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"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."

"Latar Belakang: Pneumonia komunitas masih merupakan salah satu penyebab kematian terbanyak untuk penyakit infeksi, baik di negara maju ataupun negara berkembang. Pengetahuan tentang prediktor mortalitas dapat membantu pengambilan keputusan klinis untuk tatalaksana pasien. Penelitian terdahulu mengenai prediktor mortalitas di luar negeri sebagian besar dilakukan pada usia lanjut dan hanya ditemukan satu penelitian mengenai faktor-faktor prediktor mortalitas di Indonesia namun juga terbatas pada usia lanjut. Tujuan: Mengetahui faktor-faktor prediktor mortalitas pasien pneumonia komunitas dewasa di Rumah Sakit Cipto Mangunkusumo (RSCM). Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien rawat inap dewasa RSCM yang didiagnosis pneumonia komunitas selama tahun 2010– 2014. Data klinis dan laboratorium beserta status luaran (hidup atau meninggal) selama perawatan diperoleh dari rekam medis. Analisis bivariat menggunakan uji Chi-square dilakukan pada sepuluh variabel prognostik, yakitu kelompok usia, penurunan kesadaran, komorbiditas (skor Charlson Comorbidity Index – CCI >5), sepsis, gagal napas, pneumonia berat, kadar hemoglobin <9 g/dL, hitung leukosit <4.000/ul atau >20.000/ul, kadar albumin <3 g/dL, dan kadar glukosa darah sewaktu >200 mg/dL. Data yang tidak lengkap diatasi dengan teknik multiple imputation. Variabel yang memenuhi syarat akan disertakan pada analisis multivariat dengan regresi logistik. Hasil: Subjek penelitian terdiri dari 434 pasien. Mortalitas selama perawatan sebesar 23,9%. Sebanyak 197 (45,4%) pasien adalah laki-laki dan 237 (54,6%)pasien adalah perempuan. Median usia pasien 58 tahun (rentang 18 sampai 89)tahun dan median lama perawatan adalah 8 (rentang 1 sampai 63) hari. Patogen tersering dari hasil kultur sputum adalah Klebsiella pneumoniae (28%). Prediktor mortalitas independen yang bermakna pada analisis multivariat adalah pneumonia berat (OR=29,42; IK 95% 20,81 sampai 41,58), sepsis (OR=3,65; IK 95% 2,57 sampai 5,19), gagal napas (OR=3,2; IK 95% 1,9 sampai 5,37), skor CCI >5 (OR=2,25; IK 95% 1,6 sampai 3,15) dan kadar albumin <3 g/dL (OR=1,42; IK 95% 1,04 sampai 1,95). Simpulan: Pneumonia berat, gagal napas, sepsis, skor CCI >5, dan kadar albumin <3 g/dL merupakan pediktor independen mortalitas pasien pneumonia komunitas dewasa saat rawat inap.

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Background: Community-acquired Pneumonia (CAP) is one of the causes of death from infectious disease in the developed or developing countries. The prediction of outcome is important in decision-making process. Previous studies of predictors of mortality in overseas mostly in elderly and only found one previous study in Indonesia, but also limited in the elderly.

Objective: To determine the predictors of mortality in hospitalized patients with CAP in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Methods: We performed a retrospective cohort study among hospitalized patients with CAP in Cipto Mangunkusumo Hospital between 2010–2014. Data were collected at initiation of hospitalized period and the main outcome was all-cause mortality during hospitalization. We analyzed age, decreased of consciousness, comorbidity (represented as Charlson Comorbidity Index – CCI), sepsis, respiratory failure, severe pneumonia, hemoglobin level <9 g/dL, leucocyte count <4.000/ul or >20.000/ul, albumin level <9 g/dL, and blood glucose level >200 mg/dL in bivariate analysis using Chi-Square test. Missing data were handled using multiple imputation. Multivariate logistic regression analysis was performed to identify independent predictors of mortality.

