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"Resistensi antibiotik merupakan salah satu masalah kesehatan global yang mempengaruhi efektivitas pengobatan berbagai penyakit infeksi, termasuk di rumah sakit. Penelitian ini bertujuan untuk menganalisis profil penggunaan antibiotik cefepime sebagai bagian dari kelompok antibiotik "reserve" di RSUP Fatmawati pada periode Januari hingga Oktober 2023. Penggunaan cefepime ditujukan untuk infeksi bakteri yang resisten terhadap berbagai antibiotik lain. Metode penelitian yang digunakan adalah retrospektif dengan mengumpulkan data dari rekam medis pasien, hasil uji kultur, dan konsultasi dengan Komite Pengendalian Resistensi Antimikroba (KPRA). Hasil penelitian menunjukkan bahwa sebagian besar pasien yang menggunakan cefepime adalah kelompok usia lanjut (>60 tahun), dengan tingkat mortalitas yang cukup tinggi. Dari hasil uji kultur, ditemukan bahwa sekitar 57,14% biakan menunjukkan hasil negatif, sedangkan selebihnya menunjukkan adanya bakteri seperti Escherichia coli dan Acinetobacter baumannii. Konsultasi dengan KPRA dilakukan untuk sekitar 65,08% pasien, dan persetujuan penggunaan cefepime diberikan pada 33,33% pasien. Studi ini menyimpulkan bahwa penggunaan cefepime memerlukan evaluasi lebih lanjut berdasarkan hasil kultur dan sensitivitas untuk meminimalkan risiko resistensi antibiotik yang lebih tinggi.

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Antibiotic resistance is a global health issue affecting the effectiveness of treatment for various infectious diseases, including in hospitals. This study aims to analyze the profile of cefepime usage as a "reserve" antibiotic at RSUP Fatmawati from January to October 2023. Cefepime is used for bacterial infections that are resistant to various other antibiotics. This retrospective study collected data from patient medical records, culture test results, and consultations with the Antimicrobial Resistance Control Committee (KPRA). The results showed that most patients using cefepime were elderly (>60 years), with a relatively high mortality rate. Culture tests revealed that 57.14% of the cultures were negative, while the remaining cultures indicated the presence of bacteria such as Escherichia coli and Acinetobacter baumannii. Consultations with KPRA were conducted for about 65.08% of the patients, with cefepime approval granted for 33.33% of them. This study concludes that cefepime use requires further evaluation based on culture and sensitivity tests to minimize the risk of increased antibiotic resistance. "

"Resistensi antibiotik terjadi akibat bakteri berevolusi dan rentan terhadap antibiotik sehingga dapat meningkatkan risiko penyebaran penyakit serta kematian. Antibiotik golongan karbapenem merupakan antibiotik kelompok reserve, yang dapat diakses namun penggunaannya harus disesuaikan dengan pasien dan kondisi yang sangat spesifik, ketika antibiotik lainnya telah gagal atau tidak sesuai dalam pengobatan. Penggunaan meropenem di RSUP Fatmawati dibanding antibiotik lini ke 3 lainnya sangat jauh berbeda signifikan, oleh karena itu perlu dikaji terkait karakteristik pasien, regimen, indikasi, ada tidaknya konsultasi KPRA (Komite Pengendalian Resistensi Antimikroba) dan hasil kultur serta sensitivitas antimikroba. Karakteristik pasien yang menggunakan terapi antibiotik reserve meropenem pada April 2023 didominasi oleh laki-laki (52,8%) daripada perempuan (47,2%) dengan rentang usia 51-60 yang terbanyak (23,9%). Kultur dan sensitivitas yang dilakukan (389 kali/April 2023) menyatakan bahwa hasil terbanyak berupa biakan negatif (76,6%), disusul dengan Acinetobacter baumannnii (6,9%) dan Klebsiella pneumonia (6,4%). Hasil biakan yang tidak negatif atau ditemukannya kuman patogen terdapat 91 biakan (23,4%) dari 389 biakan. Sampel yang masih sensitif terhadap antibiotik meropenem sebanyak 38 sampel (41,8%), sampel yang sudah resisten sebanyak 39 sampel (42,9%) dan yang tidak diketahui sebanyak 14 sampel (15,3%). Konsultasi terhadap tim PPRA dilakukan hanya 129 dari 176 pasien. Hasil konsultasi dapat diterima pemberiannya (32 pasien), ditolak pemberiannya (22 pasien), dan tidak direspon oleh tim PPRA (75 pasien)

