari (28,6%). Simpulan: Proporsi infeksi bakteri MDR pada pasien HAP RSUPN Cipto Mangunkusumo tahun 2015 dan 2016 berturut-turut adalah 95% dan 82,1% dengan proporsi faktor risiko infeksi bakteri MDR yang paling tinggi adalah pada pasien dengan riwayat pemakaian antibiotik 90 hari sebelum diagnosis dan albumin <2.5 g/dL.>

Background: Multi-drug Resistant (MDR) Hospital-acquired Pneumonia (HAP) is associated with high mortality, prolonged hospital stay and high cost. Therefore, it is important to have description risk factors distribution for MDR HAP.

Aim: To have description of risk factors proportion for infection with MDR bacteria in HAP patients hospitalized in Cipto Mangunkusumo General Hospital.

Methods: A Cohort retrospective study with total sampling methode was conducted to collect medical records of HAP patients hospitalized in 2015-2016. Patients were classified as infected with MDR bacteria and infected with non-MDR bacteria based on the most resistant category of the sputum firstly diagnosed infected with multidrug-resistant bacteria. Risk factors evaluation were conducted to all subjects. All analysis was done using Microsoft Excel.

Results: Proportion of HAP during 2015 and 2016 respectively were 6.12 per 1000 admission and 6.15 per 1000 admission. Proportion of HAP patients infected with MDR bacteria in 2015 and 2016 were 95% and 82,1% respectively. MDR bacteria in 2015 and 2016 were 95% and 82,1% respectively. Description of risk factors proportion for infection with MDR bacteria from the highest to lowest respectively were prior antibiotic use 90 days before diagnosis (100%), albumin level <2.5 g/dL (100%), Charlson Comorbidity index≥3 (95,9%), age >60 years (95,2%), hospitalization>5 days (92,5%), NGT insertion (92,1%), prior ICU/HCU hospitalization in the last 90 days (81,8%) and prior steroid use equivalent to prednisone >10 mg/day for >14 days (28,6%).

Conclusion: Proportion of HAP patients infected with MDR bacteria in 2015 and 2016 were 95% and 82,1% respectively with the highest risk factors proportion for infection with multidrug-resistant bacteria were prior antibiotic use in 90 days before diagnosis and albumin <2,5 g/dL."

"ABSTRAKTingginya angka insidens TB MDR di Indonesia, dibarengi dengan tingginya tingkatLost to Follow-up LTFU pada pengobatan pasien TB MDR. Pasien TB resisten obatmemiliki kemungkinan LTFU lebih besar dibandingkan pasien TB sensitif obatdikarenakan durasi pengobatan yang lebih lama. Selain itu, pasien TB MDR yang tidakmelanjutkan pengobatannya sampai tuntas memiliki peningkatan risiko kematian akibatTB. Studi ini bertujuan untuk mengetahui pengaruh rujuk balik dan tipe pasien terhadapkejadian LTFU pada pasien Multidrug-Resistant Tuberculosis TB MDR di Indonesia.Studi dilakukan pada Mei-Juni 2018 di Subdit TB ndash; Direktorat P2PML, Ditjen P2PKementerian Kesehatan RI. Desain studi yang digunakan adalah desain studi kohortretrospektif. Jumlah sampel pada studi ini adalah 961 pasien. Sampel diambil secaratotal sampling. Berdasarkan status rujuk baliknya, 86,3 pasien dilakukan rujuk balikdan 13,97 pasien tidak dirujuk balik. Berdasarkan kategori tipe pasien, 35,17 kasuskambuh, 5,52 pasien baru, 13,94 pasien pernah LTFU, 23,10 kasus gagalpengobatan kategori 1, 20,29 kasus gagal pengobatan kategori 2, 1,9 lain-lain pasien tidak diketahui riwayat pengobatan TB sebelumnya . Dari studi ini, diketahuibahwa proporsi kejadian LTFU sebesar 28,40 dengan kumulatif hazard LTFU sebesarsebesar 1,12 selama 39 bulan pengamatan, sehingga didapatkan hazard rate sebesar2,88/100 orang-bulan. Hasil analisis multivariabel dengan regresi cox time-dependentmenunjukkan bahwa rujuk balik menurunkan peluang terjadinya LTFU sebesar 46 HR 0,54; 95 CI 0,35-0,84 pada kondisi variabel tipe pasien dan umur sama adjusted . Untuk tipe pasien, tipe pernah LTFU, gagal pengobatan kategori 2 dan tidakdiketahui riwayat pengobatan TB sebelumnya meningkatkan peluang terjadinya LTFUmasing-masing sebesar 50 HR 2,02; 95 CI 1,18-3,45 , 53 HR 2,13; 95 CI1,240-3,66 , dan 74 HR 3,80; 95 CI 1,54-9,36 dibandingkan dengan tipe pasienkambuh baseline pada kondisi variabel rujuk balik, jenis kelamin, dan umur sama adjusted . Pada laki-laki, efek tipe gagal pengobatan kategori 2 lebih rendah 0,26 kalidibandingkan dengan pasien wanita dengan tipe gagal pengobatan kategori 2. Petugaskesehatan perlu meluangkan waktu yang lebih banyak untuk memberikan komunikasi,informasi, dan edukasi mengenai pengobatan TB serta mengenai manfaat rujuk balikkepada pasien TB MDR. Risiko LTFU meningkat pada pasien yang bertipe pernahLTFU, gagal pengobatan kategori 2, dan tidak diketahui riwayat pengobatan TBsebelumnya dibandingkan pasien dengan tipe kambuh, karena tipe kambuh sudah terujikepatuhannya terhadap pengobatan sebelumnya. Perlunya skrinning tipe pasien denganbaik untuk mengidentifikasi risiko LTFU berdasarkan tipe pasien sejak awal pasienmemulai pengobatan.Kata kunci: LTFU, rujuk balik, tipe pasien, TB MDR