Results: A total of 434 patients were evaluated in this study. In-hospital mortality rate was 23.9%. There were 197 (45,4%)male and 237 (54,6%) female patients. Median age of population was 58 (range 18 to 89) years old and median length of stay was 8 (range 1 to 63) days. The commonest pathogen was Klebsiella pneumoniae (28%). The independent predictors of mortality in multivariate analysis were severe pneumonia (OR 29.42; 95% CI 20.81 to 41.58), sepsis (OR 3.65; 95% CI 2.57 to 5.19), respiratory failure (OR 3.2; 95% CI 1.9 to 5.37), CCI score >5 (OR 2.25; 95% CI 1.6 to 3.15) and albumin level <3 g/dL (OR 1.42; 95% CI 1.04 to 1.95).

Conclusion: Severe pneumonia, respiratory failure, sepsis, CCI scores >5, and albumin level <3 g/dL were independent predictors of in-hospital mortality among hospitalized patients with CAP."

"Latar Belakang : Pneumonia komunitas merupakan satu masalah kesehatan yang besar. Mortalitas akibat pneumonia komunitas masih tinggi, terutama di Indonesia bila dibandingkan dengan negara-negara lain. Skor CURB-65 merupakan sistem skoring yang telah dipakai secara luas, namun memiliki beberapa kekurangan sehingga diperlukan sistem skor baru untuk menilai derajat keparahan pneumonia komunitas. Saat ini telah diperkenalkan sistem skor expanded-CURB-65 yang dinilai dapat lebih baik dalam hubungannya sebagai prediktor mortalitas 30 hari pneumonia komunitas. Tujuan : Menilai performa kalibrasi dan diskriminasi skor expanded-CURB-65 untuk digunakan dalam memprediksi mortalitas 30 hari pasien pneumonia komunitas di Rumah Sakit Umum Pusat Nasional dr.Cipto Mangunkusumo. Metode : Penelitian ini merupakan studi kohort prospektif dengan subyek penelitian pasien pneumonia komunitas yang datang ke IGD, poliklinik paru atau dirawat di ruang rawat RSCM. Keluaran yang dinilai adalah mortalitas pasien dalam 30 hari. Dilakukan penilaian performa diskriminasi skor expanded-CURB-65 menggunakan area under the curve AUC . Performa kalibrasi dinilai dengan plot kalibrasi dan tes Hosmer-Lemeshow. Hasil : 267 pasien ikut serta dalam penelitian ini dengan angka mortalitas 31,5 . Performa kalibrasi ditunjukkan oleh plot kalibrasi skor expanded-CURB-65 dengan r = 0,94 serta uji Hosmer-Lemeshow dengan nilai p = 0,57. Performa diskriminasi skor expanded-CURB-65 ditunjukkan oleh kurva ROC dengan nilai AUC 0,796 IK95 0,74-0,86. Simpulan : Mortalitas meningkat seiring peningkatan kelas risiko expanded-CURB-65. Expanded-CURB-65 menunjukkan performa kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas 30 hari pasien pneumonia komunitas di Rumah Sakit Cipto Mangunkusumo.

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Background : Community acquired pneumonia is a major health problem. Mortality due to community pneumonia is still high, especially in Indonesia compared to other countries. The CURB 65 score is a widely used scoring system, but has some drawbacks so a new scoring system is needed to assess the severity of community pneumonia. Currently, the expanded CURB 65 scoring system has been assessed better to predict 30 day mortality of community acquired pneumonia.

Aim : To evaluate calibration and discrimination performance of the expanded CURB 65 score in predicting 30 days mortality of community acquired pneumonia patients at the National Center General Hospital dr.Cipto Mangunkusumo.

Method : This study was a prospective cohort study with the study subjects community acquired pneumonia patients who came to the Emergency Room ER , pulmonary polyclinics or hospitalized in RSCM. The assessed outcome was patient mortality within 30 days. Discrimination performance of the expanded CURB 65 score assessed using the area under the curve AUC . Calibration was evaluated with calibration plot and Hosmer Lemeshow test.

