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"Latar Belakang. Sepsis merupakan masalah besar yang menyumbang tingkat mortalitas tinggi. Hal ini diperparah dengan adanya komorbid keganasan. Dalam salah satu penelitian menyebutkan pasien sepsis dengan komorbid keganasan mempunyai resiko 2,32 kali lebih tinggi dibandingkan dengan pasien tanpa komorbid keganasan. Untuk itu diperlukan data faktor-faktor yang memengaruhi mortalitas pasien sepsis dengan komorbid keganasan agar dapat memberikan terapi yang efektif dan efisien dan menurunkan angka mortalitas.Tujuan Penelitian. Mengetahui faktor-faktor yang memengaruhi mortalitas pada pasien sepsis dengan komorbid keganasan.Metode. Penelitian dilaksanakan dengan desain kohort retrospektif . Data diambil dari rekam medis pasien sepsis dengan komorbid keganasan yang dirawat di RS Ciptomangunkusumo dan memenuhi kriteria inklusi dari tahun 2020 sampai 2022. Dilakukan uji kategorik dan dilanjutkan dengan Uji regresi log pada variabel-variabel yang memenuhi syarat.Hasil. Dari 350 subjek sepsis dengan komorbid keganasan yang memenuhi kriteria inklusi didapatkan mortalitas sebanyak 287 (82%) subjek. Pada ujia kategorik bivariat didapatkan 2 variabel yang mempunyai kemaknaan secara statistik yaitu skor SOFA dan performa status dengan nilai P masing-masing <0,001 dan <0,001. Setelah dilakukan uji log regresi didapatkan Odds Ratio 5.833 IK (3,214-10,587) untuk variabel skor SOFA dan Odds Ratio3,490 IK (1,690-7,208) untuk variabel performa status.Kesimpulan. Variabel skor SOFA dan performa status mempunyai hubungan yang bermakna terhadap mortalitas pasien sepsis dengan komorbid keganasan

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Background. Sepsis is a major problem that contributes to a high mortality rate. This is exacerbated by the presence of malignancy. In one study, sepsis patients with malignancy had a 2.32 times higher risk compared to patients without malignancy. For this reason, factors that influence mortality in sepsis patients with malignancy are needed in order to provide effective and efficient therapy and reduce mortality.

Research purposes. Knowing the factors that influence mortality in sepsis patients with  malignancy.

Method. The study was conducted with a retrospective cohort design. Data were taken from the medical records of sepsis patients with comorbid malignancy who were treated at Ciptomangunkusumo Hospital and met the inclusion criteria from year 2020 to 2022. A categorical test was carried out and followed by a log regression test on eligible variables.

Results.  Of the 350 sepsis subjects with comorbid malignancy who met the inclusion criteria, 287 (82%) subjects had a mortality. In the bivariate categorical test, there were 2 variables that had statistical significance, namely the SOFA score and status performance with P values ​​of <0.001 and <0.001respectively. After doing the log regression test is obtained Odds Ratio 5.833 CI (3.214-1.587) for SOFA score variables and Odds Ratio 3.490 CI (1.690-7.208) for status performance variables.

Conclusion. SOFA score and performance status variables have a significant relationship to the mortality of sepsis patients with comorbid malignancy."