---

ABSTRACTThe high incidence rate of MDR TB in Indonesia is accompanied by high rate of lost tofollow up LTFU in the treatment of MDR TB patients. Drug resistant TB patients havea greater risk of LTFU than drug sensitive TB patients due to longer treatmentduration. In addition, MDR TB patients who did not continue treatment completely hadan increased risk of dying from TB. The aims of this study were to determine thedecentralization influence and patient type on the incidence of LTFU in Multidrug Resistant Tuberculosis MDR TB patients in Indonesia. This study was conducted inMay June 2018 at Subdirectorate of TB Directorate of Prevention and CommunicableDisease Control, Directorate General of Prevention and Disease Control Ministry ofHealth of the Republic of Indonesia. The study design was retrospective cohort. Thenumber of samples in this study was 961 patients. Samples were taken in total sampling.Based on the decentralization status, 86.3 of patients were decentralized. Based onthe type of patient category, 35.17 of relapse, 5.52 of new, 13.94 of after LTFU,23.10 of failure category 1, 20.29 of failure category 2, 1.9 of other patients unknown history of previous TB treatment . The proportion of incidence of LTFU is28.40 with cumulative hazard of LTFU equal to 1.12 during 39 months ofobservation, so hazard rate is 2.88 100 person month. In multivariable analysis withcox regression time dependent revealed that decentralization reduced the probability ofLTFU up to 46 HR 0.54, 95 CI 0.35 0.84 after controlled by type of patient andage. For patient type, treatment after LTFU, failure category 2 and unknown history ofprevious TB treatment increased the probability of LTFU by 50 HR 2,02 95 CI1,18 3,45 , 53 HR 2,13 95 CI 1,240 3,66 , and 74 HR 3,80 95 CI 1,54 9,36 consecutively compared with the type of relapse patients baseline after controlled bythe decentralization, gender, and age. In male patients with failure treatment category2, the effect was 0.26 times lower compared with failure category 2 in female patients.Health workers need to spend more time in communicating, informing and educatingabout TB treatment and the benefits of decentralization to MDR TB patients. The risk ofLTFU increased in type of patient after LTFU, treatment failure category 2, andunknown history of previous TB treatment compared with patients with relapse types.The need for good patient type screening to identify the risk of LTFU by type of patientfrom the initial of treatment.Keywords LTFU, decentralization, type of patient, MDR TB"