Results : 267 patients participated in the study with a mortality rate of 31.5. Calibration plot of expanded CURB 65 score showed r 0,94 and Hosmer Lemeshow test showed p 0,57. Discrimination was shown by ROC curve with AUC 0,796 CI95 0,74 0,86.

Conclusion : Mortality increases with increasing risk class of expanded CURB 65. Expanded CURB 65 showed a good calibration and discrimination performance in predicting 30 day mortality higher in community acquired pneumonia patients in Cipto Mangunkusumo Hospital."

"Pneumonia komunitas adalah penyebab kematian terbesar di Indonesia. Sistem skor PSI dan CURB-65 telah digunakan dalam menentukan keparahan penyakit dan keputusan tempat rawat berdasarkan risiko kematian dalam 30 hari. Tujuan penelitian ini adalah membandingkan sistem skor modifikasi PSI dan modifikasi CURB-65 pada pasien CAP sebagai prediktor mortalitas 30 hari di RS Persahabatan. Penelitian ini adalah kohort prospektif yang dilakukan pada pasien CAP yang dirawat di RS Persahabatan sejak bulan Oktober 2012-Maret 2013. Gejala klinis nilai laboratorium, foto toraks, penyakit penyerta skor PSI dan CURB-65 serta hasil akhir berupa kematian dicatat untuk dianalisis. Selama 30 hari subjek penelitian diikuti. Sebanyak 167 pasien CAP mengikuti penelitian ini didapatkan angka kematian sebesar 18,6%. Sensitivitas PSI sama dengan CURB-65 yaitu sebesar 77,4%. Spesifisitas PSI sedikit lebih tinggi dari pada CURB-65 (58,1% vs 53,7% p < 0,001). Risiko relatif mortalitas berdasarkan PSI pada kelompok risiko tinggi sebesar 3,64 kali dibandingkan kelompok risiko rendah, sedangkan risiko relatif mortalitas berdasarkan CURB-65 pada kelompok risiko tinggi sebesar 3,15 kali dibandingkan kelompok risiko rendah. Skor CURB-65 dapat dipertimbangkan sebagai prediktor mortalitas pada pasien CAP yang di rawat inap.

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Community Acquired Pneumonia (CAP) is the first leading disease with the highest mortality in hospitalized patient in Indonesia. Pneumonia severity assessment systems such as the pneumonia severity index (PSI) and CURB-65 were designed to predict severity of illness and site of care base on 30-d mortality. The purpose of this study is to comparing the PSI with CURB-65 in patient admitted with CAP as predictor 30 days mortality in Persahabatan Hospital, Jakarta. This is a prospective cohort study in hospitalized community acquired pneumonia patients in Persahabatan Hospital since October 2012- Maret 2013. Clinical symptoms, laboratory findings, chest x-ray , comorbidities, score of PSI and CURB-65, 30 days mortality were recorded for analysis. Thirty days mortality outcome were recorded to analysis which score system as the best to predict 30 days mortality. One hundred and sixtty seven patients CAP were studied with an overall 30-d mortality of 18,6%. Sensitivity of PSI were simillar with CURB-65 for predicting patients who died within 30 d (77,4% ; p < 0.001). Specificity of PSI was slighty higher than CURB-65 (58,1% vs 53,7% p < 0,001). Score PSI have risk mortality 3,64 times in high risk group CAP than low risk group CAP. Score CURB-65 have risk mortality 3,15 times in high risk group CAP than low risk CAP. CURB-65 modification was considerable to predict mortality in CAP patients hospitalized."