"Latar Belakang: Sepsis merupakan salah satu masalah kesehatan di rumah sakittermasuk di ruang Intensive Care Unit (ICU) dan angka kematiannya masih tetaptinggi meskipun dengan tatalaksana yang maksimal dan biaya yang besar. Kematianmerupakan hal yang sulit untuk diprediksi. Pasien yang telah diresusitasi denganbaik masih berpeluang untuk mengalami kematian karena proses disfungsi organyang terus berlanjut akibat tingginya tingkat inflamasi. Inflamasi yang tidakterkontrol memicu stress oksidasi dan necroptosis. Penelitian terakhir menunjukkankadar protein carbonyl (PCO) dan receptor-interacting protein kinase 3 (RIPK3)tinggi pada pasien sepsis dan dapat digunakan untuk memprediksi kematian.Penelitian ini bertujuan untuk menilai seberapa besar kegagalan resusitasi, kadarPCO, dan kadar RIPK3 dapat memprediksi kematian pada pasien sepsis.Metode: Rancangan penelitian ini adalah kohort prospektif di ruang resusitasi danICU RSUP. Dr. Moh. Hoesin (RSMH) Palembang. Penelitian dimulai setelahsertifikat etik dan izin lokasi diterbitkan sejak bulan Februari sampai Agustus 2019.Kriteria penerimaan meliputi pasien berusia 18 tahun atau lebih yang didiagnosissepsis. Kriteria penolakan meliputi keluarga menolak diikutsertakan dalampenelitian, pasien tidak dirawat di ICU, terlambat didiagnosis (lebih dari 24 jam),hamil dan didiagnosis mati batang otak. Kriteria pengeluaran meliputi pasienmeninggal kurang dari 4 jam setelah diagnosis ditegakkan dan pasien tidak dapatdilakukan follow up dalam waktu 28 hari. Tim peneliti yang telah dilatihsebelumnya mengidentifikasi semua pasien yang memenuhi kriteria penelitian.Semua subjek penelitian mendapatkan resusitasi standar dan diambil sampel darahuntuk diperiksakan ke laboratorium. Pasien diamati selama 28 hari: apakahmengalami kematian atau tidak. Kegagalan resusitasi didefinisikan sebagai kadar laktat ≥2 mmol/l atau reduksi laktat <20%. Data yang didapatkan dianalisis denganuji statistik yang sesuai menggunakan piranti lunak program STATA.Hasil: Didapatkan total 72 subjek penelitian, 13 dikeluarkan karena meninggalkurang dari 4 jam setelah diagnosis ditegakkan. Dari hasil analisis bivariatdidapatkan hubungan antara kegagalan resusitasi (RR 1,36; IK95% 0,965-1,916; p0,085), kadar PCO (RR 2,37; IK95% 1,348-4,194; p 0,0001), dan kadar RIPK3 (RR5,86; IK95% 2,07-16,61; p <0,0001). Dari hasil multivariat hanya didapatkan satuvariabel yang bermakna yaitu kadar RIPK3 (RR 5,39; IK95% 1,490-19,478; p0,010). Setelah dikontrol dengan variabel perancu usia, komorbiditas dan skorAPACHE II didapatkan variabel RIPK3 memiliki RR 4,64 dengan IK95% 1,233-17,479; p 0,023).Simpulan: Kegagalan resusitasi, kadar PCO dan kadar RIPK3 dapat memprediksikematian pada pasien sepsis.

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Background: Sepsis remains one of the health problems at the hospital including

intensive care unit (ICU) since its mortality is still high despite maximal efforts on

therapy. Mortality is an unpredictable event. Patients who were properly

resuscitated still have a probability of mortality because of severe inflammatory

state which may lead to ongoing organ dysfunctions. Uncontrolled inflammation

will trigger oxidative stress and necroptosis. Recent study showed that high level

of protein carbonyl (PCO) and receptor-interacting protein kinase 3 (RIPK3) in

septic patients could be used to predict mortality. This study wished to analyze the

ability resuscitation failure, PCO level and RIPK3 level to predict mortality in

septic patients.

Methods: This prospective cohort study was conducted at resuscitation room and

ICU of RSUP. dr. Moh. Hoesin (RSMH), a single tertiary teaching hospital in

Palembang, South Sumatera. This study was started after ethical and location

authorization were unleashed in February to August 2019. Inclusion criteria were

18 years old or above patients that were diagnosed with sepsis. Exclusion criteria

were patients whose family did not give any consent to participate the study,

patients that were not treated at the ICU, had a late diagnosis (>24 h), pregnant, and

diagnosed with brain dead. Drop out criteria including died <4 h after diagnosed

and patients that could not be followed in 28 days. Investigators were trained to

identified all eligible patients. Subjects had a standard resuscitation and their blood

was taken to be examined at the laboratory. Patients were observed in 28 days

whether there were any mortality or not. Failed resuscitation defined by examined

lactate level ≥ 2 mmol/l or lactate reduction<20%. Data was statistically analyzed

with STATA™.