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Antibiotic resistance occurs because bacteria evolve and become susceptible to antibiotics, increasing the risk of disease spread and death. Carbapenem class antibiotics are reserve group antibiotics, which can be accessed but their use must be tailored to patients and very specific conditions, when other antibiotics have failed or are not suitable in treatment. The use of meropenem at Fatmawati General Hospital compared to other 3rd line antibiotics is significantly different, therefore it is necessary to study patient characteristics, regimens, indications, the presence or absence of KPRA (Antimicrobial Resistance Control Committee) consultation and culture results and antimicrobial sensitivity. The characteristics of patients who used meropenem reserve antibiotic therapy in April 2023 were dominated by men (52.8%) rather than women (47.2%) with the highest age range of 51-60 (23.9%). The culture and sensitivity performed (389 times/April 2023) stated that the most results were negative cultures (76.6%), followed by Acinetobacter baumannnii (6.9%) and Klebsiella pneumonia (6.4%). There were 91 cultures (23.4%) out of 389 cultures that were not negative or found pathogenic germs. There were 38 samples (41.8%) that were still sensitive to meropenem, 39 samples (42.9%) that were resistant, and 14 samples (15.3%) that were unknown. Consultation with the PPRA team was conducted for only 129 out of 176 patients. The results of the consultation were accepted (32 patients), rejected (22 patients), and not responded to by the PPRA team (75 patients)."

"Latar belakang: Resistensi antibiotik merupakan ancaman kesehatan global. Tingginya tingkat reproduksi mikroorganisme dan kemampuan tekanan selektif yang kuat dari mikroorganisme menghadapi antibiotik pilihan merupakan permasalahan penggunaan antibiotik saat ini. Salah satu cara agar dapat menguatkan pemahaman dan ketaatan staf medis adalah melalui edukasi. Pemanfaatan teknologi seperti e-learning merupakan salah satu cara untuk meningkatkan tingkat pengetahuan dan ketepatan penggunaan antibiotik.Metode: Penelitian intervensi ini melibatkan seluruh DPJP dan PPDS Sp1 Ilmu Kesehatan Anak yang berstatus aktif di FKUI RSCM. Intervensi e-learning dilakukan terhadap DPJP dan PPDS dengan topik Antimicrobial Stewardship (AMS) via website EMAS UI kemudian dinilai tingkat pengetahuan pra- dan pasca-intervensi. Penggunaan antibiotik satu bulan pra- dan pasca-intervensi dinilai dengan alur Gyssens untuk menilai ketepatan penggunaan antibiotik.Hasil: Total penggunaan antibiotik pra- dan pasca-intervensi berturut-turut adalah 248 dan 229 antibiotik. Sebanyak 135 (54,4%) penggunaan antibiotik pra-intervensi dan 170 (72,24%) penggunaan antibiotik pasca-intervensi dinilai tepat. Analisis bivariat terhadap ketepatan penggunaan antibiotik menunjukkan terdapat hubungan bermakna pra- dan pasca-intervensi (OR= 0,537, IK 95% 0,363-0,795; p< 0,002). Sebanyak 42 dari total 56 DPJP anak dan 119 dari total 123 PPDS Sp1 Ilmu Kesehatan Anak mengikuti intervensi e-learning. Analisis bivariat menunjukan terdapat hubungan bermakna terhadap tingkat pengetahuan DPJP pra- dan pasca-intervensi (1 vs 32; p<0,001) dan PPDS pra- dan pasca-intervensi (10 vs 66; p<0,001).Kesimpulan: Terdapat peningkatan signifikan tingkat ketepatan penggunaan antibiotik pada pasien anak di ruang perawatan RSCM dan tingkat pengetahuan ketepatan pemberian antibiotik pada DPJP dan PPDS setelah dilakukan intervensi edukasi melalui metode e-learning.