"Community acquired pneumonia (CAP) oleh patogen resisten obat (PRO) memiliki tingkat keparahan yang tinggi. CAP akibat PRO memerlukan terapi antibiotik spektrum luas, skor Drugs Resistance in Pneumonia (DRIP) mampu memprediksi kasus tersebut. Penggunaan skor DRIP dapat mencegah kegagalan terapi antibiotik empirik dan mempersingkat lama rawatan, untuk itu diperlukan validasi. Penelitian ini merupakan studi Cohort Retrospektif pada pasien CAP yang dirawat inap selama periode Januari 2019 hingga Juni 2020. Data diambil dari rekam medis, kegagalan antibiotik bila terdapat kematian, pindah rawat ICU dan eskalasi antibiotik. Performa skor DRIP dianalisis dengan menentukan nilai kalibrasi dan diskriminasi, uji Hosmer-Lemeshow dan Area Under Curve (AUC). Diperoleh 480 pasien yang telah memenuhi kriteria. Terdapat 331 pasien (69%) dengan skor DRIP <4 dan 149 pasien (31%) dengan skor DRIP ≥4, dengan jumlah kegagalan antibiotik sebesar 283 pasien (59%), 174 pasien (61,4%) skor DRIP <4 dan 109 pasien (38,5%) skor DRIP ≥4. Kalibrasi DRIP menggunakan uji Hosmer-Lemeshow diperoleh p-value = 0,667 (p>0,05), diskriminasi AUC pada kurva ROC diperoleh 0,651 (IK 95%; 0,601-0,700). Skor DRIP menunjukkan performa yang cukup baik dalam memprediksi kegagalan antibiotic empiric pada pasien CAP yang terinfeksi PRO. Skor DRIP tidak berhubungan dengan lama rawatan di Rumah Sakit.

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Community-acquired pneumonia (CAP) caused by drug resistant pathogens (DRP) has a high level of severity. The incidence of CAP due to DRP requires broad spectrum antibiotic therapy, the Drugs Resistance in Pneumonia (DRIP) score is able to predict these cases. The use of the DRIP score can prevent antibiotic failure and minimize length of hospitalization, but validation is needed . This research is a retrospective cohort study in CAP patients who were hospitalized during the period January 2019 to June 2020. Data were taken from patient medical records, and failure of empiric antibiotics occurs when one of this criteria are found: patient mortality, ICU transfer and escalation of antibiotics as well as length of stay. Furthermore, the performance of the DRIP score was analyzed by determining the calibration and discrimination, using the Hosmer-Lemeshow test and the Area Under Curve (AUC). There were 480 patients who met the criteria. There were 331 patients (69%) with a DRIP score <4 and 149 patients (31%) with a DRIP score ≥4, with a total of 283 patients (59%) of antibiotic failures which were detailed in 174 patients (61.4%) with a DRIP score <4 and 109 patients (38.5%) DRIP score ≥4. DRIP calibration using the Hosmer-Lemeshow test obtained p-value=0.667 (p>0.05), AUC observations on the ROC curve obtained 0.651 (95% CI; 0.601-0.700). The DRIP score showed good performance in predicting failure of empiric antibiotics in infected CAP patients. PRO. The DRIP score is not related to the length of stay in the hospital."

"Latar Belakang: Pneumonia berat masih menjadi masalah kesehatan utama di Indonesia dan dunia. Sistem imun diketahui memiliki peranan penting dalam patogenesis pneumonia, namun tidak banyak studi yang menilai hubungan antara kadar CD4 dan CD8 darah dengan mortalitas akibat pneumonia berat pada pasien dengan status HIV negatif. Tujuan: Mengetahui data hubungan dan nilai potong kadar CD4 dan CD8 darah dengan angka mortalitas 30 hari pada pasien pneumonia berat di RSCM. Metode: Penelitian berdesain kohort prospektif yang dilakukan di ruang rawat intensif RSCM periode Juni-Agustus 2020. Keluaran berupa kesintasan 30 hari, nilai titik potong optimal kadar CD4 dan CD8 darah untuk memprediksi mortalitas 30 hari dan risiko kematian. Analisis data menggunakan analisis kesintasan Kaplan-Meier, kurva ROC dan multivariat regresi Cox.Hasil: Dari 126 subjek, terdapat 1 subjek yang loss to follow up. Mortalitas 30 hari didapatkan 26,4%. Nilai titik potong optimal kadar CD4 darah 406 sel/μL (AUC 0,651, p=0,01, sensitivitas 64%, spesifisitas 61%) dan kadar CD8 darah 263 sel/μL (AUC 0,639, p=0,018, sensitivitas 62%, spesifisitas 58%). Kadar CD4 darah < 406 sel/μL memiliki crude HR 2,696 (IK 95% 1,298-5,603) dan kadar CD8 darah < 263 sel/μL memiliki crude HR 2,133 (IK 95% 1,035-4,392) dengan adjusted HR 2,721 (IK 95% 1,343-5,512). Bila sepsis dan tuberkulosis paru ditambahkan dengan kadar CD4 darah dan CD8 darah, didapatkan nilai AUC 0,752 (p=0,000). Kesimpulan: Kadar CD4 dan CD8 darah memiliki akurasi yang lemah dalam memprediksi mortalitas 30 hari pasien pneumonia berat. Kadar CD4 darah < 406 sel/μL dan kadar CD8 darah < 263 sel/μL memiliki risiko mortalitas 30 hari yang lebih tinggi.