Results: Seventy two subjects were included to the study but 13 of them were

dropped out because died within 4 h after diagnosed. From bivariate analysis, there

was an association between failed resuscitation (RR 1.36; CI95% 0.965-1.916; p

0.085), PCO level (RR 2.37; CI95% 1.348-4.194; p 0.0001), and RIPK3 level (RR

5,86; CI95% 2.07-16.61; p <0.0001). From multivariate analysis using cox

regression time constant, the only variable statistically significant was RIPK3 (RR

5.39; CI95% 1.490-19.478; p 0.010). After adjusted by confounding variables,

including age, comorbidities, and APACHE II score, RIPK3 had RR 4.64 with CI

95% 1.233-17.479; p 0.023.

Conclusions: Failed resuscitation, PCO level, and RIPK3 level can predict

mortality in sepsis patients"

"Penegakkan diagnosis sepsis lebih dini perlu dilakukan agar tepat dalam inisiasi penatalaksanaan sepsis, terutama saat di instalasi gawat darurat. Insidens sepsis cenderung meningkat, di Indonesia mortalitas pada tahun 2000 mencapai 84,5%. Penyebab dari sepsis bersifat multifaktorial. Tujuan penelitian untuk mengetahui faktor yang memengaruhi peningkatan risiko mortalitas berdasarkan jumlah sumber infeksi, asal infeksi (komunitas atau nosokomial), jumlah komorbid, sistem skor, albumin, kalium, dan kreatinin darah pada pasien terdiagnosis sepsis. Desain studi adalah kohort retrospektif dengan data rekam medis RSCM dan penelitian sepsis Divisi Penyakit Tropik dan Infeksi Departemen Ilmu Penyakit Dalam FKUI/RSCM. Kriteria inklusi meliputi pasien dewasa berusia > 18 tahun terdiagnosis sepsis sesuai kriteria Surviving Sepsis Campaign 2012 (SCCM/ESICM/ACCP/ATS/SIS) tahun 2012 dan dirawat inap di RSCM dari Januari 2014?Desember 2015. Studi dianalisis dengan SPSS ver 12.0. Dari 286 pasien, 75,9% memiliki jumlah sumber infeksi tunggal dan 53,5% berasal dari infeksi nosokomial. Selain itu, 80,8% dilaporkan dengan jumlah komorbid multipel. Dari pemantauan selama 28 hari, peningkatan kalium, skor qSOFA > 2, dan skor MSOFA > 11 meningkatkan risiko terjadinya mortalitas akibat sepsis dengan HR kalium > 5,0 mEq/l 1,91 (IK 95% 1,32?1,78, p 0,001) ; HR qSOFA > 2 1,19 (IK 95% 0,92-1,54, p 0,17) dan HR MSOFA > 11 1,38 (IK 95% 0,96?1,98, p 0,07). Median lama rawat inap dari pasien dengan sepsis hari ke-3 (IK 95% 2,53?3,47). Semakin lama pemantauan, maka probabilitas kesintasan akan semakin menurun. Kalium darah, skor qSOFA, dan skor MSOFA merupakan faktor yang memengaruhi mortalitas pasien sepsis di IGD dan dirawat di RSCM selama pemantauan 28 hari.

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Early diagnosis of sepsis is essential to initiate sepsis management especially in emergency room. Sepsis incidence rate tends to increase, in Indonesia the mortality rate year 2000 reached 84.5%. The cause of sepsis is multifactorial. The objectives are to determine factors associated with increased mortality risk based on single/multiple infection sources and comorbidity, community/nosocomial infection, scoring system, albumin/potassium/creatinine concentration in patients with sepsis. This is a cohort retrospective study based on medical records and research tree of sepsis from Division of Tropic and Infection, Internal Medicine Department, FMUI-RSCM. Inclusion criteria includes patients aged > 18 years diagnosed with sepsis based on Surviving Sepsis Campaign 2012 (SCCM/ESICM/ACCP/ATS/SIS), hospitalized in RSCM within January 2014- December 2015. Analysis is based on SPSS ver 12.0. From 286 patients, there were 75.9% suffered from single source of infection and 53.5% due to nosocomial infection. There were 80.8% of septic patients had > 1 comorbidities. Within 28 days, increased potassium, qSOFA score > 2, and MSOFA score > 11 tended to increase mortality risk due to sepsis with HR of potassium > 5,0 mEq/l 1.91 (95% CI 1.32?1.78, p .001) ; HR qSOFA > 2 1.19 (95% CI 0.92?1.54, p .17) dan HR MSOFA > 11 1.38 (95% CI 0.96?1.98, p .07). Median lifetime within 28 days was 3 days (95% CI 2.53?3.47). The longer the duration of survival analysis, the lower the probability of survival. Potassium, qSOFA and MSOFA scoring system were factors associated with increased risk of mortality in patients with sepsis admitted in emergency room and hospitalized in RSCM within 28 days of survival analysis."