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Backgorund: Antibiotic resistance is a global health threat. The high rate of reproduction of microorganisms and the strong selective pressure ability of microorganisms against antibiotics are the problems of the current use of antibiotics. Education is a way to strengthen the understanding and obedience of medical staff. Utilization of technology such as e-learning can be used to increase the level of knowledge and the effectiveness of using antibiotics.

Method: This intervention study involved all active pediatric staff and pediatric residents from the Department of Child Health in FMUI-CMH. Staff and residents underwent intervention through e-learning on the topic of Antimicrobial Stewardship (AMS) via the EMAS UI website, and then the level of their pre- and post-intervention knowledge was assessed. The use of antibiotics one month pre- and post-intervention was assessed by Gyssen's flowchart to assess the appropriateness of the antibiotics usage.

Result: A total of 135 (54.4%) uses of pre-intervention antibiotics and 170 (72.24%) uses of post-intervention antibiotics were considered appropriate. Bivariate analysis of the appropriate use of antibiotics showed that there was a significant relationship pre- and post-intervention (135 vs. 170, 95% CI 0.363-0.795; p 0.002). Forty two out of 56 staff and 119 out of 123 residents participate in e-learning. Bivariate analysis showed that there was a significant relationship between the level of knowledge of pre- and post-intervention in pediatric staff (1 vs. 32; p 0.001) and pre- and post-intervention pediatric residents (10 vs. 66; p 0.001).

Conclusion: There was a significant increase in the appropriateness level of using antibiotics in pediatric patients at CMH and the level of knowledge about the appropriateness of giving antibiotics to staff and residents after educational interventions were carried out through the e-learning."

"Praktik Kerja Profesi Apoteker di RSUP Fatmawati bertujuan untuk menganalisis profil penggunaan antibiotik meropenem pada bulan Mei tahun 2023 di RSUP Fatmawati. Kajian dilakukan dengan menggunakan metode deskriptif. Tahapan kajian meliputi pengumpulan data pasien dari sistem informasi rumah sakit (ISIMRS), SIMGOS dan Open Labs, penyajian data dalam bentuk tabel deskriptif dan penarikan kesimpulan. Hail kajian menunjukkan arakteristik pasien antibiotik meropenem di RSUP Fatmawati pada Bulan Mei Tahun 2023 mencakup 184 pasien, dengan mayoritas berjenis kelamin laki-laki dan berasal dari kelompok pasien geriatri (61-70 tahun) dengan kesudahan pasien pulang dari rumah sakit. Karakteristik peresepan antibiotik meropenem di RSUP Fatmawati pada Bulan Mei Tahun 2023 sebanyak 5669 vial meropenem dengan regimen dosis paling banyak yaitu 3x1 gram dan asal ruangan pasien yang diberikan antibiotik paling banyak yaitu gedung bougenville, lantai 4 - ICU. Hasil biakan kultur menunjukkan resistensi terhadap Acinetobacter baumannii

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Pharmacist Professional Work Practices at Fatmawati Hospital aims to analyze the profile of use of the antibiotic meropenem in May 2023 at Fatmawati Hospital. The study was carried out using descriptive methods. The study stages include collecting patient data from the hospital information system (ISIMRS), SIMGOS and Open Labs, presenting the data in the form of descriptive tables and drawing conclusions. The results of the study show that the characteristics of meropenem antibiotic patients at Fatmawati General Hospital in May 2023 included 184 patients, the majority of whom were male and came from the geriatric patient group (61-70 years) with the patients later returning home from the hospital. Characteristics of meropenem antibiotic prescriptions at Fatmawati General Hospital in May 2023 were 5669 vials of meropenem with the highest dose regimen being 3x1 gram and the room where the most antibiotics were given was the Bougainville building, 4th floor - ICU. Culture results showed resistance to Acinetobacter baumannii."