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Background: Severe pneumonia is a major health problem in Indonesia and the world. The immune system is known to play an important role in the pathogenesis of pneumonia, but few studies have assessed the relationship between blood CD4 and CD8 count and mortality from severe pneumonia in patients with negative HIV status.

Objectives: Knowing the correlation data and the cut-off value of blood CD4 and CD8 count with a 30-days mortality rate in severe pneumonia patients at RSCM. Methods. This study is a prospective cohort study conducted at RSCM intensive care rooms from June to August 2020. The outputs were 30-days survival rate, optimal cut-off value for blood CD4 and CD8 count to predict 30-days mortality and mortality risk. Data analysis used Kaplan-Meier survival, ROC curves and multivariate Cox regression analysis.

Results: Of the 126 subjects, there was 1 subject who lost to follow up. The 30- days mortality rate was 26.4%. The optimal cut-off value for blood CD4 count was 406 cells/μL (AUC 0.651, p=0.01, sensitivity 64%, specificity 61%), blood CD8 count was 263 cells/μL (AUC 0.639, p=0.018, sensitivity 62%, specificity 58%). CD4 blood count < 406 cells/μL had a crude HR of 2.696 (95% CI 1.298- 5.603) and blood CD8 count < 263 cells/μL had a crude HR of 2.133 (95% CI 1.035-4.392) with an adjusted HR of 2.721 (CI 95% 1,343-5,512). If sepsis and pulmonary tuberculosis were added to the blood CD4 and CD8 count, the AUC value was 0.752 (p=0.000).

Conclusion: Blood CD4 and CD8 count had poor accuracy in predicting 30-days mortality in patients with severe pneumonia. The group with blood CD4 count < 406 cells/μL and blood CD8 count < 263 cells/μL had a higher risk of 30-days mortality."

"Pneumonia is one of very important global health problems among toddlers, especially in developing countries. Nowadays, pneumonia is one of largest causes of child mortality, especially in newborn period. In Aceh Province, pneumonia disease is the eighth of 25 biggest diseases found at primary health care with 112 cases, while pneumonia among outpatient sufferers in Aceh reached 434 cases (29.03%).This study aimed to determine factors related to incidence of pneumonia toddlers in Lambatee Village, Darul Kamal Subdistrict, Aceh Besar District.This study was analytical descriptive using cross-sectional design. Samples of study were mothers and toddlers amounted to 48 people. Data were collected on August 3rd - 14th, 2015 by interview, observation. Multivariate analysis used logistic regression. Results of study showed that the factor physical condition of house sanitation influenced to trend among toddlers suffering from pneumonia with p value 0.01< 0.05, the highest OR score 6.431 and 95% CI = 1.559 - 26.532. In conclusion, physical condition of house sanitation had six times risk of causing trend of pneumonia incidence among toddlers in Lambatee Village, Darul Kamal Subdistrict, Aceh Besar District."