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

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

"Pendahuluan. Sepsis merupakan suatu kondisi klinis yang serius dengan angka morbiditas dan mortalitas yang cukup tinggi. Procalcitonin (PCT) merupakan suatu penanda yang baik untuk diagnosis dini dan pengawasan infeksi. Studi ini bertujuan untuk melihat pengaruh pemeriksaan PCT semikuantitatif terhadap kecepatan dan ketepatan pemberian antibiotik empirik awal serta mortalitas pada pasien sepsis.Metode. Desain studi ini adalah uji klinis diagnostik acak yang merupakan suatu pragmatic trial. Subjek pada penelitian ini adalah semua pasien sepsis berusia 18 tahun atau lebih dengan atau tanpa tanda hipoperfusi atau disfungsi organ yang berobat ke Instalasi Gawat Darurat Departemen Ilmu Penyakit Dalam RSUPN dr. Cipto Mangunkusumo. Subjek dirandomisasi menjadi dua kelompok, yaitu kelompok yang diperiksa PCT semikuantitatif dan tidak diperiksa PCT semikuantitatif. Hasil pemeriksaan PCT semikuantitatif akan diberitahukan kepada dokter yang merawat pasien. Luaran primer yang dinilai pada studi ini adalah mortalitas 14 hari dan Luaran sekunder adalah kecepatan dan ketepatan antibiotik empirik awal. Penilaian ketepatan antibiotik empirik dilakukan oleh sorang Konsultan Penyakit Tropik Infeksi berdasarkan Pedoman Umum Penggunaan Antibiotik Departemen Kesehatan Republik Indonesia.Hasil. Dua ratus lima subjek memenuhi kriteria inklusi. Sembilan puluh lima dari 100 subjek pada kelompok yang diperiksa PCT dan 102 dari 105 subjek pada kelompok yang tidak diperiksa PCT dimasukkan ke dalam analisis. Mortalitas ditemukan lebih rendah pada kelompok yang diperiksa PCT (RR 0,53; IK 95% 0,36–0,77). Kelompok yang diperiksa PCT memiliki kemungkinan lebih besar untuk mendapatkan antibiotik empirik < 6 jam dibandingkan kelompok yang tidak diperiksa PCT (RR 2,48; IK 95% 1,88–3,26). Ketepatan jenis antibiotik empirik hampir sama pada kedua kelompok (RR 0,99; IK 95% 0,92–1,08).Simpulan. Pemeriksaan PCT semikuantitatif mempengaruhi mortalitas dan kecepatan pemberian terapi antibiotik empirik awal pada pasien sepsis, namun tidak mempengaruhi ketepatan terapi antibiotik empirik awal yang diberikan.

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Introduction. Sepsis is a serious clinical condition with a considerable morbidity and mortality. Procalcitonin (PCT) is a good biomarker for early diagnosis and infection monitoring. The present study aimed to investigate the effect of semi-quantitative PCT test to the empirical antibiotic initiation time, the appropriateness of empirical antibiotics and mortality in septic patients.

Methods. Study design was randomized diagnostic trial which was also a pragmatic trial. Septic patients more than 18 years old with and without signs of organ hypoperfusion or dysfunction who were admitted to Cipto Mangunkusomo hospital emergency department in internal medicine unit were eligible. Subjects were randomly assigned to either a semi-quantitative PCT-examined (study group) or a control group. Semi-quantitative PCT test result will be informed to physician who were taking care of the patients. The primary outcome was 14-day mortality. Secondary outcomes were the time of initiation and appropriateness of empirical antibiotics. A Tropical Infection Consultant will assess the appropriateness of empirical antibiotics based on Pedoman Umum Penggunaan Antibiotik Departemen Kesehatan Republik Indonesia.