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

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

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

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

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

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

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

"The first book was on "Theory and practice" of antibiotic stewardship in its broadest sense -the how to do it and the do's and don’ts. The second, on "Controlling resistance" was very much on the relationships between use and resistance and beginning to home in on the hospital as the main generator of resistance, but mainly looking at it from a disease/clinical perspective. The last 3 chapters on MRSA, ended where the 3rd book will take off. "Controlling HAI " will concentrate on specific MDR organisms highlighting their roles in the current pandemic of HAI and emphasizing that the big issue is not so much infection control but antibiotic control, in the same way that antibiotic over-reliance/ over-use has caused the problem in the first place. Up 'till now the emphasis for controlling MRSA, C diff and all the other MDROs has very much been on IC, which clearly isn't working. This book will gather all the evidence for the increasingly popular view that much more must be done in the area of antibiotic policies/ stewardship, especially when we are in danger of a "post antibiotic" era, due to a real shortage of new agents in the pipeline."

"ABSTRAKResistensi antibiotik telah menjadi ancaman global. Salah satu contoh organisme yang resisten terhadap lebih dari satu antibiotik adalah methicillin-resistant Staphylococcus aureus MRSA . Dalam menghadapi permasalahan ini, alternatif yang dapat dipilih adalah dengan menggunakan tanaman herbal, yaitu Samanea saman. Oleh sebab itu, perlu dilakukan penelitian untuk mengetahui efek antibakteri Samanea saman pada MRSA dan non-MRSA.Tujuan: Penelitian ini bertujuan untuk membandingkan aktivitas antibakteri ekstrak Samanea saman pada MRSA dan non-MRSAMetode: Penelitian ini dilakukan dengan metode eksperimental. Untuk memperoleh nilai minimum inhibitory concentration MIC digunakan broth dilution method. Selain itu, dilakukan pula penentuan nilai minimum bactericidal concentration MBC , dan jumlah koloni.Hasil: Penelitian ini menunjukkan bahwa ekstrak metanol daun Samanea saman terbukti tidak memiliki aktivitas antibakteri terhadap MRSA dan non-MRSA. Bakteri tumbuh di seluruh konsentrasi ekstrak yang digunakan. Nilai MIC dan MBC tidak dapat ditentukan. Selain itu, jumlah koloni bakteri pada setiap plat terhitung melebihi 250 koloni. Aktivitas antibakteri Samanea saman pada MRSA dan non-MRSA tidak dapat dibandingkan.Kesimpulan: Ekstrak metanol daun Samanea saman tidak memiliki efek antibakteri terhadap MRSA dan non-MRSA Kata kunci: MBC; MIC; MRSA; non-MRSA; Samanea saman.

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ABSTRACTAntibacterial resistance has been such a global burden nowadays. The well known example of multi drug resistance organism is the methicillin resistant Staphylococcus aureus MRSA . In response to the antibacterial resistance, the alternative that can be considered is the usage of herbal plant such as Samanea saman. Therefore, a research needs be conducted to investigate the antibacterial effect of Samanea saman on MRSA and non MRSA. Purpose This research aim is to compare the antibacterial activity of Samanea saman extract on MRSA and non MRSAMethods This research is an experimental study. To obtain the value of minimum inhibitory concentration MIC , broth dilution method was used. The value of minimum bactericidal concentration MBC and the number of colonies were also determined.Result This study revealed that methanol extract of Samanea saman leaves has no antimicrobial activity against MRSA and non MRSA. The bacteria grow in all concentration of the extract and therefore the MIC and MBC value could not be obtained. The level of antibacterial activity of Samanea saman in MRSA and non MRSA could not be compared.Conclusion The methanol extract of Samanea saman leaves does not have any antibacterial effect against MRSA and non MRSA. Key words MBC MIC MRSA non MRSA Samanea saman"