Results. Two hundred five patients met the inclusion criteria. Ninety five of 100 subjects from study group and 102 of 105 subjects from control group were included in analysis. Mortality risk was lower in study group (RR 0.53; 95% CI 0.36–0.77). The study group had a greater probability to have a first dose of empirical antibiotic in less than 6 hours compared to the control group (RR 2.48; 95% CI 1.88–3.26). No effect was seen in appropriateness of empirical antibiotics between groups (RR 0.99; 95% CI 0.92–1.08).

Conclusions. Semi-quantitative PCT examination affect the empirical antibiotic initiation time and mortality in septic patients, but not the appropriateness of empirical antibiotics."

"Sepsis, yang salah satunya ditandai dengan adanya bakteri dalam darah (bakteremia), merupakan keadaan klinis yang mengancam jiwa seseorang. Sehingga pemilihan antibiotik yang tepat sangatlah penting untuk mengurangi angka kecacatan dan kematian. Beberapa antibiotik yang dapat digunakan untuk menangani sepsis adalah kloramfenikol, kotrimoksasol, dan tetrasiklin. Oleh karena itu diperlukan pemantauan pola resistensi bakteri penyebab sepsis terhadap ketiga antibiotik tersebut. Data yang digunakan dalam penelitian ini adalah data sekunder yang diperoleh dari hasil uji resistensi bakteri dari spesimen darah terhadap berbagai antibiotik dari tahun 2001-2006 yang dikirim ke Laboratorium Mikrobiologi Klinik Fakultas Kedokteran Universitas Indonesia. Dari 791 isolat darah, didapatkan enam bakteri tersering yang diisolasi dari spesimen darah yaitu Staphylococcus epidermidis (25%), Acinetobacter anitratus (16%), Pseudomonas aeruginosa (13%), Klebsiella pneumoniae (8%), Staphylococcus aureus (6%), dan Salmonella Typhi (5%). Hasil uji resistensi keenam bakteri tersebut terhadap ketiga antibiotik di atas sangat bervariasi. Staphylococcus epidermidis sudah cukup resisten (37,4-51,9%) terhadap ketiga antibiotik di atas. Resistensi Acinetobacter anitratus dan Pseudomonas aeruginosa terhadap kloramfenikol dan kotrimoksasol masih rendah, masing-masing 10-16,2% dan 6,2-21,4%, sedangkan terhadap tetrasiklin resistensinya sudah cukup tinggi, 62,5% pada Acinetobacter anitratus dan 71% pada Pseudomonas aeruginosa. Klebsiella pneumoniae sudah cukup resisten (36,6-71,4%) terhadap ketiga antibiotik di atas. Resistensi Staphylococcus aureus masih cukup rendah (5,9-28,6%) terhadap ketiga antibiotik di atas. Resistensi Salmonella Typhi terhadap ketiga antibiotik di atas juga masih rendah (0-5,6%). Dapat disimpulkan bahwa resistensi bakteri yang diisolasi dari spesimen darah terhadap ketiga antibiotik di atas sudah cukup tinggi, kecuali pada Staphylococcus aureus dan Salmonella Typhi, serta pada Acinetobacter anitratus dan Pseudomonas aeruginosa terhadap kloramfenikol dan kotrimoksasol.

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Sepsis which is characterized by the presence of bacteria in bloodstream (bacteremia) is a harmful clinical state that can be life-threatening. Correct choice of antibiotics is a very important issue in reducing morbidity and mortality rates among sepsis patients. Some antibiotics that can be used to treat sepsis are chloramphenicol, co-trimoxazole, and tetracycline. Hence, it is necessary to monitor sepsis-causing bacteria resistance pattern to those three antibiotics mentioned before. The data utilized was a secondary one that was obtained from the result of blood-specimen bacterial resistance test against antibiotics in Clinical Microbiology Laboratory of Faculty of Medicine, University of Indonesia from 2001 to 2006. Of 791 blood isolates, six most frequent bacteria isolated from blood specimen were Staphylococcus epidermidis (25%), Acinetobacter anitratus (16%), Pseudomonas aeruginosa (13%), Klebsiella pneumoniae (8%), Staphylococcus aureus (6%), and Salmonella Typhi (5%), of which the results varied widely. Moderate resistance rates (37.4-51.9%) against those three antibiotics were observed from Staphylococcus epidermidis. Low resistance rates against chloramphenicol and co-trimoxazole were observed from Acinetobacter anitratus and Pseudomonas aeruginosa, each showed 10-16.2% and 6.2-21.4% respectively, while their resistance against tetracycline were already high, 62.5% in Acinetobacter anitratus and 71% in Pseudomonas aeruginosa. Klebsiella pneumonia showed moderate resistance against those three antibiotics mentioned above (36,6-71,4%). Low resistance rates (5.9-28.6%) against those three antibiotics were observed from Staphyhlococcus aureus. Very low resistance rates (0-5.6%) against those three antibiotics were also observed from Salmonella Tyhpi. It can be concluded that the resistance rates among bacteria isolated from blood specimen against those three antibiotics are already high, except Staphylococcus aureus and Salmonella Typhi, and Acinetobacter anitratus and Pseudomonas aeruginosa against chloramphenicol and co-trimoxazole."

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

"Latar Belakang. Hemodialisis (HD) menjadi pilihan utama terapi pengganti ginjal di Indonesia. Pada tahun 2016, Indonesia memiliki angka mortalitas satu tahun pasien dengan penyakit ginjal kronik (PGK) yang diterapi dengan HD (PGK-HD) lebih tinggi dibandingkan dengan negara lain. Saat ini, Indonesia belum memiliki banyak data terkait insidens dan faktor-faktor yang memengaruhi mortalitas pasien HD kronik.Tujuan. Mengetahui insidens dan faktor-faktor yang memengaruhi mortalitas satu tahun pasien HD kronik.Metode. Penelitian dilakukan dengan desain studi kohort prospektif di Rumah Sakit Dr. Cipto Mangunkusumo (RSCM) sejak 2020 hingga Desember 2021 dengan mengikuti 193 pasien yang masih hidup setelah tiga bulan dilakukan HD inisiasi. Pasien kemudian diobservasi selama sembilan bulan untuk mengetahui insidens mortalitas satu tahun dan faktor-faktor yang berkaitan. Data dianalisis menggunakan analisis bivariat diikuti dengan analisis multivariat cox regresi untuk mengetahui faktor-faktor yang memengaruhi mortalitas.Hasil. Rerata usia pasien penelitian adalah 52 tahun dan etiologi terbanyak pasien PGK-HD yaitu diabetes melitus (DM). Selama observasi, terdapat tiga pasien loss to follow up, dan terdapat 55 pasien meninggal. Insidens satu tahun mortalitas pada penelitian ini adalah 28,49% (IK 95% 22,25-35,42%). Setelah dilakukan analisis multivariat pada penelitian ini didapatkan tiga variabel yang secara signifikan memengaruhi mortalitas yaitu interdialytic weight gain (IDWG) ≥5% (OR 3,58, IK 95% 1,16-10,91), kadar hemoglobin <10 g/dL (OR 3,4, IK 95% 1,79-7,15), dan serum kalsium <8,5 mg/dL (OR 3,79, IK 95% 1,75-8,23).Kesimpulan. Insidens mortalitas satu tahun pasien HD kronik sebesar 28,49%. IDWG ≥5%, kadar hemoglobin <10 g/dL, dan serum kalsium <8,5 mg/dL merupakan faktor-faktor yang memengaruhi mortalitas satu tahun.

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Background. Hemodialysis (HD) is the main kidney replacement therapy in Indonesia. In 2016, Indonesia had a higher one-year mortality rate of chronic kidney disease (CKD) patients treated with hemodialysis (CKD-HD) compared to other countries. Currently, HD centers in Indonesia lack data related to the incidence and factors related to mortality in CKD-HD patients.

Aims. To determine the incidence and factors related to one-year mortality in Chronic HD patients.

Methods. This prospective cohort study was conducted at Dr. Cipto Mangunkusumo Hospital (RSCM) from January 2020 to December 2021, following 193 patients who survived three months after initial dialysis. Patients were observed for nine months to know the one-year mortality incidence and related factors. The data were analyzed using bivariate analysis followed by multivariate cox regression analysis to review factors related to mortality.