"Provinsi DKI Jakarta umumnya mengandalkan tangki septik di perumahan dan IPAL permukiman di kawasan tertentu sebagai tempat pembuangan tinja setempat serta membuang cairan efluennya ke saluran drainase, tetapi penelitian mengenai kinerja penyisihan unsur AMR-nya masih minim. IPAL permukiman sebagai salah satu sistem pengolahan tinja setempat menciptakan kondisi yang kondusif bagi terjadinya akuisisi resistensi antarinang via transfer gen horizontal (HGT) berdasarkan kelimpahan nutrisi, kelimpahan mobile genetic elements (MGE) yang memfasilitasi HGT, proses pengolahan, kandungan logam berat sebagai tekanan selektif, dan variabel lain-lain. Dengan demikian, penelitian ini dilakukan untuk menganalisis prevalensi ARG dan MGE dengan metode High-Throughput Quantitative Polymerase Chain Reaction (HT-qPCR), tingkat reduksi atau peningkatan ARG dan MGE, serta hubungan antara logam berat dan MGE dengan ARG di IPAL permukiman. Sebanyak 8 dari 65 gen target masih terdeteksi di semua sampel unit final (n = 8). Salah satunya adalah crAss56 yang mengindikasikan bahwa efluen cairan IPAL permukiman menjadi potensial sumber diseminasi AMR di hilir. IPAL permukiman tidak menunjukkan kemampuan reduksi kelimpahan absolut gen 16S rRNA, MGE, ARG yang konsisten, bahkan salah satunya (ST4) mengamplifikasi semua gen-gen tersebut. Terlihat pola kelimpahan ARG berbeda antara IPAL permukiman terindikasi terbengkalai dengan yang beroperasional yang menyiratkan mekanisme pengolahan tertentu, seperti pengolahan biologis (aerobik, anaerobik, kombinasi) dan klorinasi, dapat berkontribusi dalam proliferasi ARG. Analisis korelasi Spearman menunjukkan korelasi signifikan secara statistik (p-value < 0.05) dengan arah positif antara mangan (Mn) vs. ARG (qacE∆1_3 > aph3-ib > ereA), seng (Zn) vs. ARG (aph3-ib > vanA > ereA > blaSHV11 > intl3 > qnrS2), serta MGE (intl3) vs. ARG (ereA > vanA > aph3-ib > blaSHV11 > qacE∆1_3 > qnrS2). Maka, korelasi tersebut menandakan intl3 memiliki potensial tinggi sebagai fasilitator HGT. Logam berat juga mungkin menginduksi HGT dan/atau menyeleksi dengan antibiotik secara bersamaan terhadap ARB. Maka, penemuan penelitian ini menyorotkan pentingnya diadakannya pemantauan AMR di berbagai sistem air limbah, khususnya black water.

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The DKI Jakarta Province generally relies on septic tanks in residential areas and tenement wastewater treatment plants in certain areas as on-site feces disposal sites along with discharging their effluent water into drainage channels, but research on their AMR element removal performance is still limited. Tenement WWTPs as one of the on-site feces treatment systems create conditions that are conducive to the acquisition of resistance between hosts via horizontal gene transfer (HGT) based on the abundance of nutrients, the abundance of mobile genetic elements (MGE) which facilitate HGT, treatment processes, heavy metal content as selective pressure, and other variables. Thus, this research was conducted to analyze the prevalence of ARG and MGE using the High-Throughput Quantitative Polymerase Chain Reaction (HT-qPCR) method, the level of reduction or increase in ARG and MGE, as well as the relationship between heavy metals and MGE and ARG in tenement WWTPs. A total of 8 of the 65 target genes were still detected in all final unit samples (n = 8). One of them was crAss56 which indicated that tenement WWTP effluent water is a potential source of downstream AMR dissemination. Tenement WWTPs did not show a consistent ability to reduce the absolute abundance of 16S rRNA, MGE, ARG genes, in fact one of them (ST4) amplified all of these genes. It can be seen that the pattern of ARG abundance is different between tenement WWTP indicated to be abandoned and those that are operational, which implies that certain treatment mechanisms, such as biological treatment (aerobic, anaerobic, combined) and chlorination, can contribute to the proliferation of ARGs. Spearman correlation analysis showed a statistically significant correlation (p-value < 0.05) in the positive direction between manganese (Mn) vs. ARGs (qacE∆1_3 > aph3-ib > ereA), zinc (Zn) vs. ARGs (aph3-ib > vanA > ereA > blaSHV11 > intl3 > qnrS2), as well as MGEs (intl3) vs. ARGs (ereA > vanA > aph3-ib > blaSHV11 > qacE∆1_3 > qnrS2). Therefore, this correlation indicates that intl3 has high potential as a facilitator of HGT. Heavy metals may also induce HGT and/or co-select against ARBs with antibiotics. Thus, the findings of this study highlight the importance of monitoring AMR in various wastewater systems, especially black water."