Results. The mean age was 52 years-old and the most common etiology of CKD-HD was diabetes mellitus (DM). During follow-up, three patients dropped out due to loss to follow up and 55 patients died. One-year mortality incidence was 28.49% (95% CI 22,25-35,42%) in this study. After multivariate analyses, we found three significant variables for one-year mortality: interdialytic weight gain (IDWG) ≥5% (OR: 3.58, 95% CI: 1.16.88-10.91), hemoglobin level <10 g/dL variables, (OR: 3.4, 95%CI 1.79-7.15), and calcium serum <8.5 mg/dL (OR: 3,79, 95% CI 1.75-8.23).  

Conclusion. The incidence of one-year mortality in CKD-HD patients was 28.49%. IDWG ≥5%, hemoglobin <10 g/dL, and calcium serum <8.5 mg/dL are significant factors related to one-year mortality."

"Latar belakang: Sepsis neonatal masih menjadi masalah kesehatan di dunia. Hal ini tidak terlepas dari kesulitan dalam menegakkan diagnosis akibat sistem imun yang belum sempurna sehingga tidak memiliki gejala yang khas dan tidak memiliki penanda laboratorium tunggal. Tujuan: Penelitian ini bertujuan untuk menilai potensi CD64 neutrofil, HLA-DR monosit dan rasio CD64 neutrofil per HLA-DR monosit sebagai penanda sepsis neonatal. Metode: Subjek penelitian ini adalah neonatus yang  dicurigai sepsis secara klinis yang ditandai dengan gejala pada salah satu sistem organ. Diagnosis sepsis neonatal secara klinis ditegakkan berdasarkan kriteria dari European Medical Association. Expresi CD64 neutrofil dan HLA-DR monosit dilakukan menggunakan flow cytometry mengikuti protokol Quantibrite dengan hasil dilaporkan sebagai indeks fluoresens dan dikonversi menjadi antibody bound per cell (ABC). Sedangkan rasio CD64 neutrofil per HLA-DR monosit didapatkan dari hasil perhitungan. Hasil: Lima puluh subjek neonatus berhasil direkrut dalam penelitian ini, yang terdiri 24 subjek sepsis, dan 26 subjek non sepsis. Ekspresi CD64 neutrofil dan rasio CD64 neutrofil per HLA-DR monosit lebih tinggi pada kelompok sepsis neonatal dan masing-masing memiliki area under curve (AUC) 71,8% dan 70,2%. Nilai titik potong CD64 neutrofil didapatkan 5.196,15 ABC sedangkan rasio CD64 neutrofil terhadap HLA-DR monosit memiliki titik potong 13,44%. Kesimpulan: CD64 neutrofil dan rasio CD64 neutrofil per HLA-DR monosit berpotensi menjadi penanda sepsis neonatal.

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Background: Neonatal sepsis remains a global health concern. This is attributed to the challenges in establishing a diagnosis due to an immature immune system, resulting in a lack of specific symptoms and a singular laboratory marker. Objective: This research aims to explore the potential of CD64 neutrophils, HLA-DR monocytes, and the CD64 neutrophil to HLA-DR monocyte ratio as markers for neonatal sepsis. Methods: The subjects of this study were neonates with suspected sepsis, identified by symptoms affecting one of the organ systems. Neonatal sepsis confirmation followed the criteria set by the European Medical Association. CD64 neutrophil and HLA-DR monocyte examinations were conducted using flow cytometry following the Quantibrite protocol and reported as fluorescence index that were converted to antibody bound per cell (ABC). Meanwhile, the CD64 neutrophil to HLA-DR monocyte ratio was calculated. Results: Fifty neonatal subjects were recruited into this study, comprising 24 sepsis cases and 26 non-sepsis cases. The expression of CD64 neutrophils and the CD64 neutrophil to HLA-DR monocyte ratio were higher in the neonatal sepsis group, with respective areas under the curve (AUC) of 71.8% and 70.2%. The cutoff value for CD64 neutrophils was determined to be 5,196.15 ABC, while the cutoff for the CD64 neutrophil to HLA-DR monocyte ratio was 13.44%. Conclusion: CD64 neutrophils and the CD64 neutrophil to HLA-DR monocyte ratio show potential as markers for neonatal sepsis."